The Importance of Electrolytes for Hashimoto’s

Hydration may not be the first thing you think of when it comes to Hashimoto’s and thyroid health, but having adequate levels of water is absolutely essential for all areas of health — and electrolytes play a crucial role in ensuring we stay hydrated.

People with certain health concerns — including thyroid conditions and adrenal imbalances — may be more prone to dehydration caused by electrolyte imbalance, and may be more intensely affected by symptoms. (1, 2)

Throughout my Hashimoto’s journey, I’ve felt the effects of low electrolytes. It was probably not a coincidence that these symptoms of headaches, feeling dizzy when I stood up, and fatigue, correlated with my autoimmune flares… and seemed to resolve again when I was able to address their root cause.

While I make it a point to regularly consume high electrolyte foods, such as sea salt and bone broth, I often turn to supplements for extra support — especially after intense exercise, and during periods of higher stress.

Staying hydrated and replenishing our electrolyte levels is an important part of healing, and can help reduce symptoms that may often be attributed to “just having a thyroid condition,” including fatigue, constipation, dry skin, and many others.

In this article, you will learn:

• Symptoms and causes of electrolyte imbalances
• The electrolyte-Hashimoto’s connection
• The role of the adrenals
• How to know if you need electrolytes
• Food sources and supplements to replenish your electrolyte levels

What Are Electrolytes?

Electrolytes are minerals that play a critical role in the body. Through a biochemical process, electrolytes become ions (an atom or molecule with an electrical charge) that can conduct electrical signals in the body. These signals create communication and function within nerves and muscles, as the electrolytes move in or out of cells. Electrolytes are important for fluid balance, muscle contraction, and blood pressure, and play other roles in the body as well.

Electrolytes include:

• Sodium
• Potassium
• Calcium
• Magnesium
• Chloride
• Phosphate
• Bicarbonate

Potassium is the main intracellular (inside the cell) ion, and sodium is the main extracellular (outside the cell) one. Potassium and sodium get the most attention for this reason, and are arguably the most important for maintaining good hydration and electrolyte balance within the body. Sodium and potassium function in the body in a very specific balance.

The pituitary gland in the brain helps to manage electrolytes throughout the body. It can be hard to measure true electrolyte status because at times, the body needs to prioritize where electrolytes go. So, it is possible for one’s electrolytes to appear low in one area because they are being used in another area of the body.

Electrolytes and fluid balance play a critical role in cardiovascular health, especially with heartbeat and blood pressure regulation.

Potassium is especially important due to its role in heartbeat regulation, and low (or high) potassium can create cardiac abnormalities that can potentially be life-threatening.

Historically, electrolytes were solely obtained through food, and these minerals can be found in meat and fish, bone broths, fruits, vegetables, sea salt, sea vegetables, and teas. It wasn’t until the 1920s or 30s that people started consuming supplemental electrolytes, mainly in a medical setting. The famous sports drink Gatorade has been around since 1967. Today, electrolyte supplements are quite commonplace — especially for supporting the hydration needs of athletes, patients with vomiting or diarrhea, as well as those with electrolyte imbalances due to specific conditions or lifestyles. (3-5)

Electrolyte Imbalances

An electrolyte imbalance occurs when levels of one or more electrolytes within the body become too high or too low.

An electrolyte imbalance can be caused by: (6-8)

• Vomiting and/or diarrhea
• Medications such as diuretics
• Laxatives
• Dehydration from excess sweating, such as from exercise, sauna usage, or living in a hot or dry climate
• Low intake of key electrolyte minerals (low consumption of fruits and vegetables, for example)
• Eating disorders
• Diseases which impact the kidneys (eg: diabetes, kidney disease)
• Thyroid diseases such as Hashimoto’s
• An increased need for electrolytes due to a low-carb or ketogenic diet
• Too little or too much water intake
• Nutrient deficiencies
• Adrenal issues (including HPA-axis dysfunction / adrenal fatigue)
• Pregnancy

Hyponatremia (low sodium in the blood) is a common form of electrolyte imbalance for those with hypothyroidism. It tends to be more common in older adults, those with hypertension (high blood pressure), heart disease, adrenal issues, and kidney disease. Symptoms include headaches, nausea, vomiting, muscle cramps, fatigue, and fainting. In extreme cases, hyponatremia can cause disorientation, seizures, brain damage, and coma. (9, 10)

Hypernatremia (high sodium in the blood) is much less common than hyponatremia for those with Hashimoto’s. Symptoms may include weakness, nausea, loss of appetite, muscle twitching, and more severely, mental confusion, and bleeding in the brain. (11)

Hypokalemia (low potassium in the blood) is another electrolyte imbalance and may present as fatigue, constipation, frequent urination, muscle weakness, and most severely, muscular paralysis and abnormal heart rhythms. Hyperkalemia (high potassium in the blood) is also associated with abnormal heart rhythms, a slowed heart rate, and weakness. (12)

If you’re experiencing any of the symptoms listed above, you may want to monitor your electrolyte levels to see if they may be related to severe electrolyte imbalances. (I’ll address how to check your electrolyte levels further on in this article.)

But what if your levels appear to be within “normal” range? As with all things in Hashimoto’s, I’m always looking at optimizing our levels, and want to highlight that there is still the possibility that you may have subclinical or subtle electrolyte imbalances.

In other words, it is possible to have low electrolytes, or an imbalance of electrolytes, that is less severe, but that can still affect your health (especially thyroid health) and contribute to symptoms. (For example, some of my clients have tested their sodium and potassium levels and were told that their levels were within normal range, yet they benefited from balancing their electrolyte levels.)

Addressing subclinical electrolyte imbalances is especially important for those with Hashimoto’s.

The Electrolyte-Hashimoto’s Connection

Symptoms of both hyponatremia and hyperkalemia, including fatigue, weakness, low blood pressure, and even some GI symptoms, sound a lot like symptoms of hypothyroidism — which makes sense, since the thyroid and electrolytes are intimately connected.

Research suggests that electrolyte imbalances directly correlate with thyroid imbalances. This is partly due to the fact that thyroid abnormalities may lead to changes in renal function, which in turn can lead to electrolyte imbalances.

Plus, thyroid hormones are involved in the metabolism of minerals. As such, people with hypothyroidism, especially advanced cases of hypothyroidism, generally experience a slower metabolism, resulting in electrolyte abnormalities. However, the basic mechanisms of how thyroid hormones influence electrolytes are not fully understood. (13-15)

One study that aimed to find out the effect of hypothyroidism on electrolyte and mineral levels, looked at 140 cases of overt hypothyroidism from whom blood samples were collected. Their T3, T4, and TSH levels were measured. Calcium, phosphorus, magnesium, sodium, and potassium levels in the blood were also measured. The researchers concluded that the higher the TSH levels one had, the higher the magnesium and phosphorus levels were in the blood, and the lower the values of serum calcium, sodium, and potassium levels were. Thus, they found that the more severe one’s hypothyroidism is, the more severe their electrolyte imbalances may be. (16)

In yet another study, participants with hypothyroidism showed low serum sodium, chloride, and potassium levels. Conversely, those with hyperthyroidism had increased serum potassium levels. (17)

Another study conducted on 110 clinically known cases of hypothyroidism between the ages 20 and 60, demonstrated similar findings. The hypothyroid patients in their study showed serum electrolyte disturbances, such as low sodium, potassium, and calcium levels, as well as high magnesium and phosphorus levels. (18)

In most cases of electrolyte imbalance for those with hypothyroidism, the proper dose of thyroid medications should help to restore electrolyte balance. However, researchers have found that hydration status can actually complicate getting the right dose of thyroid medication by interfering with thyroid labs. In one study, TSH levels were eight percent higher in those who were dehydrated, compared to those with optimal hydration status. (19)

The good news is that this can reverse rapidly with hydration. If your TSH is a little higher than normal and you’re experiencing thyroid symptoms, part of that could be due to hydration, and increasing your water and/or electrolyte intake will increase the efficiency of your thyroid hormones.

The bottom line is that addressing thyroid hormone imbalances due to hypothyroidism, and paying attention to hydration, play an important part in addressing electrolyte imbalances and healing with Hashimoto’s.

The Role of the Adrenals

Through my clinical experience and research, I’ve learned that dehydration, nutrient deficiencies, and adrenal issues are interconnected with each other, as well as thyroid disease. Addressing adrenal imbalances can relieve some of the symptoms associated with Hashimoto’s. (Read this article about adrenal fatigue to learn more about cortisol, stress, and Hashimoto’s.)

Addressing thyroid health without addressing the adrenals can often further deplete the adrenals, making Hashimoto’s symptoms worse.

The adrenals (adrenal glands) are responsible for the production of many hormones which play an important role in electrolyte balance.

Aldosterone is a hormone made by the adrenal glands that helps to regulate blood volume, blood pressure, and sodium/potassium levels. When the adrenal glands are weakened (in the advanced stages of adrenal fatigue), sodium levels become unregulated and can fall too low, causing an electrolyte imbalance. This is the mechanism behind low blood pressure that often accompanies adrenal and thyroid imbalances. (20)

The adrenal glands also make glucocorticoid hormones like cortisol. When there is too much cortisol, thyroid hormone production is typically suppressed, and the conversion of T4 to T3 may also be impaired by suppressing the 5’deiodinase enzyme. (21)

It makes sense that the body would suppress the activation of thyroid hormone under conditions of stress. I believe that this is one of the body’s innate protective mechanisms used to conserve nutrients and resources so that they can be used to promote healing instead. (I have developed my own theory, which I call the Safety Theory, about the development of autoimmune thyroid disease — you can read more about that here.)

The problem today, however, is that in our modern world, we face different and constant stressors (toxins, negative thoughts, balancing work and family, sitting in traffic, etc.) — and these signals can promote some of the unwanted symptoms of Hashimoto’s, including weight gain, depression, and fatigue. (22)

Various states of adrenal fatigue or chronic stress are all too common in our society. Besides the sodium imbalance discussed here, high cortisol can deplete both potassium and magnesium (along with zinc, iron, copper, vitamin C, and B vitamins). (23)

If you feel dizzy upon standing, are prone to fainting, feel dehydrated, and crave salty foods, taking a deeper look at the adrenals (and electrolytes!) is an important root cause approach to healing. One key piece to recovering from adrenal dysfunction is restoring nutrient balance and maintaining good hydration. This can help with thyroid health as well!

To learn more about supporting your adrenals, download my free “Adrenals” chapter from my first book, below!

How Can I Tell If My Electrolyte Levels Are Low?

Electrolytes are often measured as part of routine annual lab work with your primary care provider, but you can certainly request these labs more often. If your blood levels of sodium, potassium, or calcium are out of the normal lab range, this would signal a severe electrolyte imbalance. This is the main way that conventional medicine looks at electrolytes. (24)

That said, as mentioned earlier, some cases of electrolyte imbalances may be “subclinical.” In other words, it is possible to have low levels of certain electrolytes, or an imbalance of electrolytes that is less severe, but still affects your thyroid health.

After all, the body, which needs pretty tight control of electrolytes in the blood, may prioritize electrolytes and concentrate them in certain areas when there is a deficiency somewhere.

Symptoms of electrolyte imbalance, Hashimoto’s, and adrenal imbalance can all overlap to some degree. Here are some common symptoms to look for:

• Fatigue (even after a good night’s sleep)
• Salt cravings
• Low blood pressure
• Feeling faint from standing
• Brain fog
• Low blood sugar
• Hitting the snooze button
• Feeling “wired, but tired”
• Mild depression
• Decreased resilience to stress
• Headaches
• Muscle aches or cramps
• Diarrhea or constipation
• Frequent urination (including drinking water and feeling the urge to urinate right away)
• Fast or irregular heartbeat
• Increased thirst
• Anxiety
• Dry skin and lips

If you experience a collection of these symptoms, you may experiment with increasing electrolytes to see if that helps to improve your symptoms. (I’ll discuss ways to increase your levels below!)

How Can I Tell Which Electrolyte I’m Deficient In?

You may need more potassium if you experience: (25)

• Excessive thirst
• Salt cravings
• Water retention
• Cognitive issues
• High blood pressure
• Heartbeat fluctuations
• Nervousness

You may need less potassium if you: (26)

• Have low blood pressure
• Are on a potassium chloride supplement
• Experience GI symptoms such as nausea or vomiting

You may need more sodium if you have: (27)

• Excessive thirst that is not alleviated by drinking plain water
• Excessive fluid loss, such as sweating or urinating
• Recently engaged in high-intensity exercise
• Diluted urine

You may need less sodium if you are: (28)

• Someone with high blood pressure
• A sodium-sensitive individual (blood pressure rises with sodium, and lowers when omitting sodium)
• A salt-resistant individual (blood pressure doesn’t change with sodium dosage changes)

Please note that electrolyte imbalances may be compounded by intense exercise, living in a hot or dry climate, and drinking caffeine or alcohol. If any of these are true for you, you may need more water and electrolytes than you think.

Food Sources of Electrolytes

Electrolyte levels can be replenished through food and beverages, over-the-counter supplementation, or via an IV drip for more serious cases.

It is very safe to consume electrolytes from food, and it is truly a foundational approach to addressing electrolyte imbalance. I have found that most people with Hashimoto’s need more sodium, potassium, and magnesium, but it’s important to note that there may be some cases where this doesn’t hold true. For example, in cases where potassium is high relative to sodium, eating high potassium foods may make someone feel worse.

A Standard American Diet is full of highly processed foods associated with high sodium (and generally low in potassium and magnesium) intake. If you are eating a whole foods-based, anti-inflammatory diet to address Hashimoto’s — such as what I share in Hashimoto’s Food Pharmacology: Nutrition Protocols and Healing Recipes to Take Charge of Your Thyroid Health — you may actually need more salt than what you are getting from your food.

One sign that you need more salt is having salt cravings, since those with adrenal issues have subclinical electrolyte imbalances caused by adrenal dysfunction.

My best tip is to eat more salt, but the right kind of salt! Iodized salt is partially responsible for the Hashimoto’s epidemic (read my article to find out why!), so it is important to choose non-iodized varieties. I like to use Celtic sea salt or Himalayan pink salt.

Besides liberally salting food, salted bone broth is a great option for hydration. In the 2015 survey I conducted on people with Hashimoto’s, participants reported that homemade broth helped with energy, mood, weight, pain, hair, skin, and thyroid labs!

To increase electrolytes through food, here are some of the best sources of sodium, potassium, and magnesium (which many people with Hashimoto’s are also deficient in).

Most of the foods listed here are safe and appropriate for the type of food plan that I often recommend to my clients, in the interest of reducing Hashimoto’s symptoms (check out this article on the best diet for Hashimoto’s for more information). Please also use caution with known or suspected food sensitivities.

High-Sodium Foods

• Sea salt (be sure to choose non-iodized varieties)
• Bone broth
• Celery
• Pickles, sauerkraut, and other fermented foods
• Seafood

High-Potassium Foods

• Bananas
• Sweet potatoes
• Potatoes
• Coconut water
• Avocados
• Winter squash
• Beans
• Dried apricots
• Prunes
• Raisins
• Yogurt
• Spinach
• Artichoke
• Beet greens

High-Magnesium Foods

• Kale, spinach, and other dark leafy greens
• Almonds, cashews, Brazil nuts, and other nuts
• Avocados
• Dark chocolate
• Black beans, and other beans
• Pumpkin, flax, and chia seeds

How Much Water Should I Drink?

It is important to also focus on drinking enough water as you work on balancing your electrolytes. You may need eight to ten glasses per day, and more with exercise or caffeinated beverages.

To determine the precise amount of water your body needs, here is a simple calculation to work with:

Calculate half your body weight in pounds, then aim to drink that number of ounces per day. For example, a 150-pound person would aim to drink 75 ounces of water per day.

You may need to help keep yourself on track with water intake. I recommend either writing a daily water goal in your journal, or drawing the amount of glasses you need, and filling them in daily. You can also use a free water counting app on your smartphone (like Waterlogged) to track your daily water intake.

If you’re at home, my personal favorite is to make a pitcher of spa water each morning (by adding cut up cucumbers, strawberries, lemons, and/or limes to a pitcher of purified water), and sipping on it throughout the day.

However, while it’s unlikely that most people will do so, I do want to mention that it’s possible to drink too much water. Water intake can contribute to electrolyte imbalance. Feeling weak, having headaches, and experiencing vomiting and nausea, are the most common signs of water over-consumption. Symptomatic water intoxication has been observed when a person drinks about three to four liters (.75 – 1 gallon) of water at one time, but this can be avoided by spacing your water consumption out throughout the course of the day. (29)

Electrolyte Drinks and Supplements

A great way to replete electrolytes in a relatively short time is by using electrolyte supplements. A word of caution, however, is that a lot of electrolyte products, including sports drinks such as Gatorade, are not necessarily healthy options because of their high levels of sugar, dyes, and flavorings. However, a little bit of natural sugar in an electrolyte supplement is okay, since glucose helps the body to absorb the electrolyte minerals.

You can make your own electrolyte drinks, and depending on if you need more or less potassium, I recommend two hydration blends that are easily made at home.

Potassium

Potassium is important for keeping fluids balanced in the body, lowering blood pressure, and addressing water retention — which in turn can help regulate the internal stress response.

How do you know if you need more or less potassium?

As mentioned earlier, you may need more potassium if you experience:

• Excessive thirst
• Salt cravings
• Water retention
• Cognitive issues
• High blood pressure
• Heartbeat fluctuations
• Nervousness

You may need less potassium if you:

• Have low blood pressure
• Are on a potassium chloride supplement
• Experience GI symptoms such as nausea or vomiting

If you are experiencing any of these symptoms, I recommend that you consult with your practitioner to test your potassium levels via a blood test, to see if either of these hydration blends are optimal for you.

More Potassium Blend:

• 1 quart of coconut water
• ¼ – ½ teaspoon sea salt (gray or pink)

Less Potassium Blend:

• 1 quart filtered water
• ½ teaspoon sea salt (gray or pink)

Sodium

Sodium has gotten a bad rap in the medical industry. However, it is crucial for regulating fluids in the body. As mentioned above, I recommend using sea salt or Himalayan pink salt, as opposed to table salt or iodized salt.

Salt nourishes the adrenals and provides the minerals, such as potassium and magnesium, that our body needs. It also offers us hydration when we are in a dehydrated state, by keeping fluid in the body (also known as water retention).

How do you know if you need more sodium? 

You will want to see if you have:

• Excessive thirst that is not alleviated with drinking plain water
• Excessive fluid loss, such as sweating or urinating
• Recently engaged in high-intensity exercise
• Diluted urine

How do you know if you need less sodium? 

You may be:

• Someone with high blood pressure
• A sodium-sensitive individual (blood pressure rises with sodium, and lowers when omitting sodium)
• A salt-resistant individual (blood pressure doesn’t change with sodium dose change)

I’ve created a recipe for “Sole,” a high concentration mixture of Himalayan sea salt and filtered water. This salt mixture can be taken once per day, up to 1 teaspoon at a time, on an empty stomach.

Supplement Options

You can also supplement with an electrolyte blend.

I developed Rootcology Electrolyte Blend as a complete and balanced formula, specifically to support people with Hashimoto’s. This formula contains the electrolytes sodium, potassium, chloride, and magnesium, along with additional thyroid supporting ingredients, including:

• Vitamin C – An important antioxidant to support the adrenals, mitochondria, thyroid hormone, and collagen production. Researchers are also finding that vitamin C may have antiviral properties and may be helpful in recovering from viral infections, such as the Epstein-Barr virus. (30)
• D-ribose – A natural sugar that supports mitochondrial health, energy production, exercise recovery, and chronic fatigue syndrome.
• Bioflavonoids – Quercetin and citrus bioflavonoids work synergistically with vitamin C to reduce inflammation. They also have antihistamine and antiviral properties. (31, 32)
• Taurine – An amino acid that supports the gallbladder (according to my estimates, about 30-50 percent of people with Hashimoto’s may have gallbladder issues), helps remove fluoride from the body, aids digestion, helps with allergies, and supports healthy blood pressure through electrolyte regulation in the cells. (33-35)

This blend may be helpful for supporting cardiovascular health, blood pressure and fluid balance, recovering from a cold or flu, replenishing electrolytes during and after sweating, supporting the adrenals, and mitigating symptoms of dehydration. (I usually recommend 1 teaspoon of Rootcology Electrolyte Blend in eight to ten ounces of water each day, or as directed by your personal provider. As always, please consult with your practitioner to ensure this supplement is right for your needs.)
Here’s what Kate had to say:

“I follow you on Facebook and read one of your articles about the Electrolyte Blend. I thought, what have a got to lose? My chiropractor was always telling me ‘you’re dehydrated’..and I was like HOW I drink a ton of water. Well apparently I was, I don’t know! Lol. The Electrolyte Blend gave me calm. No more heart palps and TMI, but I am ‘regular’ for the first time in my life! Adding the electrolyte blend is the only change I have made. I have more energy but it doesn’t like crazy energy for Hashi’s! I would think this is a huge help to my busted adrenals as well since I feel calm 🙂 Thank you!”

It is also useful to have on hand when enjoying an occasional glass of wine, or two. 🙂 When drinking alcohol, have 1 scoop in a glass of water along with each drink. (Do not exceed more than 1 scoop of Rootcology Electrolyte Blend per day.) You may want to have an additional scoop the next morning as well! This is very helpful for preventing the symptoms of a hangover, by keeping you hydrated.

You can also mix Rootcology Electrolyte Blend into smoothies, or use the blend to make popsicles, which are great for a hot day or when you’re down with the flu. I also like to have a scoop after a yoga class or hike, especially if I worked up a sweat.

Warnings/Precautions

Electrolyte supplements may not be recommended for those with sodium-sensitive hypertension, those with a pacemaker, and those with high sodium or potassium levels. Do not use if you are allergic or sensitive to any of the ingredients in this supplement.

Consult with a doctor before use if pregnant or breastfeeding.

Avoid if taking the following medications: ACE inhibitors, aminoglycoside antibiotics, anticoagulant/antiplatelet drugs, antihypertensive drugs, antidiabetic drugs, angiotensin receptor blockers, antacids, bisphosphonates, blood thinners, calcium channel blockers, corticosteroids, didanosine, digoxin, insulin, levodopa/carbidopa, lithium, potassium-sparing diuretics, quinolone antibiotics, skeletal muscle relaxants, sodium phosphates, sulfonylureas, tetracycline antibiotics, or tolvaptan.

Please note: Electrolyte Blend contains ingredients derived from non-GMO corn, but does not contain the corn protein component which can cause allergies. While it is generally well-tolerated by those with corn sensitivities, please consult with your practitioner before use if you have individual concerns.

Next Steps

While balancing electrolytes isn’t a cure for Hashimoto’s, it can be one piece of your root cause puzzle, since everything in the body is interconnected. Dehydration and an increased need for electrolytes are quite common with thyroid issues, especially since adrenal issues are typically also involved, and there is a studied correlation between thyroid hormone and electrolyte levels.

Electrolytes may be helpful in reversing some of the symptoms of dehydration that overlap with symptoms of Hashimoto’s or adrenal dysfunction — and, for some, electrolytes may even help to improve thyroid labs. The electrolyte minerals, specifically sodium, potassium, and magnesium, are generally very nourishing for the thyroid!

I always believe in a food-first and food-as-medicine approach. In this case, including a lot of mineral-rich whole foods, non-iodized sea salt, and bone broths is foundational. Since electrolyte supplements, like Rootcology Electrolyte Blend, are safe for most people and are also an effective way to address dehydration, that may be another area to experiment with, to provide the body with some support.

Now I want to hear from you! How have you used electrolytes in your healing journey?

P.S. You can also download a free Thyroid Diet Guide, 10 thyroid-friendly recipes, and the Nutrient Depletions and Digestion chapter of my first book for free, by signing up for our newsletter. You will also receive occasional updates about new research, resources, giveaways, and helpful information.

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References

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Note: Originally published in April of 2020, this article has been revised and updated for thoroughness and accuracy.