The 7 Most Common Nutrient Deficiencies in Hashimoto’s

After my own Hashimoto’s diagnosis in 2009, I wanted to figure out what I could do to live the healthiest life I could. I wanted to know if there was anything I could do to address my symptoms and reverse my condition, or at least stop its progression. So I set out on a journey to find the root cause of my disease.

I have learned that Hashimoto’s symptoms result from a combination of thyroid hormone imbalances, nutrient deficiencies, food sensitivities, an impaired ability to handle stress, an impaired ability to eliminate toxins, intestinal permeability, and one or more chronic infections.

Some of these root causes can be somewhat elusive and may take a lot of digging to uncover, but addressing nutrient depletions is usually pretty straight forward. Best of all, when we address nutrient depletions, we can feel better quickly, even when other underlying root causes are still present!

In this article, you’ll learn more about:

• The top nutrient deficiencies in Hashimoto’s
• Which nutrients require lab testing before supplementation, and which ones typically don’t
• Recommended supplements to address nutrient deficiencies
• How to understand your lab tests

Why Do We Have Nutrient Depletions?

While macronutrients — carbs, fats and proteins — are the three basic components of our diet, micronutrients are the vitamins and minerals that are vital to our wellbeing. Most people with Hashimoto’s have numerous micronutrient deficiencies. In fact, I would argue that due to our current farming practices and the Standard American Diet (S.A.D.), micronutrient depletions are a factor for most people!

Nutrient deficiencies can occur as a result of eating nutrient-poor foods, following a calorie-restricted diet, having inflammation from infections or food sensitivities, taking certain medications, or having an imbalance of gut bacteria.

Even people who are eating organic, nutrient-dense diets are at risk for micronutrient deficiencies, as factors like low stomach acid, fat malabsorption, and a deficiency in digestive enzymes will result in many of us not being able to properly break down the nutrients from the foods that we’re eating.

A lack of sufficient thyroid hormones can also lead to nutrient deficiencies, as it makes nutrient extraction from food more difficult and less efficient.

These nutrient deficiencies contribute to the development of Hashimoto’s as well as many of its symptoms. Restoring one’s nutrient levels through nutrient-dense foods, supplementation, and optimizing digestion are some of the fastest ways to feel better with Hashimoto’s and begin to restore the body!

The 7 Most Common Nutrient Deficiencies in Hashimoto’s

The most common nutrient deficiencies in Hashimoto’s are selenium, vitamin D, B12, ferritin (the iron storage protein), thiamine, zinc and magnesium (in no particular order).

The Spectracell Micronutrient Test Panel can be used to test for thiamine and magnesium deficiencies; however, selenium levels are not reliably found on blood testing. All three of these supplements can be safely taken within recommended doses without testing. Most people with Hashimoto’s have deficiencies in these nutrients, and I’ve seen very limited adverse reactions with supplementation. I’ve written separate articles for each supplement that summarize all of the related research so you can dig deeper into each one.

The 4 Thyroid Supplements Safe and Helpful for Most

Thiamine

Thiamine, (also known as B1), is a vitamin that is responsible for converting carbohydrates into energy and also helps with the digestion of proteins and fats. Thiamine is necessary for the proper release of hydrochloric acid in the stomach, which is required for proper protein digestion — essential for healing from Hashimoto’s. It has been found to often be deficient in people with Hashimoto’s and Crohn’s disease.

I wrote an entire article about thiamine a couple of years ago, and I still get hugs from readers at conferences as well as messages from people who have turned their life around with using thiamine. I recently received a letter from a reader who started on disability due to her thyroid fatigue and, with the use of thiamine, was able to return back to work!

Thiamine helped me resolve my fatigue and the low blood pressure I battled for as long as I could remember. (It was sometimes as low as 80/50 mmHg!) My blood pressure has always tested normal after I started this supplement a few years ago.

Research has shown that a dose of 600 mg per day can turn fatigue around in 3 to 5 days, and 36 percent of my surveyed readers said B1 supplementation made them feel better.

Clues that you may have a thiamine deficiency include: having Hashimoto’s or another autoimmune condition, irritable bowel syndrome (IBS), fatigue, low blood pressure, low stomach acid, brain fog, or adrenal and blood sugar issues. You may also feel worse after drinking alcohol or after taking L-glutamine.

Recommended Supplement: Benfomax from Pure Encapsulations

Dose: 600 mg per day

Expected benefits: more energy, better brain function, stabilized blood pressure, and improved blood sugar tolerance

When to expect to see benefits: usually 3-5 days

How long to take: 3 months-2 years

Special considerations: If you have an adverse reaction to thiamine (which is rare), I recommend detoxifying the liver with a liver support protocol. Sensitivities to B vitamins are a symptom of “liver congestion,” a condition that can lead to multiple chemical sensitivities and numerous symptoms.

See my full thiamine article for more information on how this nutrient could benefit you.

Selenium

I used to have panic attacks… but they stopped after I started taking selenium (and balancing my blood sugar). I’ve seen this time and time again, and it makes me so happy to see improvements with this one inexpensive nutrient!

Selenium deficiency has been recognized as an environmental trigger for Hashimoto’s, and most people with Hashimoto’s are at risk for this deficiency, which can manifest as increased anxiety, fatigue, and depression. Other populations at high risk include those with IBS, celiac disease, and people who consume grain free diets!

Numerous studies support using selenium in Hashimoto’s, Graves’, and pregnancy. In fact, selenium can prevent postpartum Hashimoto’s.

A dose of 200 mcg per day has been found to reduce TPO antibodies by about 50 percent within 3 months! Additionally, 62 percent of my readers have reported increased energy levels with the same dose.

Recommended Supplement: Selenium Methionine from Pure Encapsulations

Dose: 200-400 mcg per day

Expected benefits: less anxiety, better T4 to T3 conversion, lower thyroid antibodies, more energy, less hair loss, fewer palpitations

When to expect to see benefits: usually 3-5 days for symptoms to start improving; 3 full months to see a reduction in thyroid antibodies

How long to take: 3 months-2 years

Special considerations: If you have an adverse reaction to selenium (which is rare), you may have an iodine deficiency. While iodine can be a trigger for, and can exacerbate Hashimoto’s, some people may be deficient in it and may benefit from a low dose iodine supplement. Up to 250 mcg of iodine has been well tolerated in people with Hashimoto’s, and most multi and prenatal vitamins will contain anywhere from 150-250 mcg. (Read more about this in my article on iodine and Hashimoto’s.)

You can find more information about selenium here.

Magnesium

Magnesium has often been called the “miracle nutrient,” and I couldn’t agree more! Magnesium is necessary for more than 300 biochemical reactions in the body: it supports the immune system, maintains normal nerve and muscle function, regulates the heartbeat, strengthens bones, keeps blood glucose levels steady, and plays a role in the production of energy.

Magnesium deficiency can cause migraines, headaches, insomnia, menstrual cramps, anxiety, joint pain, and a whole host of other symptoms (including an intolerance to loud noises), while supplementation can resolve them.

I have witnessed the miracle of magnesium for myself, personally, in the realm of menstrual cramps. I used to get cramps that were so horrific, I often had to miss school and work on the first day of my menses. I remember a time during my pharmacy internship where I had to physically lay down in the back of the pharmacy because my menstrual cramps were unbearable! With enough magnesium onboard, my menstrual cramps are thankfully a thing of the past!

Additionally, studies show that long-term use can help with normalizing the appearance of the thyroid gland on ultrasound tests, and magnesium may also help for thyroid and breast nodules.

Recommended Supplement: Magnesium Citrate Powder by Rootcology or Magnesium (glycinate) by Pure Encapsulations. Choose citrate if you tend to be constipated; glycinate if your stools tend to be on the looser side. (Please note that Rootcology supplements only ship to the U.S. at this time. International readers may consider Magnesium (citrate powder) by Pure Encapsulations.)

Dose: 100-400 mg daily, at bedtime (Note: Do not exceed 400 mg per day.)

Expected benefits: reduced anxiety, reduced palpitations, more energy, improvements to the appearance of the thyroid during ultrasound tests (when used long-term), reduced menstrual cramps, relief from constipation, migraines, cramps and pain, better sleep

When to expect to see benefits: This really depends on the symptom(s) you may currently be experiencing. You may see benefits with anxiety, insomnia, and even migraines/headaches, within the first week. With menstrual cramps, they will reduce by 80-90 percent within the first month and will lessen with continued use. With regard to normalizing thyroid appearances on ultrasound tests, this may take a few years of use.

How long to take: 3 months-lifetime

Special considerations: Make sure to space your magnesium by at least 4 hours from thyroid medications, iron supplements, and calcium supplements, as magnesium can block their absorption. I prefer taking magnesium at bedtime because it promotes a restful sleep.

Magnesium citrate can cause loose stools, which may be a good or a bad side effect depending on which direction you tend to swing. Consider magnesium glycinate if you tend to experience diarrhea, or magnesium citrate if you tend to be more constipated. Keep in mind that, for some people, the glycinate version can worsen anxiety symptoms. If you are prone to anxiety, citrate would be a better choice.

For more information about the importance of magnesium, please see my full article.

Zinc

Zinc is involved as a catalyst in many different pathways in the body. It’s also very important for gut health, immune function, tissue healing, the conversion of T4 to T3, and the production of TSH. It can help tighten the intestinal junctions of those with intestinal permeability as well.

Symptoms of zinc deficiency include poor wound healing, impaired taste and smell, and thin, brittle, peeling, or white-spotted nails. Those low in zinc may also have a weakened immune system and suffer from allergies, frequent colds or respiratory infections. Low alkaline phosphatase (ALP) on a blood test can also provide an indirect indication of zinc deficiency (the optimal range for alkaline phosphatase is 70-90 IU/L).

Depleted zinc levels can also result in diarrhea, hair loss, impotence, loss of appetite, skin issues (acne, rashes, canker sores, foot fungus), depression, impaired vision, low sperm count, ADHD, unexplained weight loss, a lack of alertness, and open sores on the skin.

Over 52 percent of my surveyed readers reported feeling better after starting zinc supplementation.

Who is at Risk for Deficiency: Since zinc is needed to form TSH, those who are constantly producing TSH are more likely to develop deficiencies in zinc. If you have celiac disease or any other malabsorption syndrome that has caused intestinal damage, you may have an impaired ability to absorb zinc.

Recommended Supplement: Zinc 30 by Pure Encapsulations

Dose: 30 mg per day (larger doses require a doctor’s supervision)

Special considerations: To ensure proper absorption, zinc supplements should be taken with food. I’ve also found that taking 500 mg of evening primrose oil, twice per day, improves the absorption of zinc. (Thanks to Trudy Scott for the tip!) Doses should be no more than 30 mg per day without your doctor’s supervision. This is because doses above 40 mg may cause a depletion in copper levels. Zinc supplementation can also deplete one’s iron levels.

To learn more about zinc and Hashimoto’s, please see my full article.

The 3 Most Important Thyroid Nutrient Tests

Vitamin D, B12, and ferritin are very common nutrient deficiencies in those with Hashimoto’s, but unlike the ones mentioned above, require testing before starting supplementation. Most doctors will order these tests for you if you ask, and the tests should be covered by your insurance. If you do not have a doctor that is willing to order the tests for you, or if you have a high-deductible insurance plan, I’ve provided links for self-ordering options for each of the tests below, as well as a guideline for your optimal reference range and my preferred supplement choice.

Please note: the lab interpretation guide I provide below is based on functional labs. In some cases, doctors may consider your numbers “normal” when you are indeed deficient. Make sure to be an educated and empowered patient, and always ask for a copy of your own labs so that you don’t miss out on the life-changing effects of these important nutrients!

Vitamin D

Vitamin D deficiency is more commonly found in people with Hashimoto’s — 68 percent of my readers with Hashimoto’s reported also being diagnosed with vitamin D deficiency — and deficiency has been correlated with the presence of antithyroid antibodies. Research done in Turkey found that 92 percent of Hashimoto’s patients were deficient in vitamin D, and another 2013 study found that low vitamin D levels were associated with higher thyroid antibodies and worse disease prognosis.

According to my 2015 survey, 74 percent of my readers felt better after taking a vitamin D supplement! This isn’t surprising, as vitamin D supplements can improve our mood and help us reduce thyroid antibody levels.

Both Thyroid Peroxidase and Thyroglobulin antibodies were reduced in a Polish trial of 18 women who were supplementing with vitamin D to reach a target of 60 ng/mL. I’ve personally found that most of my clients who are in remission from Hashimoto’s keep their levels of vitamin D between 60-80 ng/mL.

Who is at Risk for Deficiency: Anyone who is not a full-time lifeguard in Southern California may be at risk. 🙂 Vitamin D deficiency is rampant, especially in most North Americans, Europeans, and Australians — and affects a large number of people with Hashimoto’s. A low-fat diet or fat malabsorption increases the risk.

Recommended Test: I recommend testing for vitamin D deficiency with the Vitamin D 25-Hydroxyvitamin or 25(OH)D test, then retesting within 3 months once you start supplementing to make sure that you are getting enough, but not too much. In contrast to most vitamins which are water-soluble and are excreted by the body in excess, vitamin D is fat-soluble and can build up.

Understanding Your Results: Vitamin D levels should be between 60 and 80 ng/mL for optimal thyroid receptor and immune system function.

Recommended Supplement: Vitamin D by Pure Encapsulations

Dose: I generally recommend a dose of 2000-5000 IU for my clients, with a recheck in 3 months.

Special Considerations: I also recommend spending time in the sunshine to get more vitamin D if you have Hashimoto’s. If you don’t live in a warm climate, get to one! You have an official prescription for a beach vacation from yours truly! Tanning beds will also do in a bind.

Take a look at my full article on vitamin D for more information on how important it is to thyroid health.

Vitamin B12

Vitamin B12 helps us with our energy production. Low levels are commonly associated with Hashimoto’s and may lead to fatigue, depression, neurological issues, impaired digestion, brain fog, tingling extremities, nerve damage, seizures, and anemia.

Who is at Risk for Deficiency: Vegans and vegetarians are at greatest risk due to the fact that B12 is only found in animal foods and cannot be synthesized by the human body. Those with pernicious anemia (a type of autoimmune condition), H. pylori, and SIBO may also be susceptible.

In my survey of 2232 people with Hashimoto’s, 33 percent reported that they had tested as deficient in this all important vitamin, and 76 percent said they felt better after taking a B12 supplement.

Recommended Test: You can test your B12 (cobalamin) levels through your healthcare provider or through Ulta Labs. This is not a routine test but is covered by most insurance plans. Levels may be low, even if all other screening tests for iron and anemia come out within the reference range.

Understanding Your Results: Optimal B12 levels should be between 700-900 pg/mL. Please note: most labs will not flag low B12 levels unless they are under 200 pg/mL.

Recommended Supplement: B12 5000 Liquid (methylcobalamin) by Pure Encapsulations

Dose: 5000 mcg, sublingually, daily for 10 days; then 5000 mcg, once per week, for 4 weeks; then 5000 mcg monthly for maintenance

Monitoring: You can’t really overdose on B12, as it’s water-soluble, but I always recommend doing the initial test and retesting 3 months later to track and monitor your progress.

Special Considerations: Be sure to use the sublingual version — swallowing B12 may result in inadequate absorption. Injections are also available and are highly effective; however, the sublingual form is just as effective, much less expensive, and is pain free.

If you have pernicious anemia, please note that it’s often caused by H. pylori, which can trigger both Hashimoto’s and pernicious anemia. Treatment can reverse both conditions! Make sure to read my article on H. pylori to learn more about this gut infection.

If you have the COMT V158M gene mutation or mitochondrial issues, the Adenosyl/Hydroxy B12 Liquid supplement from Pure Encapsulations may work better.

Please see my full article on B12 for more information that may benefit you.

Ferritin

Ferritin is our iron storage protein. Low levels are commonly associated with Hashimoto’s and may lead to fatigue, difficulty breathing, and hair loss. According to my 2015 survey of readers, supplementation made 63 percent of them feel better.

Who is at Risk for Deficiency: Women who menstruate and/or are postpartum may be at increased risk due to blood loss. Additionally, SIBO, H. pylori, low stomach acid, vegan/vegetarian diets, manganese deficiency, and heavy metal toxicity (including copper toxicity) can cause low ferritin levels.

Recommended Test: Ferritin levels may be low, even if all other screening tests for iron and anemia come out within the reference range. You need to specifically test for ferritin. Ferritin level tests can be ordered by your doctor, or you can self-order one via Ulta Lab Tests.

Understanding Your Results: Normal ferritin levels for women are between 12-150 ng/mL. According to some experts, ferritin levels of at least 40 ng/mL are required to stop hair loss, while levels of at least 70 ng/mL are needed for hair regrowth. The optimal ferritin level for thyroid function is between 90-110 ng/mL.

Recommended Supplement: OptiFerin-C by Pure Encapsulations

Dose: 1-3 capsules per day, in divided doses, with meals

Special Considerations: Ferritin can be deficient due to numerous root causes, including a lack of stomach acid that helps us absorb iron from iron-rich foods; so if supplementing does not address your levels, you will need to do some more digging. I have more information in the Advanced Protocols section of my book Hashimoto’s Protocol.

Be sure to retest your levels of ferritin, as ferritin can build up in the body and become toxic. If you have elevated ferritin levels, you may have iron overload and may benefit from blood donations.

Keep this supplement out of reach from children and pets!

You can read more about ferritin and Hashimoto’s here.

Lab Testing

All of the above labs can be ordered by your primary care doctor or endocrinologist and are covered by most insurance plans. Research supports that they should be the standard of care for everyone that has Hashimoto’s, but oftentimes, you will need to request these tests from your doctor.

Please note: if you don’t have a doctor that can order the labs for you, you can order each of the labs separately, or you can order the full Root Cause Nutrition panel from Ulta Lab Tests. This is the first company that not just lets patients order their own labs (and receive the results), but also allows you to submit your receipts to your insurance for billing! Please be sure to check with your insurance, as each company has different rules.

Action Steps

In summary, the most important nutrient depletions to address in those with Hashimoto’s include thiamine, selenium, magnesium (citrate or glycinate), ferritin, B12, vitamin D, and zinc.

Thiamine, selenium and magnesium are safe and helpful for most people with Hashimoto’s, and most people will see a significant benefit from these supplements.

If you have Hashimoto’s, you should also request lab tests for ferritin, B12, vitamin D, and zinc, to see if you would benefit from supplementation.

As with all supplements, please be sure to consult with your health care practitioner to determine the dosage and duration that is right for you.

To further help you along your healing journey, my new cookbook, Hashimoto’s Food Pharmacology: Nutrition Protocols and Healing Recipes to Take Charge of Your Thyroid Health, is available for pre-order! In addition to containing 125 delicious, nutrient-dense recipes that will help restore your depletions, this cookbook also includes information regarding how to tailor your diet to you, how to address specific symptoms with nutrition, how to use complementary nutrients to address symptoms, and when to dig deeper beyond nutrition. You can pre-order your copy today and then redeem six bonuses here as my way of saying thank you.

I hope this information helps you on your journey toward better health!

Have you tried these nutrients? How have they helped? What other nutrients have you found to benefit you? Let me know in the comments below! 🙂

References

1. Costantini A, Pala M. Thiamine and Hashimoto’s Thyroiditis: A Report of Three Cases. The Journal of Alternative and Complementary Medicine. 2014;20(3):208-211. doi:10.1089/acm.2012.0612.
2. Gärtner R, Gasnier BC, Dietrich JW, Krebs B, Angstwurm MW. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. J Clin Endocrinol Metab. 2002;87(4):1687-1691.

Note: Originally published in April 2017, this article has been revised and updated for accuracy and thoroughness.