You Might Not Need Hormone Replacement

Do you feel tired or cold much of the time? Are you anxious, irritable, depressed? Maybe you have trouble losing weight. If so, you may have an underactive thyroid (hypothyroidism)—and you’re not alone. The American Association of Clinical Endocrinologists estimates that about 27 million adults, close to 10% of the population, suffer from thyroid disease. Hypothyroidism (underactive thyroid) is the most common form, accounting for about 90% of all cases.

What to do? Hormone replacement always is an option—but you might not need it.

My advice: Start with these lifestyle changes and other natural treatments. If you’re currently taking thyroid medication, you may need less medication—so be sure to let your doctor know that you’re taking these steps…

Add iodine. You’ve probably heard that iodine deficiency is rare in the US because iodine is added to salt—and because many foods contain it. Not true. There’s been an increase in iodine deficiency because many people avoid iodized salt (or are eating less salt in general). In addition, many people eat diets that are high in pasta and bread. These foods often contain bromide, a compound that decreases iodine ­absorption.

My advice: Get tested for iodine. Low levels are easily corrected by using iodized salt…eating sea vegetables (such as nori) a few times a week…or by taking an iodine supplement.

Important: Don’t take an iodine supplement unless you need it. Too much iodine can cause thyroid inflammation and increase your risk of developing Hashimoto’s thyroiditis (a kind of hypothyroidism) or thyroid cancer.

Eat Brazil nuts. They’re high in selenium, a mineral that helps the body convert thyroxine (T4, a less active form of thyroid hormone) to triiodothyronine (T3, the active form). One study found that low-thyroid patients given selenium supplements later tested normal on a thyroid test. A few Brazil nuts a day will provide enough selenium. Other high-selenium foods include fish, chicken, turkey and beef. Note: If you live in North Dakota or South Dakota, then you already have a lot of selenium in your diet because the ground in these states is rich in selenium. Therefore, you probably will not need additional selenium as a food or supplement.

Take probiotics. I recommend them for everyone with low-thyroid function. Studies have shown that probiotic supplements—Lactobacillus, Bifidobacterium, etc.—improve the body’s ability to absorb the nutrients that are needed for thyroid health. I’ve had patients who were able to avoid using ­medication simply by optimizing their digestive health with probiotics.

My advice: Buy probiotic supplements that contain at least 20 billion colony-forming units per dose (available at health-food stores and pharmacies). Research has shown that people tend to do better when they rotate bacterial strains about every six months.

Take a daily multi. Many different nutrients are required for the body to convert T4 to the more active form of thyroid hormone, T3. Even if you eat a nutritious diet, you might not be getting enough. For insurance, take a multinutrient supplement that includes all the basics, such as potassium, selenium, B vitamins and zinc. Ask your health-care provider if you need iron in your multivitamin.

Don’t skip breakfast. The pancreas ramps up insulin production in the morning and again in the evening. You need to synchronize meals with high-insulin times to improve insulin sensitivity—the ability of cells to respond to insulin and absorb blood sugar. One study found that people with improved insulin sensitivity had lower TSH (see below) and higher T4. An example of a good breakfast would be turkey sausage and berries. The sausage is a protein that slows the absorption of the carbohydrate (the berries), which is better for blood sugar levels.

Avoid harmful foods and ingredients. Sugar, refined carbohydrates (such as white bread and white rice) and soft drinks can contribute to hypothyroidism by decreasing the levels of important minerals in your body. Opt for healthier choices—a Mediterranean-style diet is ideal, along with plenty of purified water.


If your symptoms don’t improve from lifestyle changes and natural treatments, you’ll probably need a thyroid medication. The good thing about these prescription drugs is that they precisely mimic the effects of your body’s natural hormones. You’re unlikely to experience any side effects after your doctor has determined the correct dose. Until then, you might have the same symptoms that you had before (if you’re taking too little). Or, you might have shakiness, insomnia, rapid heartbeat or an increased appetite (if you’re taking too much).

The standard prescription hormones, such as Synthroid or Levothroid, contain only T4. My advice: Ask your doctor to prescribe one of the powdered thyroid hormones—such as Armour Thyroid, Euthroid or Liotrix—that contains T3 along with T4. They usually come in a standard ratio of four parts T4 to one part T3. Studies have shown that most patients who are given both tend to do better than those who take only T4.


The standard test for low thyroid might not provide a clear answer. You could test normal but still have thyroid function that’s at the lower end of the range—which, for some people, is enough to cause problems.

Low thyroid is diagnosed with a simple blood test for thyroid-stimulating hormone (TSH). If you have low thyroxine, a thyroid hormone, your body will produce high levels of TSH to compensate. People with significantly elevated TSH—say, a reading of 5.0 mIU/L (milli-­international units per liter) or higher—have obvious hypothyroidism.

What if you test within a normal range but still are having symptoms? It doesn’t mean you’re imagining things. Laboratories have different reference ranges, the measurements that are considered normal. In 2004, endocrinologists suggested a change in the normal range so that a TSH reading of 2.5 was the upper limit. But for some people, normal isn’t optimal. I’ve found that patients can suffer from thyroid-related symptoms even when they “pass” the TSH test.

This is why it is very important to have a complete thyroid panel done when you see your doctor and not just a TSH and free T4. An entire thyroid panel includes TSH, free T3, free T4, reverse T3 and thyroid antibodies.