Case Study: Treating the Root Cause of Hashimoto’s Thyroiditis | Beyond Pills

Do you or someone you love have a thyroid disorder? This disorder, often diagnosed as Hashimoto’s thyroiditis, is becoming more and more common. I have written extensively on Hashimoto’s (linked below) and how to treat the root cause since it is a specialty of mine:

Understanding Hashimoto’s Thyroiditis 

Bad Guys in the Gut: Overcoming Autoimmunity

Hashimoto’s is a manifestation of T cell-mediated autoimmunity with environmental and genetic influences. The immune system erroneously attacks the thyroid when it shouldn’t.  Upon diagnosis of Hashimoto’s thyroiditis or hypothyroidism (aka., an underactive thyroid gland), these patients are promptly prescribed thyroid medication in the form of Levothyroxine (T4) and sent on their merry way. The problem is most of these patients cannot effectively convert thyroid hormone T4 into the active form which is required to enter cells.  The other problem is conventional medicine does not bother to understand the root cause of why these patients developed a thyroid disorder in the first place and may just chuck up the reason to be idiopathic. Just treating with T4 often causes the thyroid disease to worsen in the long run and increases these patients’ risk of developing other autoimmune diseases. 

When someone is diagnosed with Hashimoto’s, it's common for them to seek out natural treatments, such as nutritional supplementation, because just giving synthetic or bioidentical thyroid hormone is not the perfect remedy doctors would like it to be.  

One of these people, a 50-year-old woman named “Denise,” came to see me for her persistent Hashimoto’s flare-ups. She was incredibly burnt out and tired all the time. She wanted answers. Because I knew she was already diagnosed with Hashimoto’s, I was able to act quickly and begin a gut and immune system healing protocol.

We did additional testing and found high levels of arsenic and mercury levels. The biggest sources of arsenic and mercury poisoning are derived from a diet rich in fish, poultry, arsenic, red meat, and dairy products since these heavy metals are at extremely high levels in the soil and water and not easily excreted from animal protein. “Denise’s” diet had also caused severe damage to her stomach lining leading to poor absorption of critical vitamins (ie., Vitamin B12, folic acid, magnesium, calcium, iron).  Her cells were working so hard trying to clear out these toxins but could not keep up with the excess level of exposure from a regular consumption of animal protein. This led to increasing cell damage from the toxins and hence, an increasingly damage to most organs in the body.  Since the liver becoming increasingly congested from these toxins, it was unable to easily manage its other critical functions. For example, less estrogen was being broken down in the liver and instead converted to a toxic form associated with causing cancer cell growth and cardiovascular disease.


A Note About Supplementation in Hashimoto’s

Selenium (Se) is one documented dietary supplement that is an adjunctive therapy to T4 in treating Hashimoto’s. Other key nutrients include zinc, methylated (activated) B vitamins, and vitamin D. Toulis et al. (2010) did a systematic review of prospective studies following Hashimoto’s patients on T4, and meta analysis (aka., randomized, blind, and placebo-controlled) Selenium studies. They found that Hashimoto’s patients randomized to Selenium supplementation for a minimum of 3 months had significantly lower thyroid peroxidase antibody (TPO Ab) titers (p < 0.0001), a critical marker of Hashimoto’s, and a significant improvement in their general well being and mood (p = 0.016), compared to controls (no Selenium supplementation). 

However, in a 2017 placebo-controlled, randomized, prospective trial conducted by Esposito et al. Selenium was found to have minor effects on the trajectory of euthyroid Hashimoto’s versus the non-Selenium treated group at  0, 3, or 6 months. 

Takeaway: micronutrient supplementation as the only form of Hashimoto’s treatment does not work for everyone as the complete remedy. This discrepancy is likely due to varying levels of stress being one of the largest contributors to Hashimoto’s onset and flare-ups.

We know that the onset of the immune system being unable to differentiate between healthy and foreign tissue often begins years to even decades before the diagnosis of autoimmune disease.  The biggest reason is the digestive tract often endures chronic damage causing microscopic “open doors” between the gut wall and the bloodstream.  This intestinal permeability (aka., “leaky gut”) causes antibodies and toxins to leak out into the bloodstream. Antibodies, produced predominantly inside the digestive tract, begin attacking healthy tissue as being foreign. Toxins begin damaging cells throughout the body and hindering most organs’ normal physiological function. 

One of the biggest reasons for this frequent damage to the digestive and immune systems is caused by overstimulation of the sympathetic nervous system from STRESS. This fight-or-flight stress response causes poor blood circulation to the gut leading to increasing cell damage over time. 

Research that currently focuses only on a one-solution approach (i.e. T4) misses the complete picture to remedy disease such as Hashimoto’s. Future studies should assess gut barrier function in the individual and in combination with the synergy of dietary components tested. Otherwise, the time and energy spent on these studies is wasteful given the growing knowledge and body of evidence of stress and leaky gut’s connection in autoimmunity.  

“Denise” had lived with extremely high levels of stress for decades.  We realized that throwing all the supplements in the world would not improve her disease. She had to first address her toxic relationship with her spouse, her biggest stressor. By setting boundaries with her partner and releasing herself from their deep co-dependence, “Denise” was finally able to sleep better.  She was investing more time in her self-care, and shifting her future goals to be better aligned with herself versus dominated by her spouse.  

Over just a few years of working together “Denise” now has complete remission of her Hashimoto's thyroiditis. The biggest reason why her thyroid disease had persisted for years was no other physician had actively  addressed the biggest source of her disease: stress. Often times by the time a person is officially diagnosed with Hashimoto’s, they have a higher risk of developing a second autoimmune disease (Wiebolt et al., 2011; Renzullo et al., 2013). 

The further along one is in the depths of their disease, the harder it is to correct and treat. This was really challenging for “Denise” to admit, but she knew that healing herself wasn’t going to be easy at first. After many years, she was finally allowing her parasympathetic nervous system to work  optimally so that normal cell functions could occur. “Denise” was shifting away from frequently signalling a stress response and placing her sympathetic nervous system into overdrive.


Dr. Bhandari and the Advanced Health Team Are Here to Support Your Health During the Winter Months. Our team is one of experts who work to help patients suffering from chronic pain improve their bodies, allowing them to live healthier, fuller lives. We are always ready to share their expertise. To book an appointment, contact Advanced Health or call 1-415-506-9393.


Esposito, D., Rotondi, M., Accardo, G., Vallone, G., Conzo, G., Docimo, G., ... & Pasquali, D. (2017). Influence of short-term selenium supplementation on the natural course of Hashimoto’s thyroiditis: clinical results of a blinded placebo-controlled randomized prospective trial. Journal of endocrinological investigation, 40(1), 83-89. 

Renzullo, A., Accardo, G., Esposito, D., De Bellis, A., Bizzarro, A., Romano, M., ... & Faggiano, A. (2013). Hashimoto's Thyroiditis and Entero-Chromaffin-like Cell Hyperplasia: Early Detection and Somatostatin Analogue Treatment. European Journal of Inflammation, 11(3), 863-870. 

Toulis, K. A., Anastasilakis, A. D., Tzellos, T. G., Goulis, D. G., & Kouvelas, D. (2010). Selenium supplementation in the treatment of Hashimoto's thyroiditis: a systematic review and a meta-analysis. Thyroid, 20(10), 1163-1173.

Wiebolt, J., Achterbergh, R., den Boer, A., van der Leij, S., Marsch, E., Suelmann, B., ... & Van Haeften, T. W. (2011). Clustering of additional autoimmunity behaves differently in Hashimoto's patients compared with Graves' patients. European journal of endocrinology, 164(5), 789-794. 

Dr. Payal Bhandari Dr. Payal Bhandari M.D. is a leading practitioner of integrative and functional medicine in San Francisco.

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