The thyroid is a small, butterfly-shaped gland positioned in the front of the neck. It produces hormones that promote oxygen use in cells and regulate vital processes in every part of the body. Thyroid hormones have a major impact on heat production, growth, use of energy and fertility.

Hypothyroidism (or, myxedema) is a disorder in which the body lacks adequate thyroid hormone. There are several possible reasons why this may happen- none of them good. It is estimated that as many as 13 million Americans have a thyroid disorder, but up to eight million may go undiagnosed.

People suffering from hypothyroidism, from whatever cause, experience a diverse collection of symptoms, including fatigue, weakness, weight gain, hair loss, cold intolerance and constipation. Each individual will have any number of these symptoms, and they will vary with the severity of the thyroid hormone deficiency and the duration of the disease. Most will have a combination of several of these symptoms. Some patients with hypothyroidism have no symptoms whatsoever, or they are subtle and they go unnoticed until diagnosed medically.

The Thyroid-The Body's Thermostat
The thyroid produces two key hormones, thyroxin (T4) and L-triiodothyronine (T3). Iodine, used in the manufacture of these hormones, is extracted from the blood and trapped by the thyroid, where 80% of the body's supply is stored. The thyroid produces mainly thyroxin, which in turn, is converted into T3, the more active form. About 20% of T3 is formed in the thyroid gland. The majority is manufactured from circulating thyroxin in tissues outside the thyroid.

The process of iodine trapping and hormone production is directly regulated by thyroid-stimulating hormone (TSH) that is secreted by the pituitary gland. Any abnormality in this intricate system of glands and hormone synthesis and production can have far-reaching consequences.

Hypothyroidism is more common than you would think. Over five million Americans have this widespread condition. Mild thyroid dysfunction occurs in 4% to 17% of women and 2% to 7% of men, depending on whom you ask. The risk increases with age. The elderly are most susceptible to hypothyroidism, but it can affect people of all ages.

Hypothyroidism is associated with higher risk of atherosclerosis and heart disease. Probably this higher risk is because high levels of low-density lipoprotein (LDL) often occur in people with hypothyroidism. Even in subclinical hypothyroidism, LDL levels may be elevated.

Untreated hypothyroidism can, over time, cause mental and behavioral impairment, including depression, and eventually may even cause dementia.

Of course, surgical removal of all or a portion the thyroid gland produces hypothyroidism. That said, non-surgical hypothyroid is mainly a result of previous or ongoing inflammation of the thyroid gland that leaves a large percentage of the cells of the thyroid damaged and incapable of producing ample hormones. The most common reason for this thyroid gland failure is called autoimmune thyroiditis, or Hashimoto's thyroiditis, thyroid inflammation caused by the patient's own immune system.

There are several other rare causes of hypothyroidism. One of them occurs with a completely "normal" thyroid gland that is not being directed to make enough hormone by the pituitary gland. When the pituitary does not produce enough Thyroid Stimulating Hormone (TSH), the thyroid just does not have the "signal" to make hormone.

Hashimoto's Thyroiditis
This slowly developing chronic inflammation of the thyroid gland frequently results in hypothyroidism. It is named after Hakaru Hashimoto, the Japanese physician who first described it in 1912.

Hashimoto's may also be called:
Autoimmune thyroiditis
Chronic lymphocytic thyroiditis
Lymphadenoid goiter
Struma lymphomatosa
The underlying cause of Hashimoto's thyroiditis is an autoimmune reaction to proteins in the thyroid.

Experts do not understand why the immune system starts to injure the thyroid. One theory suggests that an infecting virus or bacterium with a protein resembling a thyroid protein might trigger the response.

Patients with Hashimoto's thyroiditis typically have autoantibodies against several different thyroid proteins. These thyroid antibodies are present in 95% of Hashimoto's thyroiditis patients. They serve as a useful "marker" for diagnosis without thyroid biopsy or surgery.

There is evidence for a genetic predisposition for Hashimoto's thyroiditis. Persons with autoimmune thyroid disease commonly have other coinciding autoimmune disorders. A family history of thyroid disease is not uncommon.

Men and women of any age can develop this disease, but it is most common in women between the ages of 30 or 50. In that age range, the ratio of female to male sufferers is fifty to one. Estimates of the prevalence of Hashimoto's disease vary widely, from 1 out of 10,000 people, to about 5% of adults. Some experts indicate that up to 10% of women over 50 have some indication of this condition.

In Hashimoto's disease, the thyroid gland is always enlarged. In some cases, only one side is enlarged enough to feel. During the course of this inflammatory disorder, the thyroid cells become inefficient at converting iodine into thyroid hormone, and the gland "compensates" by enlarging. Iodine uptake may be paradoxically high, while the patient is hypothyroid. The gland maintains the ability to take up iodine, while it has lost its ability to produce thyroid hormone. As the condition progresses, TSH elevates, since the pituitary is attempting to induce the thyroid to make more hormone, but thyroxin falls since the thyroid can't synthesize it. The net result is that the patient becomes hypothyroid. The disease onset is often slow and is sometimes not detected. The progress of the disease can occur over a short span (a few weeks) or several years. Approximately 25 percent of Hashimoto's patients develop pernicious anemia, diabetes, adrenal insufficiency or other autoimmune conditions.

Medically, the treatment is to start thyroid hormone replacement, preventing or correcting the hypothyroidism. This generally keeps the gland from getting larger, and, in most cases, the thyroid gland will then decrease in size. Thyroid antibodies may remain in the blood for years after the patient is on thyroid hormone replacement.

Herbal Strategy
Your treatment strategy will be to tonify the endocrine system with slow acting, long term stamina enhancing tonic herbs, reduce inflammation in general, support immune function and therefore reduce the hyperimmune response using immune amphoterics and promote thyroxin production on a maintenance basis.

Iodine is the raw material of thyroid hormone, so diets deficient in iodine can promote hypothyroidism. Around the world, about 200 million people have goiters from dietary iodine insufficiency, but the condition is almost unheard of in developed nations, where iodine has been added to salt.

Excess iodine, however, tends to suppress production of thyroid hormones. In people with thyroid antibodies, but no autoimmune symptoms, an increase in iodine can bring on symptoms. Suggestively, countries with the highest iodine intake, including the US and Japan, have the highest prevalence of chronic autoimmune thyroiditis. When people in countries with iodine deficient diets are given iodine supplements, the rate of Hashimoto's disease increases.

Recent animal models and test tube studies have shown the same effect.[ 1]

Immune Approaches
When you are dealing with an autoimmune disease, like Hashimoto's thyroiditis, you may wonder if it's a good idea to "boost" the immune system. After all, an autoimmune condition represents an over-response of the immune system to its own cells, so who would want to give the immune system even more ammunition? But, of course, it's not so simple.

With autoimmune disease, it's already obvious that we don't have a properly functioning immune system. People sometimes erroneously suppose that because the immune mechanism goes into "overdrive" with an autoimmune disorder, that they have a properly functioning — but overzealous — immune system. More to the point, autoimmune disease itself is a sign that the immune system is already dysfunctional. Patients with autoimmune thyroid disease are commonly more susceptible to infection, catch more colds and flu, catch them more easily and have longer recovery times. These are all indications that the immune system is not performing optimally.

The body has a number of mechanisms that act as the front-line against antigens. These include various types of white blood cells, which can attack antigens when they are detected. In some cases, the response is inflammation. When you inhale a cold virus, your body's response inflames your nasal passages. Clearly, anti-inflammatory herbs should be of benefit in this disorder, and, in fact, they are.

We also develop "acquired" or "adaptive" immunity, when the body is exposed to various antigens repeatedly. Lymphocytes usually develop the ability to differentiate between the body's own tissues, versus antigens. In autoimmune thyroiditis, the immune system decides that a normal tissue, the thyroid, is an antigen, and puts the immune system into action to destroy it. So, it's important to do as much as possible to help the immune system work at its best. I think of these suggestions as "immune facilitators." They certainly work in practice.

Baical Scullcap Root (Scutellaria Baicalensis)
Chinese baical scullcap root is another herb high in bioflavanoids, which inhibit histamine and leukotrienes, and are potent antioxidants. This bitter, cold herb has anti-inflammatory qualities[ 2] comparable to nonsteroidal anti-inflammatory drugs like ibuprofen, while showing no adverse effects.

The herb is a powerful antioxidant.[ 3]

The dose is 7-10 grams per day, in capsules.

Astragalus Root (Astragalus Membranaceus)
A sweet, slightly warm herb, astragalus is a staple minor tonic in Chinese medicine. In recent times it has become known as a superior immune enhancer.

Guduchi (Tinospora Cordifolia)
Sometimes called "Indian quinine," this bitter, astringent, hot herb treats flu and fever. It is antibacterial, and is widely used as a general antimicrobial remedy in Asia. Use 4- 15 grams per day in capsules.[ 4]

Thyroid Balancing Approaches
Hypothyroid responds very slowly to natural therapies. It is very unlikely to get a rise in blood thyroxin levels before 1-2 months. Expect a year for a complete recovery and a transition to maintenance protocol. Expect a very satisfactory long-term recovery with consistent compliance.

Three herbs head my list of thyroid tonics. These herbs are all slow acting balancers, and any of them might work as well as another. Choose between them according to the subtler indications of the case.

Saw Palmetto Berry (Serenoa Repens)
This well-known herb, now used mainly for other purposes, is a general glandular balancer and nourisher. Though not used much now for this purpose, I find it to be quite effective.

Physicians in the nineteenth century commonly used saw palmetto berries for anorexia, sexual and general depletion, chronic bronchitis, asthma complications, reduced libido, infertility, chronic and sub-acute cystitis and lung conditions.[ 5]

He Shou Wu (fo-ti) Root (Polygonum Multiflorum)
A Chinese tonic, he shou wu is well suited to tonifying the thyroid. The herb, also often called fo-ti, is native to China, where it continues to be widely grown. Once it has been boiled in a special black bean liquid, it is considered a superior medicine according to traditional Chinese medicine.

The Chinese common name, heshou-wu, is from the name of a famous herbalist whose infertility was supposedly cured by the herb. In addition, his long life was credited to the tonic properties of this herb. Traditional Chinese medicine uses fo-ti to treat premature aging, weakness, vaginal discharges, numerous infectious diseases, angina pectoris, premature hair loss and graying and impotence. An animal study from 2000 demonstrated that he-shou-wu is a potent protector of oxidation damage to the heart.[ 6]

The active constituents of he-shouwu have yet to be determined. The whole root has been shown to lower cholesterol levels, according to animal and human research, as well as to decrease atherosclerosis. Other research has investigated this herb's role in strong immune function, red blood cell formation and antibacterial action. The roots have a mild laxative action.

Eleuthero Root (Eleuthrococcus Senticosus)
This herb is the original "adaptogen." It is used in Chinese herbalism as a long-term builder.

Several more herbs deserve mention. Each of these may have its place in a hypothyroid protocol.

Prickly Ash Bark (Xanthoxylum Americanum)
Many Western herbalists considerer the bark of the prickly ash tree is one of the best tonic, alterative circulatory stimulants of North America. Prickly ash bark has a general benefit for long-term thyroid function.

Black Cohosh Root (Cimicifuga Racemosa)
While known mostly these days for treating hot flashes, black cohosh strengthens the endocrine system, and has anti-inflammatory action.

Gotu Kola Leaf (Centella Asiatica)
This classic tonic herb from Ayurveda has general thyroid healing benefit.

Willow Bark (Salix Alba and other species)
Willow is a traditional pain reliever that still lives up to its reputation. Willow contains salicin and other related salicylates, which are the herbal forerunners of aspirin.[ 7] Salicylates, such as those in willow, relieve pain, lower fever and diminish inflammation. According to The American Herbal Pharmacopoeia, "in modern herbal therapy, willow is predominantly used as an anti-inflammatory for symptomatic relief of gouty arthritis and as an analgesic for mild neuralgic pains, toothaches and headaches."

Aspirin thins the blood, but willow bark does not, so don't use it for heart disease.[ 8] On the other hand, it won't cause the bleeding problems common with aspirin. Patients don't experience the typical digestive disturbances of aspirin when using willow.

There are no special warnings for using willow. Use a tea brewed from up to 1 oz., dry weight, of the raw herb, per day, an extract containing 240 mg total salicin per day or the equivalent in encapsulated raw powder. Willow can be used for as long as necessary.

Ashwaganda Root (Withania Somniferum)
This Ayurvedic tonic is a general balancer for the glandular system. Ashwaganda has been shown to increase thyroid hormone in experimental animals.[ 9]

Guggul Gum (Commiphora Mukul)
This warming herb is becoming famous for lowering cholesterol. Although the mechanism of action remains obscure, recent research indicates that guggul stimulates thyroid hormone function. [ 10][ 11]

Often the patient will present already having been prescribed supplemental thyroid hormone (synthetic or natural). This can actually be a good development, as the person is often rapidly feeling better, and it buys time for the herbal treatment, which is slower, to stabilize. Once the condition is balanced, one can gradually reduce the thyroid hormone, with the advice of the physician, while monitoring blood hormone levels and being alert for the recurrence of symptoms.

Hypothyroid Program: Short term (Presentation to 2 months)
Combination formula of prickly ash bark, black cohosh root, saw palmetto, guarana seed

To establish comfort only-symptomatic treatment of fatigue and weight gain. Begins to increase endogenous thyroxin production.
2,000- 5,000 mg total, per day, not late
Gradually ease into next phase when comfort is established by reducing dose while increasing dose of next remedy.
Medium term (2 months to 4-6 months)
Combination of gotu kola leaf, saw palmetto berry, European scullcap leaf, elder berry, willow bark

Continue balancing treatment of thyroid tissue and function. Expect to see some response in blood thyroxin levels
2,000- 5,000 mg total, per day
Gradually ease into next phase when comfort is established by reducing dose while increasing dose of next remedy
Maintenance (6 months to 12 months)
For long term rebuilding of thyroid tissue, switch to a base maintenance protocol consisting of one or more of the following, based on clinical indications:

(These three slow acting tonic herbs are essentially alternate choices. Adjust as indicated clinically.)

1. Saw Palmetto berry (Serenoa Repens)
General gland benefit-general tissue restorative (clinical experience)
1-4 grams per day- titrate dose slowly, based on clinical response
2. Eleuthero Root(Eleuthrococcus Senticosus)
General gland benefit-general tissue restorative (clinical experience)
1-4 grams per day-titrate dose slowly, based on clinical response
3. Ho Shou Wu (fo-ti) Root (Polygonum Multiflorum)
General gland benefit-general tissue restorative (clinical experience)
1-4 grams per day- titrate dose slowly, based on clinical response
Other dietary supplements that may benefit hypothyroid include vitamin A and B complex. Since thyroid hormone is made from tyrosine, this amino acid may be helpful.

Include therapeutic foods in the diet. Concentrate on onion, garlic and ginger. Beverage teas such as sage, thyme and strawberry leaf could be added.

There is some recent evidence that cabbage family foods and soy products may retard thyroid function. While the significance of this is not fully understood, it is best to be prudent.

Symptoms of Hypothyroidism
Weight gain or increased difficulty losing weight
Coarse, dry hair
Dry, rough pale skin
Hair loss
Cold intolerance
Muscle cramps and frequent muscle aches
Memory loss
Abnormal menstrual cycles
Decreased libido
1 Noel R. Rose, Linda Rasooly, Ali M. Saboori, and C. Lynne Burek Linking Iodine with Autoimmune Thyroiditis Environ Health Perspect 107(suppl 5):749-752 (1999).

2 Butenko IG Gladtchenko SV Galushko SV. Anti-inflammatory properties and inhibition of leukotriene C4 biosynthesis in vitro by flavonoid baicalein from Scutellaria baicalensis georgy roots. Agents-Actions. 1993; 39

3 Zhang Jian Shen Xun. Antioxidant activities of baicalin, green tea polyphenols and alizarin in vitro and in vivo. Journal-of-Nutritional-and-Environmental-Medicine (United Kingdom). (1997). v. 7(2) p. 79-89. 1997

4 Kapoor, L.D., The CRC Handbook of Ayurvedic Medicinal Plants, CRC Press, Baton Rouge, 1990.

5 Snow, Joanne Marie, Serenoa repens, Protocol Journal of Botanical Medicine, Winter 1996, p15-16.

6 Yim TK, Wu WK, Pak WF, Mak DH, Liang SM, Ko KM Myocardial protection against ischaemia-reperfusion injury by a Polygonum multiflorum extract supplemented 'Dang-Gui decoction for enriching blood', a compound formulation, ex vivo. Phytother Res 2000 May;14(3):195-9

7 Willow Bark Monograph, European Scientific Cooperative on Phytotherapy Monographs, Exeter, UK, 1997

8 Willow Bark Monograph, American Herbal Pharmacopoeia, Santa Cruz, California, 1999.

9 Panda S, Kar A. Changes in thyroid hormone concentrations after administration of ashwagandha root extract to adult male mice. J Pharm Pharmacol 1998 Sep; 50(9):1065-8

10 Tripathi YB, Malhotra OP, Tripathi SN. Thyroid stimulating action of Z-guggulsterone obtained from Commiphora mukul. Planta Med 1984 Feb;(1):78-80

11 Panda S, Kar A. Gugulu (Commiphora mukul) induces triiodothyronine production: possible involvement of lipid peroxidation. Life Sci 1999;65(12):PL137-41


By Karta Purkh Singh Khalsa, C.D.-N., A.H.G.

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