I do for an underactive thyroid?

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IN ABOUT 10 PERCENT OF AMERICANS — mostly women — the thyroid fails to secrete enough of the hormones that control metabolism, triggering symptoms of fatigue, depression, weight gain, thinning hair, and dry skin. A common cause of hypothyroidism is the autoimmune disease Hashimoto's thyroiditis, though some cases develop from disorders of the pituitary gland. (Diagnosis is made through blood tests, which the American Thyroid Association recommends every five years starting at age 35.) While medication is often required, it helps to take an integrative approach to thyroid health.

Thyroid Specialist
The simplest solution for most mild cases of hypothyroidism is more exercise and an increase in iodine intake, which helps the thyroid produce the metabolism-regulating hormones thyroxine [T4] and triiodothyronine [T3]. Yoga, which stimulates blood flow to the neck, and foods like sushi can help. Dietary supplements containing animal sources of thyroid hormones and nutrients like selenium also give the thyroid a boost.

In severe cases, medication that supplies the missing hormones is prescribed, but that won't fix the underlying problem. In fact, the thyroid might become suppressed and eventually atrophy because the body is relying on exogenous sources of hormones. Once my patients start seeing improvement, I prescribe an exercise program and dietary supplements to get the thyroid going on its own.

— Gary S. Ross, M.D., San Francisco-based physician and co-author of Depression and Your Thyroid

Endocrinologist
The standard treatment for hypothyroidism is to prescribe replacement doses of hormones. The medication is relatively inexpensive; common brands include Levoxyl and Synthroid. If possible, take a brand name rather than a generic, since generics often aren't consistent. In most cases, you'll need to stay on a hormone replacement regimen for the rest of your life. There are no known adverse effects, but taking too much of the medication can cause hyperthyroidism. Report symptoms like nervousness and rapid weight loss right away, since hyperthyroidism can lead to bone loss and cardiac problems.

Many dietary supplements, such as calcium and iron, may interfere with absorption of thyroid hormones. Separate your intake of thyroid medication and supplements by at least four hours.

— David S. Cooper, M.D., director of the division of endocrinology at Sinai Hospital of Baltimore

Naturopath
For patients who are already taking medication, I try to get their thyroids working more effectively so they can lose weight and increase energy levels. Start with exercise, since it helps with the conversion of 14 to 73; usually one of the causes of hypothyroidism is a lack of, or else decreased, conversion of 14 to 13.

You should also get an appropriate amount of iodine. Eating saltwater fish and sea vegetables, like kelp and fucus (a type of brown algae), can improve thyroid health. Avoid salt, since the increased water retention won't help if you're experiencing weight gain.

It's important for people with hypothyroidism to take a good multivitamin that contains the trace minerals and antioxidants needed to make the thyroid more efficient, including zinc, selenium, copper, and vitamins A, B, C, and E.

— Lisa Lewis, N.D., Washington, D.C.-based spokeswoman for the American Association of Naturopathic Physicians

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