Hashimoto’s Thyroiditis

What is Hashimoto's Thyroiditis?

Hashimoto's thyroiditis is an autoimmune disease in which the immune system destroys the thyroid follicular cells that make thyroid hormone. It is also called chronic autoimmune thyroiditis or chronic lymphocytic thyroiditis, and it is the most common cause of hypothyroidism in developed countries.^[1]

Common symptoms

Early on there may be no symptoms. As thyroid hormone levels fall, people commonly notice tiredness, weight gain, feeling cold, dry skin and hair, constipation, puffiness, low mood and trouble concentrating.^{[1, 2]}

Some people develop a goiter, an enlarged thyroid. A review of local symptoms found that neck discomfort, voice changes, throat discomfort and trouble swallowing were the most frequent goiter-related complaints.^[3]

Causes and risk factors

The exact cause is not fully known. Genetic susceptibility, environmental factors and epigenetic influences interact, and both cell-mediated and antibody-mediated immune attack on the thyroid are involved.^[2] Women are affected far more often than men, with a female-to-male ratio of at least 7 to 1, and most cases appear between ages 45 and 55.^[1]

Hashimoto's can occur alone or as part of an autoimmune polyglandular syndrome, and it can occur in people with other autoimmune diseases.^[1]

How it is diagnosed and treated conventionally

Diagnosis rests on symptoms, blood tests for thyroid peroxidase and thyroglobulin antibodies, thyroid function tests such as TSH, and sometimes thyroid ultrasound.^{[2, 4]}

The mainstay of treatment is replacement of thyroid hormone once hypothyroidism develops. An American Thyroid Association guideline concluded that levothyroxine should remain the standard of care, and found no consistently strong evidence that other preparations are better.^[5] Your physician adjusts the dose using regular blood tests.

Why Hashimoto's Thyroiditis calls for a whole-person approach

Hashimoto's is more than a low hormone level. The immune system, oxidative stress, how a person feels day to day and other health conditions all play a part, and treating the hormone number alone does not always resolve how someone feels.^{[6, 7]}

For that reason, care that looks at symptoms, sleep, mood and stress alongside the thyroid blood tests is a reasonable addition to medical treatment, not a substitute for it.

Immune activity

Hashimoto's is driven by T cells and antibodies attacking thyroid tissue, which leads to progressive scarring of the gland.^[1] The aim of most complementary research on this condition is to see whether thyroid antibody levels or symptoms change.

Oxidative stress

Oxidative stress is believed to play an important role in Hashimoto's, which is one reason antioxidant plant compounds have been studied.^[7]

Symptoms that persist despite normal blood tests

A substantial share of people keep having symptoms even when their thyroid blood tests are in range, with or without levothyroxine. Reviewers describe this as an unresolved problem and report that traditional Chinese medicine, including herbal medicine and acupuncture, is being studied as a way to relieve these symptoms, with high-quality studies still needed.^[6]

Quality of life

Hashimoto's affects health-related quality of life, and many patients report their quality of life remains suboptimal despite treatment.^[7]

Acupuncture for Hashimoto's Thyroiditis

What the research shows

The research is limited. A 2024 meta-analysis pooled 14 randomized trials with 1,020 patients and found that acupuncture was associated with lower thyroid antibody levels (TPOAb and TGAb) and changes in thyroid hormone and TSH levels compared with levothyroxine tablets alone.^[8] The trials were drawn largely from Chinese databases, and the abstract does not report how reliable the individual trials were.

A 2024 exploratory trial of 58 people compared 16 weeks of acupuncture with a waiting group that took thyroxine. Thyroglobulin antibody levels and quality-of-life scores were better with acupuncture, but there was no significant difference in TPOAb or in anxiety and depression scores. The authors called the treatment possibly safe and feasible, and this was a small pilot study.^[9]

A 2025 review of persistent symptoms in Hashimoto's described acupuncture as a possible complementary option for symptom relief and called for higher-quality studies.^[6] No large sham-controlled trial has shown that acupuncture changes the course of the disease.

How acupuncture may work

How acupuncture might act in Hashimoto's is not established. In a rat model of autoimmune thyroiditis, acupuncture improved thyroid function and tissue damage and reduced signs of thyroid cell death, with changes in gut bacteria and fatty acid metabolism.^[10] This is animal research and does not show the same happens in people.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points chosen for the individual, usually left in place for about 20 to 40 minutes. The exploratory trial used a 16-week course.^[9] We reassess after a short series of visits.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had at least one minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Hashimoto's Thyroiditis

The Ayurvedic view

Ayurveda has no exact equivalent for Hashimoto's. Hypothyroid states are often discussed in terms of low metabolic fire (agni), described in one Ayurvedic trial as dhatvagnimandya, or low metabolic activity at the systemic and cellular level.^[12] This is a traditional framework used to guide treatment, not a biomedical diagnosis.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine aimed at supporting digestion and steady energy, such as regular meals and consistent sleep hours
• Herbs such as ashwagandha (Withania somnifera) and guggulu-based formulas, which have each been tested in small trials in subclinical hypothyroidism^{[12, 13]}
• Yoga and breathing practices, which have been studied in hypothyroidism^[14]
• Warm oil massage, used for relaxation

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and is only considered when it makes medical sense for the person.

What the research shows

The research is very limited for Hashimoto's itself. Most Ayurvedic studies enrolled people with subclinical hypothyroidism, a mildly raised TSH, and not people with confirmed Hashimoto's.

In a placebo-controlled pilot trial of 50 people with subclinical hypothyroidism, 8 weeks of ashwagandha root extract improved TSH, T3 and T4 compared with placebo, with few mild side effects.^[13] A small open-label trial of 30 patients compared two Ayurvedic preparations and found lower TSH in each group. It had no placebo group and only 21 people finished.^[12]

A systematic review of 11 yoga studies in hypothyroidism (516 people) found mostly positive results for thyroid levels, mood and quality of life. Several were uncontrolled or at high risk of bias.^[14]

Herbal medicine for Hashimoto's Thyroiditis

Herbs and formulas that have been studied

Chinese herbal formulas such as Yiqi Huayu Recipe, Liqi Xiaoying decoction and Shugan Sanjie therapy have been compared in trials for Hashimoto's.^[15] A review of traditional Chinese medicine for Hashimoto's covers formulas, single herbs and plant compounds, and notes that their main active components are known or presumed to have antioxidant and anti-inflammatory effects.^[7]

Nigella sativa (black seed), used in both Ayurvedic and other traditional systems, has been tested in a small trial of people with Hashimoto's.^[16]

What the research shows

The evidence is limited and preliminary. A network meta-analysis of 16 trials compared 16 Chinese herbal formulas for Hashimoto's. Most lowered TPOAb compared with no drug therapy, and all improved traditional Chinese medicine symptom scores, without affecting thyroid function and with no serious adverse events reported. The authors said the results are preliminary and need confirmation with high-quality evidence.^[15]

In a placebo-controlled trial of 40 people with Hashimoto's, 8 weeks of powdered Nigella sativa lowered TSH, anti-TPO antibodies and body weight compared with placebo.^[16] The trial was small and short, and larger studies are needed before any conclusion can be drawn.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Thyroid hormone is a drug where timing and absorption matter: a systematic review found limited evidence that coffee, soy, fiber, calcium and iron supplements reduce levothyroxine absorption.^[17] Any herb or supplement should be reviewed against your thyroid medicine, and your prescriber should know about it so TSH can be checked.

Ashwagandha has been reported to raise thyroid hormone levels and lower TSH in studies, so anyone on thyroid medicine or with a thyroid that is overactive needs medical guidance before using it. A review also notes that the safety of ashwagandha in specific patient groups needs more study.^{[13, 18]}

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[19] Herbal and dietary supplements are also a recognized cause of liver injury.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or take other prescribed medicines.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes Hashimoto's through patterns such as liver-qi stagnation or spleen and kidney deficiency. Researchers studying these approaches measure things that loosely parallel this picture: thyroid antibodies, oxidative stress, inflammation and, in animal work, gut bacteria and cell death in thyroid tissue.^{[7, 10]}

Ayurveda's low agni describes tiredness, sluggish digestion and slowed metabolism, which overlap with symptoms of an underactive thyroid.^[12] No study has shown that agni or a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for Hashimoto's is complementary. Keep your physician or endocrinologist, keep taking your thyroid medicine as prescribed, and do not stop or change it without your prescriber. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. We do not diagnose or manage the thyroid disease, and complementary therapies are not a substitute for thyroid hormone treatment, which remains the standard of care.^[5]

Please bring your diagnosis, recent TSH and antibody results, a full list of medicines and supplements, and the timing of your levothyroxine.

When to seek urgent medical care

Some symptoms of thyroid disease need prompt medical attention. Severe untreated hypothyroidism can lead to myxedema, a life-threatening state.^[1]

• Confusion, extreme drowsiness or difficulty staying awake
• Very low body temperature or feeling extremely cold
• Very slow heartbeat, fainting or chest pain
• Trouble breathing or swallowing, or a rapidly enlarging neck swelling
• Thoughts of harming yourself

If any of these occur, call 911 or go to the nearest emergency department. Call or text 988 for the Suicide and Crisis Lifeline if you are in emotional crisis.