Hypothyroidism

What is Hypothyroidism?

Hypothyroidism is a disease of thyroid hormone deficiency.^[1] It is common, more so in women and older adults, and prevalence ranges from 0.3% to 12% worldwide depending on iodine intake.^[1]

Common symptoms

Symptoms come from a general slowing of metabolism. They include fatigue, weight gain, memory and concentration problems, feeling cold, and menstrual irregularities, though they are nonspecific and the diagnosis rests on blood tests.^{[1, 2]}

In one review, fatigue affected about 68% to 83% of patients and cognitive problems about 45% to 48%.^[1]

Causes and risk factors

Hashimoto's thyroiditis, an autoimmune disease, is the cause of primary hypothyroidism in up to 85% of patients where iodine intake is adequate.^[1] Other causes include thyroid surgery, radioactive iodine or neck radiation, and drugs such as amiodarone, lithium and immune checkpoint inhibitors. Severe iodine deficiency was historically the most common cause.^[2]

A first-degree relative with hypothyroidism, and pregnancy in a woman with underlying autoimmune thyroid disease, are also associated with higher risk.^[1]

How it is diagnosed and treated conventionally

Overt primary hypothyroidism is diagnosed by a high TSH and a low free T4 on blood tests.^[1] Subclinical hypothyroidism means an elevated TSH with normal free T4, and most people with it can be observed without treatment.^[3]

Levothyroxine is the first-line treatment, with TSH checked 6 to 8 weeks after starting or changing it and then yearly once the level is at goal.^[1] An American Thyroid Association guideline concluded that levothyroxine should remain the standard of care and found no consistently strong evidence that alternatives such as thyroid extract are better.^[4]

Why Hypothyroidism calls for a whole-person approach

Hypothyroidism affects almost every body system, and not every symptom clears when the blood tests are normal. Reviewers report that about 10% of patients have persistent symptoms despite normal thyroid tests on levothyroxine.^[2]

For that reason, attention to energy, mood, sleep and everyday function alongside medical treatment is reasonable, as long as thyroid hormone replacement continues.

Quality of life

Levothyroxine improves quality of life but does not always normalize it, especially in mild hypothyroidism. Reviewers point to autoimmunity and other health conditions as possible drivers of dissatisfaction.^[5]

Autoimmunity

Autoimmune Hashimoto's thyroiditis is the dominant cause, and thyroid antibodies are linked to a higher chance of progression from subclinical to overt hypothyroidism.^{[1, 3]}

Heart and metabolic health

Untreated hypothyroidism can cause heart failure, and it can worsen insulin resistance in people with diabetes. It can also affect ovulation and fertility.^[1]

Fatigue, mood and thinking

Fatigue, difficulty concentrating, and altered mood are commonly reported in hypothyroidism.^{[1, 3]}

Acupuncture for Hypothyroidism

What the research shows

The research is very limited. A narrative review of 29 clinical projects covering 1,757 patients with thyroid disorders reported symptom reductions and better biomarkers with acupuncture, alone or with other treatment, but the author said more well-designed studies are needed. The review pooled several thyroid conditions, not hypothyroidism alone.^[6]

A 2024 exploratory trial in Hashimoto's thyroiditis randomized 58 people to 16 weeks of acupuncture or a waiting group taking thyroxine. Quality-of-life scores and thyroglobulin antibodies were better with acupuncture, while thyroid peroxidase antibodies and anxiety and depression scores did not differ. The authors described it as possibly safe and feasible. This was a small pilot, with no sham acupuncture group.^[7]

We found no sham-controlled trial showing that acupuncture improves thyroid hormone levels in hypothyroidism, and it does not replace thyroid medicine.

How acupuncture may work

We found no human mechanism studies specific to hypothyroidism. Any proposed effects, such as relaxation and a calmer stress response, remain unproven for this condition.

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.^[7] We reassess after a short series of visits to see whether symptoms are changing.

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.^[8] 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 Hypothyroidism

The Ayurvedic view

Ayurveda has no single name for hypothyroidism. Researchers have matched its features to conditions such as Vataja Shotha, Rasa Pradoshaja Vikara or a disorder of Agni, the digestive and metabolic fire.^[9] A related framework describes low metabolic activity as Dhatvagnimandya.^[10] These are traditional categories used to plan care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to support digestion and steady energy, such as regular warm meals and consistent sleep hours
• Yoga and breathing practices, which have been studied in hypothyroidism^[11]
• Herbs such as ashwagandha and guggulu-based formulas, which have been studied in small trials^{[10, 12, 13]}
• Warm oil massage for relaxation

Panchakarma procedures are not appropriate during pregnancy, acute illness or frailty, and are considered only when medically sensible.

What the research shows

The evidence is limited and comes from small trials, many without placebo groups.

A 2025 randomized trial of 46 people whose thyroid tests were not well controlled on stable levothyroxine compared a whole-system Ayurveda protocol with a guggulu formula for 60 days. TSH, weight and quality-of-life scores improved more with the whole-system protocol, and the authors said further studies are needed.^[13] In a placebo-controlled pilot of 50 people with subclinical hypothyroidism, 8 weeks of ashwagandha root extract improved TSH, T3 and T4 compared with placebo.^[12] A small open-label trial of two Ayurvedic preparations also found lower TSH in each group, with no placebo group.^[10] A 40-person trial of pippali found clinical score changes that were not statistically significant at day 20, although the authors still described it as effective.^[9]

A systematic review of 11 yoga studies (516 people) in hypothyroidism found mostly positive outcomes, but several studies were at high risk of bias and larger trials are needed.^[11]

Herbal medicine for Hypothyroidism

Herbs and formulas that have been studied

Chinese herbal medicine regards hypothyroidism as Yang deficiency and uses herbs thought to restore Yang.^[14] Ashwagandha (Withania somnifera), from Ayurveda, has been tested in a placebo-controlled pilot trial in subclinical hypothyroidism.^{[12, 15]}

What the research shows

For Chinese herbal medicine the evidence is absent. A Cochrane review searched for randomized trials of Chinese herbs in hypothyroidism, alone or with thyroid hormone, and found none, so it could not assess their effects. Its last search was in 2014.^[14]

For ashwagandha, a systematic review of 30 human studies across many conditions counted one trial in subclinical hypothyroidism, and called for larger, properly designed trials.^[15] The placebo-controlled pilot described above is that trial, and it was small and short.^[12]

Safety and herb-drug interactions

Herbs are active substances, and any herb or supplement should be reviewed with your prescriber. Ashwagandha in particular appears to raise thyroid hormones in hypothyroid settings, so it could change how much levothyroxine your body needs, and a review calls for careful consideration of its use.^[16] Other supplements matter too: a systematic review found limited evidence that coffee, soy, fiber, calcium and iron supplements reduce levothyroxine absorption.^[17] Timing and product choices should be discussed with your physician.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[18] Herbal and dietary supplements are also a recognized cause of liver injury.^[19] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes hypothyroidism as Yang deficiency.^[14] Traditionally, Yang deficiency is associated with cold, fatigue and slowness, which overlap with the metabolic slowing, cold intolerance and tiredness that come from low thyroid hormone.^[1]

Ayurveda's low agni describes sluggish digestion and metabolism in a similar way.^[10] No study has shown that Yang, agni or a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for hypothyroidism 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. Levothyroxine remains the standard of care, and none of the therapies described here has been shown to replace it.^[4]

We do not diagnose or manage the thyroid disease. Please bring your diagnosis, recent TSH and free T4 results, any thyroid antibody results, a full list of medicines and supplements, and the time of day you take your levothyroxine.

When to seek urgent medical care

Severe untreated hypothyroidism can progress to myxedema coma, which needs intensive care.^[1]

• Confusion, extreme drowsiness or difficulty staying awake
• Very low body temperature or feeling extremely cold
• Very slow heartbeat, fainting or low blood pressure
• Shortness of breath, chest pain or swelling of the legs with breathlessness
• 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.