Reader Note: Please note that none of the information provided here is intended as clinical advice, but rather as research summaries, research-based data, and patient anecdotes to help patients better self-advocate through education. Please consult with your medical team to help with clinical decisions regarding your case. 

Hypothyroidism can be reversed in some cases without medication if the root cause of your thyroid disorder is diagnosed and treated. 

Hypothyroidism, an underactive thyroid, is often viewed as a “manageable” condition, but that understates the tremendous impact it can have on your quality of life. A 2020 review of relevant research studies found that people with undertreated or untreated thyroid disorders are less productive and are considerably more likely to take sick leave. 

Signs you might have hypothyroidism can range widely, including:

• Weight gain
• Fatigue
• Dry skin and hair
• Increased sensitivity to cold
• Mood changes and disorders
• Memory problems
• Menstrual irregularities

Currently, research indicates that far too many doctors default to prescribing medication like levothyroxine for patients with hypothyroidism as a one-size-fits-all approach. A 2021 study, including collaborators from the Yale School of Public Health, the Mayo Clinic, and the University of Arkansas, estimated that approximately 21 million out of the 23 million people in the U.S. who are actively taking levothyroxine (approximately 90 percent) likely don't need the prescription. 

This is especially troublesome as levothyroxine can potentially introduce new issues with side effects such as anxiety or cardiac strain. Many patients may end up taking these drugs for the rest of their lives, despite there being no guarantees that this medication will eliminate most of their symptoms. In other situations, we have patients reporting to us that they discontinued levothyroxine on their own due to not feeling significantly better and being concerned about the side effects of the synthetic T4. However, the problem remains that there is little medical guidance available for a non-pharmaceutical treatment route if a patient chooses to opt for this. Patients are typically given two options regarding treatment: medication or doing nothing.

As Yale scientists have pointed out, “study after study has shown that there is greater risk when you overtreat with levothyroxine in patients who may not need it.”  

The practical approach to treating hypothyroidism is hunting down the root cause of an imbalance, treating or addressing this root cause through tailored non-pharmaceutical and/or pharmaceutical approaches as is appropriate, being followed more attentively by a medical team that recognizes how quickly metabolic shifts can occur and how fast problems originate without close monitoring, and getting personalized thyroid-friendly dietary advice from a registered dietitian. 

Fix the Root Cause of Hypothyroidism

Let’s examine the story of a 48-year-old patient with central hypothyroidism caused by a spinal cerebrospinal fluid (CSF) leak published in Endocrine Abstracts 2024 (Volume 99, EP928), titled “A rare case of transient central hypothyroidism,” presented at the 26th European Congress of Endocrinology in Stockholm.

Her physicians never had to address her thyroid dysfunction directly. Instead, they determined that a spinal leak was the root cause and repaired the leak with a single epidural blood patch. Her thyroid function returned to normal after the leak was treated, and her TSH, free T3, and free T4 levels were normalized within three months. 

This case demonstrates that thyroid problems with identifiable root causes, such as pituitary issues, inflammation, or injury, can be reversed by addressing these underlying issues or, at least, better treating the secondary condition and its symptoms when the root cause is known. In other words, hypothyroidism isn’t always permanent; it can be a symptom of something else. It can be directly secondary to another condition or part of a cascade of issues, such as an increasing sensitivity to iodine and then accidental overconsumption of iodine.  

Even things you wouldn’t typically suspect, like changes to your diet or a recent injury, could be responsible for your thyroid issues. If your TSH levels are off, advocate for your physicians to dig deeper and figure out why. You can help add to the picture in self-advocacy by creating timelines for when symptoms and bloodwork abnormalities began to appear.

Don’t settle for physicians who focus only on treating abnormal hormone levels without attempting to determine the underlying cause. Indeed, in some emergencies, such as severe hyperthyroidism, getting numbers down might be the top priority. Still, in a chronic care setting where symptoms persist without explanation, there should be attempts to troubleshoot for explanations. Identify and address any root causes that may be contributing to your thyroid dysfunction, such as nutrient deficiencies or overintake, environmental toxins, chronic illnesses, or other stressors. 

Regarding stressors, it’s important to note that factors such as iodine overintake causing thyroid issues such as hyperthyroidism are medically considered what is called an “insult,” which is a cause of injury or damage to the body. Correctly calling what things are, such as an injury to the body, can better frame the severity of what can occur. Gaining a better understanding of the events that led to thyroid imbalances is the first step to determining if any individual case of hypothyroidism can be reversed without medication, or potentially, treated with medication and complementary approaches, and how best to approach balance to prevent accidental swings into hyperthyroidism, as can occur.

What’s Behind the Test Numbers?

Many people are diagnosed with hypothyroidism based on a single set of lab test results and often with only a few or only one hormone reading. Doctors frequently rely on reading levels for the thyroid-stimulating hormone (TSH) alone to make their diagnoses of hypothyroidism or hyperthyroidism, and to assess how severe the condition is. 

For instance, a case of severe hyperthyroidism with matching severity of symptoms might be dismissed with a low-normal TSH, even as Free T4 continues to rise, pointing to a need for the physicians to act quickly to prevent the hyperthyroidism from worsening. Likewise, patients may be diagnosed with hypothyroidism without the physician looking further, with only a slightly elevated TSH level and a normal or even high-normal Free T4 level. Keep in mind that levothyroxine–the standard treatment for hypothyroidism–adds synthetic T4. This is why there are warnings, such as those in recent studies from Yale about side effects. This latter described situation is especially called out as harmful. 

A slightly elevated TSH with normal T4 is technically “subclinical hypothyroidism”, but it doesn’t always need a pill. Many endocrinologists now recommend a “watch and wait” approach for mild TSH elevation, as studies have shown that many patients’ TSH levels normalize on their own within a few months. The practical approach is to routinely check the patient's TSH levels at a pace that is appropriate for their condition.

Don’t panic if your TSH level is slightly elevated. It can be a transient blip. Bring resources and consult with your physicians about the risks versus rewards before starting thyroid medication on subclinical numbers. One study even found no short-term quality-of-life benefit in older adults from treating mild subclinical hypothyroidism with medication.

What can cause a temporary TSH bump? Things like severe illness, recent surgery, or even some medications like lithium and amiodarone can raise your TSH levels. Interestingly, recovery from illness or stopping birth control can also cause a temporary mismatch. Fasting time, caloric intake before fasting, and even the time of day can all impact TSH levels, even over the course of a day. 

The key point is that a single lab test showing a slightly high TSH with normal T4 levels is not the immediate life sentence that many physicians may make it out to be. This is simply feedback from your body. 

While there are certainly emergencies that require immediate action, where the opportunity allows, advocate for yourself and review with your physicians their rationale in recommending any medication. Determine whether the risks are worth the reward, consider your autonomy in the decision, and seek out second or third opinions if you feel that your questions are not being answered.  

How Too Much Iodine Can Trigger Thyroid Trouble

Consuming too much iodine is a common hidden cause of hypothyroidism. You’ve probably been told iodine is good for the body and necessary to make thyroid hormone, but too much iodine can backfire. 

The thyroid has a built-in safety system called the Wolff–Chaikoff effect that kicks in when excessive amounts of iodine are consumed, temporarily shutting down hormone production. For some individuals—especially those susceptible to autoimmune thyroiditis—the Wolff-Chaikoff effect doesn’t just pass. It lingers, potentially triggering chronic hypothyroidism or thyroid inflammation.

Foods that contain excessive amounts of salt include iodized salt, seaweed, processed snacks, kelp supplements, high-iodine multivitamins, dairy products, and fortified foods. One study warns that failing to monitor the consumption of iodine-rich salts coincides with a spike in Hashimoto’s disease. 

Clinicians have observed “iodine-induced hypothyroidism” in sensitive individuals for decades. For example, in a study from the 1990s, a significant number of iodine-sensitive study participants given a 250 mcg supplement developed hypothyroidism, and one even developed hyperthyroidism. The researchers had to stop iodine supplementation.

Global population data backs this up. For example, the risk of thyroid dysfunction changes when countries introduce iodized salt. Mandatory iodization led to an increased number of patients with thyroid antibodies and subclinical hypothyroidism in Denmark, for instance. Spain experienced an increase in cases of thyroid overactivity (thyrotoxicosis) compared to periods without iodine supplementation. Even countries like Iceland, where locals regularly consume iodine-rich foods, reported an increase in Graves’ disease after supplementation. These observations remind us that excessive iodine intake can hurt thyroid function.

Consider consulting with an iodine-informed dietitian to assess your iodine intake and determine whether the onset of your thyroid problems coincides with the addition of iodine-rich foods, such as seaweed, kelp tablets, or eggs, to your diet. 

Consider the case of Marion Davis, founder of Medical Office Marketing and a patient advocacy specialist, who discovered that the four vitamin-fortified eggs she consumed daily provided approximately 240 mcg of iodine. That’s a lot more than the recommended daily allowance of 150 mcg/day, and it led to her TSH levels spiking while her Free T4 levels remained normal and high-normal at times. 

Marion ended up cutting back on her daily egg consumption from four to three eggs and then to two eggs daily in a step-down approach to avoid shocking her body while keeping her medical team informed and engaged despite their lack of knowledge of iodine and its impact on the thyroid. She felt her metabolism changing soon after, which she was told was preposterous only for her TSH numbers to reflect a drastic change in improvement within six weeks that matched her experience. Hunger pangs and weight loss signaled that her pituitary was easing back on TSH production, and her body was no longer suppressed as she began to regain proper metabolic function. The moral: Small dietary changes can have a massive impact on your thyroid health. 

Get curious if you suspect your thyroid problems started after a recent dietary change. Identifying an excessive source of iodine could be the key to reversing your hypothyroidism.  

Practical Strategies for Improved Thyroid Health

There are concrete steps you can take to support your thyroid health without medication if a further examination of your case gives you insight into an underlying cause, where this is appropriate. These evidence-based strategies provide a robust foundation for supporting healthy thyroid function, offering clear and actionable steps to take in conjunction with your healthcare team.

1. Diet

A balanced, nutrient-dense diet with a focus on anti-inflammatory foods is excellent for your thyroid gland. Ensure you get enough iodine in your diet to avoid deficiency, but not so much that it throws your thyroid out of balance. This can vary significantly for different individuals, particularly at different stages of their lives and during different stages of their thyroid recovery journey.

Consume a variety of anti-inflammatory foods, including leafy greens, colorful vegetables, berries, healthy fats, lean protein, and fatty fish. Such foods can modestly improve thyroid autoimmunity and hormone levels.

A recent study found that patients diagnosed with Hashimoto’s disease had significantly higher free T4 and lower TSH than those consuming “more inflammatory” foods. Focus on whole, anti-inflammatory foods and track your daily iodine consumption. 

2. Lifestyle

Your thyroid works in conjunction with adrenal and other hormones, so factors such as chronic stress, lack of exercise, and poor sleep quality can exacerbate your symptoms. Manage stress with exercise, meditation, deep breathing, or yoga to help keep cortisol (the stress hormone) levels in check. 

While definitive studies on the effect of stress on thyroid health are limited, high levels of stress can disrupt the delicate thyroid-adrenal-pituitary axis. 

Aim for seven to nine hours of sleep daily, as sleep deprivation can disrupt hormone production. Exercise regularly to enjoy its mood-enhancing and metabolic benefits, but don’t expect it to resolve your thyroid issues on its own. 

A recent meta-analysis showed that regular aerobic or resistance training did not significantly change TSH, T3, or T4 levels in hypothyroid patients; however, it did improve quality of life, energy levels, and body composition. 

Exercise is essential for overall health and weight management, but it should be combined with a balanced diet under the guidance of your medical team, including a thyroid-focused dietitian.

3. Supplements

Only take supplements based on lab test results and evidence-based approaches under medical guidance. Ask your dietitian how best to approach a food-based approach to consuming vitamins while being cautious of iodine in your diet. In the course we created for patients, Vincci Tsui, RD, reviews alternative ways to meet various vitamin intake needs through food, including lower-iodine options, while avoiding potential high-iodine sources.   

Consult a healthcare provider before supplementing with any vitamin or mineral, such as large amounts of selenium or iodine, as excessive doses of many elements can be harmful. Remember Marion’s tale: even consuming healthy foods like eggs can cause thyroid dysfunction if eaten in too large quantities, compared to how sensitive the body is to iodine or other factors. Stay away from fad thyroid supplements that promise to reverse your symptoms, as many of these may contain untested blends of iodine. 

3. Functional Approach

A functional approach means digging deeper into root causes that standard doctors might miss. This could include testing for thyroid antibodies (such as Hashimoto’s), gut health (SIBO, celiac disease, and other inflammatory gut conditions), heavy metals or toxins (which can disrupt thyroid function), and hormone balance (including adrenal and sex hormones).

Look for allopathic (Western medicine) providers who take a functional approach, offering a more balanced perspective that combines modern medicine with a science-based approach to food as medicine and delves deeper into root causes.  Cure-alls, such as extreme cleanses or recommended high doses of iodine, are red flags. Look for providers who use lab test results and the latest research findings, rather than relying solely on anecdotal protocols, when exploring this route.

4. Work with a Registered Dietitian

A skilled registered dietitian (RD) can be an invaluable ally in your journey to reverse hypothyroidism. They can help create meal plans that meet your nutrient needs without excess or insufficient iodine and tailor anti-inflammatory diets to your tastes and needs. 

A dietitian will also ensure you’re getting enough key nutrients like selenium, iron, and zinc. A dietitian can help unpack your symptom journals and spot hidden sources of iodine, and they can interpret lab results and help discover the root cause of your thyroid imbalance. 

Dietitians are trained to customize diets safely to help patients achieve success in managing and even reversing specific health condition symptoms.

Take Control of Your Thyroid Health

Many people with iodine-induced thyroid imbalance have successfully restored their thyroid function through thoughtful changes to their diet or addressing root causes. 

You can also put your thyroid disorder behind you, but it helps to have guidance. Take Marion Davis, for example, who realized excessive iodine consumption was the root cause of her thyroid disorder after battling both hypothyroid and hyperthyroid swings. She was able to better balance her thyroid by reducing her iodine intake, supporting healthy thyroid function with diet and lifestyle changes, and self-advocating for her medical team to recognize that an enlarged pituitary from her spinal leak and an increased sensitivity to iodine were likely at the root of her thyroid issues, and managing her medical team to manage her with more frequent check-ins and bloodwork after too great a lapse in the past between bloodwork after poor advice encouraging reintroduction of higher iodine led to her developing severe hypothyroidism. She currently is still in the recovery phase from severe hypothyroidism which can often take months as the body continues to relearn how to achieve homeostasis after the injury of overintake of iodine causing the stress and strain of severe hyperthyroidism. 

This kind of turnaround is possible, especially if your hypothyroidism was triggered by excess iodine or another correctable cause like spinal leaks. But it’s important to proceed safely. That’s why we’re excited to offer a recorded webinar featuring Marion Davis (who lived this journey) and Canadian RD Vincci Tsui. They walk you through:

• Research and patient anecdotes regarding the U-shaped curve of benefit for iodine intake, where too much and too little can be harmful
• How to assess your current iodine intake and determine if it might be too high.
• Steps to create a personalized low-iodine diet plan without nutrient deficiencies.
• Natural strategies that bolster thyroid function (foods, supplements, and lifestyle) as your thyroid recovers.

This educational session will give you tools to take action on the root issues contributing to your thyroid problems to reduce or eliminate the need for medication, whether you have Hashimoto’s, mild TSH elevation, or overt hypothyroidism.

Ready to learn more? Purchase our recorded webinar now for $20 USD for the information you need to better advocate for yourself regarding care for your thyroid condition. We’ll show you the larger picture and teach you how to better identify foods that are less likely to cause an overload of iodine when combined.