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Your Gut Microbes and Your Thyroid: What’s the Connection?


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While there are many factors that influence thyroid function, recent research suggests that gut health may be a key player. The trillions of microbes that reside in your gut have a profound influence on the production of hormones in the body—including thyroid hormones. Read on to find out if a disrupted gut microbiome might be contributing to your thyroid problem, and learn how healing your gut could improve your thyroid function.

thyroid gut connection
Having issues with your thyroid? The answer might be in your gut. iStock.com/fotostorm

A central principle of functional medicine is addressing the underlying cause of a disease, as opposed to just treating symptoms. In a previous article on the blog, I discussed the connection between overall gut health and the thyroid. In this article, we’ll focus on the microbes themselves and the many ways in which they are connected to thyroid function.

The Importance of Microbes and Their Metabolites in Endocrine Health

In recent years, the microbiota has been implicated in numerous chronic diseases, from obesity to inflammatory bowel disease to multiple sclerosis (1). It really should be no surprise that it also has a profound impact on endocrine organs like the thyroid. Disruption of the intestinal flora and subsequent impaired thyroid function was first hypothesized back in the early 1900s, long before the terms “microbiota” and “microbiome” were even coined (2).  

Today, microbial sequencing of human fecal samples allows us to measure compositional differences in the microbiota. A 2014 study found that individuals with hyperthyroidism had significantly lower numbers of Bifidobacteria and Lactobacilli and significant higher levels of Enterococcus species compared to healthy controls (3). No equivalent study has yet been done in individuals with hypothyroidism, but given that 90 percent of hypothyroid cases are autoimmune in nature (4) and the fact that an altered microbiota has been implicated in countless other autoimmune diseases, it’s quite likely that dysbiosis plays a significant role (5).

Will healing your gut improve your thyroid function?

Microbes recognize a number of different host endocrine molecules, including adrenaline, noradrenaline, sex hormones, and thyroid hormones, and can even change aspects of their metabolism and virulence in response to these signals (6). Moreover, germ-free rats, which are raised in sterile conditions and lack gut bacteria altogether, have smaller thyroid glands than conventionally raised rats, suggesting a crucial role for these microbes in thyroid health (7).

Gut Bacteria Influence Nutrient Availability

The epithelial cells that form the lining of the gut have fingerlike projections called villi, which increase the surface area for transporting nutrients into the body. When the gut is inflamed, as is often the case with microbial dysbiosis, these villi can become truncated, resulting in impaired nutrient absorption. This includes nutrients like iodine and selenium, which are vital for thyroid health.

While the microbiota provides many benefits to the host, it also competes with the host for nutrients. The nutrients that are essential for our cells to function properly are also important nutrients for our microbes!

The composition of the microbiota may therefore influence a person’s requirement for various nutrients. In fact, a 2009 study in mice suggested that the microbiota competes with the host for selenium when selenium is scarce, impairing synthesis of selenoproteins, which are necessary for proper thyroid function (8). In another study, rats fed kanamycin, a broad-spectrum antibiotic, had significantly lower iodine uptake by the thyroid (7).

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Gut Bacteria and LPS

Lipopolysaccharide, or LPS, is a component of bacterial cell walls. When intestinal permeability is increased, often as a result of gut dysbiosis, LPS can “leak” into the bloodstream. This can wreak havoc on the thyroid in a number of ways.

Thyroid-stimulating hormone (TSH) induces the thyroid to produce T4. T4 is the inactive form of thyroid hormone and must first be converted to T3, the active form.  Our bodies produce an enzyme called iodothyronine deiodinase that is responsible for making this conversion. LPS has been shown to inhibit this enzyme, decreasing the amount of active T3 in circulation (9).

Not only do you need active thyroid hormone, but you also need receptors for thyroid hormone on cells throughout the body. Even someone whose thyroid hormone panel looks perfect could suffer from symptoms of hypothyroidism if their body does not produce enough receptors to receive signals from the thyroid. LPS has been shown to decrease expression of thyroid receptors, specifically in the liver (10).

LPS also induces expression of the sodium-iodine symporter (NIS) in thyroid cells, increasing iodine uptake in the thyroid (11). Since iodine is important for thyroid health, this might sound like a good thing, but excess iodine (especially with concurrent selenium deficiency) has been found to contribute to the development of Hashimoto’s, the autoimmune form of hypothyroidism (12).

Gut Bacteria Influence Conversion of T4 to T3

Remember in the last section how we said that inactive T4 must be converted to active T3? Well, about 20 percent of this conversion takes place in the GI tract! Commensal gut microbes can convert inactive T4 into T3 sulfate, which can then be recovered as active T3 by an enzyme called intestinal sulfatase (13).

Bile acids present another interesting connection between gut bacteria and thyroid function. Primary bile acids are produced in the gallbladder and secreted into the small intestine following the consumption of fats. Metabolism of primary bile acids by the gut bacteria results in the formation of secondary bile acids. These secondary bile acids increase activity of iodothyronine deiodinase (the main enzyme that converts T4 into T3) (14).

We’ll see one more way that gut bacterial metabolites influence thyroid health later when we talk about prebiotics.

SIBO and the Thyroid

Thyroid function is also closely related to small intestinal bacterial overgrowth (SIBO). In a healthy individual, the majority of microbes are concentrated in the large intestine. In SIBO, certain bacteria and archaea are able to colonize the small intestine and proliferate, causing bloating, gas, and distention, among other unpleasant symptoms.  

The connection between SIBO and the thyroid is underappreciated. A 2007 study found that among people with a history of autoimmune hypothyroidism, 54 percent had a positive breath test for SIBO compared to 5 percent of controls (15). It is currently unknown whether the relationship is causal.

Since thyroid hormones help stimulate gut motility, it is also possible that low motility and constipation provide an environment in the small intestine that is conducive to bacterial overgrowth.

This may be one of many examples of bidirectional interaction between the host and its resident microbes.

Conclusion: Heal Your Gut to Improve Thyroid Function

So how can we apply this information? Here are four ways that you can improve your thyroid function:

  1. Eat plenty of fermentable fiber
    Bacterial metabolites are potent endocrine modulators. When you consume fermentable fibers like cassava, sweet potato, or plantains (prebiotics), your gut bacteria ferment these fibers and produce short-chain fatty acids (SCFAs). SCFAs have been shown to inhibit enzymes closely involved in epigenetic regulation. In other words, they help determine whether a gene is expressed or not. Among many other things, SCFA-mediated inhibition of these enzymes increases expression of thyroid receptors (16).
  2. Take probiotics or eat fermented foods
    Despite the long-hypothesized link between gut microbes and thyroid function, there are few controlled studies in humans that have tried manipulating the gut microbiota to improve thyroid health. However, supplementation in broiler chickens with lactic acid bacteria has been shown to increase blood plasma thyroid hormones (17), and Lactobacillus reuteri supplementation specifically improved thyroid function in mice (18). Lactic acid bacteria are commonly found in fermented vegetables such as sauerkraut and kimchi and fermented dairy products like yogurt and kefir.
  3. Get tested/treated for SIBO or intestinal pathogens
    While the jury is still out on whether thyroid problems cause SIBO or SIBO causes thyroid problems, it certainly doesn’t hurt to get tested, especially if you are experiencing bloating, abdominal discomfort, or other symptoms characteristic of an overgrowth or infection.
  4. Take other steps to heal your gut
    Remove inflammatory foods, manage stress, and eat a nutrient-dense diet that includes plenty of gut-healing foods like bone broth. For some people, healing the gut may be sufficient to ameliorate thyroid symptoms.
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Join the conversation

  1. Fantastic article on gut microbes and absorption. Coffee is a great one to avoid because it can block the absorption of much needed minerals from our daily diet

  2. I have issues with low thyroid, gut/GERD issues and low cortisol. The result of the adrenal issues is that I am extremely sensitive to any medication, most supplements or attempt to detox. Does your practice help people slowly gain more tolerance? I can’t fix anything with supplementation until I can improve my liver clearance. Thanks!

  3. Hi dr. Kresser,
    I’ve been dealing with Hypothyroidism for quite sometime. I know my ph is bad showing me to be very acidic, I have horrible gerd, my physician feeds me synthroid (which seems to help), I’ve been growing a gut without even trying, And I lose energy and strength while trying to work hard or just taking a high impact walk. One of the best things I’ve tried is wild flower honey that I purchase at local farmers markets. It helps with my gut and sinuses.
    I am very appreciative of this article on the thyroid to gut relationship and will put to practice what you advise ASAP.
    Thanks Doc.

    • Chris is not a “doc” he is a L.Ac. Just read your post, you can take a look at his other articles. Especially one where he refutes the acid/alkaline hypothesis

    • Honey is very acid forming. It will only increase the acidity in the body. The microorganisms in the honey are good for us though.

  4. I never really thought about the link between gut bacteria and thyroid. This article made me consider that with the impact gut microbes have on thyroid they also regulate the metabolism as well, completely fascinating…

  5. I read your article about hypothyroidism.
    I was diagnosed with rheumatoid arthritis a year ago. I am taking methotrexate orally, 12.5 mg 1 x week, in addition to lots of other supplements to try and calm the inflammation and balance the gut micro biome.
    I have just been diagnosed with hyperparathyroidism, with a high blood calcium level (10.9-11 mg/dl) and high PTH level (87 pg/ml).
    Your article only speaks about the thyroid and inflammation in the gut. But would my hyperparathyroidism be also caused by gut inflammation?
    I had a Sestamibi scan which did not show tumors, however I have heard they are not reliable. I am scheduled to have surgery to search for and take out likely tumors on the parathyroid glands. Thank you for any insight.

  6. Hi Chris
    My daughter had a complete parasitology test and has D. Fragilis, high E. Coil and zero lactobacillus and zero Bifidobacteria bacteria. She has taken Paromomycin for the parasitic infection. Will it be possible for the Laco and Bifidobacteria species to return from zero growth?
    Thanks for all your great work.

  7. I have Hashimoto’s and have been on the same dosage of Levothroid for 10 years. After reading your article on selenium, I started eating 1-2 Brazil nuts a day and a few months later had to drop my dosage. Cool, huh?

    Taking Femdophilus (Jarrow) probiotic seems to work well for me. It has L. reuteri and L. rhamnosus, among others.

  8. Chris, To your knowledge, is there a connection between Enlarged Thyroid (Goiter) and Uterine Fibroids. May 2015, I had a biopsy of both in the same week (both came back negative).
    Cancelled the recommended (scheduled) Full Hysterectomy… the
    OB-GYN not impressed/happy!
    When I mentioned to the Endocrinologist that I was also having a fibroid biopsy, he didn’t even comment. I don’t get it, as I see both conditions being related to the Endocrine (Hormonal) System. The Gynaecologist didn’t make any connection either.

    • Hi Judy-
      I have thought the same thing. In 2012 I had an endometrial cyst removed and I asked my Gynecologist if this has any correlation with my Thyroid. He said “nope” What prompted me to ask this question is are two things ;family history of Thyroid disease (at the age of 40 my grandmother had a Hysterectomy). And the attached links-see below
      Fast forward to 2014, all with in one week I was FINALLY diagnosed with Hashimoto and Thyroid cancer. I say finally because since 2012 I felt the symptoms of a dysfunctional thyroid but had always tested in the “normal” range (2.0-2.5). Even at the time of being diagnosed with Hashimoto my TSH was considered normal.


    • HI Judy, I thing we re on to something here. I had 14 uterine fibroids removed this November by myomectomy. I’m 34 and hoping to get pregnant this year. However, 3 months after the surgery 4 small new fibroids had regrown and simultaneously my blood tests revealed hyperthyroid. I’m being tested this week for graves disease, but my endo dr doesn’t think its related. My groom and I have been eating Paleo since May. We have increased our intake of fermented food and occasionaly supplementing with probiotics. I feel like wea re as healthy as we have ever been, but still having these pathologies come up is frustrating. I have been writing a blog about my experiences if you want to read. We are going to continue to search for answers and solutions.

    • Hi Judy, Extremely interesting and i believe evrything is linked as very similar to i.
      Feb 2015 diagonised with hyperthyroidism, come October 2015, massive fibroids with an external one that grew to the size of being 22 weeks pregnant, due to age (51) i have had a complete hysterectomy for it appeared sinister. With 7 weeks off work i have been trying to research and believe i have to get off my thyroid medication. I have found a way, linking it to the gut and using a naturopath. Vicki

      • I am at my wits end as to what to do next. Any advice would be greatly appreciated. I am getting to the stage where i just want to give up.
        Beginning of 2012 my abdomen suddenly became very distended and i literally looked like i was 9 months pregnant. My waist measurement went from 28 to 38 virtually overnight and stayed like that for the next 3 years (it is still not normal but is now the least of my problems) I put on 10 kilos in weight without changing my diet and I have always had a small appetite. Anyway at the same time i found digesting food painful and food would sit in my stomach for up to 8 hours after eating. End of 2012 I Had an ultrasound which as well as finding gallstones also showed a fibroid of 5cm and a massive amount of gas in my abdomen. Blood tests showed that i had both b12 and iron anaemia and very high chloresterol. I had my gallbladder removed mid 2014 but my abdomen didnt go down and at the same time my periods became very heavy and painful. Another scan showed the fibroid had grown to the size of a grapefruit so had a hysterectomy at the end of 2014. Still my abdomen remained huge and by this time I felt so poorly that I could barely function. Joints very painful (especially hips, sometimes needing crutches to walk) chronic fatigue, brain fog etc etc. 3 thyroid function tests came back normal then a doctor in spain scanned my thyroid and said the gland was massive although no external swelling and had many nodules. Next thyroid test showed my thyroid was very overactive. Started taking carbimazole last november and last weeks test showed my levels are now normal. I still have problems digesting food and am about to have a second endoscopy (the first showed inflammation with no explaination). I now give myself b12 injection every 3 months and am waiting result of a blood test for celiacs. In the last month I have had cellulitis in my nose! shingles and now a sinus and chest infection which just wont go ( darent take antibiotics as they play havoc with my digestive system) I am so tired of being passed around different consultants who do Test after test. All of them refuse to consider that all my problems may be linked. I have always believed that they are as prior to 2012 i was very fit and healthy. These days i barely feel alive most of the time and I am praying that someone out there might just be able to help me on to the path of at least feeling somewhere near normal instead of a freak.

  9. I appreciate you pointing out the study showing the huge correlation between SIBO and patients with hypothyroidism, and it is certainly something I think that is under appreciated by most physicians.

    SIBO in general seems to be widely ignored, even by many gastroenterologists.

    I would also point out that for many people with thyroid problems it will be very difficult to treat the gut without first addressing thyroid replacement (if necessary). Thyroid hormone itself can cause issues with intestinal motility and HCL levels perpetuating many common gut imbalances (SIBO and intestinal dysbiosis come to mind).

    I think the better and more efficient approach is to treat both simultaneously (whenever possible).

    As always, great and informative article.

    • I am hyperthyroid but I still have SIBO so my fast thyroid has not sped up my motility at all. Fixing the malabsorption of nutrients and fats I believe is the key to helping the thyroid but if the bacteria/organisms are eating my nutrients then will supplements even help, I don’t know. So far no supplements have really helped.

      • After multiple SIBO treatments (rifaximin and herbal antibiotics/antifungals) with success that didn’t last even for 1 week I went high fat, low carb and no grains for 6 months. My digestion and SIBO worsened so much that I was at a loss! I didn’t know what to eat anymore. Then I heard that sufficient bile was necessary for SIBO control, motility and of course- fat absorption. Since my symptoms worsened after increase in fat consumption it was logical to assume that I had problems with bile (either genetic or liver congestion) So I tried lecithin, 10g a day. Lecithin is a component of bile and when you supplement with it it makes bile flow easier. Plus it might actually emulsify fats on the spot, that is your stomach and small intestine. (not sure about this one) Anyway, I couldn’t believe the improvement in motility and digestion. Try it. If it works for you you will find out in 2-3 days.
        I am going to do a liver cleanse since I do have problems with it. I get pains on the right side ever since I overdosed on vitamin A 5 years ago. Inflammation due to vit A toxicity probably thickened my bile and congested the ducts. Regardless of what some people say about liver flush (that it’s just emulsified oil and not the actual stones) people do feel better after it. So I am gonna try.

  10. My 32 year old granddaughter who is type 1 diabetic for 5yrs. Has gastroparesis off an on for a year, in the ER and hospital about 3 times a month. Has all test except endoscopy will have in May. Could all the Reglan and narcotics have cause more problems? She needs a healthy gut yes?

  11. We all have good pertinent questions, I myself have been taking multiple bacteriocidal herbs and antibiotics for high hydrogen an methane SIBO, with long standing Candida overgrowth, and it’s very difficult to navigate and know when to go to the next step, and what it is, when you have a career, kids….life.
    I gets real complicated, and it appears nobody is minding this store and giving answers.
    Good luck.

    • Chris, are lactobacillus really supposed to be there? Isn’t lactobacillus acidophilus a firmicute? Don’t we seek for more bacteroids? Is lactibacillus able to start a cascade “good” bugs colonization?

      • Humans have for a very long time consumed foods preserved by lactofermentation whether it was on purpose or by accident. Refrigeration is only a very modern convenience. It only stands to reason that this particular type of bacteria, present on almost everything in nature, works harmoniously with our physiology.

      • Yes, lactobacillus is definitely supposed to be there—at least in most human guts that have been studied.

  12. I have a question about the thyroid and health. I had a growth on my thyroid and had to have the entire thyroid removed. How does this affect my overall health and ability to lose weight?

    • Presuming you are taking thyroid hormone and maintaining levels in the normal range, it may not have a significant impact. But if you have Hashimoto’s or another autoimmune thyroid condition, it’s possible that the body is still mounting an attack against the small amount of remaining thyroid tissue (thyroidectomy does not typically remove 100% of the tissue because of the risk of damaging other structures in that area).

      • Chris, my mum had her goiter removed before I was born, can that be the most likely cause/reason I have hypothyroidism?

  13. Chris what’s your take on the view that If you fix thyroid the body will naturally fix the gut – and that probiotics and fermented foods are unnecessary and even contraindicated for many with gut issues?

    • You could just as soon say it the other way around: fix the gut and that will take care of the thyroid. The reality is these relationships are bi-directional, and both systems will likely need to be addressed for healing to occur.

      • My reply would apply here. I have been Hypothyroid Hashimotos for years with other autoimmune issues. My thyroid dose kept going up because I could never get it under to control. I developed massive fibroids over many years and finally had a total hysterectomy 1.5 years ago. At the same time I went full on with a paleo/AIP diet. My thyroid meds were 250mg of Synthroid and 3mcg of Liothyronine prior to hysterectomy/diet. Now 1.5 years after both I am down to 125mg of Synthroid. Hormone and gut balance is huge!

  14. Chris,
    This information makes a case for my experience.
    All within a 4 month span I was diagnosed with hashimoto,papillary thyroid cancer,total thyroidectomy and radiation.
    In order for me to prepare for the radiation uptake I had to be off my Levothroxine for four weeks and avoide iodine in my diet. Pretty much consisted of a Paleo diet. Because as you know iodine is in everything. My endocrinologist informed me that I would feel “poopy” (tired and sluggish) and advised that I take the last week off from work during the 4 week withdrawal. I never felt “poopy” I felt great! I attribute this to the food that my body had been desiring all this time and truly a time to heal.
    I was that person whose thyroid panel never indicated an issue. I had my thyroid checked regularly due to my mother,grandmother and aunts all dealing with various forms of a dysfunctional thyroid. Although it always fell in the 2.0-2.5 range the docs passed as all good. However my symptoms told me otherwise. And I knew in the back of my head all was not well.
    What is your recommendation for someone who had their thyroid removed?

    • To get your thyroid hormone levels into the normal range using replacement hormone. That’s the best you can do when your thyroid has been removed.

  15. Chris, I had an allergic reaction to shell fish about 20 years and since then I have been on synthroid. Is it possible to restart your thyroid?

  16. Thank you Chris for the very informative article. I did know about the connection between thyroid dysfunction and gut flora imbalance because of the books I’ve read and the webinars I’ve listened to. In my own health journey I noticed low thyroid symptoms long before I had SIBO or even knew what it was. I did suffer with constipation, but that is also a symptom of Hashimoto’s. I learned the hard way that SIBO is contraindicated for fermented vegetables with their lacto and bifido strains. I have found that I can tolerate Prescript Assist soil organisms for probiotics, but that means I am missing all the benefits of fermented vegetable strains. I also used MEGASporebiotic but stopped as I’m pretty certain it has a corn derivative as a filler since it doesn’t say corn free on the label. The other thing I learned the hard way is that bone broth may be counterproductive for healing the gut. I drank one cup of homemade bone broth per day for a year and a half when I was using Sarah Ballantyne’s Autoimmune Paleo Food Protocol. I learned from a Cyrex Labs Array 10 blood test last fall that I am now making antibodies to gelatin, which is supposed to be healing for the gut. I learned recently that it is a protein in the bone broth that is troublesome and that meat broth is a safer way to heal the gut. I am about to embark on The Autoimmune Solution approach by Dr. Amy Myers, which will address the SIBO and heal the gut simultaneously. I sure hope this is the ticket to getting the Hashimoto’s into remission. Thank you so much for helping those of us who so desperately want to feel better.

    • Vernie,
      I am confused about the bone broth statement. Everything I read says that it is a major component to healing a leaky gut. I have been drinking it and following an autoimmune protocol (started with Amy Myers) for over a year. I feel fantastic. I do have a low thyroid (diagnosed recently) but think the broth helped heal my gut or close to it. No foods bother me anymore! I am still going to be tested this week for SIBO and parasites to be sure nothing else is stopping me from healing.

  17. Yes, my thyroid symptoms have been alleviated by healing my leaky gut. My thyroid numbers were’t awful, but I had just about every symptom of hypothyroidism and tested positive for food sensitivities to dairy, eggs, almonds. Though I was not a junk food eater, I was having almonds, almond milk, eggs and yogurt. By eliminating those foods, adding in bone broth daily and going on a low carb high fat diet, now adding in carbs like sweet potato and other fermentable foods along with some supplements, after a year, I can feel that my gut is healing. My thyroid symptoms are receding, my extra weight just fell away, my hair is growing back and my energy is returning. My thyroid numbers are also better.

    PS I did not have SIBO

    • Hi Mary,
      What test did you do to determine sensitivity to the foods mentioned?


  18. How do you reccommend balancing feeding the bacteria in your large intestine with pre-biotics, but not over-feeding the ones in the small intestine when you have SIBO. My experience is showing my that my SIBO is causing hypothyroidism. It seems like a tricky thing to get gut health while starving other bacteria. (and I’ve been taking Xifaxin and botanicals). Maybe one day medicine will advance enough that we can have daily feedback on how things are in the gut, and we can respond accordingly.

    • I have a similar question:

      How do you know when to feed the bacteria in your large intestine with prebiotics, when you are trying to avoid fermentable fibers in the small intestine when you have SIBO?

      • You either treat the SIBO first, and then do prebiotics later, or you can introduce prebiotics via rectal enema implant.

    • You’re correct: it is a tricky problem. See my response to the other similar comment about this.

    • I have SIBO as well, and I added in resistant starch for easy prebiotics and I’ve definitely noticed good change. From what I’ve read, the resistant starch is great because the bacteria feed off of it, but it’s not fully digested, so it “sweeps” the small intestine on its way to the large intestine. Potato starch and plantains are good sources.

  19. I am a newbie to this, but I started with acid reflux about a year ago, then extreme fatigue, nausea, tested positive for SIBO and high TSH, ended up in the hospital for diverticultis infection at the same time. Had antiobiotics when released from the hospital, now I have physical anxiety, nausea, less acid reflux but abdominal pain, heartburn and constipation.

    I’m trying to figure out what is causing what. I’m getting retested for SIBO because it’s believed the antibiotics I had might have gotten rid of it. I am also on Synthroid which has given me more energy. I couldn’t eat fermented foods for a long time due to acid reflux but I am able to now. I also take probiotics and as much bone broth as possible. I will be tested soon again for thyroid. This is all following five years of chronic pain from a sports injury that messed up my alignment and my brain from knowing how to use my muscles.

  20. Hi Chris,
    I was diagnosed with hypothyroidism in 2012. After two years of seeing an internist every 3 months and trying every thyroid medication available at ever increasing dosages, nothing was improving my symptoms or blood test results. I bought your book after finding your name searching the internet. You seemed to be one of the only non-militant, reasonable, flexible, and non-crazy authorities out there. You were one of the only people ever to explain the whys and complexity of auto-immune conditions. There is no one solution that fits everyone. I cut coffee, corn, all grains, and sugar. I started eating liver, selenium rich foods, plantains (my go to for carbs), and making my own broth. Within 3 months of this dietrary change, I had the best blood test results during my two years of struggle with this frustrating condition and frustrating interactions with many doctor visits. My TSH finally went below 4.5 after remaining between 6-10 with all the hypothyroid/hyperthyroid symptoms in between dosage changes; I was also stretching out the remaining synthroid I had until I could see a new doctor. At that point, I had nothing to lose by trying your reasonable and sound advice. No medication including all forms of t4 and dosages, combos of t4 and t3 (hate t3!! for me) did any good for me alone. The diet and a small dosage of synthroid did the trick. My hair grew back. I sleep better. The tingling in my hands and feet disappeared. Joint pain disappeared. Brain fog disappeared. Mood swings disappeared. I’ve been on this diet for 18 months now and will never go off it if I have to feel the way I did two years ago and worry about being bald. So thank you! thank you! thank you! I’ve passed your name and book onto many others who ask about auto-immune conditions and how to improve symptoms.