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Thyroid Problems (Underactive, Overactive, Nodules & Cancer)

The thyroid is a small gland in the neck that sets the pace for the whole body. Underactive, overactive, lumpy or enlarged — most thyroid problems are found with a simple blood test or neck exam and are very treatable, and most thyroid cancers have an excellent outlook.

Call 911 for a possible thyroid emergency.

See a doctor promptly for a new lump in the front of your neck — especially with a hoarse voice that isn’t getting better, trouble swallowing or breathing, or pain or pressure in the front of the neck (NHS (opens in a new tab), NCI (opens in a new tab)). Most lumps turn out to be harmless, but only tests can tell (American Thyroid Association (opens in a new tab)). Also call your doctor right away for chest pain, a rapid or irregular heartbeat, shaking, or trouble sleeping while taking thyroid hormone — these can mean the dose is too high (MedlinePlus (opens in a new tab)).

What does the thyroid do?

The thyroid is a small, butterfly-shaped gland at the front of your neck, a little larger than a quarter. It makes hormones that control how your body uses energy — so they touch nearly every organ, down to how fast your heart beats (NIDDK (opens in a new tab), NCI (opens in a new tab)). The pituitary gland in the brain sets the pace with thyroid-stimulating hormone (TSH): when thyroid hormone runs low, TSH rises, and when it runs high, TSH falls (American Thyroid Association (opens in a new tab)). Thyroid trouble comes in a few forms: too little hormone, too much, a gland that is enlarged, or lumps (nodules) in the gland. Some people have more than one.

Underactive thyroid (hypothyroidism)

Hypothyroidism means the thyroid doesn’t make enough hormone, so many body functions slow down. Nearly 5 in 100 Americans age 12 and older have it, though most cases are mild; it is much more common in women and in people over 60 (NIDDK (opens in a new tab)).

Hashimoto’s disease

The most common cause in the U.S. is Hashimoto’s disease (autoimmune thyroiditis), in which the immune system makes antibodies that damage the thyroid (NIDDK (opens in a new tab), American Thyroid Association (opens in a new tab)). It is 4 to 10 times more common in women, most often starts between ages 30 and 50, runs in families, and is more likely if you have another autoimmune condition such as celiac disease, lupus, rheumatoid arthritis, Sjögren’s syndrome or type 1 diabetes (NIDDK (opens in a new tab)). It can progress slowly over many years, and you may have no symptoms early on (American Thyroid Association (opens in a new tab)). The gland may swell into a goiter, which can cause a feeling of fullness in the throat (NIDDK (opens in a new tab)).

Other causes

Hypothyroidism can also follow thyroid surgery, radioactive iodine or radiation to the neck, thyroiditis (inflammation of the thyroid), some medicines — including lithium, amiodarone and certain cancer drugs — too little iodine, or damage to the pituitary gland; some babies are born without a working thyroid (American Thyroid Association (opens in a new tab)). Iodine deficiency is extremely rare in the United States (NIDDK (opens in a new tab)).

Symptoms

Symptoms develop slowly, so you may not notice them for months or even years. Common ones are tiredness, feeling cold, constipation, dry skin, dry or thinning hair, weight gain, low mood, trouble concentrating, muscle and joint aches, a hoarse voice, and heavy or irregular periods (NIDDK (opens in a new tab), NHS (opens in a new tab), American Thyroid Association (opens in a new tab)). Many of these are common and don’t necessarily mean a thyroid problem (NIDDK (opens in a new tab)); a blood test is the only way to know (American Thyroid Association (opens in a new tab)). See our Hair guide, Chronic Fatigue guide, Depression guide and Anemia guide for conditions that overlap. A thyroid check is also reasonable if you have high cholesterol (NIDDK (opens in a new tab); see our Cholesterol guide), and women with fertility trouble are often tested too (NIDDK (opens in a new tab); see our Female Problems guide).

Why treating it matters

Untreated, hypothyroidism can contribute to high cholesterol, high blood pressure, heart disease and heart failure, and problems in pregnancy; rarely it leads to myxedema coma (NIDDK (opens in a new tab)). See our Heart guide.

How it is diagnosed: the TSH test

Tip: the supplement biotin can make thyroid blood tests look abnormal when they are normal. Stop it before testing — the American Thyroid Association says 2 days, and the levothyroxine label says at least 2 days (American Thyroid Association (opens in a new tab), FDA label, DailyMed (opens in a new tab)). FDA has also warned that biotin can cause falsely high or falsely low results on some lab tests (FDA guidance (opens in a new tab)).

Overactive thyroid (hyperthyroidism)

An overactive thyroid makes too much hormone, and body functions speed up. Symptoms include nervousness, irritability, trouble sleeping, tiredness and weakness, sensitivity to heat, a fast or irregular heartbeat, trembling, weight loss and sometimes a swollen neck (NHS (opens in a new tab)). About 4 in 5 people with an overactive thyroid have Graves’ disease (NHS (opens in a new tab)) — see our Graves’ Disease guide for the eye disease, treatment choices and thyroid storm in depth.

  • Toxic nodule or toxic multinodular goiter: one or more usually benign nodules that make hormone on their own. A thyroid scan shows which areas are overactive. Medicine can control it but doesn’t fix the nodule, so surgery or radioactive iodine is usually suggested (American Thyroid Association (opens in a new tab)).
  • Thyroiditis: inflammation can leak stored hormone, causing a temporary overactive phase followed by an underactive one. Painless (silent) and postpartum thyroiditis follow this pattern, and the overactive phase lasts about 1 to 3 months; about a third of people have both phases. Subacute thyroiditis, possibly viral, makes the thyroid painful. Most people recover normal function within 12 to 18 months, though some are left with a permanently underactive thyroid (American Thyroid Association (opens in a new tab)).
  • Medicines such as amiodarone can also cause it (NHS (opens in a new tab)). Kelp supplements have too — see the Herbal section.

Treatment options are medicine that lowers hormone production, radioactive iodine or surgery (NHS (opens in a new tab)). A beta-blocker can control symptoms such as a fast heart rate (American Thyroid Association (opens in a new tab)). Stopping antithyroid medicine suddenly or missing doses can trigger thyroid storm (NHS (opens in a new tab), review, J Clin Endocrinol Metab 2026 (opens in a new tab)).

Goiter and thyroid nodules

A goiter is simply an enlarged thyroid. It doesn’t necessarily mean the gland is malfunctioning — it can occur with too much, too little or the right amount of hormone. Causes include iodine deficiency (a leading cause worldwide, but uncommon in the U.S.), Hashimoto’s disease, Graves’ disease and multinodular goiter (American Thyroid Association (opens in a new tab)). Goiters are usually painless and not serious, but should be checked; a goiter can cause a cough, a hoarse voice, a feeling that something is stuck in the throat, or trouble swallowing or breathing (NHS (opens in a new tab)).

A thyroid nodule is a lump of thyroid cells inside the gland. Nodules are very common — by age 60, about half of people have one — and more than 90% are benign. Most cause no symptoms and are found by chance on an exam or on imaging done for another reason; a few cause neck pain or, if large, trouble swallowing or breathing. Thyroid blood tests are usually normal even when a nodule is cancerous, so the evaluation relies on a neck exam, ultrasound and sometimes a fine needle biopsy (a thin needle takes cells for a pathologist to examine, often in the office). Benign nodules are watched with ultrasound every 6 to 12 months and a yearly exam (American Thyroid Association (opens in a new tab)). Giving thyroid hormone to shrink benign nodules or goiters doesn’t work in places with enough iodine, such as the U.S. (American Thyroid Association (opens in a new tab)).

Thyroid cancer

Fewer than 1 in 10 thyroid nodules is cancer (American Thyroid Association (opens in a new tab)). Thyroid cancer usually shows up as a painless lump and often causes no other symptoms; later signs can include hoarseness, trouble swallowing or breathing, and pain when swallowing (NCI (opens in a new tab), NHS (opens in a new tab)).

  • Papillary (about 70–80% of cases) and follicular (about 10–15%) cancers are called differentiated; papillary tends to grow slowly and has an excellent outlook. Medullary (about 2%) sometimes runs in families, and anaplastic (under 2%) is the rare, aggressive form (American Thyroid Association (opens in a new tab)). Differentiated tumors can usually be cured; anaplastic ones grow fast and have a poorer chance of recovery (NCI (opens in a new tab)).
  • Risk factors include being female, age 25 to 65, radiation to the head and neck in childhood, a history of goiter, and a family history of thyroid disease or thyroid cancer (NCI (opens in a new tab)). Radiation treatment for cancers such as Hodgkin’s disease or breast cancer that includes the head, neck or chest raises the risk; routine dental X-rays, chest X-rays and mammograms do not (American Thyroid Association (opens in a new tab)). See our Hodgkin Lymphoma guide and Cancer guide.
  • Outlook: NCI’s SEER program reports a 98.3% five-year relative survival overall, 99.9% when the cancer is confined to the thyroid, 98.1% when it has spread to nearby lymph nodes, and 48.3% when it has spread to distant parts of the body. Statistics describe large groups and cannot predict one person’s course (NCI SEER (opens in a new tab)).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

Thyroid Problems (Underactive, Overactive, Nodules & Cancer): six approaches compared
ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Underactive: daily levothyroxine with regular TSH checks. Overactive: antithyroid medicine, radioactive iodine or surgery (see the Graves’ guide). Goiter and nodules: exam, ultrasound, biopsy and watchful follow-up. Cancer: surgery, sometimes radioactive iodine, then lifelong thyroid hormone. Cost estimate being researched. Strong evidence. Hypothyroidism can usually be well controlled with medicine, though most people take it for life. Most thyroid cancers have an excellent outlook.
Chiropractic No role in treating thyroid disease. About $55–$100 a follow-up visit and $90–$200 for a first visit without insurance; not a treatment for thyroid disease. Nothing we found shows that it treats thyroid disease. MBHA advises no neck manipulation until a new neck lump has been checked.
Acupuncture Fine needles, used alongside medical treatment, mainly for stress and comfort. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Little reliable research; one review says better-designed studies are needed. Not a replacement for thyroid medicine.
Herbal medicine Ashwagandha, kelp, iodine and selenium are all promoted for the thyroid. Kelp and iodine supplements can cause harm; biotin spoils thyroid lab tests. Cost estimate being researched. Weak or mixed evidence. NCCIH does not recommend ashwagandha for people with thyroid disorders. Selenium may lower antibodies in Hashimoto’s, but its clinical value is unproven.
Massage therapy Gentle relaxation massage, avoiding pressure on the front of the neck. At one national chain, about $125–$160 for a 60-minute massage for non-members; memberships about $70–$90 a month. May help you relax. Nothing we found shows it treats thyroid disease.
MBHA Wellness Coach An MBHA Wellness Coach helps with a steady pill routine, supplement and lab preparation, sleep, stress, movement, follow-up and realistic expectations. MBHA coaching cost estimate being researched. Supports your medical care; one small trial found added yoga improved quality of life alongside levothyroxine.

Approach 1 of 6

Conventional medicine (AMA)

An endocrinologist (hormone specialist) or your primary doctor usually leads care; a surgeon with thyroid experience is involved for nodules, cancer or some overactive thyroids. We don’t list doses — ask your doctor or pharmacist.

1. Underactive thyroid: levothyroxine

Hypothyroidism is treated by replacing the hormone your thyroid can’t make. The usual medicine, levothyroxine, is identical to thyroxine (T4), the hormone a healthy thyroid makes. It comes as a pill, a liquid or a soft gel capsule; the newer forms may help people with digestive problems that affect absorption (NIDDK (opens in a new tab)). Your doctor starts you on a low amount and adjusts it gradually (MedlinePlus (opens in a new tab)); the dose depends on factors such as your weight, age and other conditions (American Thyroid Association (opens in a new tab)). It may take several weeks to notice a change, and levothyroxine controls hypothyroidism but does not cure it (MedlinePlus (opens in a new tab)).

Timing and absorption: calcium, iron, coffee and more

Levothyroxine is usually taken once a day on an empty stomach, 30 minutes to an hour before breakfast (MedlinePlus (opens in a new tab), NHS (opens in a new tab)), with a full glass of water (MedlinePlus (opens in a new tab)). The NHS says to take it 30 to 60 minutes before your first meal or any caffeinated drink such as tea or coffee (NHS (opens in a new tab)). The American Thyroid Association says bedtime dosing is an alternative if that makes it easier to avoid food and other medicines; the key is to be consistent (American Thyroid Association (opens in a new tab)).

  • Calcium and iron: take calcium carbonate (such as Tums) or an iron supplement at least 4 hours before or after levothyroxine (MedlinePlus (opens in a new tab)); the FDA label lists calcium carbonate and ferrous sulfate (iron) among products that can bind levothyroxine (FDA label, DailyMed (opens in a new tab)). Multivitamins with iron or calcium can have the same effect (NIDDK (opens in a new tab)).
  • Coffee: NIDDK lists espresso coffee, grapefruit juice and soy among things that can affect absorption (NIDDK (opens in a new tab)). A 2021 systematic review found limited evidence that coffee, soy, fiber, calcium and iron all reduced absorption, and that leaving a gap between levothyroxine and these is an effective fix (review, Pharmaceuticals 2021 (opens in a new tab)).
  • Other medicines: the NHS lists antacids and acid reducers such as omeprazole, some seizure and heart medicines, St John’s wort and biotin among those that may not mix well (NHS (opens in a new tab)). Tell your doctor and pharmacist about everything you take, including supplements; our Medication Safety guide has more.

T3 and “natural” thyroid

If you don’t feel better on levothyroxine alone, some doctors add liothyronine (T3) (American Thyroid Association (opens in a new tab)); the American Thyroid Association says a 3 to 6 month trial of the combination may be reasonable but that T3 alone is not indicated, because it is short-acting and can cause a fast heartbeat, insomnia and anxiety (American Thyroid Association (opens in a new tab)). Dried animal thyroid extracts vary from batch to batch, are harder to keep stable, and should not be used in pregnancy (American Thyroid Association (opens in a new tab)).

Thyroid hormone is not a weight-loss drug. The levothyroxine label carries a boxed warning: thyroid hormones should not be used for obesity or weight loss; at normal replacement doses they don’t reduce weight in people with normal thyroids, and larger amounts can cause serious or even life-threatening toxicity (FDA label, DailyMed (opens in a new tab), MedlinePlus (opens in a new tab)).

2. Overactive thyroid

Treatment is anti-thyroid medicine, radioactive iodine or surgery, with beta-blockers for symptoms (NHS (opens in a new tab), American Thyroid Association (opens in a new tab)). After radioactive iodine or surgery, you may need lifelong thyroid hormone (NHS (opens in a new tab), American Thyroid Association (opens in a new tab)). Our Graves’ Disease guide covers these in detail.

3. Goiter and nodules

A goiter caused by an under- or overactive thyroid is treated by treating that problem; many goiters with normal hormone levels need no treatment but need yearly monitoring, and surgery is considered if the goiter squeezes the airway (American Thyroid Association (opens in a new tab)). Benign nodules are watched with ultrasound; surgery is advised for nodules that are cancerous or highly suspicious, or that keep growing or look worrisome (American Thyroid Association (opens in a new tab)).

4. Thyroid cancer

Surgery is the first step: removing the affected lobe (lobectomy) or the whole thyroid. Some people then have radioactive iodine to destroy leftover thyroid tissue (American Thyroid Association (opens in a new tab)), and levothyroxine afterward replaces the lost hormone (MedlinePlus (opens in a new tab)). After cancer surgery, higher-than-usual thyroid hormone is sometimes used to keep cancer cells from growing, and your doctor monitors the heart and bones (American Thyroid Association (opens in a new tab)). Surgery has risks: temporary hoarseness in roughly 5–7% of people and, with total thyroidectomy, a 1–3% chance that all four parathyroid glands are damaged or removed, causing low calcium (American Thyroid Association (opens in a new tab)); choose an experienced thyroid surgeon. Lifelong follow-up with neck ultrasound and thyroglobulin blood tests looks for recurrence (American Thyroid Association (opens in a new tab)).

What it costs

Cost estimate being researched. Ask your doctor’s office and insurer what you will pay for blood tests, ultrasound, biopsy, medicine, radioactive iodine or surgery.

How well it works — what to expect

Hypothyroidism can be well controlled with thyroid hormone when you take it as directed and keep up your follow-up blood tests (NIDDK (opens in a new tab)). The American Thyroid Association also says there is no proven benefit to taking levothyroxine for symptoms that overlap with hypothyroidism when thyroid hormone levels are normal; if labs are normal, other causes deserve a look (American Thyroid Association (opens in a new tab)). For cancer, see the outlook figures above.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic has no role in treating thyroid disease. We found little research on the topic, and nothing we read shows that chiropractic care changes thyroid function, thyroid antibodies, nodules or cancer.

MBHA caution about neck work. If you see a chiropractor for neck or back pain, mention your thyroid condition. MBHA advises no neck manipulation or deep pressure until a new neck lump or swelling has been checked, and none after recent thyroid surgery or with a large goiter. NCCIH says serious side effects of spinal manipulation, such as strokes involving neck arteries, are very rare, and may be more likely in people with underlying health problems (NCCIH (opens in a new tab)).

A good chiropractor can still be a helpful second pair of eyes. One 2023 case report described a woman with known thyroid nodules whose lasting neck pain was eventually traced, after a chiropractic consultation led to imaging, to thyroid cancer that had spread; the authors urge follow-up when symptoms don’t resolve (case report, Cureus 2023 (opens in a new tab)). A single case proves little, but if neck pain or a lump doesn’t settle, get it checked. See also our Neck guide.

What it costs

Without insurance, about $55–$100 for a follow-up visit and $90–$200 for a first visit (The Pricer (opens in a new tab)).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

We found little reliable research on acupuncture for thyroid disease. A 2018 narrative review of 29 clinical projects (1,757 patients in several countries) reported symptom and lab improvements, with acupuncture alone or alongside other treatment, but concluded that more well-designed research is needed (review, J Integr Med 2018 (opens in a new tab)).

Some people use acupuncture for stress and general well-being, always alongside — never instead of — thyroid medicine. NCCIH says relatively few complications are reported, but some have come from non-sterile needles and improper treatment (NCCIH (opens in a new tab)). Choose a licensed acupuncturist; MBHA advises no needling over a thyroid nodule, a goiter or a healing surgical scar.

What it costs

About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer (opens in a new tab)).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Avoid kelp, seaweed and iodine supplements unless your doctor prescribes them. With Hashimoto’s disease or other autoimmune thyroid disease you may be sensitive to iodine; foods with large amounts such as kelp or dulse, and iodine supplements, can cause or worsen hypothyroidism (NIDDK (opens in a new tab)). Excess iodine from the diet or supplements can harm the thyroid (American Thyroid Association (opens in a new tab)). Some cough syrups contain iodine too (NIDDK (opens in a new tab)).

Kelp

Kelp-containing weight-loss or “thyroid support” tablets can backfire. One 2019 case report describes a 70-year-old woman with no thyroid disease who developed temporary hyperthyroidism about three months after taking kelp tablets; her thyroid returned to normal after she stopped them and took antithyroid medicine for three months. The authors advise that kelp supplements be taken only under a doctor’s supervision with monitoring of thyroid function (case report, Medicine 2019 (opens in a new tab)).

Ashwagandha

This Ayurvedic herb is promoted for the thyroid and for stress. The evidence is mixed and the cautions are real:

In short: don’t take ashwagandha for the thyroid without your doctor’s knowledge, and have your TSH checked if you do. We give no amounts.

Selenium

Selenium is covered in “Iodine, selenium and biotin” below. The short version: it may lower thyroid antibodies in Hashimoto’s disease, but whether that helps you feel better is unproven, and NIDDK says no specific guidance is currently available (NIDDK (opens in a new tab)).

Biotin, and supplements in general

Biotin, common in “hair, skin and nails” products, can throw off thyroid blood tests; stop it for 2 days before testing and tell your doctor you take it (American Thyroid Association (opens in a new tab), FDA label, DailyMed (opens in a new tab)). Herbs and supplements can interfere with how medicines work and can act like drugs; “natural” doesn’t mean safe (American Thyroid Association (opens in a new tab), NCCIH (opens in a new tab)). Tell your doctor and pharmacist about every supplement you take. Supplement costs: cost estimate being researched.

Approach 5 of 6

Massage therapy

Nothing we found shows that massage treats thyroid disease or changes thyroid hormone levels, but gentle massage may help you relax. NCCIH says the risk of harm appears low, though rare serious problems have been reported, mostly with vigorous types such as deep tissue massage (NCCIH (opens in a new tab)).

  • No pressure on the front of the neck. This is MBHA advice for everyone with a known nodule, a goiter, thyroid cancer or recent thyroid surgery — and for anyone with a new neck lump until a doctor has looked at it.
  • Choose gentle, relaxing work on the back, shoulders, scalp, hands and feet. Tell your therapist about any surgical scar, and let them know if heat bothers you if your thyroid is overactive.

What it costs

Prices vary by location. At one national chain, franchise price lists show about $125–$160 for a 60-minute massage for non-members and about $65–$90 for members, whose memberships run about $70–$90 a month (The Pricer (opens in a new tab)). Tips are extra.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build habits that support your treatment, alongside your doctor.

MBHA coaching cost estimate being researched.

Another approach

Subclinical thyroid disease: the evidence, honestly

“Subclinical” means the TSH is outside the normal range while the thyroid hormones themselves (T4 and T3) are still normal. Whether to treat is genuinely debated.

Subclinical hypothyroidism (mildly high TSH)

Subclinical hyperthyroidism (low TSH)

Many people have no symptoms, and not all cases need treatment right away; you and your doctor decide based on the cause, symptoms, age and conditions such as weak bones or heart problems (American Thyroid Association (opens in a new tab)). Without symptoms, older patients are often just monitored (American Thyroid Association (opens in a new tab)). A 2025 review links it to atrial fibrillation, osteoporosis and dementia, and notes that the question of when treatment helps is still being studied (review, Curr Opin Endocrinol Diabetes Obes 2025 (opens in a new tab)).

Practical takeaway: a borderline result is a reason for a repeat test and a conversation, not automatically for a prescription.

Another approach

Thyroid disease, pregnancy and the postpartum

Left untreated, hypothyroidism in pregnancy can affect both mother and baby, but thyroid medicine is safe to take in pregnancy (NIDDK (opens in a new tab)). Untreated, it raises the chance of pre-eclampsia, birth defects, premature birth and miscarriage (NHS (opens in a new tab)).

An MBHA pregnancy guide is planned.

Another approach

The two thyroid emergencies

Myxedema coma is the extreme end of untreated hypothyroidism: body functions slow to a life-threatening point and it needs immediate treatment (NIDDK (opens in a new tab)). It is very rare — a 2025 review of nearly 700 cases estimated about 0.12 cases per million people per year — but fatal for a large share, with an overall mortality of 38.8% in that review. Nearly 9 in 10 patients had altered mental status, about 7 in 10 had low body temperature, and about two-thirds had a heart rate under 60. Most cases had an identifiable precipitating factor (review, Thyroid Res 2025 (opens in a new tab)). Treatment is in an intensive care unit (review, JAMA 2025 (opens in a new tab)), with thyroid hormone (review, Endocr Pract 2025 (opens in a new tab)); the levothyroxine label says to use a form made for injection into a vein rather than oral tablets (FDA label, DailyMed (opens in a new tab)). The best prevention is taking your thyroid medicine and keeping appointments. If someone with thyroid disease is confused, very cold and unusually drowsy, call 911.

Thyroid storm is the opposite: an extreme flare of untreated or poorly controlled hyperthyroidism. Common triggers are infection, surgery, injury, suddenly stopping antithyroid medicine, severe stress and iodine exposure. It causes high fever, a racing heart, agitation or confusion, vomiting and diarrhea, and it needs immediate intensive treatment; mortality is 5% to 25% even with care (review, J Clin Endocrinol Metab 2026 (opens in a new tab), NHS (opens in a new tab)). Call 911. Our Graves’ Disease guide covers storm in more detail.

Another approach

Iodine, selenium and biotin: the facts

Iodine

Your thyroid needs iodine, found in some foods and in iodized salt, to make its hormones (NCI (opens in a new tab)). Too little causes goiter and hypothyroidism, which is why it remains common worldwide, but it is rare in the U.S. (American Thyroid Association (opens in a new tab), NIDDK (opens in a new tab)). The opposite problem matters more here: too much iodine can cause or worsen thyroid disease, especially in people with autoimmune thyroid conditions (NIDDK (opens in a new tab)). The American Thyroid Association says avoiding iodine or loading up on it are both commonly recommended but are generally not beneficial; iodine supplements are recommended in certain situations such as pregnancy (American Thyroid Association (opens in a new tab)). Ask your doctor before changing your iodine intake.

Selenium

Selenium is a trace mineral involved in thyroid hormone making. For Hashimoto’s disease:

  • A 2014 Cochrane review of four trials (463 people) at unclear to high risk of bias found selenium lowered thyroid antibody levels, but called the evidence incomplete and not reliable enough to guide treatment (Cochrane summary, Eur Thyroid J 2014 (opens in a new tab)).
  • A 2024 meta-analysis of 35 studies found selenium lowered TSH (in people not taking thyroid hormone) and TPO antibodies, with no more side effects than controls, and rated the certainty of evidence as moderate. Hormone levels such as free T4 did not change (meta-analysis, Thyroid 2024 (opens in a new tab)).
  • NIDDK says researchers are studying selenium and vitamin D, but no specific guidance is currently available (NIDDK (opens in a new tab)).

So lower antibodies are likely; a proven benefit to how you feel is not. Ask your doctor whether it fits you; we give no amount.

Biotin

Biotin is the one supplement that can fool your thyroid tests. It can make results look abnormal when they are normal; stop it at least 2 days before testing and tell your doctor (American Thyroid Association (opens in a new tab), American Thyroid Association (opens in a new tab), FDA label, DailyMed (opens in a new tab)). FDA has also warned that people taking more than the recommended daily intake can get falsely high or falsely low results on some lab tests (FDA guidance (opens in a new tab)).

Another approach

When symptoms overlap with other conditions

Fatigue, weight change, low mood, feeling cold or anxious, and hair thinning all have many causes besides the thyroid, so a normal TSH is useful information. If your thyroid labs are normal, look at other causes with your doctor (American Thyroid Association (opens in a new tab)). Related MBHA guides: Hair, Chronic Fatigue, Depression, Anemia, Cholesterol, Heart, Female Problems and Graves’ Disease. An MBHA Weight Control guide is planned.

Member stories

Living with Thyroid Problems (Underactive, Overactive, Nodules & Cancer)? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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