Our thyroid gland is the butterfly-shaped endocrine gland found in the lower front of the neck, below the Adam’s apple, close to the windpipe. It plays a role in creating hormones that regulate bodily functions such as metabolism, body temperature, heart rate, and blood pressure. The thyroid hormones help in the utilization of energy in the body as well as in the proper functioning of the brain, heart, muscles, and other bodily organs. Our thyroid is under attack all the time because of our lifestyle, toxins in our environment, hormones in our foods, low level radiation, iodine deficiency, and more. Almost 30% of the patients in my clinic have some kind of a thyroid issue.

A glimpse at hypothyroidism

In over three decades of my practice as an Ayurvedic and Naturopathic physician, one of the most common health issues I have encountered is hypothyroidism, also known as the underactive thyroid disease. There are over 3 million cases of hypothyroidism every year in the United States. About 1 in 7 to 1 in 8 persons has a chance of becoming a patient of hypothyroidism. It is more common in females. Some of the common symptoms of hypothyroidism include: fatigue, depression, weight gain, constipation, and a poor ability to handle cold. There may be a swelling in the front part of the neck as a result of goiter or an enlarged thyroid gland.

A blood test of the thyroid hormones is used to check for problems in the thyroid gland. When we talk about the thyroid function, we are initially concerned with normal levels of the hormone, triiodothyronine or T₃. With hypothyroidism, our thyroid gland does not create sufficient thyroid hormone thyroxine or T₄, and the levels of thyroid stimulating hormone or TSH are usually high. T₄ is the inactive hormone and has to be converted into T₃ to become active. Nutrients in our diet aid this conversion process, and when the thyroid is not functioning properly, it can lead to problems like hypothyroidism. For example, iodine deficiency causes hypothyroidism.

Understanding subclinical hypothyroidism

A milder form of hypothyroidism, subclinical hypothyroidism, also known as mild thyroid failure, is characterized by normal levels of the T₄, but an elevated TSH (4.5-10µIU/L). There is also a presence of antithyroid antibody clusters, including microsomal antithyroperoxidase (TPO) and antithyroglobulin in blood. Subclinical hypothyroidism is diagnosed when you have no obvious symptoms or mild symptoms of hypothyroidism. It is often caused by its precursor, Hashimoto’s thyroiditis, which is a chronic autoimmune condition, where the immune system attacks the thyroid and creates inflammation. Subclinical hypothyroidism affects 3% to 8% of the world population. It affects 6% to 10% females and 2.4% to 3% males, globally.

Subclinical hypothyroidism may aggravate other serious diseases. These conditions include dyslipidemia, type 2 diabetes mellitus, impairment in vascular function, aortic calcification, atherosclerosis, as well as myocardial and neuromuscular dysfunction. Lifelong treatment with allopathic drugs does solve some of the issues, but does not cover the entire spectrum of the disease. Often, doctors prescribe levothyroxine for subclinical hypothyroidism when the TSH level goes above 10µIU/L. However, this is controversial when levothyroxine is prescribed for patients who have TSH levels between 4.5 and 10µIU/L, taking into consideration the overall advantages and disadvantages of the therapy. Recent studies indicate that thyroid hormone therapy for subclinical hypothyroidism does not increase survival, and there is no significant difference between treatment and placebo in terms of symptom improvement and health-related quality of life.

Ashwagandha for thyroid function

One of my favorite Ayurvedic herbs for thyroid function is Ashwagandha. The Latin name for Ashwagandha is Withania somnifera. It is grown in India in a “deserty” soil. It has been used for over 5000 years. Ashwagandha is an adaptogen or a rasayana that eliminates toxins, stabilizes the physiologic processes, restores homeostasis, and rejuvenates the body. It has anti-inflammatory, antioxidant, anti-anxiety, immunomodulatory, hypotensive, sedative, and hormone balancing properties. In clinical research, Ashwagandha has proven to demonstrate its activity and efficacy, as discussed by our ancient teachers of Ayurvedic medicine.

Many previous research studies in animal models have shown that Ashwagandha has an effect on thyroid activity. Ashwagandha is known to increase the T₃ thyroid hormone, which regulates mitochondrial energy production, giving energy and helping burn fat, thereby, providing symptomatic improvement in hypothyroidism patients. It also increases free T₄ levels. Moreover, Ashwagandha is especially known to be a useful botanical in treating subclinical hypothyroidism by reducing TSH and bringing it into a normal range.

A new research study on the treatment of subclinical hypothyroidism with Ashwagandha

A recent pilot study assessed the safety and efficacy of Ashwagandha root extract in patients of subclinical hypothyroidism. A prospective, randomized, double-blind, placebo-controlled study was conducted at a hospital in Varanasi, India between May 2016 and September 2016. Fifty people participated in the study. They all had elevated levels of TSH between 4.5 and 10µIU/L, serum T₃ and T₄ levels within normal range, and were between ages 18 and 50 years. They were randomly chosen to be in one of the two following groups for 8 weeks: 25 in treatment group (13 males and 12 females) and 25 in placebo group (14 males and 11 females). As a double-blind design, neither the doctors nor the participants in the two groups knew which participants were in the treatment group and which participants were in the placebo group at the time of the study to avoid bias.

The persons in treatment group received 300mg of Ashwagandha root extract (containing 5% withanolides) twice daily (600mg total per day), and the placebo group received starch every day. Serum T₃, T₄, and TSH levels were measured at baseline, fourth week, and eighth week. Four participants, two from each group, left the study prior to the second day of the experiment. A total of 46 participants, 23 per group, completed the study. The average age of the participants was 35.56 years in the treatment group and 35.08 years in the placebo group.

After eight weeks, the treatment group receiving Ashwagandha showed an improvement in serum T₃, T₄, and TSH statistically significantly in comparison to the placebo group. The T₃, T₄, and TSH levels at baseline were similar for both groups.The serum T₃ levels in the treatment group increased by 18.6% at four weeks and by 41.5% at eight weeks from baseline. The serum T₃ levels in the placebo group decreased by 15.9% from baseline at four weeks and a 0.03% decrease from baseline was seen at eight weeks. The serum T₄ levels in the treatment group increased by 9.3% at four weeks and by 19.6% at eight weeks from baseline. The serum T₄ levels in the placebo group did not change significantly over the duration of the study. The serum TSH levels decreased significantly in the treatment group in contrast to the placebo group.

Over a period of eight weeks, Ashwagandha normalized the levels of thyroid hormones in the treatment group. Treatment with Ashwagandha was considered safe based on measurements of physical, hematologic, and vital parameters. Four participants, one in the Ashwagandha group and three in the placebo group, experienced mild and short-term adverse effects such as fever, cough, weakness, and headache. However, these adverse effects were temporary and mild. One of the limitations of this pilot study is that it comprised a small sample size and study duration, so future studies with a larger population and longer duration are necessary to understand the underlying mechanisms of Ashwagandha as a treatment for subclinical hypothyroidism.

In this experiment, Ashwagandha increased serum T₃ and serum T₄, while decreasing serum TSH. These results indicate that Ashwagandha might play a role in regulating the hypothalamic-pituitary-thyroid axis (HPT axis). Ashwagandha is an anti-stress botanical that lowers the hormone cortisol in the body. Chronic stress activates the hypothalamic-pituitary-adrenal axis (HPA axis) by elevating cortisol, which inhibits the HPT axis, lowering serum T₃ and T₄ levels in the body. Via lowering cortisol, Ashwagandha downregulates the HPA axis, upregulating the HPT axis, which normalizes thyroid hormone levels. Other factors that inhibit the HPT axis by activating the HPA axis (reducing serum T₃ and T₄ as a consequence), are inflammation and dopamine levels. Since Ashwagandha is an anti-inflammatory and has anti-dopaminergic properties, this characteristic of the herb might lead to its thyroid balancing effects. The researchers concluded that treating subclinical hypothyroidism patients with Ashwagandha may be valuable for bringing their thyroid hormone levels into normal range. In my clinical practice, many patients with subclinical hypothyroidism have normalized without use of Levothyroxine or Synthroid. When folks were on Levothyroxine or Synthroid, doses were substantially reduced.