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Hashimoto's Disease: Understanding Its Impact on T4 To T3 Conversion from a Naturopathic and Functional Medicine Perspective

Written by Portland Clinic of Natural Health on July 24, 2023

Hashimoto's disease, also known as Hashimoto's thyroiditis, is an autoimmune disorder that affects the thyroid gland. It is the most common cause of hypothyroidism, a condition characterized by an underactive thyroid.

In this blog post, we will explore the nature of Hashimoto's disease and its impact on the conversion of T4 (thyroxine) to T3 (triiodothyronine) from the perspective of naturopathic and functional medicine.

Understanding Hashimoto's Disease

Hashimoto's disease occurs when the immune system mistakenly attacks the thyroid gland, leading to inflammation and damage. While the exact cause is unknown, factors such as genetic predisposition, environmental triggers, and hormonal imbalances may contribute to its development.

The Role of T4 and T3 in Thyroid Function

The thyroid gland produces hormones called T4 and T3, which are crucial in regulating metabolism, growth, and development.

  • T4 is the primary hormone secreted by the thyroid.
  • T3 is the more biologically active form.

The conversion of T4 to T3 occurs primarily in the liver and other tissues, facilitated by enzymes called deiodinases.

Hashimoto's Impact on T4 to T3 Conversion

In Hashimoto's disease, the autoimmune attack on the thyroid gland can disrupt the production and release of thyroid hormones. While T4 levels may initially be elevated due to increased inflammation and gland destruction, the thyroid gland's function can decline over time, resulting in reduced hormone production.

Furthermore, Hashimoto's disease can interfere with converting T4 to T3. Studies have shown that chronic inflammation, a characteristic feature of autoimmune disorders like Hashimoto's, can downregulate the activity of deiodinase enzymes responsible for this conversion. Consequently, there is a higher concentration of inactive T4 and a relative deficiency of the active T3 hormone. (1)

Naturopathic and Functional Medicine Approaches

Naturopathic and functional medicine approaches to Hashimoto's disease aim to address the underlying causes and promote optimal thyroid function. While conventional medical treatment typically involves hormone replacement therapy, naturopathic and functional medicine practitioners often incorporate additional strategies.

Diet and Nutritional Support

A nutrient-dense, anti-inflammatory diet can help reduce inflammation and support thyroid health.

Focus on consuming whole foods, including fruits, vegetables, lean proteins, healthy fats, and adequate fiber.

Certain nutrients like selenium, zinc, iodine, and vitamin D are essential in thyroid function and may be recommended as supplements if deficiencies are identified. (2, 3)

Stress Management

Chronic stress can exacerbate autoimmune conditions.

Stress-reducing techniques such as meditation, yoga, breathing exercises, and regular physical activity can help modulate the immune response and promote overall well-being. (4)

Gut Health Optimization

Emerging research suggests a link between gut health and autoimmune diseases.

Naturopathic and functional medicine practitioners may assess and address any imbalances in gut flora and intestinal permeability ("leaky gut") to reduce immune system activation and inflammation. (5)

Herbal and Nutritional Supplements

Certain herbs and supplements, such as ashwagandha, curcumin, omega-3 fatty acids, and adaptogens, have been studied for their potential to support thyroid health and modulate the immune system.

However, consulting with a qualified healthcare professional before incorporating any supplements is crucial. (6)

The Complexity of Hashimoto's Disease as an Autoimmune Condition

Hashimoto's disease is a complex autoimmune condition that affects thyroid function, including the conversion of T4 to T3.

From a naturopathic and functional medicine perspective, addressing underlying factors like inflammation, nutrient deficiencies, and stress can be crucial in managing Hashimoto's disease and optimizing thyroid function.

Collaborating with a qualified healthcare provider specializing in integrative approaches can help create an individualized treatment plan tailored to each person's unique needs.


  1. Mancini A, Di Segni C, Raimondo S, Olivieri G, Silvestrini A, Meucci E, Currò D. Thyroid Hormones, Oxidative Stress, and Inflammation. Mediators Inflamm. 2016;2016:6757154. doi: 10.1155/2016/6757154. Epub 2016 Mar 8. PMID: 27051079; PMCID: PMC4802023.
  2. Mahmoodianfard S, Vafa M, Golgiri F, Khoshniat M, Gohari M, Solati Z, Djalali M. Effects of Zinc and Selenium Supplementation on Thyroid Function in Overweight and Obese Hypothyroid Female Patients: A Randomized Double-Blind Controlled Trial. J Am Coll Nutr. 2015;34(5):391-9. doi: 10.1080/07315724.2014.926161. Epub 2015 Mar 11. PMID: 25758370.
  3. Zhang J, Chen Y, Li H, Li H. Effects of vitamin D on thyroid autoimmunity markers in Hashimoto's thyroiditis: systematic review and meta-analysis. J Int Med Res. 2021 Dec;49(12):3000605211060675. doi: 10.1177/03000605211060675. PMID: 34871506; PMCID: PMC8711703.
  4. Sharif K, Watad A, Coplan L, Lichtbroun B, Krosser A, Lichtbroun M, Bragazzi NL, Amital H, Afek A, Shoenfeld Y. The role of stress in the mosaic of autoimmunity: An overlooked association. Autoimmun Rev. 2018 Oct;17(10):967-983. doi: 10.1016/j.autrev.2018.04.005. Epub 2018 Aug 14. PMID: 30118900.
  5. Virili C, Fallahi P, Antonelli A, Benvenga S, Centanni M. Gut microbiota and Hashimoto's thyroiditis. Rev Endocr Metab Disord. 2018 Dec;19(4):293-300. doi: 10.1007/s11154-018-9467-y. PMID: 30294759.
  6. Dolan K, Finley H, Gasta M, Houseman S. Managing Hashimoto's Thyroiditis Through Personalized Care: A Case Report. Altern Ther Health Med. 2018 May;24(3):56-61. PMID: 29428930.

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