Managing Hashimoto's with Acupuncture & East-Asian Medicine

April 11, 2023

By Dr. Sydney Malawer, DAIM L.Ac.

In my clinical approach to thyroid care, I religiously follow the work and trainings of Dr. Heidi Lovie, an acupuncturist and Chinese medicine practitioner out of New York who is an expert in Hashimoto’s thyroiditis - both as a practitioner and patient as she has had her own experience with Hashi’s (the lovingly colloquial term for Hashimoto’s that Dr. Lovie uses often) since she was a teenager. If you or someone you love has Hashimoto’s, I recommend you read her personal story - it’s effectively a novel but it will bring you to tears and leave you feeling so human and seen. I also had the honor and pleasure to work with Dr. Lovie during my doctoral program as she agreed to be my advisor for my thesis project on yin fire, a Chinese medical concept that explains modern day chronic inflammatory conditions of which Hashimoto’s is one. She generously shares her wealth of knowledge on the subject and explains things in the most approachable, down-to-earth way that makes it accessible to the masses. Much of my explanations below come from her trainings and distilled wisdom on the subject.

So before we go into the techniques around managing Hashimoto’s, let’s briefly go over the important physiology and pathophysiology of the thyroid.

Thyroid 101

The thyroid is like the body’s powerhouse - its messengers (thyroid hormones) provide ignition for the metabolism of every single cell in the body. This butterfly-shaped gland in our neck is the main control center for our body’s energy production and temperature regulation. When it’s not functioning properly, it can lead to a myriad of symptoms as your body tries to compensate in getting back to homeostasis. There are three main hormones that are important when dealing with thyroid function:

Thyroid Stimulating Hormone (TSH): TSH is produced and released by the pituitary gland and stimulates the thyroid gland to produce and release thyroid hormones T4 and, to a lesser extent, T3.
Thyroxine (T4): T4 is the primary hormone produced by the thyroid gland and is considered a “prohormone”, as it is not biologically active until it loses an iodine molecule when it is converted into T3.
Triiodothyronine (T3): T3 is the active form of the thyroid hormone, responsible for regulating metabolism, heart rate, and body temperature among other physiological processes. It is mainly produced by the conversion of T4 in the liver, kidneys, and other peripheral tissues as opposed to the thyroid gland itself.

When the thyroid isn’t producing enough T4 and by proxy T3, the body then goes into a hypothyroid state. Hashimoto’s thyroiditis is an autoimmune condition where your body attacks components of thyroid tissue, eventually leading to the underproduction of thyroid hormone and therefore leading the body into this hypothyroid state. Lymphocytes accumulate in thyroid tissue and tend to attack one or multiple components of the thyroid hormone production process: thyroid perioxidase (TPO), thyroglobulin (Tg), or in some cases thyrotropin (TSH) receptors. Clinical Hashimoto’s is diagnosed by minimally having high TSH and low T4 and free T4 along with one of the above antibodies, although 5% of people with Hashimoto's do not test positive for any thyroid antibodies. Many people have subclinical Hashimoto's, where they may produce antibodies but their hormone numbers are not yet affected (see this breakdown of the 5 stages of Hashimoto's by Dr. Izabella Wentz). In practice, we find that it’s important to minimally track TSH, free T4, AND free T3 as well as the identified antibodies to get a better idea of how to treat and what treatments are working.

The standard clinical presentation of hypothyroidism is fatigue, cold intolerance, weight loss resistance, hair loss, dry skin, and constipation. While many of these symptoms are common in people with clinical hypothyroidism, each person is unique in how it presents. To quote Dr. Lovie, “Hashi’s comes in all shapes and sizes.” Many people come into our clinic either with a Hashimoto’s diagnosis or we discover subclinical Hashimoto’s during routine lab work, and what strikes me the most is how strikingly different each one of their presentations are. Most of them present with a plethora of symptoms that their primary care doctors have labeled “anomalies” from exhaustion to migraines to hot flashes that end in bone-chilling cold and no two of them are alike. How autoimmune thyroid issues show up is like a fingerprint - it’s unique to each individual and will have its own twists and turns that are unlike that of anyone else.

Hashimoto's in East-Asian Medicine

There are several EAM patterns that you will find in patients with Hashimoto's, but remember Hashimoto’s can result in pretty much any pattern so in the end you must treat the pattern. Below are the common patterns seen in clinical practice that tend to manifest in people with Hashimoto’s:

Spleen Qi/Yang Deficiency: The Spleen in Chinese medicine is comprised of the anatomical spleen and pancreas and is responsible for the transformation and transportation of food and fluids in the body. When it is deficient, it is common to feel fatigue, weak digestion, bloating, and other symptoms commonly seen in Hashimoto's.
Kidney Yang Deficiency: Kidney Yang is essential for maintaining warmth and energy in the body. A deficiency can manifest as cold extremities, fatigue, lower back pain, watery stools or constipation, and a sluggish metabolism.
Heart-Kidney Miscommunication: This is the most common pattern seen in Hashimoto’s that occurs around menopause. The Kidneys (specifically Kidney yin) are responsible for nourishing and cooling the body and anchoring heat in the body so that it does not harass the Heart. When Kidney yin is deficient, it can lead to symptoms like night sweats, insomnia, and anxiety due to heat harassing the heart.
Liver Blood Deficiency: Liver blood is essential for nourishing the organs, tissues, and carrying hormones (such as T3) to all cells of the body. A deficiency in Liver blood can lead to emotional imbalances such as anxiety and depression, fatigue, menstrual irregularities, muscle aches and joint pain.
Liver Qi Stagnation: The Liver is responsible for the smooth flow of qi and blood throughout the body. When Liver Qi becomes stagnant, it can result in emotional imbalances, stress, and frustration.
Phlegm & Dampness: In Chinese medicine, an accumulation of Phlegm or Dampness in the body can obstruct the normal flow of Qi and lead to sluggishness, weight gain, and a swollen thyroid gland.
Blood Stasis: When Blood circulation is impeded, it can cause stagnation and contribute to inflammation and pain. Blood Stasis is often present in chronic conditions like Hashimoto's, where the immune system is continually attacking the thyroid gland.
Yin Fire with or without Gu Syndrome: As Dr. Heidi says, “when it’s weird, it’s either yin fire or gu.” Yin Fire scenarios are multi-patterned “knots” of disease that stem from long-term suboptimal functioning of Spleen qi leading to the displacement of metabolic fire which turns into inflammation. These are people who have three or more of the above patterns mentioned going on at the same time. This is seen often in long-term untreated chronic inflammatory conditions which is common to find in people with Hashimoto’s. Gu syndrome is a Chinese medical concept of chronic parasitism, where the body is continuously fighting a long term infection such as Epstein-Barr Virus (EBV), Lyme’s disease, or a parasitic infection that technically cleared up long ago but the body hasn’t gotten out of the pattern of fighting it yet. Yin Fire scenarios and Gu syndrome can often be seen together.

Techniques for Managing Hashimoto's

No Gluten (sorry): When gluten is broken down in the intestines it breaks down into a protein called gliadin, which has an uncanny ability to unravel tight junctions between the epithelial cells of the small intestines and sneak its way into the bloodstream. When invaders enter the blood stream that quickly, the body’s immune system goes on the defense and starts attacking the gliadin and any molecules that look even remotely like it. Unfortunately for those with autoimmune thyroid conditions, gliadin looks amazingly similar to thyroid cells, a phenomenon known as ‘molecular mimicry’. This means when someone with autoimmune thyroid disease (Hashimoto’s or Graves) eats gluten-containing grains, it is highly likely they are increasing their anti-thyroid antibodies and damaging thyroid tissue further. In the initial phases it’s important to follow a therapeutic anti-inflammatory as you’re lowering inflammation (hopefully through the guidance of trained practitioner like those who have completed training as an AIP coach or work at WellTheory), but after when you begin to reintroduce foods you can negotiate almost any other food except for gluten-containing ones.

Get acupuncture weekly: Studies have shown that even non-specific insertion of acupuncture needles has an effect that regulates the body’s immune response, reducing inflammation and calming the autoimmune response that's at the root of Hashimoto's. It also can help improve thyroid function by stimulating appropriate points related to the thyroid itself such as Ren 22 and Liver 4 (my personal favorite to moxa for thyroid health). It also can help alleviate common Hashimoto’s symptoms such fatigue, depression, and digestive issues while reducing stress and anxiety that can exacerbate Hashimoto's symptoms.

Get a customized herbal medicine prescription: Tailored to your unique constitution and pattern of imbalance, Chinese herbal formulas help address the root causes of Hashimoto’s, modulate the body’s immune response, and help lower antibodies and therefore lessen destruction of thyroid tissue. Common Chinese herbal formulas used in the treatment of Hashimoto’s is Ping Wei San, Ban Xia Hou Po Tang, Xiao Chai Hu Tang, Bu Zhong Yi Qi Tang, Si Jun Zi Tang, and Dan Zhi Xiao Yao San, although for best results it’s best to to have a practitioner modify and tailor the formula to your specific “flavor of Hashi’s".

Perform neck gua-sha daily: A study in a Korean medical journal on women who tested positive for TPO antibodies found that performing gua sha on the back of the neck daily for one month reduced TPO antibodies in almost 100% of participants. Dr. Lovie empirically found the same occurrence in her situation as well as 90% of her patients and not just for TPO antibodies but for all thyroid antibodies. This is why I recommend performing neck gua sha once daily for 3-5 minutes and monitor your thyroid antibodies every 6-8 weeks. To learn proper technique, I recommend this tutorial video by Sandra Lanshin Chiu, L.Ac.

Get enough selenium, zinc, iodine, tyrosine, and vitamin D: People with Hashimoto's require optimal levels of selenium, zinc, iodine, tyrosine, and vitamin D to support healthy thyroid function and mitigate hypothyroid symptoms. Selenium acts as an antioxidant, protecting the thyroid from oxidative stress and reducing inflammation due to autoimmunity. Zinc is essential for a healthy immune system as well as the synthesis of thyroid hormones, while iodine is a critical component of the hormones themselves and tyrosine, an amino acid, is a building block for thyroid hormones and plays a crucial role in their production. Vitamin D not only contributes to immune system regulation but also influences the production and activity of thyroid hormones. If you have Hashimoto's, making sure you get enough of these nutrients is vital for overall thyroid health and improving quality of life. As a practitioner I prefer food over supplements, although there are times when supplementation is needed in order to get you to baseline and then you can takeover with food. The chart below gives an incomplete list of foods that contain these vital thyroid-friendly nutrients:

Navigate stress: One of the most profoundly impactful lifestyle habits that affects your health is learning how to properly navigate stress. Notice the use of “navigate” rather than “manage” - stress is inevitable in our lives, so learning how to work with it rather than against it is a better solution. Below are some techniques that can help with navigating everyday stress:

Emphasize Joy: Do at least one thing that brings you joy every day - whether that’s playing with a dog or going for a walk with your partner or writing in your journal or chatting with a loved one on the phone. Dr. Laurel Mellin of UCSF who popularized the technique of Emotional Brain Training has found that the antidote to stress isn’t relaxation but rather joy, and that our minds are hardwired to experience joy.
Move intentionally: Natural, intentional movement for 45 minutes 5 days per week is shown to be more effective at regulating blood sugar (a determinant of the health of your digestive and immune systems) and decreasing stress than 20 minutes of cardio at the gym. Ways to move intentionally are walking or biking to run errands rather than driving, participating in a yoga class, or practicing tai chi.
Experience emotions: Repressing emotions is one of the biggest contributors to stress and also the most difficult for us to recognize. Finding a safe space to experience our emotions - whether it be grief, fear, anger, worry, or any other emotion that comes up - is important to our overall health and especially to reducing inflammatory response. There are formal spaces such as therapy, counseling, and coaching, and there are also at-home techniques such as EFT and meditation.

Monitor your bloodwork: You can do this under the care of your primary care practitioner, whether that be a licensed acupuncturist (in certain states), a naturopathic doctor, or an endocrinologist. There are also direct-to-consumer testing services such as Paloma Health that allow you to monitor your thyroid panel, TPO antibodies, and vitamin D.

Take your medication: If you’ve been given medication, take the medication. Given how important the thyroid is to the body’s proper functioning, you don’t want to screw around with it by not taking your meds. Especially if you’ve had Hashimoto’s for 5+ years with uncontrolled antibodies, there might be enough damage to the thyroid tissue that you will be on medication indefinitely and that’s ok! What you can focus on now is minimizing the continued damage to the thyroid by modulating the immune system to lower antibodies. If you do start feeling more hyperthyroid symptoms such as increased anxiety, overheating, and/or a racing heart, talk to your doctor about testing your thyroid hormones and possibly adjusting the dose of your meds if necessary.

These are obviously general guidelines and will take you about 50% of the way if not under the care of a knowledgeable practitioner. For example, some people with Hashimoto’s have carbohydrate intolerance and therefore need to be limiting their carb intake, while others may also have Polycystic Ovarian Syndrome (PCOS) since this occurs often with Hashimoto’s (Dr. Heidi describes Hashimoto’s and PCOS as “peanut butter and jelly” in terms of how often they come together) and therefore need to focus on lowering testosterone and blood sugar, while others may have Hashimoto’s that’s actually stemming from undiagnosed celiac disease that goes into complete remission after removing gluten from the diet. Since each person is a snowflake, it’s important to work with a practitioner so you can get individualized care and an appropriate treatment plan to help you with your special circumstances. If you’re curious if working with us at Tendervine Health is the right fit for you in managing your Hashimoto’s, schedule a Free Phone Consultation here.