Thyroid Autoimmune Disease
Michael Friedman


Thyroid autoimmune disease
Hashimoto's disease


Autoimmune diseases are a group of disorders in which the immune system dysfunctions and attacks host tissues. Although the pathogenesis of autoimmune thyroid disease has not been elucidated, there are several factors that have been associated with the disorder. Factors include genetic predisposition, nutrient deficiencies, use of certain medications affecting thyroid function, and environmental factors including exposure to radiation, heavy metals, and chemical contaminants. Thyroid disorders are often treated with drug therapy, which often have serious side effects and do not necessarily treat the underlying condition leading to the thyroid dysfunction. In recent years there has been increased interest in herbs and supplements as individuals take more interest in their health and well being. For autoimmune disease, vitamin D supplementation is recommended as deficiency in this nutrient has been associated with the disorder. Additionally, it also modulates T cell response and inhibits Th1 cytokines. In cases of autoimmune hyperthyroid disorder, rosmarinic acid, selenium and iodide supplementation are recommended. For autoimmune hypothyroid disorder, blue flag (Iris versicolor) and guggul (Commiphora mukul), selenium and iodide supplementation are indicated. Each of these supplements plays a specific role in restoring normal thyroid function. Further, rosmarinic acid found in plants such as rosemary (Rosmarinus officinalis), bugleweed (Lycopus virginicus), and lemon balm (Melissa officinalis) also calms excess T cell activity and pro inflammatory cytokine release. The use of these combinations of supplements should restore thyroid hormone homeostasis in autoimmune thyroid disorders. Proper medical supervision is required to ensure these herbs and nutrients are used safely and potential adverse effects are avoided.



McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012; 42:252–65.
Ishii H, Inada M, Tanaka K, et al. Sequential deiodination of thyroxine in human thyroid gland. J Clin Endocrinol Metab. 1982; 55:890–6.
McGrogan A, Seaman HE, Wright JW, de Vries CS. The incidence of autoimmune thyroid disease: a systematic review of the literature. Clin Endocrinol (Oxf). 2008; 69:687–96.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000; 160:526–34.
Spitzweg C, Joba W, Heufelder AE. Expression of thyroid-related genes in human thymus. Thyroid. 1999; 9:133–41.
Hutfless S, Matos P, Talor MV, Caturegli P, Rose NR. Significance of prediagnostic thyroid antibodies in women with autoimmune thyroid disease. J Clin Endocrinol Metab. 2011; 96:E1466–71.
Baskin HJ, Cobin RH, Duick DS, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002; 8:457–69.
Walsh JP, Brenner AP, Feddema P, Leedman PJ, Brown SJ, O’Leary P. Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques. J Clin Endocrinol Metab. 2010; 95:1095–104.
Gallagher CM, Meliker JR. Mercury and thyroid autoantibodies in U.S. women, NHANES 2007–2008. Environ Int. 2012; 40:39–43.
Kim ES, Lim DJ, Baek KH, et al. Thyroglobulin antibody is associated with increased cancer risk in thyroid nodules. Thyroid. 2010; 20:885–91.
Gupta P, Kar A. Role of ascorbic acid in cadmium-induced thyroid dysfunction and lipid peroxidation. J Appl Toxicol. 1998; 18:317–20.
Swarup D, Naresh R, Varshney VP, et al. Changes in plasma hormones profile and liver function in cows naturally exposed to lead and cadmium around different industrial areas. Res Vet Sci. 2007; 82:16–21.
Wade MG, Parent S, Finnson KW, et al. Thyroid toxicity due to subchronic exposure to a complex mixture of 16 organochlorines, lead, and cadmium. Toxicol Sci. 2002; 67:207–18.
Yoshizuka M, Mori N, Hamasaki K, et al. Cadmium toxicity in the thyroid gland of pregnant rats. Exp Mol Pathol. 1991; 55:97–104.
Nishida M, Sato K, Kawada J. Differential effects of methylmercuric chloride and mercuric chloride on oxidation and iodination reactions catalyzed by thyroid peroxidase. Biochem Int. 1990; 22:369–78.
Kawada J, Nishida M, Yoshimura Y, Mitani K. Effects of organic and inorganic mercurials on thyroidal functions. J Pharmacobiodyn. 1980; 3:149–59.
Pusey CD, Bowman C, Morgan A, Weetman AP, Hartley B, Lockwood CM. Kinetics and pathogenicity of autoantibodies induced by mercuric chloride in the brown Norway rat. Clin Exp Immunol. 1990; 81:76–82.
Powell JJ, Van de Water J, Gershwin ME. Evidence for the role of environmental agents in the initiation or progression of autoimmune conditions. Environ Health Perspect. 1999; 107(Suppl 5):667–72.
Agency for Toxic Substances and Disease Registry (ASTDR). Toxicological Profile for Mercury. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, 1999.
Chaurasia SS, Kar A. Influence of lead on type-I iodothyronine 5′-monodeiodinase activity in male mouse. Horm Metab Res. 1997; 29:532–33.
Chaurasia SS, Kar A. Protective effects of vitamin E against lead-induced deterioration of membrane associated type-I iodothyronine 5′-monodeiodinase (5′D-I) activity in male mice. Toxicology. 1997; 124:203–09.
Gupta P, Kar A. Cadmium induced thyroid dysfunction in chicken: hepatic type I iodothyronine 5′-monodeiodinase activity and role of lipid peroxidation. Comp Biochem Physiol C Pharmacol Toxicol Endocrinol. 1999; 123:39–44.
Yoshida K, Sugihira N, Suzuki M, et al. Effect of cadmium on T4 outer ring monodeiodination by rat liver. Environ Res. 1987; 42:400–05.
Merrill EA, Clewell RA, Gearhart JM, et al. PBPK predictions of perchlorate distribution and its effect on thyroid uptake of radioiodide in the male rat. Toxicol Sci. 2003; 73:256–69.
Harrington RM, Shertzer HG, Bercz JP. Effects of chlorine dioxide on thyroid function in the African green monkey and the rat. J Toxicol Environ Health. 1986; 19:235–42.
Wang H, Yang Z, Zhou B, Gao H, Yan X, Wang J. Fluoride-induced thyroid dysfunction in rats: roles of dietary protein and calcium level. Toxicol Ind Health. 2009; 25:49–57.
Allain P, Berre S, Krari N, et al. Bromine and thyroid hormone activity. J Clin Pathol. 1993; 46:456–58.
Howdeshell KL. A model of the development of the brain as a construct of the thyroid system. Environ Health Perspect. 2002; 110(Suppl 3):337–48.
Porter WP, Jaeger JW, Carlson IH. Endocrine, immune, and behavioral effects of aldicarb (carbamate), atrazine (triazine) and nitrate (fertilizer) mixtures at groundwater concentrations. Toxicol Ind Health. 1999; 15:133–50.
Brouwer A, Morse DC, Lans MC, et al. Interactions of persistent environmental organohalogens with the thyroid hormone system: mechanisms and possible consequences for animal and human health. Toxicol Ind Health. 1998; 14:59–84.
Hagmar L, Rylander L, Dyremark E, Klasson-Wehler E, Erfurth EM. Plasma concentrations of persistent organochlorines in relation to thyrotropin and thyroid hormone levels in women. Int Arch Occup Environ Health. 2001; 74:184–8.
Persky V, Turyk M, Anderson HA, et al. The effects of PCB exposure and fish consumption on endogenous hormones. Environ Health Perspect. 2001; 109:1275–83.
Chevrier J, Harley KG, Bradman A, Gharbi M, Sjodin A, Eskenazi B. Polybrominated diphenyl ether (PBDE) flame retardants and thyroid hormone during pregnancy. Environ Health Perspect. 2010; 118:1444–9.
Marsh AB, Bergman A, Bladh LG, Gillner M, Jakobsson E. Synthesis of p-hydroxybromodiphenyl ethers and binding to the thyroid receptor.Organohalogen Compounds. 1998; 37:305–8.
Moriyama K, Tagami T, Akamizu T, et al. Thyroid hormone action is disrupted by bisphenol A as an antagonist. J Clin Endocrinol Metab. 2002; 87:5185–90.
Mangano JJ. A post-Chernobyl rise in thyroid cancer in Connecticut, USA. Eur J Cancer Prev. 1996; 5:75–81.
Kronenberg HM, Polonsky KS, Melmed S, editors. Williams Textbook of Endocrinology. Philadelphia: WB Saunders, 2003.
Dong BJ. How medications affect thyroid function. West J Med. 2000; 172:102–6.
Delange F. The disorders induced by iodine deficiency. Thyroid. 1994; 4:107–28.
Pizzulli A, Ranjbar A. Selenium deficiency and hypothyroidism: a new etiology in the differential diagnosis of hypothyroidism in children. Biol Trace Elem Res. 2000; 77:199–208.
Watts DL. The nutritional relationships of the thyroid. J Orthomol Med. 1989; 4:165–9.
Duntas LH. Environmental factors and autoimmune thyroiditis. Nat Clin Pract Endocrinol Metab. 2008; 4:454–60.
Safran M, Paul TL, Roti E, Braverman LE. Environmental factors affecting autoimmune thyroid disease. Endocrinol Metab Clin North Am. 1987; 16:327–42.
Stangl GI, Schwarz FJ, Kirchgessner M. Cobalt deficiency effects on trace elements, hormones and enzymes involved in energy metabolism of cattle. Int J Vitam Nutr Res. 1999; 69:120–6.
Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009; 5:374–81.
Kelly GS. Peripheral metabolism of thyroid hormones: a review. Altern Med Rev. 2000; 5:306–33.
Bugaresti JM, Tator CH, Silverberg JD, et al. Changes in thyroid hormones, thyroid stimulating hormone and cortisol in acute spinal cord injury.Paraplegia. 1992; 30:401–9.
Azizi F, Amini M, Arbab P. Time course of changes in free thyroid indices, rT3, TSH, cortisol and ACTH following exposure to sulfur mustard.Exp Clin Endocrinol. 1993; 101:303–6.
McCormack PD, Thomas J, Malik M, Staschen CM. Cold stress, reverse T3 and lymphocyte function. Alaska Med. 1998; 40:55–62.
Johansson G, Laakso ML, Karonen SL, Peder M. Examination stress affects plasma levels of TSH and thyroid hormones differently in females and males. Psychosom Med. 1987; 49:390–6.
Limanova Z, Sonka J, Kratochvil O, Sonka K, Kanka J, Sprynarova S. Effects of exercise on serum cortisol and thyroid hormones. Exp Clin Endocrinol. 1983; 81:308–14.
Radomski MW, Hart LE, Goodman JM, Plyley MJ. Aerobic fitness and hormonal responses to prolonged sleep deprivation and sustained mental work. Aviat Space Environ Med. 1992; 63:101–6.
Suda AK, Pittman CS, Shimizu T, Chambers JB Jr. The production and metabolism of 3,5,3′-triiodothyronine and 3,3′,5-triiodothyronine in normal and fasting subjects. J Clin Endocrinol Metab. 1978; 47:1311–9.
O’Brian JT, Bybee DE, Burman KD, et al. Thyroid hormone homeostasis in states of relative caloric deprivation. Metabolism. 1980; 29:721–7.
Hugues JN, Burger AG, Pekary AE, Hershman JM. Rapid adaptations of serum thyrotrophin, triiodothyronine and reverse triiodothyronine levels to short-term starvation and refeeding. Acta Endocrinol (Copenh). 1984; 105:194–9.
Palmblad J, Levi L, Burger A, et al. Effects of total energy withdrawal (fasting) on thelevels of growth hormone, thyrotropin, cortisol, adrenaline, noradrenaline, T4, T3, and rT3 in healthy males. Acta Med Scand. 1977; 201:15–22.
Scriba PC, Bauer M, Emmert D, et al. Effects of obesity, total fasting and re-alimentation on L-thyroxine (T4), 3,5,3′-L-triiodothyronine (T3), 3,3′,5′-L-triiodothyronine (rT3), thyroxine binding globulin (TBG), cortisol, thyrotrophin, cortisol binding globulin (CBG), transferrin, alpha 2-haptoglobin and complement C′3 in serum. Acta Endocrinol (Copenh). 1979; 91:629–43.
Burger AG, O’Connell M, Scheidegger K, Woo R, Danforth E Jr. Monodeiodination of triiodothyronine and reverse triiodothyronine during low and high calorie diets. J Clin Endocrinol Metab. 1987; 65:829–35.
Liang H, Juge-Aubry CE, O’Connell M, Burger AG. Organ-specific effects of 3,5,3′-triiodothyroacetic acid in rats. Eur J Endocrinol. 1997; 137:537–44.
Chu M, Seltzer TF. Myxedema coma induced by ingestion of raw bok choy. N Engl J Med. 2010; 362:1945–6.
Fenwick GR, Heaney RK, Mullin WJ. Glucosinolates and their breakdown products in food and food plants. Crit Rev Food Sci Nutr. 1983; 18:123–201.
McMillan M, Spinks EA, Fenwick GR. Preliminary observations on the effect of dietary brussels sprouts on thyroid function. Hum Toxicol. 1986; 5:15–9.
Higdon J. Evidence Based Approach to Dietary Phytochemicals. New York: Thieme Medical Publishers, Inc., 2007.
Dekker M, Verkerk R, Jongen WM. Predictive modelling of health aspects in the food production chain: a case study on glucosinolates in cabbage. Trends Food Sci. 2000; 11:174–81.
Keck E, Degner FL, Schlaghecke R. Alcohol and endocrinologic homeostasis. Z Gastroenterol. 1988; 26:39–46.
Langer P, Foldes O, Gschendtova K. Effect of ethanol and linoleic acid on changes in biliary excretion of iodothyronines possibly related to thyroxine deiodination in rat liver. Horm Metab Res. 1988; 20:218–220.
Loucks AB, Callister R. Induction and prevention of low-T3 syndrome in exercising women. Am J Physiol. 1993; 264:R924–30.
Loucks AB, Heath EM. Induction of low-T3 syndrome in exercising women occurs at a threshold of energy availability. Am J Physiol. 1994; 266:R817–23.
Timbo BB, Ross MP, McCarthy PV, Lin CJ. Dietary supplements in a national survey: prevalence of use and reports of adverse events. J Am Dietet Assoc. 2006; 106:1966–74.
Sourgens H, Winterhoff H, Gumbinger HG, Kemper FH. Effects of Lithospermum officinale and related plants on hypophyseal and thyroid hormones in the rat. Pharmaceut Biol. 1986; 24:55–63.
Hur YG, Yun Y, Won J. Rosmarinic acid induces p56lck-dependent apoptosis in Jurkat and peripheral T cells via mitochondrial pathway independent from Fas/Fas ligand interaction. J Immunol. 2004; 172:79–87.
Hur YG, Suh CH, Kim S, Won J. Rosmarinic acid induces apoptosis of activated T cells from rheumatoid arthritis patients via mitochondrial pathway. J Clin Immunol. 2007; 27:36–45.
Park SH, Oh HS, Kang MA, et al. The structure-activity relationship of the series of non-peptide small antagonists for p56lck SH2 domain.Bioorg Med Chem. 2007; 15:3938–50.
Won J, Hur YG, Hur EM, et al. Rosmarinic acid inhibits TCR-induced T cell activation and proliferation in an Lck-dependent manner. Eur J Immunol. 2003; 33:870–9.
Kang MA, Yun SY, Won J. Rosmarinic acid inhibits Ca2+-dependent pathways of T-cell antigen receptor-mediated signaling by inhibiting the PLC-gamma 1 and Itk activity. Blood. 2003; 101:3534–42.
Frances D. Botanical approaches to hypothyroidism: avoiding supplemental thyroid hormone. Med Herb. 2002; 12:1–5.
Singh AK, Tripathi SN, Prasad GC. Response of commiphora mukul (guggulu) on melatonin induced hypothyroidism. Anc Sci Life. 1983; 3:85–90.
Tripathi YB, Malhotra OP, Tripathi SN. Thyroid stimulating action of Z-guggulsterone obtained from Commiphora mukul. Planta Med. 1984; 50:78–80.
Tripathi YB, Tripathi P, Malhotra OP, Tripathi SN. Thyroid stimulatory action of (Z)-guggulsterone: mechanism of action. Planta Med. 1988; 54:271–7.
Antonio J, Colker CM, Torina GC, Shi Q, Brink W, Kaiman D. Effects of a standardized guggulsterone phosphate supplement on body composition in overweight adults: a pilot study. Curr Ther Res. 1999; 60:220–7.
Panda S, Kar A. Gugulu (Commiphora mukul) induces triiodothyronine production: possible involvement of lipid peroxidation. Life Sci. 1999; 65:L137–41.
Zagrodzki P, Ratajczak R. Selenium supplementation in autoimmune thyroiditis female patient—effects on thyroid and ovarian functions (case study). Biol Trace Elem Res. 2008; 126:76–82.
Duntas LH. The role of selenium in thyroid autoimmunity and cancer. Thyroid. 2006; 16:455–60.
Ekholm R, Bjorkman U. Glutathione peroxidase degrades intracellular hydrogen peroxide and thereby inhibits intracellular protein iodination in thyroid epithelium. Endocrinology. 1997; 138:2871–78.
Grineva EN, Malakhova TV, Tsoi UA, Smirnov BI. [Efficacy of thyroxine and potassium iodide treatment of benign nodular thyroid lesions]. Ter Arkh. 2003; 75:72–5.
Goodman HM. Thyroid Gland, 4th edn. Basic Medical Endocrinology. Burlington, MA: Academic Press, 2009.
Kogai T, Liu YY, Richter LL, Mody K, Kagechika H, Brent GA. Retinoic acid induces expression of the thyroid hormone transporter, monocarboxylate transporter 8 (Mct8). J Biol Chem. 2010; 285:27279–88.
Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011; 99:39–51.
Kahaly GJ, Dienes HP, Beyer J, Hommel G. Iodide induces thyroid autoimmunity in patients with endemic goitre: a randomised, double-blind, placebo-controlled trial. Eur J Endocrinol. 1998; 139:290–97.
Tamer G, Arik S, Tamer I, Coksert D. Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid. 2011; 21:891–6.
Cantorna MT, Mahon BD. Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Exp Biol Med (Maywood). 2004; 229:1136–42.
Ginanjar E, Sumariyono,Setiati S, Setiyohadi B. Vitamin D and autoimmune disease. Acta Med Indones. 2007; 39:133–41.
Chen W, Lin H, Wang M. Immune intervention effects on the induction of experimental autoimmune thyroiditis. J Huazhong Univ Sci Technol Med Sci. 2002; 22:343–5, 354.
Fournier C, Gepner P, Sadouk M, Charreire J. In vivo beneficial effects of cyclosporin A and 1,25-dihydroxyvitamin D3 on the induction of experimental autoimmune thyroiditis. Clin Immunol Immunopathol. 1990; 54:53–63.
Lemire JM, Archer DC, Beck L, Spiegelberg HL. Immunosuppressive actions of 1,25-dihydroxyvitamin D3: preferential inhibition of Th1 functions. J Nutr. 1995; 125:1704S–8S.
Kivity S, Agmon-Levin N, Zisappl M, et al. Vitamin D and autoimmune thyroid diseases. Cell Mol Immunol. 2011; 8:243–7.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 4.0). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.