Hashimoto thyroiditis (chronic autoimmune thyroiditis)

An autoimmune thyroid disease with antibody-mediated thyroid tissue destruction. The clinical course ranges from euthyroidism with antibodies and no symptoms to subclinical and overt hypothyroidism. Standard therapy in hypothyroidism: levothyroxine. Selenium is discussed as an adjunct for antibody titre reduction.

ICD-10 E06.32 drugs

Also known as: Hashimoto disease, Chronic autoimmune thyroiditis

Drugs used for this condition

CSelenium (oral salts and chelates: selenomethionine, sodium selenite, selenium yeast)Case-by-case decision · Mineral supplements. Trace elementsThe 2013 Cochrane review showed a moderate reduction in TPO antibody titres with selenomethionine 200 µg daily in autoimmune thyroiditis. The clinical significance of antibody titre reduction is debated – long-term effects on progression to hypothyroidism, levothyroxine dose, or symptoms have not been confirmed in large RCTs. Russian endocrinology guidelines 2021 do not include selenium as first-line in Hashimoto thyroiditis. The decision is individualised.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

DIodine (umbrella: potassium iodide, kelp / Fucus vesiculosus)Not recommended · Trace element; substrate of thyroid hormone synthesisBiohacker blogs frame high-dose iodine (12.5 mg Iodoral / Lugol protocol, 50 mg Brownstein) as «Hashimoto treatment» and «thyroid activation». Endocrine Society 2017 and SEEN strongly advise against this: in autoimmune thyroiditis excess iodine accelerates gland destruction and shifts patients into hypothyroidism. NIH ODS 2024 notes that milligram iodine doses (60–300 times the daily requirement) are hazardous. Hashimoto management is levothyroxine titrated to TSH under endocrinology supervision, not iHerb Lugol. If milligram iodine has been prescribed without anti-TPO antibody testing, consider a second opinion.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit