Sources & how to read the evidence

This guide was built from the primary literature — clinical guidelines, randomised trials, and meta-analyses — and graded by how strong the evidence actually is. Hashimoto's sits between cautious mainstream medicine and a busy functional-medicine world, so where a claim is thin or a product is hyped, it says so and shows both sides.

How it was built

The approach: Every load-bearing claim comes from a named guideline, trial, or meta-analysis, with the evidence dots (●●●●● = strong and replicated, down to ○○○○○ = essentially unproven) reflecting study design, size, and replication. Figures are group averages; individuals vary widely. This is educational, not a diagnosis or a prescription — and where the mainstream and functional camps genuinely disagree (T3/NDT, antibody-tracking, the 'optimal' TSH), it shows both sides rather than picking one.
The key sources: What it is & why it hides: the StatPearls Hashimoto's review and ATA patient materials, plus the pre-clinical-antibody, hashitoxicosis, iodine-excess, and smoking-paradox literature. Tests & interpretation: the ATA thyroid-function-test guidance, the anti-TPO performance and Whickham-progression data, and the TSH reference-range debate. Treatment: the 2014 ATA hypothyroidism guideline, the 2021 ATA/BTA/ETA combination-therapy consensus, the TRUST trial (subclinical), and the 2017 ATA pregnancy guideline. Diet & supplements: the Teng iodine study (NEJM) and the U-shaped-curve data, the Krysiak gluten-free pilot, the Abbott AIP study, the selenium meta-analyses, and the Farhangi Nigella sativa trial. The frontier: the LDN autoimmune literature, the peptide reviews, the TSHR-peptide tolerance trial in Graves', the CAR-T-for-autoimmunity reviews, and the novel-T3 and thyroid-organoid work.

Educational reference — not medical advice

This guide summarises published research for general education. It is not a diagnosis, a prescription, or a substitute for care. A normal TSH does not rule out Hashimoto's — push for the antibodies if you're symptomatic — and never start, stop, or change thyroid medication on your own. Be especially wary of high-dose iodine and anything sold as a 'cure,' and decide everything here with a qualified clinician.

The Hashimoto’s Guide