Episode 131: Can Hashimoto's Be Reversed? The Honest Answer Nobody Explains
Is Hashimoto's permanent?
If you've been diagnosed with Hashimoto's thyroiditis, you've probably searched the same question countless times: Can Hashimoto's be reversed? Depending on where you look, you'll either find promises of a cure or be told you'll simply have to live with it forever. The truth is far more nuanced, and far more hopeful. In this episode, Nicole Goode breaks down what current research actually says about Hashimoto's remission, thyroid antibodies, thyroid medication, and functional medicine, so you can stop sorting through conflicting advice and start making informed decisions about your health.
You'll learn the critical difference between reversal, remission, and disease management, why lowering your thyroid antibodies doesn't necessarily mean you're cured, and what the latest evidence says about selenium, gluten, gut health, nutrient deficiencies, chronic stress, hormones, and viral infections like EBV.
Nicole also shares the evidence-based framework she uses in clinic to help patients reduce symptoms, calm autoimmune activity, and support long-term thyroid health, without chasing unrealistic promises or relying on fear-based wellness advice.
This episode answers questions like:
“Can Hashimoto's go into remission?”
“Can thyroid antibodies go back to normal?”
“Should everyone with Hashimoto's avoid gluten?”
“What causes Hashimoto's flare-ups?”
“Can you stop taking thyroid medication?”
“Can Hashimoto's symptoms disappear?”
“What supplements help Hashimoto's?”
Whether you're newly diagnosed or you've been living with Hashimoto's for years, this episode will help you understand what's actually possible, where to focus your energy, and how to build a sustainable plan that works with your body instead of against it. If you're looking for clear answers, practical guidance, and an honest conversation grounded in both science and clinical experience, this is the episode you've been searching for.
DISCLAIMER: The content in this podcast and related website is not intended to be a substitute for medical advice. It is not intended to be used to diagnose or treat, instead it is designed to help educate and inspire. Always seek the advice of a professional medical practitioner or qualified health practitioner. Never ignore or disregard advice given to you based on information in this podcast or related website and do not delay in seeking medical advice.
Timestamps:
[01:23] - Remission vs. Reversal Explained
Understand the difference between reversal, remission, and managing Hashimoto's.
[03:49] - Can You Lower Hashimoto's Antibodies?
What current research says about reducing thyroid antibodies naturally.
[05:20]- Does Going Gluten-Free Help Hashimoto's?
Who benefits from eliminating gluten, and who may not.
[07:00]- Which Hashimoto's Symptoms Can Actually Improve?
Fatigue, brain fog, hair loss, weight gain, and thyroid medication.
[08:00]- What Can't Be Reversed with Hashimoto's?
Why remission is a more realistic goal than chasing a cure.
[10:55]- How to Support Hashimoto's Naturally
Gut health, stress, nutrients, hormones, EBV, and root-cause treatment.
[13:50]- How to Support Hashimoto's Naturally
When medication changes may be possible, and when they aren't
“The wellness world often tells you Hashimoto’s can be completely cured. Conventional medicine often tells you there’s nothing you can do except take medication. The truth is neither of those extremes. You may not be able to erase your autoimmune predisposition, but you can absolutely calm the immune attack, reduce symptoms, lower antibodies, and help your body feel well again. And that’s a message more people need to hear.”
Essential learnings from this episode…
Reversal and remission are not the same thing. Many people ask if Hashimoto's can be reversed, but remission is often the more realistic, and achievable goal.
Research shows that thyroid antibodies are not fixed forever. Targeted interventions like correcting nutrient deficiencies and addressing root causes may help reduce Hashimoto's antibodies.
Gluten isn't the answer for everyone with Hashimoto's. Some people experience significant improvements after removing gluten, while others see little change. The key is identifying whether gluten is one of your individual triggers rather than following a one-size-fits-all approach.
Treating Hashimoto's goes far beyond thyroid medication. Supporting gut health, reducing chronic stress, correcting nutrient deficiencies, balancing hormones, and addressing infections like EBV can all play an important role in improving symptoms and long-term thyroid health.
The best outcomes often come from combining appropriate thyroid medication with a personalized functional medicine approach that addresses the underlying drivers of autoimmune disease.
Stop chasing a cure, start building long-term health. Focusing on helping your body reach remission instead of searching for a miracle cure can lead to better energy, clearer thinking, fewer symptoms, and a healthier relationship with your diagnosis.
EPISODE 131
Important links & mentions from this episode
The Optimal You 7 Day Reset (£7.99)
Episode 92: How Hashimoto’s Affects the Brain: 5 Signs of Neuroinflammation
Episode 119: How Gut Health Affects Your Immune System + 5 Myths Debunked with Eli Brecher
Episode 126: Perimenopause or Thyroid Problems? How to Tell the Difference (And Why It Might Be Both)
Episode 127: How Your Home Environment Impacts Thyroid Health & Autoimmune Disease
Episode 130: Can Epstein-Barr Virus Cause Multiple Sclerosis? New Research Explained
Goode Health Clinic Functional Medicine Packages
Take the FREE MitoImmune Health Assessment
-
(0:00 - 2:20)
If you've been diagnosed with Hashimoto's, I will bet money that you have typed this question into Google probably in the middle of the night and probably more than once. Can Hashimoto's be reversed? Because it is the question, it's the one everyone wants the answer to. And depending on where you look, you get one of two answers.
The wellness industry says yes, and very often offers to sell you the cure. Conventional medicine says no, this is for life, take your medication and get on with it. And both of those answers, in my view, are wrong, because both of them are too clean cut.
So today I want to give you the honest answer. I'm Nicole Goode, a certified functional medicine practitioner, and this is the Goode Health podcast. Today's episode is the one I've been quietly putting off doing for a while.
I knew I needed to do it. I knew this discussion needs to be had because Hashimoto's reversal is a question with thousands of articles online and very, very little nuance attached to any of them. It's also the thing that people ask me most on enquiry calls.
So today I'm going to walk you through what the actual evidence says about what can change, what probably can't change, why the distinction matters, and the functional medicine playbook I use with people in clinic, what I prioritise and in what order, and the mindset shift that in my experience makes the biggest practical difference of all. This is deliberately not a quick episode because the question deserves a real answer. So let's jump straight in.
Before I tell you what can and can't change, I want to spend a couple of minutes on language because so much of the confusion around this whole question is honestly a language problem. When people say reversed, what they're usually meaning is something like, I want this gone. I want my immune system to stop attacking my thyroid.
I want my antibodies to be undetectable. I want to come off medication. I want my body back the way it was before.
I don't want to have Hashimoto's. And that is a completely understandable wish. And it's something that we would all reach for.
But medically, there are some distinctions that we need to draw because they change what we are actually aiming for and what counts as success. There is reversal, meaning the disease process is undone completely and permanently. The autoimmune attack is gone.
Antibodies are negative. Thyroid function is fully restored and there is no medication. So that is what language around reversal can mean.
(2:20 - 3:55)
That's what some people mean when they're talking about it. But there is also language around remission. So remission means the disease is quiet.
It's still there, but it's quiet. Symptoms are managed or they are absent. Antibody levels may drop, sometimes dramatically.
They may become normal again. The underlying autoimmune predisposition is still there with remission, but it is not actively expressing itself in a way that disrupts your life. And I think this distinction between reversal and remission is really important because actually when people are asking the question, can Hashimoto's be reversed? What they really want to know is, can Hashimoto's get into remission? And there's a very different answer to those two questions.
Then we also have management, meaning the symptoms are controlled, usually with medication. You feel well enough, even though the disease is still active and still there in the background. So that's another situation that can happen.
Now, most of the people who I see in clinic who feel really well with Hashimoto's are somewhere on that spectrum between very well-managed and remission. So quite often they don't have detectable antibodies, but they may not be medication-free, but they're doing everything to support their thyroid. They're well and they're living their lives and they're not defined by the diagnosis.
When I answer the question, can Hashimoto's be reversed? The honest answer changes a lot depending on which of those things you actually mean. So let me give you the honest answer to each one. Let's start with the good news, because there is a lot of it and there is now genuine mainstream evidence behind much of it.
(3:55 - 5:03)
This isn't wellness conjecture anymore. What can change is your antibody levels, sometimes by a lot and sometimes back into normal range. And one of the clearest single interventions for that is selenium.
So this is a really good example. A 2024 meta-analysis pulled together 29 studies with more than 2000 patients across those studies and found that selenium supplementation produced a statistically significant reduction in thyroid antibodies, specifically the TPO antibodies. Earlier trials at 200 microgrammes a day showed reductions of 40 to 50 percent over time with meaningful changes appearing as early as three months and continuing through 12 months of consistent use.
So that's a serious effect. And that's just one of the things that can impact antibody levels. But this shows you that this is real science and that is your immune system genuinely calming down its attack on your thyroid in response to just one well-targeted nutrient.
And like I said, there's so much more that can be done here. This is just an example. Now, as a caveat, please do not go and start taking tonnes of selenium because of this episode.
(5:03 - 8:41)
Selenium is one of those nutrients where dose really matters and too much can cause its own problems as well. So this is something to do with a practitioner who knows your levels, knows your antibody levels and can look at what the right dose is for you. But the principle stands, your antibodies are not a permanent number.
They can move. So what else can change them? The evidence for gluten elimination, for example. This is a hugely talked about topic in Hashimoto's world.
And honestly, it's a little bit more mixed than the wellness Internet would have you believe. A 2023 meta-analysis of non-celiac Hashimoto's patients found that a gluten-free diet did improve TSH and free T4, which is meaningful for how you feel. But the reduction in TPO antibodies did not reach statistical significance.
There was a trend, but the data was genuinely a bit mixed. So some of the studies behind this are a little bit mixed and we do see sometimes gluten can help bring those antibody levels down. Sometimes we need to reduce the gluten, but we need to do other things as well.
For example, the selenium. So sometimes more than just gluten elimination is needed to bring those antibodies down. For other people, just eliminating gluten will bring those antibodies down.
So everybody is slightly different. And this doesn't mean that gluten elimination is pointless, far from it. What it means is that gluten removal helps a subgroup of people, particularly people with underlying gluten sensitivity or gut barrier issues or celiac disease itself, or even just some of the genetics for celiac disease.
And we know that most people with Hashimoto's have at least one of those. And actually the crossover of Hashimoto's and celiac is much more common than in the general population. So more people with Hashimoto's will have celiac than the general population would have.
So if you are someone where removing gluten makes you feel dramatically better, your body is telling you something real and you should listen. If you remove it for six months and nothing changes, there's another driver that we need to find. We need to look elsewhere to build on that.
What else can change? Symptoms can change, sometimes dramatically. Energy, brain fog, mood, weight, hair, sleep. When you genuinely address the root drivers underneath the autoimmune process, many people experience real durable improvement that they thought they'd lost forever.
And medication needs can change too. Some people with consistent work on root causes over time can reduce medication. And that should always be done under careful supervision of your doctor.
And it isn't a guarantee. We can never say, a lot of people will come into clinic and say, can you get me off my medication? No, it's no guarantee that we can get you off medication. And it shouldn't be the goal, but it does happen.
Real people, real cases, real practitioners, including myself in clinic, have seen it. So if your question is, can my Hashimoto's get meaningfully better with my antibodies dropping, my symptoms resolving, my medication needs potentially changing? The honest answer is yes. Very often, yes.
Now the part that most people don't want to hear, but the part that in my experience actually sets people free, the things that can't change. So what probably can't change is your underlying autoimmune predisposition. You have a genetic loading that made you more vulnerable to autoimmunity in the first place.
And that loading is still there. And once your immune system has learned to recognise your thyroid as a target, once that immune memory is established, it doesn't, in most cases, fully unlearn that. Your immune system has a memory.
That is actually one of its greatest strengths in other contexts. And it's why vaccines work. It's why your immunity to chickenpox lasts for decades.
(8:41 - 9:12)
But in autoimmunity, that memory is part of the problem. The cells that learn to recognise your thyroid stay around, even when the active attack is dialled all the way down. So the most honest thing that I can tell you with this is the autoimmune process can become quiet.
And quiet is genuinely properly transformative. But the immune system's familiarity with your thyroid is, in most cases, a permanent feature. Which means, and here is the part that matters most, even when you reach a state where your antibodies are low and your symptoms are gone, the predisposition stays.
(9:12 - 9:45)
So the work doesn't really end. It just changes. You don't want to get to a point where you feel better and then stop doing all of the things that you've been doing to feel that way.
You move from active intervention to active maintenance. And I know that that can sound disappointing at first. It can sound like a sentence.
But sit with it for a moment because the reframe is actually freeing. If your goal is not make this gone forever, but find what my body needs to settle and keep giving it to my body, that's a very achievable goal. That's a goal that you don't keep failing at.
(9:45 - 10:37)
And this is exactly why the distinction between reversal and remission matters so much. Because the wrong goal will exhaust you. I see this in clinic all the time.
Someone comes to me having read every Hashimoto's book, listened to every Hashimoto's podcast, tried every protocol, spent thousands on supplements, removed everything from their diet, and they are utterly depleted. Not because the interventions themselves are wrong, but because they are chasing a finish line that may not exist for them. They're not aiming for a mission which is real and achievable.
They're aiming for complete eradication, which sets up a story in which they are constantly failing. And that's exhausting. And then on the other end of the spectrum, I see people who have been told this is for life, take your medication, there's nothing else that you can do.
And they've given up. They've totally given up on the idea that they could feel any better. And that's not true either.
(10:37 - 10:54)
So please hear this. The wellness internet over promises. Conventional medicine with Hashimoto's often under promises.
The truth sits somewhere squarely in the middle. And the middle is clinical remission, very well managed disease, and symptom freedom. And that is genuinely a great place to be.
(10:55 - 11:50)
So what does the actual work look like? Let me give you a bit of an insight into what I use in clinic, because I get asked this all the time, and I think it helps to see the shape of it. So one of the things we need to look at is the gut. Hashimoto's and gut function are deeply interconnected, and you cannot calm an immune system that is attacking the thyroid while the gut barrier is leaky.
The microbiome is dysregulated and food sensitivities are pouring fuel onto the fire every single day. So we look at gut function, we look at digestion, we look at the microbiome, we look at the bowel, and we do real structured work there, not a probiotic and hope for the best. We need to look at stress and the nervous system.
Chronic stress is one of the most reliable drivers of immune dysregulation. And the relationship between cortisol and autoimmune flares is well established. So if your nervous system is in a state of chronic activation, and honestly, so many of the people I see with Hashimoto's sit exactly there, that has to be addressed.
(11:51 - 12:02)
And I want to be clear, this is not a do some meditation approach. This is a genuine structural change on how your nervous system actually spends its days. Third is your nutrient status.
(12:03 - 12:36)
Hashimoto's depletes certain nutrients, and certain nutrient deficiencies make Hashimoto's worse. Selenium, I've already mentioned. Iron as well.
Many women with Hashimoto's are quietly low in iron, and low iron impairs the conversion of thyroid hormone into its active form. Vitamin D as well, strongly associated with autoimmune outcomes. Zinc, B12.
These are not glamorous, but they are foundational and they will make a difference. And then viral load and infectious load. And we touched on this going back to last week's episode when we looked at EBV.
(12:36 - 12:58)
Viral reactivation is increasingly understood as a driver of Hashimoto's, just as it is in MS that we discussed last week. So if there is a clear infectious history, EBV, chronic Lyme, persistent low-grade infections, that becomes part of the picture too. And bringing down that viral load and reducing viral reactivation is really important and can have a significant difference.
(12:59 - 13:09)
And then hormones. Hashimoto's lives right at the intersection of the thyroid and the sex hormones. Perimenopause very often unmasks or makes much worse an underlying Hashimoto's process.
(13:10 - 14:39)
And I've talked about this in real detail before. So if you're in your 40s and your Hashimoto's has just appeared or just got noticeably harder, there could be a hormone story to address. And then environmental load.
The home and thyroid episode I did is the long version of this. But in short, your environment is part of your immune environment and reducing what it's coming into contact with absolutely matters. These are some of the things that we look at.
Gut, stress, nutrients, viral load, hormones, environment. Not as a checklist, not to do all at once. That would be really overwhelming.
But these are things that we need to consider when we're working on the thyroid, not just the thyroid itself. And doing this with a practitioner is really going to help you to find the right steps for you to make sure that you're moving in the right direction for what's going on in your body. Now, a quick word on medication, because this comes up every single time.
You do not have to choose between conventional medicine and functional medicine. In fact, I have a conventional medicine GP in clinic that we work with, with our thyroid and Hashimoto's patients. I want to say that as clearly as I possibly can, because the wellness world sometimes frames this as binary, as if taking thyroid medication is somehow giving up or admitting defeat.
And it absolutely isn't. Levothyroxine and the other thyroid medications are genuinely useful tools. And often the most important thing you can do first is to get that level right and get your TSH balanced and then start working on everything else that we need from the functional medicine.
(14:39 - 16:42)
For many people, getting on the right dose of the right medication is the thing that finally lets them function and lets them be able to work on all the other things we look at through functional medicine. Over time, that dosage may then need to be reassessed by your doctor, and it may be reduced. But what we know is that you do not have to choose between one or the other.
And that is really important. The goal is the lowest friction life. It's not an ideological purity.
Some people end up needing less medication over time as the underlying work pays off. Some people stay on a steady dose forever and feel completely well. Both of those are genuinely good outcomes.
So don't let anyone make you feel otherwise. Let me leave you with the mindset shift that I think makes the biggest practical difference of anything I've said today. If you can move from I want this gone to I want to give my body what she needs to settle, everything changes.
You stop chasing a finish line that may or may not exist for you. You stop punishing yourself when you do not reach it. You start instead to notice the actual improvements, the energy that comes back, the hair that thickens, the mood that lifts, the brain fog that clears, and you start trusting your body to keep being supported.
Hashimoto's become something you live alongside well rather than something you are constantly trying to defeat, which, as we've said, is exhausting. And that, in my experience, is where the real wellness lives with this condition. Not in the elusive promise of cured, but in a quiet, real, daily settling of a body that is finally being properly listened to.
If you want a stretched starting point for this work, somewhere to begin that isn't just another supplement or another diet, Optimal You is the book I wrote to walk you through these pillars, including a thyroid pillar, but also all the other ones that we have touched on, so that you understand the system you're working with and you can build from foundations rather than chasing protocols. We'll link the book in the show notes below this episode. And if you would like the whole picture properly assessed, the gut, the immune side, the hormones, all of it together as one interconnected system, that's exactly what the mitoimmune health assessment is built for.
(16:42 - 17:19)
And you can take that free online. We'll link it in the show notes below. So the honest answer, can Hashimoto's be reversed in the strictest sense? Probably not for most people.
Can it become genuinely beautifully quiet? Can you reach remission? Absolutely yes. Antibodies can fall. Symptoms can lift.
Life can come back. You do not need to chase cured. You need to aim for well, and well is right there for you to take.
Thank you for being here with me today. If you think somebody would benefit from this episode, then please do share it. And don't forget to rate on your favourite podcast app.
Look after yourself and I'll see you next week on the Goode Health podcast.
Thank You For Tuning In
We are so grateful for you tuning in today to our podcast. If you enjoyed today’s show, you can really help us spread the word by sharing the episode and joining in on the conversation over on Instagram @goode_health.
Rating and reviewing the episode is highly helpful, I promise I read every single one and reviewing the show really helps us in the podcast charts.
Finally, don’t forget to subscribe to the show on your favourite podcast player so that you don’t miss an episode!
