Recent studies support the growing interest in alternative healthcare and natural remedies. Complementary and integrative medicine (CIM) refers to the group of modalities not typically part of standard practices in the conventional healthcare model. According to the American Thyroid Association, patients with thyroid disease choose CIM to help cope with the side effects of conventional medicine, ease the stress and anxiety related to chronic disease, find adjunctive care, and try to cure their disease (11). 

Ashwagandha, a revered herb in Ayurvedic medicine, has a longstanding history of traditional use for its adaptogenic properties, promoting overall well-being and vitality. Recently, it has garnered increasing attention for its potential benefits in thyroid health. As a natural remedy, ashwagandha's adaptogenic and anti-inflammatory qualities are being explored for their potential to support thyroid function and complement conventional treatments for thyroid disorders.

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Understanding Thyroid Health and Disorders

The thyroid gland is a crucial component of the endocrine system, responsible for producing hormones that regulate various bodily functions. The hypothalamus and pituitary gland tightly control thyroid function through a signaling cascade called the hypothalamic-pituitary-thyroid (HPT) axis. 90% of the thyroid hormones are released as thyroxine (T4), which is converted to triiodothyronine (T3). These hormones are essential for maintaining metabolism, energy production, and overall cellular function. 

Hypothyroidism occurs when the thyroid produces insufficient hormones, leading to symptoms such as fatigue, weight gain, and cold intolerance. Hashimoto's thyroiditis is the most common cause of hypothyroidism in iodine-sufficient areas of the world. In this type of hypothyroidism, the immune system produces antibodies that attack and damage the thyroid, impairing its ability to produce sufficient hormones.

Hyperthyroidism results from an overactive thyroid that produces excessive hormones, causing symptoms such as anxiety, insomnia, and heat sensitivity. 80% of hyperthyroid cases in the United States are caused by Graves' disease, an autoimmune disorder characterized by autoantibodies that stimulate the thyroid gland to overproduce thyroid hormones. 

Conventional treatments for thyroid disease typically rely on medications that balance thyroid hormone levels. Synthetic thyroid hormone replacement with levothyroxine (replacement T4) is the first-line therapy for managing hypothyroidism. Hyperthyroidism can be treated with antithyroid medications (methimazole or propylthiouracil), radioactive iodine ablation of the thyroid gland, or surgical removal of the thyroid gland. 

What Is Ashwagandha?

Ashwagandha (Withania somnifera) is an adaptogenic herb with a rich history in Ayurvedic medicine, where it is revered for its numerous health-promoting properties. Commonly referred to as Indian ginseng or winter cherry, ashwagandha has been used for thousands of years, with records of its use dating back to ancient Egypt, to address a variety of ailments and promote overall well-being. (25) 

In Ayurveda, ashwagandha is classified as a Rasayana, a rejuvenating tonic believed to enhance vitality and longevity. It has been traditionally employed to combat stress and inflammation, improve energy levels, support reproductive function, and boost the immune system. Ayurvedic practitioners utilize ashwagandha to address a multitude of conditions, including arthritis, constipation, insomnia, anxiety, and neurodegenerative diseases. (25)

The primary active constituents isolated from ashwagandha's aerial parts and roots include steroidal lactones (withanolides and withaferins), sitoinosides, and alkaloids. These active components have demonstrated anti-inflammatory, anti-cancer, antioxidant, adaptogenic (anti-stress), neuroprotective,  immunomodulatory, and endocrinological properties in various studies.

Ashwagandha's Role in Thyroid Function

Plenty of research supports ashwagandha's beneficial actions on the various branches of the endocrine system, including the pituitary, adrenal glands, ovaries, testes, and thyroid.

As an adaptogen, ashwagandha's influence over the hypothalamic-pituitary-adrenal (HPA) axis has been widely studied. The HPA axis is the neuroendocrine system that regulates the body's response to stress. It involves a complex interplay between the hypothalamus, pituitary gland, and adrenal glands, leading to the secretion of hormones, such as cortisol, which play a central role in the body's stress response and overall homeostasis. Adaptogens exert their anti-stress effects by modulating the activity of the HPA axis. This has been confirmed with clinical studies that have measured significant reductions in stress hormones (cortisol and DHEA-S) in stressed and anxious individuals taking supplemental ashwagandha. 

You may wonder, "How is this pertinent to thyroid function?" The body's response to stress indirectly influences the regulation of thyroid hormones. Cortisol suppresses the HPT axis by inhibiting the release of hormones called thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH) from the hypothalamus and pituitary, respectively. Ultimately, this results in decreased production and conversion of thyroid hormones. In cases of stress-mediated hypothyroidism, ashwagandha can be used as a natural stress-relieving agent to balance cortisol levels and optimize thyroid function. (10) 

It also appears that ashwagandha can directly influence thyroid function by influencing the HPT axis and preventing oxidative stress within the thyroid gland. Studies suggest that ashwagandha can increase the thyroid's secretion of T4 and T3. It is important to note that many of these findings have come from animal models; therefore, while promising, it is essential to interpret them with caution. However, there is one small study that has been able to reproduce similar results in humans with subclinical hypothyroidism (SCH). SCH is defined as thyroid dysfunction as indicated by high TSH and normal T4. In a double-blind, randomized, placebo-controlled trial, Sharma et al. evaluated the responses of 50 patients with SCH to placebo or ashwagandha root extract (administered at 300 mg twice daily). At the end of the 8-week trial, patients taking ashwagandha had measurable increases in T4 and T3 and significant reductions in TSH. While more studies are needed, these results suggest that ashwagandha is indicated in treating SCH. 

Integrating Ashwagandha in Thyroid Disorder Management 

Integrative endocrinology involves a comprehensive approach to hormonal health, combining conventional medical practices with complementary and lifestyle interventions. It emphasizes addressing the root causes of endocrine imbalances and optimizing overall well-being. 

In conjunction with conventional thyroid treatments, ashwagandha could be an adjunctive therapy to address the underlying causes and symptoms of thyroid dysfunction. An example is using ashwagandha to balance the HPA axis and practicing mind-body therapies to reorient to stressful triggers to address stress-mediated thyroid dysfunction. Additionally, ashwagandha could be recommended as a natural immunomodulating agent to balance the innate and adaptive immune systems and reduce inflammation in patients with thyroiditis (thyroid inflammation). 

Ashwagandha can also be used in palliative care, relieving uncomfortable symptoms as thyroid hormones are being rebalanced and underlying imbalances are being corrected. Clinical trials have shown ashwagandha to be effective in treating anxiety, insomnia, poor cognition, joint pain, and muscle fatigue – common symptoms of thyroid disorders. 

Dosage, Forms, and Administration of Ashwagandha

Ashwagandha can be bought in capsule, powder, tincture, and tea forms. Root and leaf extracts should be standardized to contain up to 35% withanolides. Ashwagandha extract is commonly dosed between 250-500 mg, taken once to twice daily. 

For patients taking ashwagandha in conjunction with thyroid replacement therapy: Taking other medications or supplements at the same time as synthetic thyroid hormones can interfere with the absorption of these medications. It is recommended that thyroid replacement medications, including levothyroxine, liothyronine, and desiccated thyroid extract, be taken on an empty stomach at least 30-60 minutes before food, drinks (except for water), medications, and supplements.

Safety and Precautions in Using Ashwagandha

Current literature supports that ashwagandha can be taken safely in doses of 1,000 mg daily for up to three months. Beyond anecdotal reports, the existing scientific data is presently inadequate to make conclusions on its long-term safety.

Mild side effects, including diarrhea, nausea, and vomiting, have been reported with using ashwagandha in large doses. There have been a few (rare) number of cases reported linking ashwagandha use to liver injury. (38) 

Patients who are pregnant, breastfeeding, scheduled for surgery, or have hormone-sensitive prostate cancer should not take ashwagandha before consulting a healthcare professional. There is also evidence that ashwagandha may interact with certain medications, including those for diabetes and high blood pressure, immunosuppressants, and sedatives. (3) 

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Ashwahandha and Thyroid Health: Key Takeaways

Ashwagandha holds a significant place in traditional medicine, and its adaptogenic and medicinal properties make it a subject of interest in contemporary health and wellness discussions. Given its direct effects on neuroendocrine signaling pathways, there is a growing amount of promising evidence supporting the use of ashwagandha in modulating stress and thyroid function. As with any supplement, individuals considering ashwagandha supplementation should consult with healthcare professionals, especially if they have underlying health conditions or are taking medications.