Beyond levothyroxine: a narrative review of adjunctive management strategies for Hashimoto's thyroiditis.

BACKGROUND AND OBJECTIVE: Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disorder and the leading cause of hypothyroidism worldwide. Standard management primarily relies on thyroid hormone replacement, with surgical intervention reserved for patients with compressive symptoms or malignancy. Although biochemical euthyroidism can usually be achieved with appropriate hormone therapy, a subset of patients continues to report persistent symptoms such as fatigue, cognitive difficulty, weight changes, and reduced quality of life (QOL), even after biochemical optimization. This narrative review summarizes current evidence on adjunctive, non-hormonal, and non-surgical management strategies for HT. METHODS: A narrative review of the literature was conducted to evaluate available data on alternative medicine approaches, dietary interventions, lifestyle modification, and nutritional supplementation, with particular attention to clinical outcomes, autoimmune markers, and patient-reported symptom improvement. KEY CONTENT AND FINDINGS: Emerging adjunct strategies include wet cupping, acupuncture, dietary modification, physical activity, and micronutrient supplementation. Some studies have reported improvements in QOL, autoimmune activity, or symptom burden; however, the existing evidence is heterogeneous, methodologically limited, and often based on small or uncontrolled studies. CONCLUSIONS: Adjunctive therapies may offer potential benefit for selected patients with persistent symptoms beyond conventional hormone replacement, but current data are insufficient to support definitive clinical recommendations. High-quality randomized controlled trials are needed to clarify efficacy, safety, and the role of these interventions in individualized patient care.