l-Thyroxine monotherapy, the novel and physiologically savvy method for treatment of hypothyroidism, contrasted with the traditional approach of natural thyroid preparations that was marred by potency concerns. In less than a decade, there was a major shift in treatment of hypothyroidism such that normalization of TSH with l-thyroxine monotherapy became the new standard of care (Appendix Table) (52). Many clinicians advocated for this to be first-line therapy and for patients previously treated with desiccated thyroid to be transitioned to l-thyroxine monotherapy (50).

Megan Casper, RDN, a dietitian based in New York City and the founder of Nourished Bite, points out that iodine deficiency is the leading cause of hypothyroidism worldwide. This mineral can’t be made by the body, so dietary sources like iodized salt, dairy products, seafood, seaweed, and fortified cereals are important. “Iodine is an essential nutrient in the body, and thyroid hormones are composed of iodine,” explains Rizzo. “Those lacking thyroid hormones may also be lacking iodine.”

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