Hypothyroidism is one of those conditions that often hovers just beneath the radar. You feel lousy, then get used to dragging yourself around and may not even think it’s important enough to tell your doctor about it. Of course there’s a simple blood test for hypothyroidism (underactive thyroid), and treatment—a daily synthetic thyroid replacement hormone pill, or levothyroxine—is fairly straightforward. But in my opinion, thyroid replacement hormone alone usually doesn’t take care of the problem, because it helps patients feel better—but not great. That’s not good enough!

Here’s what most people don’t realize: A major cause of hypothyroidism is an autoimmune condition known as Hashimoto’s thyroiditis (in some cases, hypothyroidism is due to other causes such as thyroid surgery or thyroid cancer). As an autoimmune disease, Hashimoto’s throws the immune system out of whack so that it goes on the attack, for unknown reasons, against the thyroid gland. This means that you’ve got a bigger problem than an empty gas tank—your whole body needs some tuning up. If your doctor has told you that you have Hashimoto’s, talk to him/her about adding the following natural approaches to your standard thyroid replacement regimen…

1. Avoid food allergens. Food allergies are linked to autoimmune disease. Gluten and wheat allergies are particularly common in people with thyroid disease. To find out if you have food allergies (believe it or not, many people who have food allergies aren’t aware of it), ask your doctor for an IgG blood test. If it’s positive, avoiding the foods you’re allergic to will increase your vitality and nicely augment your hormone replacement therapy.

2. Try supplements and tweak your diet. Low iodine, zinc and selenium can reduce thyroid hormone production—a bad situation when you already have low thyroid levels. That’s why I prescribe low-dose supplements—300 micrograms (mcg) of iodine…30 mg of zinc…and 100 mcg of selenium daily—for my patients with Hashimoto’s. (Before trying these supplements, be sure to check with your doctor—especially if you have any other chronic health condition or take medication.) Also, avoid “goitrogens”—foods that suppress thyroid function by interfering with the absorption of iodine, which plays such a key role in keeping this gland healthy. Goitrogens include raw kale and broccoli and soy (in any form). Cooked green veggies are OK—heat deactivates the goitrogenic substances.

3. Get some natural sunlight. When our eyes are exposed to sunlight, it fuels the pineal gland in the brain to produce thyroid hormone. To get this thyroid benefit, take your sunglasses off for at least 30 minutes a day when you’re outdoors. (If you have an eye disease, such as glaucoma, this is not advisable.)

4. Do aerobic exercise for 20 minutes, four times a week. Moderate exercise increases thyroid hormone production and boosts the immune system by improving circulation, enhancing cardiac function and relieving stress.

5. Improve circulation to your thyroid gland. Hashimoto’s often impairs blood circulation to the thyroid gland. To promote better blood flow, you can try yoga or simply do a “shoulder stand” for a few minutes every day—raise your hips and legs above your head while you lie on your back. (Don’t do this if you have glaucoma, high blood pressure or neck problems.)