Photobiomodulation as the First Disease-Modifying Therapy for Hashimoto Thyroiditis**
By Dr. Angela Mazza, DO, ABAARM, FAAMFM, ECNU, CDE
Introduction: A New Horizon in Autoimmune Thyroid Disease
Hashimoto thyroiditis (HT) is the most common autoimmune endocrine disorder in the world—and one of the most frustrating for patients and clinicians alike. Affecting an estimated 14–20 million Americans, Hashimoto’s gradually destroys thyroid tissue through chronic lymphocytic inflammation, oxidative stress, and progressive fibrosis. For decades, the medical community has approached this condition with one main tool: thyroid hormone replacement. While levothyroxine effectively normalizes laboratory values, it does nothing to halt the autoimmune attack, restore thyroid structure, reduce antibody burden, or improve tissue health.
This leaves millions of patients symptomatic and discouraged, even when their labs read as “normal.” Fatigue, brain fog, weight changes, cold intolerance, mood disturbances, and metabolic dysfunction persist in up to 40% of individuals despite appropriate thyroid hormone dosing. The discrepancy between biochemical euthyroidism and ongoing clinical suffering highlights a central truth: Hashimoto’s is not merely a hormone deficiency—it is a progressive autoimmune and tissue disease.
Dr. Angela Mazza, a nationally recognized integrative endocrinologist, believes it is time to elevate thyroid care beyond hormone replacement and into the era of true disease modification. Based on her experience, advanced imaging collaborations, and deep understanding of endocrine immunology, she proposes a bold scientific direction: Photobiomodulation (red and near-infrared light therapy) may be the first realistic, non-pharmacologic therapy capable of modifying the course of Hashimoto thyroiditis at its root.
**The
Science Behind Photobiomodulation:
Why Red Light Has a Unique Role in Thyroid Health**
Photobiomodulation (PBMT), including red and near-infrared (NIR) light therapy, uses specific wavelengths (typically 600–1100 nm) to stimulate cellular repair, reduce inflammation, and restore physiologic function. Unlike ablative lasers or heating devices, PBMT works at low power densities, initiating photochemical—not thermal—reactions within cells.
The thyroid gland is uniquely suited to benefit from PBMT for several reasons:
1. High Mitochondrial Density
Thyroid follicular cells are among the most metabolically active cells in the body. PBMT directly stimulates cytochrome c oxidase within mitochondria, leading to:
· Increased ATP production
· Enhanced cellular energy metabolism
· Improved oxygen use
· Restoration of injured or dysfunctional cells
A gland dependent on mitochondrial-driven hormone synthesis is ideally positioned to respond positively to PBMT.
2. Reduction of Oxidative Stress
Hashimoto’s is characterized by heightened oxidative stress—partly because the thyroid uses hydrogen peroxide (H₂O₂) to create hormones, and partly because autoimmune inflammation generates excess reactive oxygen species (ROS).
PBMT has been shown to:
·
· Activate the body’s natural antioxidant enzymes
· Reduce oxidative injury within thyroid tissue
This helps protect thyroid follicles from continued immune-mediated destruction.
3. Immune Modulation
Hashimoto’s involves an overactivation of Th1 and Th17 immune pathways and impaired T-regulatory (Treg) function. PBMT has demonstrated:
· Downregulation of NF-κB (a major inflammatory switch)
· Reduction of pro-inflammatory cytokines (IL-6, TNF-α, IL-1β)
· Increased Treg activity and improved immune tolerance
· Shift from M1 to M2 macrophages, promoting resolution instead of damage
This is precisely the type of immune correction needed in HT.
4. Improved Microcirculation
Lack of microvascular flow contributes to tissue inflammation and impaired healing. PBMT stimulates nitric oxide release and angiogenesis, improving perfusion and allowing nutrients, oxygen, and immune-calming factors to reach damaged tissue.
5. Potential Reversal of Fibrosis
Long-standing Hashimoto’s causes fibrosis and architectural distortion visible on ultrasound. PBMT has shown the ability to regulate collagen turnover, reduce fibroblast overactivity, and promote structural recovery—an unprecedented outcome in thyroid disease.
Evidence Supporting PBMT in Hashimoto’s
Although relatively new in thyroid medicine, PBMT already has promising published evidence:
· A 2010 pilot study showed improved thyroid echogenicity, reduced antibodies, and measurable improvements on ultrasound.
· A 2013 randomized, placebo-controlled trial demonstrated improved thyroid function and reduced levothyroxine requirements in a significant portion of treated participants.
· A 2018 longitudinal study found sustained benefits up to 6 years post-treatment, including improved thyroid architecture and, in some cases, maintained euthyroidism without medication.
· A 2022 systematic review concluded that PBMT is safe, biologically plausible, and shows consistent signals of benefit—yet emphasized the need for larger, properly designed clinical trials.
While early-stage, these findings support Dr. Mazza’s premise that PBMT may be the first intervention capable of altering the natural history of Hashimoto thyroiditis.
Why Current Thyroid Care Is Not Enough
The standard treatment approach—monitoring labs and adjusting medication—fails to address:
· Ongoing autoimmune destruction
· Tissue-level inflammation and fibrosis
· Vascular stagnation
· Mitochondrial dysfunction
· Antibody persistence
Adjunctive interventions such as selenium, myo-inositol, dietary changes, or low-dose naltrexone can provide incremental support but do not stop or reverse disease progression. The result is a clinical gap: patients remain symptomatic because the underlying disease remains unaddressed.
PBMT may finally offer a tool to intervene where endocrine medicine has historically been unable to act.
Dr. Mazza’s Vision: A
Disease-Modifying Future for Thyroid Care
Dr. Mazza proposes a groundbreaking clinical trial that integrates:
· Red/NIR photobiomodulation
· High-resolution ultrasound
· Elastography for fibrosis analysis
· Vascular Doppler assessment
· Thyroid antibodies and hormone panels
· Clinical symptom scoring
This holistic, multimodal assessment merges endocrine science with state-of-the-art imaging to evaluate PBMT’s capacity to restore thyroid health—not just manage symptoms.
Her vision is clear:
“Hashimoto’s has never had a true disease-modifying therapy.
Photobiomodulation may be the first treatment capable of changing the
trajectory of thyroid autoimmunity.”
This study aims to produce the most comprehensive thyroid PBMT dataset ever
generated in the
Advantages for PBMT Developers
Manufacturers stand to gain:
1. Clinical Validation for Expanded Indications
A successful trial supports FDA considerations, clinical claims, and broader adoption.
2. Entry Into a Multi-Million-Patient Market
Thyroid disease affects 1 in 8 women and is one of the most undertreated autoimmune disorders.
3. Differentiation in a Competitive PBMT Industry
Being the first device validated for autoimmune thyroiditis establishes unmatched market leadership.
4. High-Visibility Clinical Exposure
Results will be shared through medical conferences, scientific publications, and national education initiatives.
Conclusion:
Lighting the Path to a New Standard of Care
Hashimoto thyroiditis has remained a clinical paradox: highly prevalent, deeply impactful, yet medically underserved. Hormone replacement manages symptoms, but does not change the underlying autoimmune disease. With photobiomodulation, Dr. Mazza sees the possibility of a true shift—a therapy that addresses mitochondrial health, inflammation, microcirculation, oxidative stress, and tissue integrity all at once.
This theory is grounded in strong scientific rationale, supported by emerging evidence, and guided by clinical experience. If validated, PBMT could become the first-ever treatment capable of modifying the course of Hashimoto thyroiditis.
For device innovators and PBMT manufacturers, this is not just an
opportunity—it is a chance to participate in a transformative movement in
thyroid medicine.
The light that photobiomodulation delivers may very well become the light that
leads millions of patients to lasting, meaningful healing.
