How Myo-inositol Can Improve Hashimoto’s Symptoms

As an avid researcher, I am always struck by the interrelationship between diseases of the body and the mind. A good example of this that I often observe with Hashimoto’s clients is anxiety, mood swings, and OCD (obsessive-compulsive disorder) symptoms. I see these as clues that a person may be having underlying issues with their thyroid.

As a pharmacist, I’ve been frequently dismayed that our modern medical solution to these mind-body connections is to throw completely different prescription medications at the two. Not only does this often mean neglecting to “fix” the real root causes of both conditions, but many medications meant to address psychiatric symptoms often have unwanted side effects that make the physical health situation worse.

Looking for root causes is so important. I’ve seen many cases where people find out that something as relatively straightforward as a nutrient deficiency or a blood sugar imbalance may be causing anxiety symptoms and exacerbating their thyroid condition.

The good news is that I’ve seen these people start to feel better quickly once they have identified and addressed their root causes. For example, having people take therapeutic dosages of two nutrients, selenium and myo-inositol, in addition to working to balance their blood sugar, can work wonders at reducing their anxiety and OCD symptoms, as well as reducing their thyroid antibodies and thyroid symptoms. Some people have even seen their TSH level drop, or have gone into remission, after supplementing with selenium and myo-inositol together.

Blood sugar imbalance can be a root cause of Hashimoto’s and anxiety, and is also a co-occurring symptom of another condition that affects many women, polycystic ovary syndrome (PCOS). (1,2) Myo-inositol has been found to improve symptoms of PCOS. It has also been found to be effective in increasing insulin sensitivity, which results in improvements in reproductive health, including enhanced fertility. (3)

As you can see, myo-inositol can be greatly beneficial for Hashimoto’s!

In this article, you’ll discover:

• What myo-inositol is and how it supports our health
• How myo-inositol can improve Hashimoto’s symptoms
• The connection between PCOS, Hashimoto’s, and blood sugar levels
• The connection between anxiety, depression, OCD, and Hashimoto’s
• Recommended dosage and precautions

What Myo-inositol Is and How It Supports Our Health

Myo-inositol is an important nutrient that serves key functions relating to hormone signal transduction throughout our endocrine system. As such, myo-inositol plays an important regulatory role relating to thyroid health (regulating the thyroid-stimulating hormone, or TSH) and reproductive health (regulating the follicle-stimulating hormone, or FSH). It also regulates glucose uptake and may be involved in serotonin uptake (our happy and calming hormone). (4-6)

Myo-inositol has been found to provide many valuable health effects, including anti-inflammatory, anti-oxidant, anti-diabetic, and anticancer effects. (7)

Research has shown that myo-inositol supplementation reduces thyroid antibody and TSH levels, as well as improves symptoms associated with anxiety, mood swings, depression, and OCD. (4) Research has also found that myo-inositol improves PCOS symptoms such as menstrual irregularities, acne, insulin resistance, and weight. (8) More will be discussed about each of these, further on in this article.

So what exactly is myo-inositol? And why might you be deficient in it?

Myo-inositol is a form of inositol, a type of natural sugar alcohol that’s present in mammalian cells. Inositol was previously known as vitamin B8, as it used to be thought of as an essential nutrient, but it was later learned that myo-inositol is actually made within our bodies, so it lost its “official” vitamin designation. However, just because we can make it internally, does not mean that we can’t be deficient in it! (9)

There are actually nine forms (referred to as isomers) of inositol, with the two most common being myo-inositol and D-chiro-inositol. These two forms are seen in much of the research relating to inositol, and in fact, they have been studied as a combination treatment relating to PCOS.

Myo-inositol is found in many plants and in the tissues of animals. Foods with the highest concentration of myo-inositol are fruits, beans, corn, and nuts. Blueberries, one of my favorite superfoods, are an especially rich source! (10)

Research has shown that although it is synthesized in the body, some individuals may not be able to meet their body’s metabolic needs through its own synthesis alone. (11)

While the human body (via the liver and kidneys) can produce up to 4 g/day of inositol, it has been found that the overly processed, high glucose (and low fiber) Western diets that many people follow, only provide about 1 g/day of the compound. (7)

People can be deficient due to their diet, poor nutrient absorption (common in Hashimoto’s), or perhaps even a genetic predisposition (such as having poor glucose metabolism). (7)

High glucose levels hinder inositol availability by increasing its degradation and by inhibiting both myo-inositol biosynthesis and absorption. (7)

How Myo-Inositol Can Improve Hashimoto’s Symptoms

Blood sugar imbalance is a potential root cause of Hashimoto’s, and I’ll talk more about that in the next section. But first, let me talk about the importance of myo-inositol relating to thyroid-stimulating hormone (TSH) signaling.

As I mentioned earlier, due to its key role in TSH signaling, myo-inositol supplementation has been shown to reduce thyroid antibodies, reduce TSH levels, and even achieve remission in people with Hashimoto’s. (4,12)

TSH signaling is a very complex process, and there are two different branches of signaling that have an impact on TSH levels. One of these branches is inositol-dependent, so too little inositol causes TSH resistance, resulting in too much TSH being produced. (12) Myo-inositol improves TSH sensitivity, which in turn results in a reduction of TSH levels.

Think of it this way. If someone has earplugs in their ears, they can’t hear well, so you have to yell for them to hear you. But if they remove the earplugs, they can hear you without you having to speak at a loud volume. The same concept applies to TSH. Without adequate myo-inositol, the body has to be “louder” and generate greater levels of TSH. In my first book, Hashimoto’s: The Root Cause, I discussed how an elevation of TSH, for whatever reason, may result in triggering or exacerbating the autoimmune process of Hashimoto’s. Providing myo-inositol in clinical studies appears to “remove the earplugs,” so to speak… resulting in less TSH being produced. (12)

There have been a number of studies focused on myo-inositol relating to Hashimoto’s, PCOS, and OCD. Let’s first focus on Hashimoto’s.

Myo-Inositol and Selenium Work Synergistically to Support Optimal Thyroid Function

In most of the studies relating to Hashimoto’s, myo-inositol has been evaluated in conjunction with selenium, likely because the research has already proven selenium to be effective at reducing thyroid antibodies. (12) This is not surprising, as selenium deficiency is one of the most common nutrient deficiencies that I see in people with Hashimoto’s, and over 50 percent of them are likely deficient in it.

Selenium supplementation has been tied to a reduction in thyroid antibodies, improvements in thyroid symptoms, and a reduction in anxiety. (13,14) I routinely recommend that my clients and readers try selenium to see if it helps them feel better. You can read much more about selenium here.

Given selenium’s well-understood benefits for Hashimoto’s, studies have evaluated the incremental benefit of taking both selenium and myo-inositol over simply taking selenium alone.

And the findings have shown there are benefits to taking both. (12)

In one study done in 2013, patients with autoimmune thyroiditis were split into two groups, with one group being treated with 600 milligrams of myo-inositol and 83 mcg of selenium (selenomethionine) per day for six months, and the other being treated with just selenium. While both groups showed a decrease in thyroid antibodies, the group treated with myo-inositol also experienced a 31 percent reduction in TSH levels. The selenium group showed no change in TSH levels. (15)

The group taking the myo-inositol and selenium also showed a 44 percent reduction in thyroid antibodies, while the group taking selenium alone showed a 42 percent reduction in antibodies. Thyroglobulin was reduced by 48 percent with the myo-inositol/selenium combination, versus 38 percent with just selenium alone.

Some people actually went into remission after starting the myo-inositol. Improvements were seen in people’s assessment of their personal well-being. The authors of this study also pointed out that these two compounds were safe, with no side effects seen as part of their data collection.

In a more recent follow-up study in 2017, these results were confirmed and then expanded upon. Thyroid antibodies, TSH, and quality of life were all significantly improved after the administration of both myo-inositol and selenium. Interestingly, there was one case of hyperthyroidism included in this study, and in that single case, the supplementation increased TSH levels up to normal concentrations. (12)

My own clinical results also support the improvements that may be seen when taking myo-inositol with selenium. I recommend this combination as a first step for people with mild elevations in TSH and thyroid antibodies, and sometimes it’s just enough to do the trick. I often recommend using myo-inositol powder instead of using sweetener in tea!

The Connection Between PCOS, Hashimoto’s, and Blood Sugar

In at least one study, it was found that up to 50 percent of people with Hashimoto’s have an impaired tolerance to carbohydrates, causing issues with blood sugar imbalances and insulin surges. (16) I have found that many of my clients suffer from these types of surges, which can cause nervousness, anxiety, lightheadedness, and fatigue.

In a 2017 study on insulin resistance and Hashimoto’s, the authors concluded that high thyroid antibody levels are related to high fasting blood glucose levels and high insulin levels. Their findings indicated a possible relationship between insulin resistance, autoimmune thyroiditis, and TSH levels. They also concluded that patients testing with positive thyroid antibodies should be followed closely for diabetes mellitus and cardiovascular events. (1) (Learn more in my article about blood sugar imbalances and Hashimoto’s.)

Blood sugar and insulin resistance are also a problem commonly seen in women with PCOS. (3)

PCOS is an endocrine, reproductive and metabolic disorder, affecting at least 5 to 10 percent of reproductive-age women, worldwide. (17) Women with PCOS are found to have a 50 to 70 percent incidence of insulin resistance, independent of body size and build. In those who are obese, the prevalence of insulin resistance rises to 80 percent. (18)

Given these statistics, a common treatment for PCOS includes the insulin-sensitizing drug metformin. It has been shown to improve insulin sensitization and ovulatory function. (18) Metformin does, however, have a number of negative side effects.

Remember when I said myo-inositol is involved in hormone signal transduction and helps to regulate TSH, FSH, and glucose uptake? Well, due to its similar regulatory role relating to addressing glucose intolerance, myo-inositol has been identified as being a potential substitute for metformin in improving PCOS symptoms. Subsequently, research focused on this has confirmed the positive results of myo-inositol supplementation. (18)

Myo-inositol is the most abundant inositol form found within the ovary, with approximately 99 percent of the ovarian intracellular inositol being myo-inositol. (20) Studies have shown that a high concentration of myo-inositol is required to ensure healthy oocyte (immature egg) maturation in the ovary. (21)

So it is no wonder, then, that research has found myo-inositol to be beneficial for women with PCOS! One study found that after just 12 weeks of myo-inositol supplementation, there were improvements to insulin levels and LH/FSH levels, with both being significantly reduced. (These markers can be a potential signal of fertility challenges when elevated.) Menstrual cycles also normalized. (22)

In another study, myo-inositol supplementation was found to improve the number of good quality oocytes, clinical pregnancies, and delivery rates in overweight women with PCOS. Insulin sensitivity improved as well. (23)

Additionally, there are many studies that have focused on the benefits of pairing myo-inositol and D-chiro-inositol to reduce insulin resistance and improve ovarian function in women with PCOS. (24-26)

In one of these studies, a myo-inositol and D-chiro-inositol combination therapy was found to improve oocyte quality, embryo quality, and pregnancy rates during in vitro fertilization. (25)

In another study, the combined myo-inositol and D-chiro-inositol treatment was found to be better than myo-inositol alone at improving ovulation, endocrine, and metabolic parameters. (26) An additional study showed a significant improvement in insulin sensitivity as well as lipid profile in PCOS patients. (27)

Besides metformin, myo-inositol is now considered a further insulin-sensitizing supplement that could benefit women with PCOS. (3) Unlike metformin, which is known for numerous side effects, including lactic acidosis, a potentially serious side effect, myo-inositol was reported to be well tolerated (although I have seen reports of people feeling more tired after taking it).

There is also a connection seen between women with both PCOS and hypothyroidism. My theory is that this connection can be partly explained by shared root causes, such as both having blood sugar imbalances as well as having deficiencies in myo-inositol (resulting in a less-than-optimal inositol-dependent signaling pathway). In one study, it was found that 22.5 percent of women with PCOS also had hypothyroidism, compared to just 8.75 percent in controls. (28) The same authors also found TPO antibodies present in 27 percent of patients with PCOS, versus 8 percent in controls. More recently, a study found a higher prevalence of Hashimoto’s, higher antibody levels, and elevated TSH levels in PCOS patients. (30)

In light of its insulin-sensitizing activity, myo-inositol is used today to prevent and/or treat a number of metabolic disorders related to insulin resistance, such as metabolic syndrome, gestational diabetes mellitus, and PCOS.

The Connection Between Anxiety, Depression, OCD, and Hashimoto’s

Research has shown that anxiety, depression, mood fluctuations, OCD behaviors, and a general feeling of being “unwell,” are early signs of an autoimmune attack on the thyroid, and can be correlated to thyroid antibodies, even when the TSH level is still “normal.” (30,31)

Many new clients come to me after being prescribed anxiety and mood-related medications, including SSRIs (Selective Serotonin Reuptake Inhibitors), lithium, antipsychotics, dopamine, and benzodiazepines. They don’t feel well, and may have other thyroid symptoms, but in many cases, are still being told their TSH level is normal, so their thyroid is fine (oh, and “just keep taking those anxiety meds!”). Sometimes the term hypochondriac is thrown about. I’ve had way too many clients who were told they were bipolar, when in fact their thyroid was out of balance.

Yet, there is research that concludes with the recommendation that people presenting with these types of psychiatric symptoms be initially screened for underlying thyroid issues. (32)

Anxiety and mood disorders are very common thyroid symptoms. A study in 2004 found that there is an association between the presence of an anxiety or mood disorder, and the presence of TPO antibodies. (33) (You can read more about mood disorders and Hashimoto’s.)

The most common type of anxiety disorder reported in people with thyroid antibodies is obsessive-compulsive disorder (OCD). (34) I myself used to have issues relating to OCD (which interestingly is very common in pharmacists and those with Type A personalities, like yours truly!) and anxiety, which seemed to rear their ugly heads before I got my Hashimoto’s into remission, and when I have had flare-ups.

But, I have seen the positive effects of successful interventions, like removing reactive foods, reducing stress, and treating Streptococcal-based gut imbalances (which have been tied to OCD — and in my findings, also Hashimoto’s), as well as addressing various nutrient deficiencies. Two that I recommend most often relating to OCD, are selenium and myo-inositol.

Several studies have found that daily treatment with inositol resulted in improvements in OCD symptoms like anxiety and avoidant behavior (measured as a reduction on the Yale-Brown Obsessive-Compulsive Scale). (35,36)

In one small study, 13 patients with obsessive-compulsive disorder were given either 18 g of inositol or a placebo, daily, for 6 weeks. The subjects had significantly lower scores on the Yale-Brown Obsessive-Compulsive Scale when taking inositol. The authors concluded that inositol is effective for depression, panic, and obsessive-compulsive disorders, a spectrum of disorders responsive to selective serotonin reuptake inhibitors. (36)

Just like myo-inositol regulates TSH, FSH, and glucose uptake, research has shown that it may be involved in the modulation of serotonin uptake, too. (6) I think it is a much more natural solution to anxiety and OCD behaviors versus some of the psychiatric prescription medications that so many people are on today!

Along with anxiety and OCD, depression is also associated with Hashimoto’s.

In a meta-analysis comprised of 19 studies, with a total of 36,174 participants (34,094 for anxiety and 35,168 for depression), patients with AIT (autoimmune thyroiditis), subclinical hypothyroidism, or overt hypothyroidism had significantly higher scores on standardized depression and anxiety tests. The authors concluded that patients with AIT exhibit an increased chance of developing symptoms of depression and anxiety, or receiving a diagnosis of depression and anxiety disorders. (30)

The study found that approximately 23.8 percent of patients with AIT experience depression, and approximately 41.6 percent of patients with AIT experience anxiety disorders.

To learn more about depression and Hashimoto’s, please see my article.

It makes sense that mood swings, anxiety, OCD, and even depression can be so intertwined with Hashimoto’s. Fluctuating thyroid hormone levels (due to any number of root causes), adrenal stress, and even the autoimmune process itself (when your body is making antibodies that attack the thyroid), can be common culprits. The good news is there are a lot of interventions that can help, including addressing the nutrient deficiencies and blood sugar balancing issues we’ve been discussing.

One other strategy that I often discuss with clients having these types of anxiety and mood-related symptoms, is changing up their thyroid medication to a T3-containing medication like Nature-Throid, WP Thyroid, Armour, or compounded T4/T3. In my survey of Root Cause readers, around 60 percent reported improved mood after switching to a T3-containing medication.

Recommended Dosage and Precautions

Given the research and the results in my own clinical practice, I typically recommend that people with Hashimoto’s try supplements such as selenium and myo-inositol. Generally, you do not need to test your own levels of these nutrients. They have been shown to be safe (with noted precautions) in the research, so my philosophy is to try them and see if they result in improvements.

Rootcology offers two products that contain myo-inositol.

The first is Rootcology Myo-Inositol Powder, which contains the myo-inositol form of inositol, for reducing TSH and thyroid antibodies. (12) This powder can also help promote relaxation and restful sleep, as well as balance hormones. (40-42) If you’re experiencing high blood sugar, myo-inositol can be helpful in improving insulin sensitivity and carbohydrate metabolism. (42) This form is great for anyone who doesn’t like taking pills or who wants to replace sugar or other sweeteners in their tea or coffee, as myo-inositol has half of the sweetness of table sugar and may just do the trick! I recommend taking 700 mg daily. 

The other recommendation is Selenium + Myo-Inositol. This brand new formulation contains myo-inositol plus selenium in the form of selenomethionine, which work together to support optimal thyroid function. They can also reduce TSH and thyroid antibodies. (12) For anyone looking to support immune health, hormone balance, and metabolic health, in addition to their thyroid, this is a great option. (37-39) I recommend taking one capsule per day. Each capsule contains 600 mg of myo-inositol and 83 mcg of selenium.

Here’s what Jan had to say after trying my Myo-Inositol Powder:

I have just started using this product. Being unable to use most supplements due to extreme reactions and sensitivity, I was skeptical at first. However, I use it at a substantially reduced amount and have found it to be very helpful for my anxiety, irritability and overall mood. Having Hashimotos has been a real struggle for me most of my life and conventional doctors have been unable to direct me in any way to help with this obstacle so I have felt unhinged for over 6 years. After reading the product information provided, I decided to give it a try and ‘hope for the best’. I am pleasantly surprised at the peacefulness that has returned to my body. Thank you for your product. I hope all continues to go well with my usage and that I can try some of your other recommendations. Thank you for being there when there was nowhere else to turn.

With Rootcology’s 30-day, 100% satisfaction guarantee, you have nothing to lose but your symptoms! If you are unsatisfied for any reason, you may return the product within 30 days for a full refund, minus shipping/handling fees.

Precautions

As always, I suggest you work with a good functional medicine practitioner and consult with him or her before trying these or any other supplements, especially if you are pregnant, breastfeeding, or have specific health conditions. In addition, if you are on psychiatric medications, please do not go off them without working with the prescribing practitioner.

Myo-Inositol/Selenium + Myo-Inositol

Myo-inositol may not be properly cleared when the kidneys are overworked, such as in kidney disease or while taking diuretics. As such, myo-inositol should not be taken by people who have kidney disease or who may already be taking supplements, such as cleavers (a diuretic herb), that can affect the kidneys or the lymphatic system.

Do not take Myo-Inositol or Selenium + Myo-inositol if you are pregnant, lactating, or taking the following medications: antidiabetic drugs, anticoagulant/antiplatelet drugs, barbiturates, blood thinners, and/or immunosuppressants. People with diabetes taking any form of myo-inositol should watch for signs of low blood sugar (hypoglycemia), as myo-inositol may lower blood sugar and hemoglobin A1c levels.

Rarely, myo-inositol has been associated with nausea, headaches, dizziness, or fatigue. If you experience these effects, discontinue taking it.

Some people have reported increased bleeding with the use of myo-inositol, so I would not recommend it with a history of heavy bleeding, or in those taking blood thinners. If you experience any of these effects, discontinue taking it.

While research has shown that myo-inositol seems to have a normalizing effect on testosterone in women with PCOS, myo-inositol has been shown to increase testosterone in men with low levels of this hormone. Thus, myo-inositol can be used by both men and women. However, a word of caution for men who are sexually active: myo-inositol can increase sperm quality, leading to surprise pregnancies in partners of men who were previously thought to be infertile. (43)

Please note: Myo-Inositol Powder contains ingredients derived from non-GMO corn, but does not contain a protein component that could cause an antigenic response. While it is generally well-tolerated by those with corn sensitivities, please consult with your practitioner before use if you have individual concerns.

Selenium

Though selenium side effects and toxicity are rare, doses in excess of 800 mcg per day can be toxic. The RDA for selenium has been defined as 55 mcg in the United States, and an upper limit of 400 mcg has been suggested. Selenium may also interact with other supplements and medications, such as cholesterol-lowering statin drugs, antacids, chemotherapy drugs, corticosteroids, niacin, and even birth control pills.

Those with a CBS gene mutation have difficulty breaking down selenium. If you know you have a CBS gene mutation, then regularly monitoring your selenium levels is necessary.

Selenium supplements are also associated with a risk of non-melanoma skin cancer (squamous cell carcinoma), so people at high risk of skin cancer should not take these supplements. In addition, there is possibly a link between selenium and prostate cancer, although data on this topic is conflicting.

Selenium intake may also cause side effects in those with diabetes.

Please review my selenium article to learn more about both benefits and precautions.

Monitoring Your Thyroid Hormones When Taking Myo-Inositol

Whenever you start a lifestyle or complementary intervention to address Hashimoto’s, I encourage you to work with your doctor to monitor your thyroid symptoms, thyroid hormones, and thyroid antibodies. This is a great idea for any lifestyle intervention, but a must for lifestyle changes that could impact your TSH, like myo-inositol, especially if you are already taking thyroid medications.

Myo-inositol can lower TSH by an average of 30 percent within six months, thus potentially reducing your requirement (or need) for thyroid meds. (12) So as you move forward with supplementation, please look out for the following symptoms of being overmedicated: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, heat intolerance, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and/or excessive sweating.

I recommend testing thyroid hormone levels every six to 12 weeks while using complementary therapies, to ensure your thyroid medication dosage is optimized, or sooner if you are showing any of the above symptoms.

Testing TSH, T4, T3, and the two most common Hashimoto’s antibodies, TPO and TG antibodies, is an important part of ensuring that the lifestyle changes you are making are both safe and helpful. 🙂 (You can read more about tests here.)

If your doctor is ordering these thyroid labs for you, be sure to request a copy so that you can see them for yourself and ensure that they are interpreted correctly. If you aren’t able to order through your physician, you may also wish to self-order your own thyroid monitoring labs. I recommend the Ulta Labs thyroid panel for monitoring your progress, which can be ordered anywhere in the U.S. (Some, but not all, insurance companies may reimburse you for self-ordered labs; please be sure to check with your plan.)

What You Can Do Today

People with Hashimoto’s are prone to nutrient deficiencies. (44) While it’s important to investigate and correct underlying root causes (such as food sensitivities, blood sugar imbalances, or gut issues), in the meantime, myo-inositol supplementation could help you feel better.

Remember, much of the research relating to Hashimoto’s has shown that myo-inositol can increase the effectiveness of selenium. Both have been found to reduce thyroid antibodies and anxiety. (12,15) Myo-inositol has also been shown to reduce TSH levels and balance blood sugar, as well as help with depression, mood swings, and OCD. It can encourage a healthy mood, emotional wellness, and less stressful behaviors. (12,45,46)

For those with PCOS, myo-inositol may help to support a healthier reproductive system, as well as improve ovulatory function. (21,23)

Even those who haven’t yet been diagnosed with thyroid disease, due to having a “normal” TSH level, could still have thyroid antibodies, and I recommend testing for those. It is easy and inexpensive, and antibody testing provides you with “early warning” information that can help you prevent further damage to your thyroid. Remember, you can have thyroid antibodies for years – even a decade – prior to testing abnormal for TSH.

I hope this helps you on your healing journey! Let me know how taking myo-inositol and selenium together works for you.

Looking for more info? Supplements can help or hurt your thyroid! Download my FREE eBook to learn about safe and effective supplements that can help your thyroid symptoms naturally.

You can also download a free Thyroid Diet Guide, 10 thyroid-friendly recipes, and the Nutrient Depletions and Digestion chapter from my first book for free by signing up for my weekly newsletter. You will also receive occasional updates about new research, resources, giveaways, and helpful information. And, for future updates, make sure to follow us on Facebook and Instagram!

References

1. Ceyhun V, Tezcan K, Perihan V, et al. Insulin resistance in the patients with euthryroid Hashimoto thyroiditis. Biomedical Research. 2017;28(4).
2. DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril. 2005 May;83(5):1454-60.
3. Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections. 2017;6(8):647-658. doi:10.1530/EC-17-0243.
4. Fallahi P, Ferrari SM, Elia G, et al. Myo-inositol in autoimmune thyroiditis, and hypothyroidism. Rev Endocr Metab Disord. 2018;19(4):349-354. doi:10.1007/s11154-018-9477-9
5. Zheng X, Lin D, Zhang Y, et al. Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. Medicine (Baltimore). 2017;96(49):e8842. doi:10.1097/MD.0000000000008842
6. Levine J. Controlled trials of inositol in psychiatry. Eur Neuropsychopharmacol. 1997;7(2):147-155. doi:10.1016/s0924-977x(97)00409-4
7. Dinicola S, Minini M, Unfer V, Verna R, Cucina A, Bizzarri M. Nutritional and Acquired Deficiencies in Inositol Bioavailability. Correlations with Metabolic Disorders. International Journal of Molecular Sciences. 2017;18(10):2187. doi:10.3390/ijms18102187.
8. Formuso C, Stracquadanio M, Ciotta L. Myo-inositol vs. D-chiro inositol in PCOS treatment. Minerva Ginecol. 2015 Aug;67(4):321-5.
9. Chhetri DR. Myo-Inositol and Its Derivatives: Their Emerging Role in the Treatment of Human Diseases. Front Pharmacol. 2019;10:1172. Published 2019 Oct 11. doi:10.3389/fphar.2019.01172
10. Clements RS Jr, Darnell B. Myo-inositol content of common foods: development of a high-myo-inositol diet. Am J Clin Nutr. 1980;33(9):1954-1967. doi:10.1093/ajcn/33.9.1954
11. Berdanier C. Is Inositol an essential nutrient? Nutrition Today. 1992.
12. Nordio M, Basciani S. Treatment with Myo-Inositol and Selenium Ensures Euthyroidism in Patients with Autoimmune Thyroiditis. International Journal of Endocrinology. 2017;2017:2549491. doi:10.1155/2017/2549491.
13. Ventura M, Melo M, Carrilho F. Selenium and Thyroid Disease: From Pathophysiology to Treatment. Int J Endocrinol. 2017;2017:1297658. doi:10.1155/2017/1297658
14. Benton D, Cook R. The impact of selenium supplementation on mood. Biol Psychiatry. 1991;29(11):1092-1098. doi:10.1016/0006-3223(91)90251-g
15. Nordio M, Pajalich R. Combined Treatment with Myo-Inositol and Selenium Ensures Euthyroidism in Subclinical Hypothyroidism Patients with Autoimmune Thyroiditis. Journal of Thyroid Research. 2013;2013:424163. doi:10.1155/2013/424163.
16. Gierach M, Gierach J, Skowrońska A, et al. Hashimoto’s thyroiditis and carbohydrate metabolism disorders in patients hospitalised in the Department of Endocrinology and Diabetology of Ludwik Rydygier Collegium Medicum in Bydgoszcz between 2001 and 2010. Endokrynol Pol. 2012;63(1):14-17.
17. Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P T. 2013;38(6):336-355.
18. Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril. 2012;97(1):18-22. doi:10.1016/j.fertnstert.2011.11.036
19. Regidor PA, Schindler AE. Myoinositol as a Safe and Alternative Approach in the Treatment of Infertile PCOS Women: A German Observational Study. Int J Endocrinol. 2016;2016:9537632. doi:10.1155/2016/9537632
20. Unfer V, Nestler JE, Kamenov ZA, Prapas N, Facchinetti F. Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials. Int J Endocrinol. 2016;2016:1849162. doi:10.1155/2016/1849162
21. Gupta D, Khan S, Islam M, Malik BH, Rutkofsky IH. Myo-Inositol’s Role in Assisted Reproductive Technology: Evidence for Improving the Quality of Oocytes and Embryos in Patients With Polycystic Ovary Syndrome. Cureus. 2020;12(5):e8079. Published 2020 May 12. doi:10.7759/cureus.8079
22. Artini PG, Di Berardino OM, Papini F, et al. Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study. Gynecol Endocrinol. 2013;29(4):375-379. doi:10.3109/09513590.2012.743020
23. Kalra B, Kalra S, Sharma JB. The inositols and polycystic ovary syndrome. Indian J Endocrinol Metab. 2016;20(5):720-724. doi:10.4103/2230-8210.189231
24. Colazingari S, Treglia M, Najjar R, Bevilacqua A. The combined therapy myo-inositol plus D-chiro-inositol, rather than D-chiro-inositol, is able to improve IVF outcomes: Results from a randomized controlled trial. Arch Gynecol Obstet. 2013;288:1405–11.
25. Nordio M, Proietti E. The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone. Eur Rev Med Pharmacol Sci. 2012;16:575–81.
26. Benelli E, Del Ghianda S, Di Cosmo C, Tonacchera M. A Combined Therapy with Myo-Inositol and D-Chiro-Inositol Improves Endocrine Parameters and Insulin Resistance in PCOS Young Overweight Women. Int J Endocrinol. 2016;2016:3204083. doi:10.1155/2016/3204083
27. Minozzi M, Nordio M, Pajalich R. The combined therapy myo-inositol plus D-Chiro-inositol, in a physiological ratio, reduces the cardiovascular risk by improving the lipid profile in PCOS patients. Eur Rev Med Pharmacol Sci. 2013 Feb;17(4):537-40.
28. Singla R, Gupta Y, Khemani M, Aggarwal S. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian Journal of Endocrinology and Metabolism. 2015;19(1):25-29. doi:10.4103/2230-8210.146860.
29. Singh J, Wong H, Ahluwalia N, Go RM, Guerrero-Go MA. Metabolic, Hormonal, Immunologic, and Genetic Factors Associated With the Incidence of Thyroid Disorders in Polycystic Ovarian Syndrome Patients. Cureus. 2020;12(11):e11681. Published 2020 Nov 24. doi:10.7759/cureus.11681
30. Siegmann E, Müller HHO, Luecke C, Philipsen A, Kornhuber J, Grömer TW. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis A Systematic Review and Meta-analysis. JAMA Psychiatry. 2018;75(6):577–584. doi:10.1001/jamapsychiatry.2018.0190.
31. Müssig K, Künle A, Säuberlich AL, et al. Thyroid peroxidase antibody positivity is associated with symptomatic distress in patients with Hashimoto’s thyroiditis. Brain Behav Immun. 2012;26(4):559-563. doi:10.1016/j.bbi.2012.01.006
32. Heinrich TW, Grahm G. Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited. Prim Care Companion J Clin Psychiatry. 2003;5(6):260-266. doi:10.4088/pcc.v05n0603
33. Carta MG, Loviselli A, Hardoy MC, et al. The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future. BMC Psychiatry. 2004;4:25. Published 2004 Aug 18. doi:10.1186/1471-244X-4-25
34. Caykoylu A, Kabadayi Sahin E, Ugurlu M. Could the thyroid gland dominate the brain in obsessive-compulsive disorder? [published online ahead of print, 2022 Apr 20]. Neuroendocrinology. 2022;10.1159/000524627. doi:10.1159/000524627
35. Carey PD, Warwick J, Harvey BH, et al. Single photon emission computed tomography (SPECT) in obsessive-compulsive disorder before and after treatment with inositol. Metab Brain Dis. 2004 Jun;19(1-2):125-34.
36. Fux M, Levine J, Aviv A, Belmaker RH. Inositol treatment of obsessive-compulsive disorder. American Journal of Psychiatry. 1996;153:1219-1221. https://doi.org/10.1176/ajp.153.9.1219
37. Hoffmann PR, Berry MJ. The influence of selenium on immune responses. Mol Nutr Food Res. 2008;52(11):1273-1280. doi:10.1002/mnfr.200700330
38. Arthur JR, Nicol F, Beckett GJ. The role of selenium in thyroid hormone metabolism and effects of selenium deficiency on thyroid hormone and iodine metabolism. Biol Trace Elem Res. 1992;34(3):321-325. doi:10.1007/BF02783686
39. Othman FB, Mohamed HJBJ, Sirajudeen KNS, Noh MFBM, Rajab NF. The influence of selenium status on body composition, oxidative DNA damage and total antioxidant capacity in newly diagnosed type 2 diabetes mellitus: A case-control study. J Trace Elem Med Biol. 2017;43:106-112. doi:10.1016/j.jtemb.2016.12.009
40. Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001;21(3):335-339. doi:10.1097/00004714-200106000-00014
41. Mashayekh-Amiri S, Delavar MA, Bakouei F, Faramarzi M, Esmaeilzadeh S. The impact of myo-inositol supplementation on sleep quality in pregnant women: a randomized, double-blind, placebo-controlled study. J Matern Fetal Neonatal Med. 2022;35(18):3415-3423. doi:10.1080/14767058.2020.1818225
42. Costantino D, Minozzi G, Minozzi E, Guaraldi C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009;13(2):105-110.
43. Oliva MM, Minutolo E, Lippa A, Iaconianni P, Vaiarelli A. Effect of Myoinositol and Antioxidants on Sperm Quality in Men with Metabolic Syndrome. International Journal of Endocrinology. doi: 10.1155/2016/1674950.
44. Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto’s Thyroiditis. Thyroid. 2017;27(5):597-610. doi:10.1089/thy.2016.0635
45. Pintaudi B, Di Vieste G, Bonomo M. The Effectiveness of Myo-Inositol and D-Chiro Inositol Treatment in Type 2 Diabetes. Int J Endocrinol. 2016;2016:9132052. doi:10.1155/2016/9132052
46. Mukai T, Kishi T, Matsuda Y, et al. A meta-analysis of inositol for depression and anxiety disorders. Hum Psychopharmacol. 2014 Jan;29(1):55-63. doi: 10.1002/hup.2369.
47. Kannan S. Myo-inositol: Uses: Risks: Side effects. iCliniq. 2022. Published March 11, 2022. Accessed September 22, 2022. https://www.icliniq.com/articles/drug-and-supplements/myo-inositol

Note: Originally published in October 2018, this article has been revised and updated for accuracy and thoroughness.