Hashimoto's thyroiditis (HT) affects more than 14 million individuals in the United States, most of them women. Thyroid replacement therapy has long been the foundation of medical treatment for HT; however, recent research supports a role for nutritional approaches. This case report describes the management of a 34-y-old female with HT who declined thyroid replacement therapy and was successfully managed for a period of 5 mo. The patient was advised to follow a phytonutrient rich diet (eg, berries); avoid sensitive foods (gluten and soy); and consume quality fats, fermented foods, and filtered water. Nutritional supplementation of vitamins (B complex, D3), α-lipoic acid, coenzyme Q10, magnesium, omega-3 oil (DHA/EPA), and probiotics were used in conjunction with an herbal tincture. (Altern Ther Health Med.