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Objective: The prevalence of primary hypothyroidism is increasing in adults (PHTA), and the reduction in the threshold for treatment and also the requirement to increase drug usage are major problems in approaching this disorder. Persian Medicine (PM) looks from a different view on etiology of diseases. Therefore, we tried to present the etiologies of PHTA according to an important book of PM i.e. “Zakhire Kharazmshahi”. Method: At first, the common symptoms and signs of PHTA were identified by investigating the Medline, Scopus, and Cochrane databases and their Persian equivalents were extracted from PM sources. These synonyms were searched as keywords in the book and the primary causes that were mentioned in association with the signs and symptoms were extracted. Then, we explained the total etiologies that were discussed for the occurrence of the causes, with respect to the principles of health care in PM. Results: "Cold distemperament", an increase in "Phlegmatic Humor ", an increase in "Melancholic Humor" and "Emtela" (repletion) were recognized as four main causes of PHTA. According to the book, the most important etiologies of these conditions are insufficient exercise, overeating, food intake before total stomach emptying and excessive amounts of cold temperament substances (foods, herbs, seeds, spices, etc.) in daily diet. Conclusion: From the viewpoint of PM, lifestyle spatially eating habits and physical activity play important causative roles in occurring and prognosis of PHTA. Hence, it is recommended to assess these results by more observations and clinical studies.