The Internet is awash with iffy information about hypothyroidism and what some people call the “hypothyroidism diet”—that is, what people with an underactive thyroid should eat to avoid the need for medication.
But is there really a diet for people with hypothyroidism? Not exactly, says endocrinologist Sarah Fishman, MD, PhD. No specific diet or eating pattern is likely to eliminate symptoms of the disorder, which include weight gain, joint pain, hair loss, sensitivity to cold and menstrual irregularities…as well as depression and brain fog. People with moderate-to-severe hypothyroidism generally need hormone-replacement therapy—typically a daily prescription pill containing the synthetic thyroid hormone levothyroxine—for the rest of their lives. But diet still can play a part in easing symptoms.
What is hypothyroidism?
The thyroid, a walnut-size, butterfly-shaped gland at the base of the neck, is supposed to produce metabolism-governing hormones at just the right levels to keep body functions running smoothly. If these hormones are absent or produced in insufficient quantities, hypothyroidism, also called underactive thyroid, and its characteristic symptoms arise. This can happen following treatment for thyroid cancer or other problems, including partial or complete surgical removal of the thyroid…a rare hereditary condition in which the body’s tissues don’t respond to thyroid hormones…or because of a malfunctioning pituitary gland—the pituitary gland produces thyroid-stimulating hormone (TSH).
But most cases of hypothyroidism are caused by Hashimoto’s disease, an autoimmune disorder in which antibodies produced by the body’s immune system attack the thyroid. Hashimoto’s disease (also called autoimmune thyroiditis) can run in families, but its cause is poorly understood.
How is hypothyroidism diagnosed and treated?
Because its symptoms are vague and overlap with those associated with nutritional deficiencies and other ailments or even just aging, hypothyroidism typically is diagnosed with blood tests for T3/T4, both made by the thyroid gland, and thyroid stimulating hormone (TSH), made by the pituitary gland in the brain in response to blood levels of T3 and T4. When blood levels of T3 and T4 are low, TSH goes up…and when T3 and T4 are high, TSH goes down.
Medication for hypothyroidism generally should be taken first thing in the morning on an empty stomach. Wait at least 30 minutes before eating or drinking anything other than water. After you start treatment, it is a good idea to repeat testing every six months or so to see if thyroid function has changed or if the medication dosage needs to be adjusted because of weight gain or loss or other factors.
Caution: Over-the-counter nutritional supplements touted as boosting or supporting thyroid health often contain high levels of iodine and other substances that can worsen rather than alleviate thyroid symptoms.
How does diet fit in?
People with mild hypothyroidism caused by Hashimoto’s disease sometimes feel better if they avoid bread, pasta and other gluten-containing foods…as well as red meat, fried foods, refined foods and other so-called pro-inflammatory foods. Their diet should focus on consumption of lean meat, fish, fruits, vegetables, nuts and seeds.
In some cases, eating such a gluten-free, anti-inflammatory diet—akin to the so-called Paleolithic (paleo) diet—eases symptoms to the point that the need for thyroid hormone-replacement therapy is reduced or even eliminated.
