What To Eat on a Hashimoto’s Thyroiditis Diet

Written by Dr. Ruscio on December 14, 2020

Written by Dr. Ruscio on December 14, 2020 — Reviewed by Hannah Hamlin

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

Reduce Autoimmunity With an Anti-Inflammatory Thyroid Diet

What Is Hashimoto's?|
Eating Right for Hashimoto's|
Best Diet for Hashimoto's|
Supplements|
Eat Well and Thrive|

Key Takeaways:

Hashimoto’s thyroiditis is a common autoimmune disease that can cause symptoms like fatigue, brain fog, and dry skin.
The best place to start healing Hashimoto’s is by focusing on the gut-thyroid axis, as the gut is where thyroid dysfunction and many symptoms arise from.
Choosing a diet that reduces inflammation, balances blood sugar, and is nutrient-dense can often provide complete symptom relief.
Evidence shows that an elimination diet like Paleo, AIP, or low-iodine can reduce thyroid symptoms and improve thyroid function.
Choosing the best thyroid diet for you will likely require some experimentation, and it’s best to start with the easiest, least-restrictive option.
Getting adequate amounts of selenium, HCl, and iron is also important for supporting healthy thyroid function.

If you have Hashimoto’s thyroiditis or have hypothyroid symptoms such as fatigue, weight gain, or hair loss, what you eat can help mitigate your symptoms. A wide range of diets — everything from Paleo to vegan — are recommended for autoimmune thyroid disorders. Research suggests several particular Hashimoto’s thyroiditis diets can be helpful for Hashimoto’s disease.

Finding the right Hashimoto’s diet for you can help lower inflammation, promote a healthy immune response, and even improve nutrient absorption to boost thyroid function.

Starting with a whole-food, elimination-based diet like the Paleo diet or autoimmune protocol (AIP) is great for getting your thyroid health back on track. And if you still aren’t getting the relief that you’re looking for, a low-iodine diet is a research-backed way to restore healthy thyroid function.

Let’s discuss what Hashimoto’s thyroiditis is, how to tell if you have it, and what the research says about which diets work to improve thyroid health.

What Is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis — also known as lymphocytic thyroiditis — is when your body’s immune system attacks your thyroid gland. This autoimmune response may damage your thyroid gland, and if left unchecked, may lead to low levels of thyroid hormone.

Hashimoto’s thyroiditis is the most common cause of hypothyroidism [1] and is one of the most common autoimmune diseases [2].

Thyroid hormone is important for many health functions, including metabolism, energy, and mood. An underactive thyroid gland may cause symptoms of Hashimoto’s disease and hypothyroidism, including [3]:

Fatigue
Weight gain
Hair loss
Brain fog
Low body temperature
Constipation
Dry skin
Joint pain

While hypothyroidism can cause this wide variety of symptoms (and many more), it’s important to work with your doctor to determine whether or not you are truly hypothyroid as these symptoms are often present in many other conditions.

However, if you have three or more of the above symptoms, there’s a chance you may have hypothyroidism — especially if you checked the boxes for fatigue and dry skin. A study of a hypothyroid questionnaire found that the most common symptoms to correlate with hypothyroidism were tiredness, (81%), dry skin (63%), shortness of breath (51%), and hair loss (30%) [3].

As a final disclaimer, symptoms alone can’t determine whether you have hypothyroidism and/or Hashimoto’s thyroiditis, so be sure to talk to your doctor about a blood test.

Do You Have Hashimoto’s Thyroiditis?

If a blood test shows that you have elevated thyroid peroxidase (TPO) [4] or thyroglobulin (TG) [4] antibodies and your thyroid gland is inflamed, you have Hashimoto’s thyroiditis. However, you can have Hashimoto’s disease and not be hypothyroid.

Your endocrinologist or healthcare practitioner will check your thyroid-stimulating hormone (TSH) and T4 hormone levels on blood tests as well. If your TSH level is elevated above the reference range and your T4 level is low, you are hypothyroid [5]. However, not all hypothyroidism requires hormone treatment and subclinical hypothyroidism may resolve on its own for many [6]. For more, see What Are Optimal Thyroid Levels?.

Elevated thyroid antibodies are not an immediate cause for alarm. In a large thyroid study, only 10-20% of participants with elevated TPO antibodies progressed to full-blown hypothyroid disease after nine years [7]. However, elevated thyroid antibodies are a message from your immune system that is worth paying attention to.

Treating Hashimoto’s Thyroiditis

Thyroid hormone replacement therapy with levothyroxine (synthetic T4 hormone, or thyroxine) is the standard treatment for Hashimoto’s disease. This helps reduce your hypothyroid symptoms and your TSH levels, but this treatment does nothing to reduce thyroid antibodies or the inflammation caused by an overzealous immune system.

Thyroid medication is only one piece of the treatment puzzle for Hashimoto’s thyroiditis. Gut health is also closely related to thyroid health. Improving your gut health, through eating an appropriate anti-inflammatory diet [8] and improving your gut microbiome [9, 10, 11, 12] can reduce inflammation and your thyroid symptoms, improve absorption of your thyroid medication [11], and even in some cases reduce your thyroid antibodies [13].

Eating Right: Hashimoto’s Diets

An anti-inflammatory diet is one of the first steps to take to improve your gut and thyroid health. Gut health is a common contributing factor to thyroid disease via the gut-thyroid axis. This can feel like a tricky topic to understand how to navigate, which is why I created a thyroid course to help break it down in more detail.

To keep it simple here, for many, tackling diet alone is enough to improve thyroid dysfunction and symptoms. Healing an autoimmune disorder like Hashimoto’s through diet starts with:

Eating a balanced diet full of whole foods, quality proteins, and healthy fats
Balancing blood sugar
Avoiding potential food sensitivities

Gluten and dairy are inflammatory for many people and may trigger a strong immune response that leads to gut inflammation. This inflammatory response in the digestive tract can contribute to autoimmunity and Hashimoto’s thyroiditis. Gluten can be especially inflammatory if you have celiac disease, which often goes undiagnosed.

An anti-inflammatory diet can also help heal a leaky gut, which is strongly linked to autoimmunity and thyroid disease [14, 15, 16, 17, 18, 19, 20]. Let’s review what research says about Hashimoto’s thyroiditis diets.

Gluten-Free, Dairy-Free, and Paleo Diet

Gluten and dairy are two of the most common food sensitivities, and research shows that avoiding these two foods can improve thyroid function and thyroid symptoms.

A gluten-free diet reduced thyroid antibodies in a group of women with Hashimoto’s disease [21]. Other studies have shown that eliminating dairy or gluten may help improve thyroid function [8, 22]. In two other studies, lactose restriction and a gluten-free diet led to significant decreases in TSH levels for patients taking synthetic thyroid hormone [8, 22].

One additional study showed that women with Hashimoto’s who ate a low-carb diet reduced their thyroid antibodies by 44% [23].

The Paleo diet, modeled after the typical diet of paleolithic humans, is both gluten and dairy-free and is generally low-carb because it is legume and grain-free. It includes grass-fed and wild-caught protein, a wide variety of fruits and veggies, and healthy fats from foods such as avocados, olive oil, nuts, seeds, and spices.

I recommend starting with this diet as it is one of the least-restrictive options for an elimination-based diet, while still offering numerous health benefits.

Autoimmune Protocol (AIP) Paleo Diet

The autoimmune Paleo diet — also called the autoimmune protocol (AIP) diet — is an adaptation of the Paleo diet that removes more foods that may trigger inflammation for those with autoimmunity. The AIP diet is much more restrictive than the standard Paleo diet, which is why we don’t recommend starting here, but it can be an excellent tool for some people.

In addition to removing gluten, dairy, legumes, and grains, the AIP also removes nightshade vegetables (like tomatoes, peppers, and potatoes), nuts, seeds, eggs, and seed-derived spices.

An exciting pilot study saw improvements in the quality of life and symptoms of women with Hashimoto’s thyroiditis who used the AIP diet for 10 weeks [24]. Their tests showed no significant changes to any measures of thyroid function or antibodies, but their inflammation decreased by 29%. This illustrates how antibody levels don’t necessarily track with symptoms, and shouldn’t solely be used as a benchmark for improvement.

While the direct benefits of using an AIP diet for Hashimoto’s needs more research, there’s additional evidence that shows the AIP type diet to be helpful in reducing inflammation and other types of autoimmunity [24, 25, 26, 27].

If you don’t see enough symptom relief from the Paleo diet, the AIP diet is a promising next step as many people have found benefit from this nutrient-dense diet.

Low-Iodine Diet

A low-iodine diet is typically prescribed during radioactive iodine treatment for thyroid cancer, but research suggests it may also be a good Hashimoto’s thyroiditis diet.

A systematic review and meta-analysis (the highest quality data) concluded that excess iodine from water and iodized salt intake increased the incidence of thyroid conditions [28]. And a number of studies have actually shown that a low-iodine diet can significantly improve hypothyroidism [29, 29]. In one study, 78.3% of Hashimoto’s patients normalized their thyroid function in three months on a low iodine diet [30].

High-iodine foods include seafood, seaweed, egg yolks, legumes like beans and lentils, soy products, and molasses.

Cutting iodine alone may not address any underlying inflammation or an unhealthy gut that could be playing a role in your symptoms. It’s often best to combine it with an anti-inflammatory diet for the most benefit. The Paleo diet works as a great low-iodine diet, as it removes both iodized salt and dairy — two of the highest sources of iodine.

Lastly, don’t completely cut iodine from your diet, as your body and thyroid still need it in order to work properly. You need about 150-450 mcg of iodine daily to maintain normal thyroid function.

Do You Need To Worry About Goitrogens?

The iodine molecule is the backbone of your thyroid hormone, and iodine deficiency can make it difficult for your body to create enough thyroid hormone.

Certain foods, called goitrogens, are thought to block the absorption of dietary iodine and therefore increase the incidence of goiter (an enlarged thyroid gland).

Cruciferous vegetables like kale, broccoli, and cabbage, and additional foods such as soy are goitrogenic. Consuming them in high quantities is thought to increase your risk of developing a goiter by blocking the absorption of iodine. But does research support this?

It appears that normal, moderate consumption of goitrogens is considered safe, even if you have a thyroid condition [31]. However, if you’re worried about the adverse effects, boiling or steaming the above foods helps reduce the level of goitrogens.

In most cases, the health benefits of eating normal amounts of high-goitrogen foods outweigh the possible negative consequences. However, if you notice reactions or adverse side effects to these foods, even after steaming or boiling, you can consider eliminating them from your diet.

What Is the Best Hashimoto’s Diet?

With all of these choices, which is the best diet plan for Hashimoto’s patients? There’s no one right diet for everyone (and the above diets aren’t an exhaustive list), so the answer truly depends on your body’s unique needs. Evidence shows that each one of these diets can reduce thyroid symptoms and improve thyroid function, but choosing the best thyroid diet for you will likely require some experimentation.

The easiest way to start is with the simplest anti-inflammatory diet option.

A Paleo diet is gluten-free, dairy-free, legume (soy) free, and low-carb, and is likely to remove artificial ingredients that may aggravate an autoimmune illness like Hashimoto’s.

If you see little to no improvement after three weeks on the Paleo diet, consider trying either the autoimmune Paleo diet or the low FODMAP diet (see below).

The autoimmune protocol Paleo diet isn’t always the best diet for autoimmunity. I recommend trying the AIP diet only if you didn’t notice improvement on a less-restrictive diet.

In addition to starting an anti-inflammatory diet, like the ones above, you can add on the low iodine diet or a low-goitrogen diet for further benefit.

There are more elimination-based diets than the ones we discussed, such as the low FODMAP diet. Low FODMAP is great for correcting any underlying gut imbalances that may be a factor in developing thyroid autoimmunity. If you have thyroid issues along with significant digestive symptoms, like gas, bloating, and stool changes that didn’t respond to a Paleo diet, the low FODMAP diet might be the best next step for you.

How to Follow An Elimination Diet

As with all elimination diets, remove the recommended foods for 2-3 weeks, or until your symptom relief starts to plateau. Then you may reintroduce foods slowly (over 3 days) one at a time to check for reactions, and use what you learn to create a maintenance diet that helps you feel better. There’s no need to continue to avoid foods you don’t react to, and the goal is to create a diet that contains a wide variety of foods and is unique to your needs

Here are a few elimination diet tips to help you succeed, no matter which diet you choose:

Keep it simple to start. Find a few basic staple recipes or use simple substitutions in your favorite dishes (like swapping white potatoes for sweet potatoes) and develop a simple meal plan. Once you’re comfortable with your new diet, expand your menu to include new recipes.

Be prepared. Stock your pantry with basic meal plan ingredients, and remove all off-plan foods. Batch-prepare your simple starter recipes, and freeze individual servings.

Be as strict as possible about the diet for 2-3 weeks. This will help you feel better faster and give you better results during your food reintroductions.

Don’t stay on any diet too long if it’s not working. You should start to notice some positive changes within a few weeks. If you don’t see any change, consider trying something different.

Supplements To Support Your Hashimoto’s Thyroiditis Diet

In addition to elimination diets, there are several supplements for Hashimoto’s thyroiditis that have been shown to reduce thyroid symptoms and improve thyroid function.

Probiotics

Thyroid health is closely linked to gut health, and probiotics have been shown to improve digestive symptoms and balance the gut microbiome [32, 33]. For example, probiotics were shown in one study to allow some patients to reduce their thyroid medication dosage [34].

Probiotics have also been shown to help resolve small intestine bacterial overgrowth (SIBO) [35, 36], which has been closely associated with thyroid disease [37], and to reduce inflammation [32].

Including a quality probiotic from each of the three main probiotic categories — Lactobacillus and Bifidobacteria blends, Saccharomyces boulardii, and soil-based probiotics — may help improve your constipation, brain fog, fatigue, and autoimmunity, and reduce your thyroid medication dosage. For more on how to use probiotics, see our Probiotics Starter Guide.

Vitamin D

Research shows that Vitamin D deficiency is associated with the severity of hypothyroidism [38], and those with hypothyroid disease may have significantly lower vitamin D levels than those without [39].

A meta-analysis concluded that vitamin D supplementation improves thyroid antibody levels [40], and another study showed women with Hashimoto’s who supplemented with vitamin D and selenium had improved thyroid antibodies [41].

Though more research is needed, supplementing vitamin D may improve your Hashimoto’s thyroiditis. Vitamin D supplements are an option, or safe sun exposure is a free and more bioavailable way to get your vitamin D. If you choose to go the supplement route, be sure to get your vitamin D levels checked by your healthcare provider, as high levels can be toxic to your body.

Selenium

The data about selenium for hypothyroidism has been mixed [42].

Several studies, including a systematic review and meta-analysis, showed that selenium reduced thyroid antibodies [43, 44]. However, a systematic review and meta-analysis found that long-term selenium use had no effect on thyroid hormone levels or hypothyroid patients [45]. One study’s results suggested selenium supplementation may be helpful in correcting a deficiency but not as a long-term treatment plan [46].

If you have Hashimoto’s, it may be worth supplementing with selenium for 3-6 months to see if you see benefit. However, the positive effects of selenium supplementation have been found to stall at the 9-month mark [46] If you prefer to get your nutrients through food (as do we), Brazil nuts are a good food source of selenium.

HCl (Stomach Acid)

Up to 40% of hypothyroid patients may also have stomach autoimmunity, resulting in low stomach acid [47, 48].

Supplemental stomach acid, typically consumed as betaine hydrochloride (HCl), can help your body better absorb iron and vitamin B12, which are also often deficient in hypothyroid patients [49, 50, 51, 52, 53, 54, 55].

You’re most likely to benefit from betaine HCl if you:

Are over 65
Have a history of anemia (see Iron, below)
Have an autoimmune condition, like Hashimoto’s thyroiditis

Iron

Low iron levels can be one reason your thyroid medication doesn’t seem to be working. Low serum ferritin (your storage form of iron) was correlated with hypothyroid lab markers [56], and low iron has been shown to be related to thyroid hormone status [57]. Increasing ferritin levels to more than 100 micrograms per liter improved fatigue for hypothyroid women [58].

If you have a history of anemia or your ferritin level is below 100 mcg/L, iron supplementation or eating iron-rich foods like spinach, brussels sprouts, and red meat may help improve your thyroid symptoms. HCl supplements may also help you to absorb iron better.

Eat Well and Thrive on a Hashimoto’s Diet

The best Hashimoto’s diet is one that incorporates simple dietary changes to improve nutrient absorption and reduce inflammation. Eat a healthy, whole foods diet to start, and modify if you don’t see the improvement you hoped for.

And if you find it difficult to get started, feel uninspired by your food options, or have questions about pursuing a specific diet, my book, Healthy Gut, Healthy You offers a clear protocol for healing inflammation. You can also consult a dietitian or schedule a visit with us to get help finding your way to wellness. With a little effort, you will be eating delicious, health-supporting meals, and again have the energy to do the things you love.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

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