What To Eat on a Hashimoto’s Thyroiditis Diet

Reduce Autoimmunity With an Anti-Inflammatory Thyroid Diet

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.

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.

Hashimoto's Thyroiditis diet: A woman with her hand on her chin and looking sideways

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 Trusted SourcePubMedGo to source] and is one of the most common autoimmune diseases [2 Trusted SourcePubMedGo to source].

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 fatigue, weight gain, hair loss, brain fog, low body temperature, constipation, and dry skin. Autoimmune conditions like Hashimoto’s are also commonly associated with joint pain [3 Trusted SourcePubMedGo to source, 4 Trusted SourcePubMedGo to source, 5 Trusted SourcePubMedGo to source] and leaky gut [6 Trusted SourcePubMedGo to source, 7 Trusted SourcePubMedGo to source, 8 Trusted SourcePubMedGo to source, 9 Trusted SourcePubMedGo to source, 10 Trusted SourcePubMedGo to source, 11 Trusted SourcePubMedGo to source].

Hypothyroid symptoms infographic

While hypothyroidism can cause this wide variety of symptoms, it’s important to not get carried away with assumptions. 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%), hair loss (30%) [12 Trusted SourcePubMedGo to source]. Work with your doctor to determine whether or not you are truly hypothyroid.

Do You Have Hashimoto’s Thyroiditis?

If a blood test shows that you have elevated thyroid peroxidase (TPO) [13] or thyroglobulin (TG) [14] antibodies and your thyroid gland is inflamed, you have Hashimoto’s thyroiditis. However, you can have Hashimoto’s disease and not be hypothyroid.

Your doctor will check your Thyroid Stimulating Hormone (TSH) and T4 hormone levels on blood tests as well. If your TSH level is elevated, and your T4 level is low, you are hypothyroid [15]. (For more, see What Are Optimal Thyroid Levels?)

Elevated thyroid antibodies are not 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 [16 Trusted SourcePubMedGo to source]. However, elevated thyroid antibodies is 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 [17 Trusted SourcePubMedGo to source] and improving your gut microbiome [18 Trusted SourcePubMedGo to source, 19 Trusted SourcePubMedGo to source, 20 Trusted SourcePubMedGo to source, 21 Trusted SourcePubMedGo to source] can reduce inflammation and your thyroid symptoms, improve absorption of your thyroid medication [22 Trusted SourcePubMedGo to source], and even in some cases reduce your thyroid antibodies [23 Trusted SourcePubMedGo to source].

Eating Right: Hashimoto’s Thyroiditis Diets

An anti-inflammatory diet is one of the first steps to take to improve your gut and thyroid health. Improving an autoimmune disorder like Hashimoto’s through diet starts with:

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

Common inflammatory foods like gluten and dairy may trigger the strong immune response and gut inflammation that can contribute to autoimmunity and Hashimoto’s thyroiditis. 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 [24 Trusted SourcePubMedGo to source]. Other studies have shown improved thyroid function by eliminating dairy or gluten may help [25 Trusted SourcePubMedGo to source, 26 Trusted SourcePubMedGo to source]. In two other studies, lactose restriction and a gluten-free diet led to significant decreases in TSH levels for patients taking synthetic thyroid hormone [27 Trusted SourcePubMedGo to source, 28 Trusted SourcePubMedGo to source].

One additional study showed that women with Hashimoto’s who ate a low-carb diet reduced their thyroid antibodies by 44% [29 Trusted SourcePubMedGo to source].

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 grain and legume-free. It includes grass-fed and wild-caught protein, a wide variety of fruits and veggies, healthy fats from foods such as avocados and olive oil, and nuts, seeds, and spices.

Autoimmune Paleo Diet (AIP)

The autoimmune Paleo diet — also called the autoimmune protocol — 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. 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 improved the quality of life and symptoms of women with Hashimoto’s thyroiditis who used the AIP diet for 10 weeks [30]. Their tests showed no significant changes to any measures of thyroid function or antibodies, but their inflammation decreased by 29%. This illustrates how antibodies levels don’t necessarily track with symptoms, and shouldn’t necessarily be used as a benchmark for improvement.

Though these results are hopeful, this is only one study, and more research needs to be done.

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 [31 Trusted SourcePubMedGo to source]. And a number of studies have actually shown that a low-iodine diet can significantly improve hypothyroidism [32 Trusted SourcePubMedGo to source, 33 Trusted SourcePubMedGo to source]. In one study, 78.3% of Hashimoto’s patients normalized their thyroid function in three months on a low iodine diet [34 Trusted SourcePubMedGo to source].

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

Do You Need To Worry About Goitrogens?

Hashimoto's Thyroiditis diet: variety of green vegetables

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 to therefore increase the incidence of goiter. (A goiter is an enlarged thyroid gland and is caused by iodine deficiency.)

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[35 Trusted SourcePubMedGo to source]. Boiling or steaming foods reduces 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 to these foods, you can consider eliminating them from your diet.

What Is the Best Hashimoto’s Thyroiditis Diet?

With all of these choices, which is the best diet for Hashimoto’s patients? There’s no one right diet for everyone, 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 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, the low iodine diet, or a low-goitrogen diet.

The Autoimmune Paleo diet is not necessarily the best diet for autoimmunity. I recommend trying the autoimmune paleo diet only if you didn’t notice improvement on a less-restrictive diet.

As with all elimination diets, remove the recommended foods for a few weeks, reintroduce foods 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.

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 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

Hashimoto's Thyroiditis diet: Probiotics pills

Thyroid health is closely linked to gut health, and probiotics have been shown to improve digestive symptoms and balance the gut microbiome [36 Trusted SourcePubMedGo to source, 37 Trusted SourcePubMedGo to source]. For example, probiotics were shown in one study to allow some patients to reduce their thyroid medication dosage [38 Trusted SourcePubMedGo to source].

Probiotics have also been shown to help resolve SIBO [39 Trusted SourcePubMedGo to source, 40 Trusted SourcePubMedGo to source], which has been closely associated with thyroid disease [41 Trusted SourcePubMedGo to source] and to reduce inflammation [42 Trusted SourcePubMedGo to source].

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

Vitamin D deficiency has been shown in research to be associated with the severity of hypothyroidism [43 Trusted SourcePubMedGo to source], and those with hypothyroid disease have been shown to have significantly lower vitamin D levels than controls [44 Trusted SourcePubMedGo to source].

A meta-analysis concluded that vitamin D supplementation improves thyroid antibody levels [45 Trusted SourcePubMedGo to source], and another study showed women with Hashimoto’s who supplemented with vitamin D and selenium had improved thyroid antibodies [46 Trusted SourcePubMedGo to source].

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.

Selenium

The data about selenium for hypothyroidism has been mixed [47 Trusted SourcePubMedGo to source].

Several studies, including a systematic review and meta-analysis, showed that selenium reduced thyroid antibodies [48 Trusted SourcePubMedGo to source, 49 Trusted SourcePubMedGo to source]. However, a systematic review and meta-analysis found that long-term selenium use had no effect on thyroid hormone levels or hypothyroid patients [50 Trusted SourcePubMedGo to source]. One study’s results suggested selenium supplementation may be most useful until sufficiency is reached but has diminishing returns after that point [51 Trusted SourcePubMedGo to source].

If you have Hashimoto’s, it may be worth supplementing with selenium for 3-6 months and then discontinuing use. Brazil nuts are a good food source of selenium.

Stomach Acid

Up to 40% of hypothyroid patients may also have stomach autoimmunity, resulting in low stomach acid [52 Trusted SourcePubMedGo to source, 53 Trusted SourcePubMedGo to source].

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 [54 Trusted SourcePubMedGo to source, 55 Trusted SourcePubMedGo to source, 56 Trusted SourcePubMedGo to source, 57 Trusted SourcePubMedGo to source, 58 Trusted SourcePubMedGo to source, 59 Trusted SourcePubMedGo to source, 60 Trusted SourcePubMedGo to source].

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 [61], and low iron has been shown to be related to thyroid hormone status [62]. Increasing ferritin levels to more than 100 micrograms per liter improved fatigue for hypothyroid women [63 Trusted SourcePubMedGo to source].

If you have a history of anemia or your ferritin level is below 100 mcg/L, iron supplementation or eating iron-rich foods may help improve your thyroid symptoms. HCL supplements may also help you to absorb iron better.

Eat Well and Thrive With Hashimoto’s

Making simple diet changes to improve your blood sugar and reduce inflammation can help you feel better, despite your Hashimoto’s diagnosis. Eat a healthy, whole foods diet to start, and modify if you don’t see the improvement you hoped for. With a little effort, you will be eating delicious, health-supporting meals, and again have the energy to do the things you love.

➕ References
  1. Use for reference links. Use Pubmed citation NOT just URL when available

Need help or would like to learn more?
View Dr. Ruscio’s additional resources

Get Help

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!