The best diet for an underactive thyroid (Hashimoto’s thyroiditis or hypothyroidism) is often one focused on improving gut health.
Tackling underlying autoimmunity and dysbiosis can help to normalize thyroid hormone levels.
An elimination diet based on a Paleo framework is the best place to start for most people.
If a Paleo diet doesn’t ease symptoms like fatigue, brain fog, and digestive issues, you could try moving onto a low FODMAP diet or even the AIP (autoimmune protocol) diet.
It’s important to have a nutritious diet with adequate amounts of selenium, iron, and vitamin D.
Probiotics can help to deal with gut and thyroid symptoms too.
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When it comes to foods to eat and foods to avoid, there’s no one thyroid diet chart that suits everyone. Many thyroid issues such as Hashimoto’s thyroiditis and hypothyroidism stem from underlying gut and autoimmune issues that vary in intensity and symptoms from person to person.
While one person with hypothyroidism might be able to eat a wide variety of foods, others might struggle with many gut and dietary sensitivities.
In this article, we’ll look at the three main diets that can help to balance both an unhealthy gut and underactive thyroid, including symptoms such as:
We’ll also investigate key nutrients and supplements that should be part of any thyroid diet chart to help keep your thyroid gland healthy.
The Gut-Thyroid Connection
First, let’s briefly define Hashimoto’s disease and hypothyroidism, and determine why gut and thyroid health are so intricately related.
Hashimoto’s thyroiditis is an autoimmune condition in which the immune system starts to attack the thyroid gland. Registering elevated levels of thyroid peroxidase (TPO) antibodies is the usual indicator of this condition .
Hypothyroidism can sometimes develop from Hashimoto’s and is when your thyroid stops producing enough thyroid hormones needed for efficient metabolism. A high level of thyroid-stimulating hormone (TSH) usually indicates hypothyroidism.
Autoimmune thyroid conditions and poor gut health are often connected via the “gut-thyroid axis.”
When things go wrong with both gut and thyroid health, an unbalanced gut microbiota (dysbiosis) is often the common connection . Dysbiosis is known to cause or be connected with :
Inflammation, increased intestinal permeability, and altered immune responses (remember: Hashimoto’s thyroiditis is an autoimmune disease)
Altered activity of enzymes that impact thyroid hormone levels
Reduced absorption of minerals that are important to the thyroid, including iodine, selenium, zinc, and iron
Brain fog, depression and other cognitive issues that overlap with thyroid symptoms [4, 5]
Research also indicates that when gut problems are dealt with, thyroid health also improves, sometimes considerably.
One small study found a huge average drop in TPO (thyroid peroxidase antibodies (raised in Hashimoto’s patients) when over 2000 patients were treated for H. pylori gut infections . Treating H. pylori has also been shown to improve TSH levels [7, 8, 9].
Treating Blastocystis hominis (a gut pathogen) has been also shown to reduce inflammatory markers, thyroid antibodies, and TSH levels .
Similarly, identifying and removing food triggers is often very helpful for thyroid patients [10, 11]. This is what we see in the clinic week over week.
Your Thyroid Diet Chart: 3 Key Elimination Diets
Given that gut sensitivities are often tied to hypothyroid issues, an elimination diet, which removes problem foods, is one of the best ways to improve both sets of symptoms. An elimination diet involves taking the foods most likely to cause sensitivity out of your diet for a period of time (usually 2-3 weeks) before gradually reintroducing them to see how your symptoms respond.
An elimination diet plan can be modeled on any type of diet, but the best approach is to start with the lowest level of restriction, only increasing the number of foods you eliminate (or modifying the types of food you eliminate) if you don’t get the results you need.
The three elimination diets that we find people get best results with for gut and hypothyroid issues are the Paleo diet, low FODMAPs diet and autoimmune protocol (AIP) diet. Here’s a quick overview before we go into more detail.
Here’s a quick overview before we go into more detail.
Unprocessed, ancestrally focused. Removes or minimizes dairy, wheat, legumes, additives.
General good health, quelling inflammation and autoimmune issues; moderate gut sensitivities.
Eliminates a range of carbs that can create bacterial.
Overgrowth in those sensitive to them.
Inflammatory and other reactive gut conditions such as IBS and IBD; thyroid and autoimmune conditions which have a lot of gut symptoms.
Similar to Paleo but eliminates a wider variety of foods including the nightshade group (e.g. tomatoes, potatoes, peppers).
More intractable Autoimmune and gut conditions; specifically where sensitivity to the nightshade family may be triggering symptoms.
1. The Paleo Diet
For most patients an elimination diet based on a Paleo framework is the best place to start.
The Paleo diet eliminates a number of inflammatory and potentially triggering foods (e.g. grains, dairy, legumes, processed foods), while not overly restricting carbs and still allowing you to eat quite a wide variety of other foods (vegetables, fruits, lean meats, fresh fish, healthy fats, nuts and seeds). As such, it makes a great starting thyroid diet chart for most people.
Iodine: A Double Edged Sword
Though iodine is vital for the basic functioning of the thyroid gland and the manufacture of thyroid hormones, too much can be as bad as too little. For the most part it is therefore not a good idea to supplement with iodine.
In fact, multiple studies have shown iodine supplements may also actually increase the overall incidence of hypothyroid conditions, including goiter and autoimmunity (22)(23)(24)
Sometimes short term iodine restriction can benefit hypothyroid patients:
In one study, a third of hypothyroid patients returned to normal thyroid function after 21 days of iodine restriction (25)
In other research, 63% of patients decreased their high TSH values by iodine restriction (26)
In short, to optimize your thyroid function, food sources of iodine (or at most a low-dose iodine supplement) is probably the best way to go. And if you already have Hashimoto’s or hypothyroidism, check with your health practitioner before making big increases in your intake of iodine.
What About Goitrogens?
Certain food components — called goitrogens — are thought to block the absorption of dietary iodine and to increase the chance of an enlarged thyroid gland (goiter), caused by the body struggling to make enough thyroid hormones.
Goitrogens are found in the highest amount in cruciferous vegetables, which includes kale, broccoli, brussels sprout, spinach, and cabbage. Soy foods also contain some goitrogens.
But before you consider banning tofu and healthy green veggies, it appears that normal, moderate consumption of goitrogens is considered safe, even if you have a thyroid condition (27).
You should only eliminate these foods if you notice symptomatic reactions to them.
Boiling or steaming foods also reduces goitrogens. So to minimize any potential problems it could be a good idea to serve cruciferous veggies cooked rather than raw.
Tying it All Together
In conclusion, there is no such thing as a “one-size-fits-all” thyroid diet chart. A nutrient-dense Paleo-style diet is a good starting place for many with impaired thyroid function and the underlying autoimmunity, inflammation, and gut dysbiosis that often comes along with it.
Backing this up with probiotics can increase your chance of a complete resolution of thyroid and gut symptoms, including fatigue, bloating, and brain fog.
That said, thyroid issues can sometimes be more complex. You can arrange an appointment with one of the highly qualified practitioners at the Ruscio Institute for Functional Medicine to receive more personalized care.
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.
Other Vital Nutrients for Thyroid Health
Thyroid diet charts can be overly focused on foods and nutrients not to eat. But there are also a handful of essential nutrients that play a vital role in thyroid hormone production and activation (19). We’ve laid these out in the table below:
Where to Get It
Needed for the formation of thyroid hormones (T3 and T4)
Iodized salt, prunes, corn, fish, eggs
Needed for activation/inactivation of Thyroxine (T4) hormone. Also has helpful antioxidant/anti-inflammatory effects
Brazil nuts, meat, liver, fish, shellfish, spinach
Needed for the action of a key enzyme in thyroid hormone synthesis
Meat, animal offal (organ meats such as liver), nuts and seeds (e.g. pumpkin and chia seeds), cocoa and bitter chocolate, sardines, seafood
Helps balance thyroid levels. A deficiency is linked with increased antibody titers against thyroid antigens
Flax seeds, pumpkin seeds, millet and other whole grains, meat, buckwheat
Protective against autoimmune conditions
Oily fish, eggs and sunshine. A daily supplement is a more reliable way to get it
Helps reduce elevated thyroid antibodies and thyroid stimulating hormone (TSH). Inositol may work in part by improving the thyroid gland’s sensitivity to TSH
Citrus fruit, cantaloupe, bananas, raisins and fiber-rich foods. A quality myo-inositol supplement can be useful to lower TSH and TPO antibodies in hypothyroid patients (20)(21)
Fröhlich E, Wahl R. Thyroid Autoimmunity: Role of Anti-thyroid Antibodies in Thyroid and Extra-Thyroidal Diseases. Front Immunol. 2017 May 9;8:521. DOI: 10.3389/fimmu.2017.00521. PMID: 28536577. PMCID: PMC5422478.
Knezevic J, Starchl C, Tmava Berisha A, Amrein K. Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function? Nutrients. 2020 Jun 12;12(6). DOI: 10.3390/nu12061769. PMID: 32545596. PMCID: PMC7353203.
Fröhlich E, Wahl R. Microbiota and thyroid interaction in health and disease. Trends Endocrinol Metab. 2019 Aug;30(8):479–90. DOI: 10.1016/j.tem.2019.05.008. PMID: 31257166.
Bravo JA, Julio-Pieper M, Forsythe P, Kunze W, Dinan TG, Bienenstock J, et al. Communication between gastrointestinal bacteria and the nervous system. Curr Opin Pharmacol. 2012 Dec;12(6):667–72. DOI: 10.1016/j.coph.2012.09.010. PMID: 23041079.
Dopkins N, Nagarkatti PS, Nagarkatti M. The role of gut microbiome and associated metabolome in the regulation of neuroinflammation in multiple sclerosis and its implications in attenuating chronic inflammation in other inflammatory and autoimmune disorders. Immunology. 2018 Jun;154(2):178–85. DOI: 10.1111/imm.12903. PMID: 29392733. PMCID: PMC5980216.
Bertalot G, Montresor G, Tampieri M, Spasiano A, Pedroni M, Milanesi B, et al. Decrease in thyroid autoantibodies after eradication of Helicobacter pylori infection. Clin Endocrinol (Oxf). 2004 Nov;61(5):650–2. DOI: 10.1111/j.1365-2265.2004.02137.x. PMID: 15521972.
Centanni M, Gargano L, Canettieri G, Viceconti N, Franchi A, Delle Fave G, et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med. 2006 Apr 27;354(17):1787–95. DOI: 10.1056/NEJMoa043903. PMID: 16641395.
Bugdaci MS, Zuhur SS, Sokmen M, Toksoy B, Bayraktar B, Altuntas Y. The role of Helicobacter pylori in patients with hypothyroidism in whom could not be achieved normal thyrotropin levels despite treatment with high doses of thyroxine. Helicobacter. 2011 Apr;16(2):124–30. DOI: 10.1111/j.1523-5378.2011.00830.x. PMID: 21435090.
Ribichini D, Fiorini G, Repaci A, Castelli V, Gatta L, Vaira D, et al. Tablet and oral liquid L-thyroxine formulation in the treatment of naïve hypothyroid patients with Helicobacter pylori infection. Endocrine. 2017 Sep;57(3):394–401. DOI: 10.1007/s12020-016-1167-3. PMID: 27848196.
Asik M, Gunes F, Binnetoglu E, Eroglu M, Bozkurt N, Sen H, et al. Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine. 2014 Jun;46(2):279–84. DOI: 10.1007/s12020-013-0065-1.
Virili C, Bassotti G, Santaguida MG, Iuorio R, Del Duca SC, Mercuri V, et al. Atypical celiac disease as cause of increased need for thyroxine: a systematic study. J Clin Endocrinol Metab. 2012 Mar;97(3):E419-22. DOI: 10.1210/jc.2011-1851. PMID: 22238404.
Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Sousa-Guerreiro C. A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scand J Pain. 2016 Aug 22;13:166–72. DOI: 10.1016/j.sjpain.2016.07.004. PMID: 28850525.
Varjú P, Farkas N, Hegyi P, Garami A, Szabó I, Illés A, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies. PLoS ONE. 2017 Aug 14;12(8):e0182942. DOI: 10.1371/journal.pone.0182942. PMID: 28806407. PMCID: PMC5555627.
Abbott RD, Sadowski A, Alt AG. Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto’s Thyroiditis. Cureus. 2019 Apr 27;11(4):e4556. DOI: 10.7759/cureus.4556. PMID: 31275780. PMCID: PMC6592837.
Ng QX, Peters C, Ho CYX, Lim DY, Yeo W-S. A meta-analysis of the use of probiotics to alleviate depressive symptoms. J Affect Disord. 2018 Mar 1;228:13–9. DOI: 10.1016/j.jad.2017.11.063. PMID: 29197739.
Talebi S, Karimifar M, Heidari Z, Mohammadi H, Askari G. The effects of synbiotic supplementation on thyroid function and inflammation in hypothyroid patients: A randomized, double‑blind, placebo‑controlled trial. Complement Ther Med. 2020 Jan;48:102234. DOI: 10.1016/j.ctim.2019.102234. PMID: 31987229.
Shi W-J, Liu W, Zhou X-Y, Ye F, Zhang G-X. Associations of Helicobacter pylori infection and cytotoxin-associated gene A status with autoimmune thyroid diseases: a meta-analysis. Thyroid. 2013 Oct;23(10):1294–300. DOI: 10.1089/thy.2012.0630. PMID: 23544831.
Konrad P, Chojnacki J, Kaczka A, Pawłowicz M, Rudnicki C, Chojnacki C. [Thyroid dysfunction in patients with small intestinal bacterial overgrowth]. Pol Merkur Lekarski. 2018 Jan 23;44(259):15–8. PMID: 29374417.
Danailova Y, Velikova T, Nikolaev G, Mitova Z, Shinkov A, Gagov H, et al. Nutritional management of thyroiditis of hashimoto. Int J Mol Sci. 2022 May 5;23(9). DOI: 10.3390/ijms23095144. PMID: 35563541. PMCID: PMC9101513.
Pace C, Tumino D, Russo M, Le Moli R, Naselli A, Borzì G, et al. Role of selenium and myo-inositol supplementation on autoimmune thyroiditis progression. Endocr J. 2020 Nov 28;67(11):1093–8. DOI: 10.1507/endocrj.EJ20-0062. PMID: 32669509.
Nordio M, Pajalich R. Combined treatment with Myo-inositol and selenium ensures euthyroidism in subclinical hypothyroidism patients with autoimmune thyroiditis. J Thyroid Res. 2013 Oct 2;2013:424163. DOI: 10.1155/2013/424163. PMID: 24224112. PMCID: PMC3809375.
Foley TP. The relationship between autoimmune thyroid disease and iodine intake: a review. Endokrynol Pol. 1992;43 Suppl 1:53–69. PMID: 1345585.
Katagiri R, Yuan X, Kobayashi S, Sasaki S. Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies. PLoS ONE. 2017 Mar 10;12(3):e0173722. DOI: 10.1371/journal.pone.0173722. PMID: 28282437. PMCID: PMC5345857.
Gaberšček S, Gaberšček B, Zaletel K. Incidence of thyroid disorders in the second decade of adequate iodine supply in Slovenia. Wien Klin Wochenschr. 2021 Mar;133(5–6):182–7. DOI: 10.1007/s00508-020-01662-5. PMID: 32377868.
Tajiri J, Higashi K, Morita M, Umeda T, Sato T. Studies of hypothyroidism in patients with high iodine intake. J Clin Endocrinol Metab. 1986 Aug;63(2):412–7. DOI: 10.1210/jcem-63-2-412. PMID: 3722332.
Kasagi K, Iwata M, Misaki T, Konishi J. Effect of iodine restriction on thyroid function in patients with primary hypothyroidism. Thyroid. 2003 Jun;13(6):561–7. DOI: 10.1089/105072503322238827. PMID: 12930600.
Knudsen N, Laurberg P, Perrild H, Bülow I, Ovesen L, Jørgensen T. Risk factors for goiter and thyroid nodules. Thyroid. 2002 Oct;12(10):879–88. DOI: 10.1089/105072502761016502. PMID: 12487770.
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