In the 1995 American Thyroid Association (ATA) guidelines, biological and synthetic thyroid hormone preparations containing T4 plus T3 were not recommended out of concern for fluctuating and often elevated serum T3 concentrations (71). In conjunction with the American Association of Clinical Endocrinologists in 2012, the ATA continued to recommend l-thyroxine monotherapy and noted that evidence does not support using synthetic combination therapies; in addition, they stated that “desiccated thyroid hormone should not be used for the treatment of hypothyroidism” (72). In 2014, the ATA recommendations evolved with the recognition that 1) serum T3 levels might not be normalized in all l-thyroxine–treated hypothyroid patients and 2) some patients remain symptomatic while receiving l-thyroxine monotherapy. Titration of l-thyroxine dose to achieve normal TSH concentrations remains a first-line approach, but trials with combination therapy can be considered. In addition, the guidelines recognize that although superiority data are lacking, some patients do experience a clinical response with desiccated thyroid preparations or combination therapy with l-thyroxine plus l-triiodothyronine (1). The European Thyroid Association has similar recommendations (2).
When the hypothalmus decides we need more thyroid hormone in circulation (cold weather or increased activity level for example) it sends a chemical messenger called thyrotropin-releasing hormone (TRH) which goes to the pituitary gland. The pituitary than sends thyroid stimulating hormone (TSH) over to the thyroid. TSH activates the production of a protein called thyroglobulin.
Over my several decades working as a Functional Medicine doctor, I can assure you that even in the toughest cases, you can heal your thyroid. With some patients, I can do this through the dietary, nutrient, and lifestyle factors I’ve discussed here. For others, that healing requires trial and error using several medications and working closely with a physician.
No one diet or plan works for everybody, including the thyroid diet that I’ve described here, as each person has a unique way of healing. There is a saying: “One person’s food is another’s poison.” It’s always worth remembering that just because one diet worked for one person it does not mean it will work for you too. One person could have healed their thyroid by just changing the water filters (by getting rid of fluoride) alone, while another needs to implement five major diet and lifestyle changes to start feeling just a little better. Let’s respect our differences.
I’m Kate, and I'm here to inspire you to live a more non-toxic life. Expect real food that tastes as good as it makes you feel. Deep dive into natural + holistic wellness topics, with a focus on hormones, gut + thyroid health. No restrictive diets, no products that don't work, no unrealistic lifestyle changes, no sacrifice. Here, we strike the balance between good + good for you. I'm living proof this natural lifestyle and healthy food heals!
Gluten intolerance is highly associated with inflammatory disorders of all kinds (63). It is also a contributing factor in many autoimmune diseases such as celiac disease, rheumatoid arthritis, type I diabetes, Hashimoto’s thyroiditis, autoimmune cardiomyopathy, lymphoma and dermatitis herpetiformis (skin disease) among others (64, 65). If you have a thyroid problem or just want to avoid having a future thyroid problem, the first place to start is on a gluten-free nutrition program!
Physicians hesitated to use l-thyroxine monotherapy over concern that it could result in a relative T3 deficiency, despite growing discontent with potency of natural thyroid products (39) and reduced cost of l-thyroxine, such that the 2 treatments were approximately equivalent (36, 41). The seminal discovery of peripheral T4-to-T3 conversion in athyreotic individuals largely obviated this concern (42). This laid the foundation for the corollary that treatment with l-thyroxine could replace thyroid hormone in such a way that the prohormone pool would be restored and the deiodinases would regulate the pool of active T3. Within a decade there was a major transition toward l-thyroxine monotherapy as first-line therapy (Appendix Table and Figure) (38).
A complete thyroid diet solution includes more than just food. I cannot emphasise how important these are for managing stress and emotions, especially for people with hyperthyroidism. We underestimate what stress and emotions do to us; each flare-up of anger, feelings of guilt, fear, hostility, jealousy, etc. fires up the adrenals which release cortisol, and cortisol has a detrimental impact on the thyroid.
Hypothyroidism is a very common condition. Approximately 3% to 4% of the U.S. population has some form of hypothyroidism. This type of thyroid disorder is more common in women than in men, and its incidence increases with age. Examples of common causes of hypothyroidism in adults include Hashimoto's thyroiditis, an autoimmune form of overactive thyroid, lymphocytic thyroiditis, which may occur after hyperthyroidism (underactive thyroid), thyroid destruction from radioactive iodine or surgery, pituitary or hypothalamic disease, medications, and severe iodine deficiency.
Your mood is especially susceptible to changes in hormone levels, so some people with hypothyroidism deal with depression, anxiety, trouble getting good sleep and low immunity. The thyroid gland helps regulate chemical messengers called neurotransmitters, which control your emotions and nerve signaling. This is the reason an out-of-balance thyroid can mean drastic emotional changes at times.
Short of eating a few kelp salads, you probably don't have to worry about getting too much iodine from any other foods. In particular, dairy products are full of this nutrient (and in more manageable amounts), according to a 2012 research in the journal Nutrition Reviews. Part of the reason is because livestock are given iodine supplements and the milking process involves iodine-based cleaners. Plain, low-fat yogurt, or Greek yogurt is a good source—it can make up about 50% of your daily intake of iodine.
If hypothyroidism is left untreated, symptoms of myxedema can appear. These include very dry skin, and swelling around the lips and nose called non-pitting (firm) edema. More severe symptoms can be life-threatening and include low blood pressure, decreased body temperature, shallow respirations, unresponsiveness and even coma. Fortunately, advanced hypothyroidism such as this is quite rare.
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Essential fatty acids found in fish oil are critical for brain and thyroid function. DHA and EPA omega-3s found in fish oil are associated with a lower risk for thyroid symptoms, including anxiety, depression, high cholesterol, inflammatory bowel disease, arthritis, diabetes, a weakened immune system and heightened autoimmune disease. Omega-3 fish oil such as cod liver oil can also help balance levels of omega-6s in the diet, which is important for ongoing health.
*Cassava bears special mention here. You may have heard of it because it is the starchy root vegetable from which tapioca is made, but cassava is also a popular staple food in many Third World countries, where it is eaten boiled, mashed, or ground into flour. Fresh cassava root contains a harmless substance called linamarin, which can turn into hydrocyanic acid (aka cyanide!) when the plant is damaged or eaten. Flaxseeds also contain linamarin. Cyanide is very toxic, so the human body converts it into thiocyanate (which, although it does interfere with thyroid function, is less toxic than cyanide and easier for the body to eliminate).
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Goitrogenic foods can act like an antithyroid drug in disabling the thyroid function. They prevent the thyroid from using available iodine. It is made worse if you use a lot of salt because that causes the thyroid to swell. Do not eat these in large amounts if you are taking thyroid hormone replacement. It is thought that the enzymes involved in the formation of goitrogenic materials in plants can be destroyed by cooking, so cook these foods thoroughly if you want to eat them.
But determining the correct dosage isn’t a quick process — you will need a blood test between six and eight weeks after you first start taking your medicine to see if your hormone levels are normalizing. If your doctor thinks you need a dosage adjustment, he or she will do so and recheck your hormone levels after another six to eight weeks. Once your thyroid hormone levels stabilize, you won’t need another thyroid check for six months. (5) Controlled hypothyroidism requires only an annual checkup. (3)
It's important to note, however, that selenium has what doctors call a "narrow therapeutic window." In optimal amounts, it can help ensure good thyroid function and have other benefits, but is toxic in amounts not that far above "normal." This is especially important to remember if you are taking a multi-vitamin that contains zinc as well as a zinc supplement.
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Please Note: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any diet or exercise program.
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