Everything You Need to Know About the Hashimoto’s Diet — Plus, New Treatments for Hashimoto’s Thyroiditis

Do you wear a sweatshirt even when other people are outside in T-shirts? Do you find yourself dragging your feet through your day? And why is there so much hair coming off on your hairbrush? These are all signs of Hashimoto’s thyroiditis, an autoimmune condition that is the most common cause of hypothyroidism in the United States. Treatment involves medication management—but lifestyle factors, including your diet, also affect your thyroid health and function.

If you’re interested in learning more about Hashimoto’s and what you should or shouldn’t eat to help calm symptoms (including whether gluten-free is the answer), keep reading. We have guidance to help you feel empowered in managing this condition.

Understanding Hashimoto’s disease and thyroid function

Your thyroid is a butterfly-shaped gland at the base of your neck. Its function is to churn out thyroid hormones, which circulate in your blood to regulate your metabolism. In turn, this affects your body temperature regulation, heart rate, food and energy metabolism, and your nervous system.

Ideally, your thyroid keeps zipping along, releasing the right amount—not too much, not too little—of thyroid hormone. But, like all tissues in the body, the thyroid can be damaged. In the case of Hashimoto’s disease, it’s the body’s own immune system that attacks the thyroid, typically causing hypothyroidism, or an underactive thyroid, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

As a result of a sputtering thyroid, your body’s metabolism runs slower, which can cause a slowing down in systems all over your body. You may gain a little bit of weight, struggle to poop on a regular schedule, and your favorite moisturizer may not cut it anymore. Here’s a closer look at the symptoms of Hashimoto's, per the NIDDK:

• Cold intolerance
• Constipation
• Dry skin
• Fatigue
• Fertility problems. (Nearly half of women with Hashimoto’s were found to have infertility, according to prior research.)
• Irregular menstrual cycle and other menstrual changes
• Joint and muscle pain
• Slower heart rate
• Thinning hair
• Weight gain

In terms of how or why Hashimoto’s develops, doctors can’t predict when it will happen. Given it is an autoimmune condition, you need the combination of genetics and an environmental trigger. Having a family history of Hashimoto’s or a personal history of autoimmune disease, being a female, and aging may increase your risk for the disease.

The importance of diet in managing Hashimoto’s disease

Although medications are a cornerstone of Hashimoto’s treatment (more on that below), a good nutritional foundation is also important for:

• Supporting thyroid function.
• Getting adequate macronutrients, vitamins, and minerals.
• Improving gut health.
• Managing metabolic health (such as blood sugar and insulin levels).
• Reducing inflammation.
• Reducing the risk of complications of Hashimoto’s, including high cholesterol and blood pressure and heart disease.

“In my experience half of Hashimoto’s treatment can be done with medical management and the other half comes from a healthy lifestyle like good nutrition,” says Nicole German Morgan, RDN, LD, CLT, a registered dietitian nutritionist specializing in optimizing thyroid nutrition care.

Functional dietitians recommend a variety of strategies for diet improvement, including potentially following a gluten-free or Autoimmune Protocol diet, polyphenol- and phytosterol-rich foods, and potential supplements.

Foods for thyroid health

When deciding what type of diet to follow for Hashimoto’s, the fortunate news is that you have options, including:

• Mediterranean diet, which focuses on vegetables, fruits, legumes, nuts, seeds, fish, and olive oil and limits sources of saturated fat and added sugars.
• Gluten-free diet, which benefits many people with thyroid disease, though not everyone will need to go gluten-free.
• Autoimmune Protocol Diet, which is an elimination diet where you cut out inflammatory foods that can trigger autoimmunity. Eventually, you may slowly add some of these foods back in if they do not trigger your symptoms.

There is no one best diet for Hashimoto’s disease, but there are a few dietary guidelines for thyroid support that clinicians often recommend:

• Consume enough protein, such as fish, poultry, and occasional red meat, as well as plant sources like legumes, says Morgan. Protein helps build thyroid hormones.
• Eat fiber-rich foods, which is good for bowel regularity and healthy cholesterol levels. Many Hashimoto’s patients go gluten-free, and cutting out many grains may reduce their fiber intake, says Morgan. Make sure you’re filling your plate with vegetables, fruits, nuts, and seeds, as well as gluten-free grains like quinoa, brown rice, or gluten-free oats.
• Consume colorful plant foods like fruits and vegetables and nuts for phytosterols and polyphenols to help counter inflammation.
• Focus on consuming several thyroid-healthy nutrients. “These are all important cofactors to help support healthy thyroid function, hormone production, thyroid hormone conversation and utilization,” says Alisha Knicely, RDN, IFP, a registered dietitian specializing in thyroid health and recovery:
• B vitamins
• Iodine (*Although iodine is necessary for thyroid health, excess iodine can trigger or worsen Hashimoto’s.)
• Magnesium
• Selenium
• Vitamin A
• Vitamin D
• Zinc

In addition to diet, don’t forget about adequate sleep and stress management. “Stress and lack of sleep greatly impact the body’s ability to make enough active thyroid hormone and can affect the immune system,” says Morgan. Consider these a good base for your well-being. “If you’re struggling, it may not be your diet, but other areas of your life that are holding you back,” she says.

Foods to avoid for Hashimoto’s disease

Some foods may make Hashimoto’s worse. These are not the same for everyone, and your clinician will have specific ideas for what will help you:

Gluten-containing foods

Trying out a gluten-free diet is frequently recommended. “Eating gluten-free tends to be one of the most helpful things for patients in terms of symptom improvement,” says Morgan. Celiac and other gluten sensitivities are also common in Hashimoto’s patients. (If you’re also diagnosed with celiac, a gluten-free diet is necessary.) A gluten-free diet may help reduce inflammation in the intestines, improve possible leaky gut, and create a healthier gut microbiome. In addition, avoiding gluten may also help promote the absorption of several nutrients important for thyroid health, like iodine, selenium, zinc, and vitamin D.

One meta-analysis published in Frontiers in Endocrinology in 2023 found that eliminating gluten has benefits for thyroid function overall after about six months, but the evidence isn’t strong enough to recommend it for everyone who is diagnosed with Hashimoto’s. That’s why many providers recommend doing a six-month trial run to see how gluten-free may affect your symptoms and thyroid levels. Gluten is found in products made with wheat, barley, rye, and triticale (a wheat-rye hybrid), including many breads, pastas, processed snacks, and desserts.

Ultra processed foods

Eating a high amount of ultra processed foods may promote insulin resistance. “There seems to be a link between Hashimoto’s and insulin resistance,” says Dana Gibbs, MD, a physician specializing in thyroid and hormonal imbalance. “Start by getting artificial foods out of your diet,” says Dr. Gibbs. Foods in this category include sugar-sweetened beverages, fast food, many frozen foods (like pizza or frozen meals), flavored yogurts, packaged desserts, hot dogs and sausages, packaged snacks, and more.

Another issue with these foods is that they’re often rich in unhealthy fats and added sugar, and therefore are calorie-dense. “When processed foods take the place of nutrient-dense foods, you can be overfed calorie-wise but undernourished with micronutrients and fiber,” says Knicely. Finally, ultra-processed foods harm your gut health, which can also contribute to inflammation, she adds.

Alcohol

Alcohol contains sugar and it may also contain gluten, depending on what you’re drinking, says Knicely. “People never love to hear me recommend avoiding alcohol, but the damage it causes to the gut, brain, and liver is well-documented,” she says.

Some iodine-rich foods

Iodine is a nutrient needed to produce thyroid hormones. The problem? Too much iodine can be harmful for people who have Hashimoto’s disease. However, a low-iodine diet may be helpful: a small, earlier study of Hashimoto’s patients found that 78.3% of those who restricted their iodine intake returned to normal thyroid function after three months compared to 45.5% of a group that did not restrict their intake.

Foods high in iodine include seaweed like kep, nori, kombu, and wakame. That doesn’t mean you have to avoid iodine; it’s found plentiful in other good-for-you foods like eggs, yogurt, and some seafood–but you should talk to your clinician about a safe amount to include in your diet.

Do not supplement with iodine unless specifically instructed by your clinician–even small supplementary doses can cause significant changes in thyroid function in predisposed individuals, potentially leading to hypothyroidism.

Your personal food triggers

One of the challenging things about autoimmune conditions like Hashimoto’s is that everyone has their own food triggers. It can be tough to determine what yours are, which is where some clinicians may advise trying an elimination diet. This is when you avoid many types of foods–even those that are traditionally healthy—and then add them systematically and slowly back in, watching for an increase in symptoms.

“There is so much overlap between food sensitivities and autoimmune triggers. If you feel worse on a food, then you shouldn’t eat it,” says Dr. Gibbs. Doing an elimination diet under the guidance of a clinician is your best bet. Keeping a diary can also help you make connections between what you eat and your symptoms.

Supplements for Hashimoto’s disease

Many clinicians suggest supplements to support your thyroid, our experts say. These are recommended on a case-by-case basis with the goal of optimizing your diet first and then using supplements to fill in any gaps:

• A thyroid-specific multivitamin containing nutrients such as B vitamins, selenium, and zinc
• Digestive enzymes
• Iron
• Magnesium
• Omega-3 fatty acids
• Vitamin D

Every thyroid has different needs, so check in with your clinician before starting on a supplement. What’s recommended for you personally depends on your diet, other health concerns, food preferences, and more. Make sure you’re taking third-party certified supplements, which ensure the safety and quality of what’s in the bottle.

Levothyroxine is a medication that’s prescribed to treat hypothyroidism. It’s a known finicky med. Instructions include taking it with a full glass of water 30 to 60 minutes before eating food or drinking coffee, otherwise, your body may not fully absorb it. So here’s the deal–the supplements you may be taking–namely multivitamins that contain iron or calcium–can also run interference with absorption, says the NIDDK. Talk to your clinician about the supplements, including vitamins, minerals, and herbals, you may be taking and ask how they should be spaced out from your thyroid medication.

Functional medicine providers may also prescribe a compounded treatment called low-dose naltrexone (LDN). It may work by temporarily blocking opioid receptors, increasing endorphin production. As a result, this potentially regulates immune function and reduces thyroid antibodies. However, its efficacy varies, and more research is needed to fully understand its benefits and optimal use.

Creating a personalized diet plan for thyroid health

The diet that works for one person with Hashimoto’s might not be right for another. With direction and guidance from a qualified clinician, you might choose to follow a gluten-free diet, the Autoimmune Protocol Diet, or another eating pattern for a set period of time (such as three to six months) to see if it helps. (How it helps can be determined by how you feel/your symptoms and blood testing to check your thyroid levels or antibodies or the status of other nutrients.) If it didn’t make a difference for you, you might move on to trying another plan.

It can be difficult to draw connections between what you eat and your symptoms—that’s a testament to the many different foods and ingredients we eat all day. Keeping a food diary to track symptoms and identify your personal trigger foods can be so helpful. Writing it down in a diary (or jotting in the Notes app in your phone) can help you notice patterns in the foods that agree—and disagree—with you. Eventually, you may have created your own diet that’s specific to your body’s needs.

You don’t have to do this on your own. Consulting a dietitian, especially one who specializes in thyroid health or autoimmunity, will help immensely. They are your side-kick in creating a personalized plan that takes your taste and dietary preferences, nutrient needs, and more into consideration. With that type of individualization, you’re able to enact and stick with changes that really make a difference for your health.

Common mistakes to avoid in thyroid disease management

After a diagnosis of Hashimoto’s, you may have a lot of info thrown at you. Everyone on the internet has an idea of how to best treat it. Do you need medication at all? Can you get your thyroid back in working order with lifestyle alone?

These are all great conversations to have with your clinician. Don’t try to manage your thyroid disease all on your own—you’ll want an expert to help guide you toward the treatment you need. They can also help you plan out an appropriate diet without feeling as if you have to eliminate so much. “When there’s so much restriction, I worry that it complicates things in a way that someone who has Hashimoto’s—and a baseline level of fatigue already—doesn’t need,” says Dr. Gibbs.

For example, one common misnomer is that you should avoid cruciferous vegetables, as plants like cabbage, kale, cauliflower, broccoli contain glucosinolates. These are compounds that compete with iodine in the thyroid and could therefore interfere with the gland’s function. However, as Morgan points out, cooking these vegetables decreases this risk—and you’d need to eat high quantities of these raw veggies daily for them to be an issue. There isn’t evidence to suggest that you need to give them up entirely, which is great because they can serve as a rich source of fiber.

Another food that’s a mistake to avoid completely is soy protein. “Soy protein can impact the thyroid but only when consumed in high quantities every day. If consumed occasionally, it should not affect thyroid hormone,” says Morgan. Aim for whole sources of soy like tofu, edamame, and soy milk over fortified processed soy products, adds Dr. Gibbs.

Finally, another common mistake is not getting enough protein and fiber in your Hashimoto’s diet. This can happen when you’re decreasing your calorie intake. These foods are important for helping you feel full and satisfied if you’re aiming to lose weight, and they also are good for improving insulin resistance. Increasing fiber intake will also help keep you regular to help relieve the common symptom of constipation.

New treatments for Hashimoto’s thyroiditis

Hashimoto’s is treated by addressing hypothyroidism, which is done with levothyroxine, a medication that replaces the thyroid hormone T4 in your body.

Still, not everyone finds full relief with levothyroxine alone and symptoms remain. In that case, combination therapy with T4/T3, which is available as a prescription, is often recommended. One new combination medication on the market is Adthyza. Insulin-reducing therapies, like metformin, may also be used, says Dr. Gibbs.

Although compounded LDN is already being recommended for some patients with Hashimoto’s thyroiditis, researchers are examining its potential applications, when it should be used, and for whom. This medication is being explored as a treatment for Hashimoto’s thyroiditis due to its potential to modulate the immune system and reduce inflammation. It’s not right for every person with Hashimoto’s, so talk to your functional medicine provider if this compounded medication fits into your plan.

Beyond that, Hashimoto’s is not just a disease of low thyroid function. It’s also important to address the autoimmunity (antibodies) and metabolic consequences of the disease. Your clinician can help guide you toward the treatment best suited to you. Taking a root-cause approach to Hashimoto’s disease treatment provides guidance on how it should be specifically treated for you.

Clinical trials and future research

There is continual research on Hashimoto’s and how it can be better treated. Clinical trials help researchers understand Hashimoto’s, determine what behavioral factors make a difference in disease management, and aim to improve care. Clinical trials may also look at new medications, combination of treatments, or behavioral health interventions.

Current areas of research interest include the relationship between Hashimoto’s and Grave’s disease, the impact of the gut microbiome on the development of Hashimoto’s, how the disease is managed alongside thyroid cancer or type 1 diabetes, and how diet changes and supplements affect Hashimoto’s, according to research in Frontiers in Endocrinology.

Clinical trials are studies that you volunteer for. To find one in your area, visit Clinicaltrials.gov. There, you can search for Hashimoto’s and see if you’re eligible for upcoming or ongoing trials. If you need assistance in using this search, don’t hesitate to ask your clinician for help.

Frequently asked questions (FAQs)

What foods should be avoided with Hashimoto's?

Avoid ultra-processed foods like fast food, sugar-sweetened beverages, and packaged dessert and snack foods as these tend to be high in saturated fat and added sugar. Limit your intake of high-iodine foods, such as seaweed. Consider removing gluten and eating a gluten-free diet. Finally, learn what your personal food triggers are and avoid those.

Are eggs ok with Hashimoto's?

Yes, eggs are generally a good source of protein, and they also contain zinc and selenium, both thyroid-supportive nutrients. If you are following the Autoimmune Protocol diet, eggs are not allowed in the initial phase of the diet. There is some data to suggest that eggs may be a common food intolerance in people who have Hashimoto’s, but everyone has individual reactions to foods. An elimination diet can help you pinpoint your personal food triggers.

What is Hashimoto's belly?

Hashimoto’s belly may refer to either weight gain in the abdominal area  or gastrointestinal symptoms like bloat and stomach pain that people often report—or both. Effective treatment of the condition will reduce Hashimoto’s belly.

What is the best breakfast for someone with Hashimoto's?

You have so many great breakfast options when you have Hashimoto’s. Focus on whole, anti-inflammatory foods that supply protein and fiber, and avoid added sugar. While there is no one “best” breakfast, options include smoothies, chia pudding, egg and vegetable scrambles, and yogurt parfaits, depending on the specific diet you’re following.

What is the most effective treatment for Hashimoto's thyroiditis?

Hasthimoto’s thyroiditis is effectively treated with medication management (levothyroxine), as well as healthy lifestyle habits, including an anti-inflammatory diet, exercise, sleep, and stress management.

What is the new treatment for Hashimoto's disease?

Adthyza is a combination medication that contains levothyroxine (T4) and liothyronine (T3) and is derived from porcine (pig) thyroid glands. It is designed to treat hypothyroidism in people who continue to experience symptoms taking T4 alone. This medication is not FDA approved; talk to your clinician if this is a good option for you.

What should you not do with Hashimoto's?

You can live a full life with everything you enjoy doing when you have Hashimoto’s. With effective treatment, which includes both medical therapies and lifestyle changes, you can regain your energy, improve your mood, and more—all to feel like yourself again.

What are the new thyroid medications for 2024?

In August 2024, the Food & Drug Administration approved Yorvipath (palopegteriparatide), an injection that treats hypoparathyroidism in adults. (Hypoparathyroidism is a rare disease that differs from hypothyroidism with its own set of symptoms and treatments.)

Developing a Hasthimoto’s diet that’s individualized to your body’s needs can feel complicated, especially when there is more than one type of diet that may work for you. Eating an anti-inflammatory whole foods based diet and avoiding highly processed foods is one step, but you’ll also need to make sure you’re eating enough protein and fiber, especially if you’re aiming to lose weight. Identifying your own unique food triggers—and avoiding those foods—will also help you feel your best.

Above all, know that you can have someone in your corner helping you every step of the way in developing your own individualized Hashimoto’s thyroiditis diet. Connect with a clinician at Parsley Health who will work to create a personalized plan to manage your Hashimoto’s.