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Symptoms and Support for Hyperthyroidism

February 6, 2025

In this episode of "Dishing Up Nutrition's Ask a Nutritionist" series, registered dietitian Brandy Buro explains what it means to have an overactive thyroid (hyperthyroidism) and provides practical dietary solutions. She discusses the symptoms and complications of hyperthyroidism, including Graves' disease, and offers detailed guidance on beneficial dietary changes—from eliminating gluten to managing iodine intake. Listeners will learn about important nutrients, therapeutic supplements, and specific food recommendations that can help manage hyperthyroid conditions naturally, alongside medical treatment.

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Transcript:

BRANDY: Hello and welcome to Dishing Up Nutrition's “Ask a Nutritionist” series. My name is Brandy Buro. I'm a Licensed and Registered Dietitian here at Nutritional Weight & Wellness. On today's episode, we'll be doing a follow up to a previous episode that aired a couple of weeks ago where I talked all about the thyroid gland and what it means to have an underactive thyroid or hypothyroid.

So on today's show, I'll be focusing on what it means to have an overactive thyroid or hyperthyroid. Hyperthyroid is not as common as hypothyroid, but it can be just as disruptive to your health. So today we'll be talking about the steps you can take through food and lifestyle choices in order to feel your best and start to heal. So let's get right into it.

What is hyperthyroidism & what can cause it?

Hyperthyroidism occurs when the thyroid gland makes too many thyroid hormones. It's usually caused by an autoimmune disorder, in which case you may have heard it referred to as Graves’ disease, but it can also be linked to genetics and certain nutrient deficiencies.

Women are more likely to have Graves’ disease than men, and it typically occurs somewhere in their 40s and 40s and 60s. So midlife. So how would you know if you have Graves’ disease or hyperthyroidism? Well, I wanted to just go over a few of the common symptoms of hyperthyroidism just to give you an idea.

So you could feel more anxious and irritable. fatigued, you could develop sleeping problems like insomnia. You may notice increased heart rate or heart palpitations, even tremors. You may notice that you're sweating a lot more than normal, especially compared to what you would expect for the activity that you're doing at the time.

You may even suddenly lose weight that you didn't intend to lose or without really trying. You may see changes in your bowel movement. You're using the bathroom more or you're experiencing diarrhea. And something you may visually see is your neck might start to swell. You may actually see a goiter develop, which is your thyroid that is swollen because it's so enlarged.

Another visible sign of Graves’ disease, specifically the autoimmune form of hyperthyroidism is bulging or puffing of the eye area. And that can actually cause sensitivity to light. You may see redness around the eye. Your vision might be impacted. You might have trouble seeing and you may actually feel pain in the eye area.

So it's not just like a visible symptom from the outside, but it can actually be pretty uncomfortable and painful. So you're probably catching on that hyperthyroidism can impact the entire body head to toe. These are symptoms that aren't just annoying or uncomfortable, but they can actually lead to more serious complications down the line.

For example, if you don't manage hyperthyroidism, if you don't treat this, you can actually develop osteoporosis because hyperthyroidism impairs your ability to absorb calcium. There's also a phenomenon called thyroid storm, which is a very rapid increase in your thyroid hormones, T3 and T4. And with that very sudden rapid increase, you'll start to feel confused, really agitated. You may feel really weak. Your blood pressure will start to drop. You'll see irregular heartbeats and very extreme cases, you could actually fall into a coma.

So this is pretty rare, but it is more likely to happen if you're not managing the disease very well. So as you can see, hyperthyroid is a pretty serious issue that does need your attention. And the way they would treat this medically is maybe with a medication or because we're talking about an overactive thyroid, they'll do things to try to slow the function of the thyroid so they can do this by using radioactive iodine therapy, which means, they will administer iodine, the thyroid readily absorbs it, and then radiation will target the thyroid and actually kill the thyroid cells.

So that's one way they might do it. Or in some cases, they may perform a thyroidectomy, which is where they'll surgically remove part of the thyroid, or in some cases, the entire thyroid would be removed. So that's just, you know, how they might treat it medically.

What can be done through food & diet to manage hyperthyroidism?

But today, we're going to talk more about what you can do through food, through your diet, to help manage hyperthyroidism. So just as it is with hypothyroidism, I recommend removing gluten. So gluten is a huge trigger for autoimmune diseases, particularly in its role in creating antibodies against the thyroid. So when we are working on an autoimmune condition of the thyroid, like Graves’ disease or Hashimoto's, which is the hypothyroid autoimmune disease, if you remember from our discussion on the previous episode, we always recommend a 100 percent gluten free diet, not just a low gluten diet or gluten free on the weekdays diet, and absolutely 100 percent gluten free diet as best as you can.

I think an interesting connection that's very common for people with celiac disease is to also have an autoimmune thyroid disorder. So either hypo or hyper thyroid disorders. This might be new information, but celiac disease can present itself even without any obvious digestion issues. So you may have celiac disease and not know it because you think, well, my digestion is pretty normal.

I have a bowel movement every day. I don't really have any concerns in that department. But the thing is you may have celiac disease and it may present itself in skin issues. It could show up as brain inflammation or something that's not typically related to a food sensitivity.

And one of those less obvious signs of a gluten sensitivity is thyroid issues because those gluten proteins are known to interfere with your thyroid. So that's why the very first thing when working on healing your thyroid is to eliminate gluten. So this includes any food with wheat, rye, barley, and just to be totally thorough, we also recommend eliminating oats because oats are not always gluten free.

Oats are very often cross contaminated with gluten grains, you know, cross contaminated in the processing facility or even in the field that they're grown, they can be exposed to other gluten grains, so that would be a good one to eliminate as well. And we don't recommend simply switching to your favorite gluten free versions of your favorite breads or cookies or crackers, because in the end, they are still ultra processed foods.

They don't provide a lot of nutrients. They're usually pretty high in processed carbohydrates and sugar, you know, so it's not really doing you a lot of good just to switch to gluten free XYZ. So instead, it's best to focus on real foods that actually give your body some nutrition and help heal your thyroid and heal your gut.

Stick to real, minimally processed foods

Try to stick to real foods as much as possible, minimally processed whenever you can. So what we're talking about is high quality meats, natural healing fats, lots of fruits and vegetables. So eliminating gluten and focusing on real foods is a really great place to start. But if you're suffering from an autoimmune condition like Graves’ disease, you may need to also experiment with eliminating some other food sensitivities;

Consider eliminating possible food sensitivities

Dairy being a really common one. Dairy is quite inflammatory for the gut for a lot of people and again, this is a food sensitivity that a lot of people go about their lives not realizing that they are sensitive. So it's not always going to show up as a digestive symptom, you know there's other signs of inflammation to clue you in that this could be a problem for you.

So when you're trying to develop a meal plan that checks all the boxes and is something that you can see yourself eating and something that you're going to enjoy consistently, this may mean that you have to do things a little differently than you do now, and it might mean that you have to get creative and try new foods.

Which can be really fun, but it can be overwhelming at first. So, to get started, I recommend meeting with a dietitian, so you have that support and guidance when you're ready to develop that plan and make these changes. A dietitian is going to sit down with you and figure out what types of meals you'll enjoy, what is realistic for your life, in your family, and talk through what kinds of things that you can expect in that process; not just with preparing these foods and accessing these foods, but also what you can expect when it comes to how you feel.

Basically working with a dietitian is going to put somebody on your team that is going to clear the air and give you a clear path forward. It doesn't have to be as intimidating as it sounds if you have the right support.

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Heal the gut to improve autoimmune conditions

Something to keep in mind throughout this process is that autoimmune conditions and their symptoms will improve as you heal the gut. So this is why we want to be eating real foods that heal your body and eliminate the ultra processed foods, especially those that contain gluten because those are actually damaging the gut more.

Therapeutic supplements options

So if you're working with a dietitian or a nutritionist, they're likely going to recommend some therapeutic supplements to pair with this therapeutic meal plan. I think a really good probiotic and L-glutamine. Healing the gut through diet alone sometimes isn't enough. And those therapeutic supplements can just accelerate the process.

Lower iodine intake

Aside from a diet that, that is geared towards lowering inflammation and healing your gut, something else you want to think about is lowering your iodine intake when it comes to hyperthyroidism. Iodine is something that helps your body make thyroid hormones. So in the case of hyperthyroidism, the thyroid is already overstimulated and it's already making too much thyroid hormone. So one thing you can do to slow down that process is by lowering your iodine intake.

So where do we get iodine in our diet? Well, for many Americans, the main source of iodine is through iodized salt. So a really quick, easy thing to do right now is switch out the salt that you use at home for your cooking with a non-iodized salt. So that will be step one. And in general, you know, we're recommending that you eat real foods, whole foods as much as possible, which are naturally very low in salt, and it's not going to be iodized salt.

And we recommend avoiding ultra processed packaged foods. So automatically, this is going to reduce your iodine intake. Because the sodium in processed foods is usually iodized. So if you are removing or reducing processed foods, cooking more at home with a non-iodized salt, you're already doing a lot to control your iodine intake.

More on what to eat

And what we're suggesting you do instead is think fresh fruits and vegetables, fresh meats that you make at home, natural fats, natural healing fats. And you don't want to skip the fats. Fats are a big part in helping manage inflammation and protecting your thyroid and balancing that thyroid hormone production.

So don't skimp on those fats. Have a little bit of fat with every meal and snack, things like avocados, coconut milk, butter, unsalted butter, unsalted nuts, unsalted seeds. These are all healing fats. And for a hyperthyroid diet, you could actually incorporate something called goitrogenic foods because these are going to bind to any iodine that is in your food and help slow thyroid function.

Eat cruciferous vegetables

So goitrogenic foods are vegetables from the cruciferous and brassica families. So these are the smelly ones. So think broccoli, cauliflower, cabbage, Brussels sprouts, kale, bok choy. I would also put like arugula in this group. So remember the smelly vegetables are a good thing because they can help control your iodine intake.

Avoid fish & seafood

Normally, I would recommend fish and seafood as a good protein option, but in the case of hyperthyroidism, it's an exception because fish and seafood are high in iodine. So instead we recommend eating other high quality animal based proteins like grass fed beef, poultry and eggs. So there's still a lot of good choices for you.

Other supplement considerations

And as far as other supplements to think about, L-carnitine is something that can help reduce thyroid function and treat an overactive thyroid. L-carnitine is an amino acid that we naturally get in many of our animal based proteins, because it is a protein. But for hyperthyroidism, it is recommended to supplement at higher doses than you might get naturally in your food.

So we're talking two to four grams of L-carnitine a day. Use caution with this though, because if you take too much L-carnitine, it can actually slow the thyroid too much, and then you might swing to the other extreme, hypothyroidism. So we don't want to slow it down too much. You really want to use caution. Don't take more than what's effective.

So this is where working with a dietitian would be helpful and work with your care team to be getting your thyroid tested regularly just to watch those labs and monitor your symptoms.

Iron is another really important nutrient for thyroid function. And low iron has been connected to hyperthyroidism. So an iron supplement might be something you want to do daily, especially if you've seen that your ferritin levels are low, but at minimum, it's important to incorporate iron rich foods into your meal plan every day. So this would be a variety of meats, especially red meat, like grass fed beef.

I would say dark, dark poultry would also be a good source. Chicken thighs, chicken legs. Liver is also a really rich source of iron. As a bonus, all of these foods also contain zinc. And that's another important mineral for your thyroid function. So it's kind of a two for one with good quality meat.

You're getting not only iron, but some zinc along with it. And like I mentioned earlier, hyperthyroidism can increase your risk of osteoporosis. So, supplementing with a high quality calcium supplement and enough vitamin D may also be necessary just to help prevent bone loss.

And calcium is naturally found in dark leafy greens like broccoli and kale, which can be good for iodine control. But calcium can also be in nuts and seeds. I think many of you are probably wondering about dairy as a source of calcium, but we did discuss dairy as being kind of an iffy one because it is very often an inflammatory food, especially for an autoimmune condition. Many people decide it's best to avoid dairy.

So when it comes to underactive thyroid or overactive thyroid, we recommend limiting dairy. Not necessarily thinking about that as your main source of calcium. Another thing to note is dairy is pretty high in iodine, and like we just discussed, iodine is something that we need to limit in a hyperthyroid diet. So think of those deep leafy greens, nuts and seeds as a good source of calcium and consider doing a calcium supplement like calcium citrate.

Lastly, I would recommend supplementing with omega-3 fatty acids. Typically, I suggest two to 3,000 milligrams every day. I do think that an omega-three supplement is wise because the food sources that are the most concentrated in omega-threes are fatty fish.

And remember, we don't typically recommend that someone with hyperthyroidism eat a lot of fish or seafood because they're just really high in iodine, but the omega-3 fats are essential for so many aspects of our health, especially in reducing Inflammation in the body, but also your brain health and your heart health. So we do want to keep those in our diet somehow, and it's something that we can only get through food or a high quality supplement. So we can't overlook that when you're also reducing your fish and seafood intake.

Well, that about wraps up our mini episode of “Ask a Nutritionist” that's all about hyperthyroidism. Like I mentioned earlier, it's really important that you work with a dietitian or a nutritionist if you have a diagnosis of an overactive or an underactive thyroid. A dietitian or nutritionist is going to help you develop a meal plan and a supplement plan to help you get the nutrients you need to feel your best and heal your thyroid.