From the Guidelines
Hashimoto's thyroiditis cannot be cured through diet and lifestyle changes alone, but these modifications can help manage symptoms and potentially slow disease progression. The most recent and highest quality study, 1, published in 2023, recommends following the principles of healthy dietary patterns and avoiding individual nutritional triggers. Based on this, focus on an anti-inflammatory diet rich in whole foods, vegetables, fruits, lean proteins, and healthy fats while avoiding gluten, dairy, processed foods, and refined sugars which may trigger inflammation in some individuals. Some key points to consider:
- Ensure adequate selenium (200 mcg daily) and vitamin D intake, as deficiencies are common in Hashimoto's patients.
- Stress management through meditation, yoga, or other relaxation techniques is important since stress can worsen autoimmune responses.
- Regular moderate exercise like walking, swimming, or cycling can help manage weight and reduce inflammation.
- Prioritize 7-8 hours of quality sleep nightly to support immune function. These lifestyle modifications work by reducing overall inflammation, supporting immune system regulation, and optimizing thyroid function. However, these approaches should complement, not replace, conventional medical treatment with thyroid hormone replacement therapy (typically levothyroxine) prescribed by your healthcare provider, as Hashimoto's typically requires lifelong medication management with regular monitoring of thyroid function tests 1.
From the Research
Dietary and Lifestyle Changes for Hashimoto's
- Dietary interventions can be a complementary treatment for Hashimoto's disease, affecting thyroid function and anti-inflammatory properties 2
- Elimination of gluten, lactose, or energy restriction with or without excluding selected foods may improve antibody levels against peroxidase (anti-TPO), thyrotropin (TSH), and free thyroxine (fT4) 2
- Consumption of Nigella sativa may also improve these parameters 2
- However, the effectiveness of these interventions may vary due to heterogeneous thyroid conditions, high variability between patients, and differences in habitual intake of critical nutrients 2
Importance of Nutrients
- Iodine, selenium, vitamin D, and gluten play a crucial role in the management of Hashimoto's thyroiditis 3
- Careful supplementation of possible deficiencies is recommended for the dietary management of Hashimoto's patients 3
- Vitamin D preparations may reduce thyroid autoimmunity in levothyroxine-treated women with Hashimoto's thyroiditis and normal vitamin D status 4
Treatment and Management
- The management of Hashimoto's thyroiditis depends on its clinical manifestations, including diffuse or nodular goiter with euthyroidism, subclinical hypothyroidism, and permanent hypothyroidism 5
- Levothyroxine substitution is often required, and the dose is based on the degree of preserved thyroid functionality and lean body mass 5
- There is insufficient evidence to recommend for or against therapy with triiodothyronine (T3), apart from in pregnancy when only levothyroxine is indicated 5
Epidemiology and Pathogenesis
- Hashimoto's thyroiditis is the most frequent autoimmune thyroid disorder, and its cause is thought to be a combination of genetic susceptibility and environmental factors 6
- The pathologic features of lymphocytic infiltration, especially of T cells, and follicular destruction are the histological hallmark of autoimmune thyroiditis (AIT) 6
- An important role in the immune-pathogenesis of AITDs is due to chemokines and cytokines 6