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How to Eat Healthy When You Have TED

Why nutrition plays an important role when you are managing hyperthyroidism and thyroid eye disease.

How to Eat Healthy When You Have TED

Thyroid Eye Disease (TED) is a condition that usually develops in people with an overactive thyroid (hyperthyroidism) caused by an autoimmune disorder called Graves’ disease.

When it comes to managing TED, diet plays an important role. Some foods may exacerbate symptoms of Grave’s disease or hyperthyroidism. In addition, if you eat foods that you’re sensitive to, this could impact your immune system and cause your Grave’s disease to flare.

Iodine
Excessive intake of iodine may trigger hyperthyroidism in older adults or those with a pre-existing thyroid disease. Foods that are naturally high in iodine include things that come from the sea (especially white fish such as haddock and cod) as well as seaweed, kelp, and some other sea vegetables. Some foods are often fortified with iodine, meaning iodine is added to them. These include salt, bread, and dairy products such as milk, cheese, and yogurt. Other iodine-rich foods include egg yolks, milk chocolate (due to the dairy content), and commercially prepared bakery products that are made with iodate dough conditioners.

Gluten
A significant number of people with thyroid disease also have celiac disease (an autoimmune disease in which eating gluten leads to damage of the villi in the small intestine). Gluten is a general name for a proteins found in wheat, rye, barley, and triticale (which is a cross between wheat and rye).

Some patients with celiac disease have reported a lower need for thyroid hormone replacement after being on a gluten-free diet for a period of time. One reason is that being on a gluten-free diet allows the small intestine to heal, and therefore thyroid medication may be better absorbed. A gluten-free diet may also cause a lower inflammatory response and reduce the inflammation of the thyroid gland.

Gluten can be found in many foods—such as pastas, breads, and baked goods—but may also be present in foods you might not expect, such as soups, sauces, salad dressings, and most beers. Be sure you’re checking nutritional labels for gluten and opting for gluten-free options. Many foods that traditionally have gluten are also available in gluten-free versions these days.

Foods for a healthier thyroid
Just as certain foods may exacerbate some aspects of thyroid disease, other foods contain specific nutrients that are an important part of a healthy diet when you have TED. They include food and drinks that are rich in:

  • Calcium. People with hyperthyroidism may have trouble absorbing calcium. This can cause bones to become brittle over time and increase your risk of developing osteoporosis. Eating a diet that’s high in calcium may help. Good choices include green leafy vegetables (such as kale and spinach) along with almonds, sardines, and okra. Dairy products (such as milk, cheese, and yogurt) are also calcium-rich—but since they may also be fortified with iodine, it’s a good idea to talk to your healthcare provider or a dietician about how much dairy you should be having.
  • Vitamin D. This important vitamin serves many functions, among them helping your body to more readily absorb calcium. Most vitamin D is made in the skin through the absorption of sunlight, but there are dietary sources as well, including certain types of fish. If you are eating fish, choose carefully—while tuna is a good source of vitamin D, it also comes from the ocean (making it high in iodine). More TED-friendly fish options include freshwater salmon and cod.
  • Magnesium. Magnesium is important in helping your body to absorb vitamin D. Furthermore, if you’re not getting enough magnesium, it could potentially worsen your hyperthyroidism. Foods high in magnesium include avocados, almonds, legumes, and pumpkin seeds.
  • Selenium. Essential for thyroid hormone production, selenium helps protect the thyroid from damage caused by oxidative stress. The thyroid contains high amounts of selenium, and a deficiency can cause the thyroid to stop working properly. Rich sources of selenium include mushrooms, brown rice, sunflower seeds, and sardines.

Putting together TED-friendly meals
When it comes to creating meals, there are lots of delicious directions in which you can go. For breakfast, you might opt for oatmeal. Oats are gluten-free but they may be processed in the same facilities as gluten-containing grains. When shopping for oatmeal, be sure to look for “gluten-free” on the label—this means they haven’t shared a facility with foods that contain gluten. Consider topping your oatmeal with almonds or fresh fruit.

For lunch, a good option is a fresh salad of leafy greens tossed in oil and vinegar, topped with slices of avocado and sprinkled with pumpkin seeds. Add some gluten-free crackers on the side for a little extra crunch. Dinner could be fillet of grilled freshwater salmon with sides of roasted broccoli and brown rice. Just make sure the salt you use to prepare your meals is non-iodized.

Making changes that make a difference
When it comes to managing TED, dietary adjustments can go a long way. Your healthcare provider can recommend a registered dietician who focuses on autoimmune diseases to help guide you. Because everyone’s health is unique, talk to your healthcare provider before you make any changes to your diet.

Medically Reviewed in February 2021.

Sources:
American Thyroid Association. "Graves’ Eye Disease (Graves’ Ophthalmopathy or Graves’ Orbitopathy)."
National Institute of Diabetes and Digestive and Kidney Disorders. "Grave's Disease."
National Institutes of Health Office of Dietary Supplements. "Iodine."
Gluten Intolerance Group. "Celiac Disease & Thyroid Conditions."
Beyond Celiac. "What is Celiac Disease?"
Celiac Disease Foundation. "What is Gluten?"
Celiac Disease Foundation. "Gluten-Free Foods."
Mayo Clinic. "Graves' Disease."
National Osteoporosis Foundation. "A Guide to Calcium-Rich Foods."
British Dietetic Association. "Food Fact Sheet: Iodine."
NIH Osteoporosis and Related Bone Diseases National Resource Center. "Calcium and Vitamin D: Important at Every Age."
Anne Marie Uwitonze and Mohammed S. Razzaque. "Role of Magnesium in Vitamin D Activation and Function." The Journal of the American Osteopathic Association, 2018. Vol. 118, No. 3.
Kunling Wang, Hongyan Wei, et al. "Severely low serum magnesium is associated with increased risks of positive anti-thyroglobulin antibody and hypothyroidism: A cross-sectional study." Scientific Reports, 2018. Vol. 8, No. 1.
Roy Moncayo and Helga Moncayo. "The WOMED model of benign thyroid disease: Acquired magnesium deficiency due to physical and psychological stressors relates to dysfunction of oxidative phosphorylation." BBA Clinical, 2015. Vol. 3.
Cleveland Clinic. "Magnesium Rich Food."
Kristian Hillert Winther, Margaret Philomena Rayman, Steen Joop Bonnema and Laszlo Hegedus . "Selenium in thyroid disorders — essential knowledge for clinicians." Nature Reviews Endocrinology, 2020. Vol. 16
Vincenzo Triggiani, Emilio Tafaro, et al. "Role of iodine, selenium and other micronutrients in thyroid function and disorders." Endocrine, Metabolic & Immune Disorders - Drug Targets, 2009. Vol. 9, No. 3.
National Institutes of Health Office of Dietary Supplements. "Selenium."
Beyond Celiac. "Are Oats Gluten-Free?"
American Thyroid Association. "Low Iodine Diet."

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