The thyroid, a butterfly-shaped gland at the front of the neck, might not seem like much to look at, but when it is malfunctioning, it can wreak havoc on your health. The thyroid produces thyroxin (T4) and triiodothyronine (T3) hormones that control the metabolism, respiration, temperature and other important functions of the body. Too much or too little of these hormones can lead to thyroid disorders like hyperthyroidism and hypothyroidism.
An overactive thyroid (hyperthyroidism) is often caused by inflammation (thyroiditis) due to viral infections or medications and can sometimes occur after pregnancy. According to Serge A. Jabbour, MD, FACP, FACE, division director of endocrinology, director of Diabetes Center and director of Comprehensive Weight Management Program at Thomas Jefferson University Hospital, this overload of thyroid hormones causes anxiety, weight loss, increased appetite, heart palpitations and hand tremors among other symptoms.
An underactive thyroid (hypothyroidism) is the reverse situation in which the thyroid gland does not make enough hormones. This condition, also frequently the result of thyroiditis, is observed most often in women and adults over age 50. Common symptoms include fatigue, hard stools or constipation, increased sensitivity to cold temperature, weight gain and depression.
Two autoimmune diseases also impair thyroid function. Graves' disease causes hyperthyroidism and Hashimoto's disease, hypothyroidism. Jabbour emphasized that if you experience any of these symptoms you should see your physician and get your thyroid stimulating hormone (TSH) measured. Produced by the pituitary gland, TSH controls the production of T3 and T4.
To treat these disorders, medication is commonly used. The most commonly prescribed medication for hypothyroidism is levothyroxine, while treatment for hyperthyroidism includes antithyroid medicines (propylthiouracil or methimazole), radioactive iodine to destroy the thyroid gland and stop the excess production of hormones, and surgery to remove the thyroid.
A dissatisfaction with standard care, however, has led to a growing interest in a more holistic approach to thyroid disease, one that favors lifestyle modifications, not medication. Jen Wittman, CHHC, AADP, creator of Thyroid Loving Care and a certified holistic health expert, chef and author is an advocate of this is approach. Wittman was diagnosed with Hashimoto's, but was able to reverse the disease without taking medication.
"In my experience, changing the diet, gut health, stress level and fitness of a person helps support the body so that medication is unnecessary, or at minimum, can work more effectively," Wittman said.
Adopting a healthy diet
Wittman recommends eliminating gluten, caffeine and soy, as well as reducing sugar for all thyroid conditions, but says diets depend on the individual.
She explained that some people benefit from a Paleo or Autoimmune Paleo protocol, while others need to avoid foods like nightshades (paprika, cayenne, tomatoes, bell peppers, eggplant and potatoes) or polyunsaturated fatty acids like vegetable and canola oils. Others also find cutting out alcohol or dairy from their diet helps.
"There is no effective one-size fits all approach when it comes to reversing thyroid and autoimmune conditions," she said.
According to Charlie Seltzer, MD, owner of Lean4Life Weight Loss & Fitness Solutions, another change some health practitioners suggest for those suffering from Hashimoto's is avoiding eating raw goitrogenic foods like cruciferous vegetables (think: broccoli and kale) that interfere with the function of the thyroid gland.
But opinions on diet's impact on thyroid function tend to vary. Jabbour, for example, doesn't believe that diet and exercise can treat thyroid disease.
However, one thing they can all agree on is that eating healthier can combat weight gain and lessen some of the symptoms like fatigue and depression, especially in the first six weeks of hormonal treatment when a balance of hormones hasn't been reached yet.
To supplement or not?
Too much or too little of certain nutrients can greatly impact thyroid function.
Stella Lucia Volpe, PhD, RD, LDN, FACSM, professor and chair of the department of nutrition sciences at Drexel University in the College of Nursing & Health Professions, explained that hypothyroidism could be, but not always is, a result of iodine deficiency. Zinc or iron deficiencies can be factors as well.
For instance, the thyroid converts iodine into thyroxin (T4) and triiodothyronine (T3) so a lack of iodine in your diet can interfere with hormone production.
But iodine deficiency is rare in the United States, Jabbour cautioned. Therefore supplementation could actually be dangerous if no true deficiency is present, leading to the exact opposite problem.
Too much iodine in your diet is also a concern if you are at risk for hyperthyroidism. Mario Skugor, MD, an endocrinologist at Cleveland Clinic, advises his patients with Graves' disease to avoid iodine-rich foods because their thyroid is already secreting an excess of T3 and T4.
Wittman believes that most people with thyroid disease require nutritional supplementation at least short-term, but that they often can be weaned off them.
"There's just not one simple way to reverse these conditions in everyone," Wittman said. "Instead there are several different supplements, lifestyle changes, healing modalities and dietary modifications that can be used to reverse the conditions and eliminate symptoms."
Seltzer warned against supplementing on your own. See your physician and get appropriate testing first to make sure it is necessary in the first place.
Exercise & Your Thyroid
Opinions on exercise also differ. While exercise in general is good for everyone, Seltzer doesn't see it playing an important role in thyroid conditions.
"The best exercise routine is the one that a person is most likely to stick with," Seltzer said. "I like resistance training supplemented with cardiovascular exercise, with a focus on interval training, but if someone hates lifting weights, then anything is better than nothing."
Wittman advises her clients to choose exercises that don't tax the adrenal system like gentle yoga, walking or Tai Chi.
Jabbour and Skugor say patients with hyperthyroidism need to watch the intensity and duration of their workouts because exercise can exacerbate an already rapid heart rate and other symptoms.
What's the best approach?