Foods to Eat (and What to Avoid) if You Have Graves' Disease

If you have Graves' disease - an autoimmune condition that causes hyperthyroidism, which is an overactive thyroid gland - you may already be taking medication. Unlike some other conditions, Graves' disease can't be reversed with dietary changes alone. It has to be treated with conventional medicine.

"Medical intervention is always the first step with Graves'," says Susan Spratt, MD , an endocrinologist at Duke University Hospital in Durham, North Carolina.

Once you're being treated, though - and after your doctor has given you the green light - you can consider making changes to your diet. For people with Graves' disease, some nutrients, such as calcium and vitamin D , are important, whereas others, including iodine, can be harmful, explains Kelly Kennedy , a registered dietitian with Everyday Health. This is also why Dr. Spratt always recommends medicine first and then dietary and lifestyle changes as complementary treatments.

Here's what to eat and what to avoid if you have Graves' disease. (Just remember to always talk to your doctor before making any changes to your diet.)

1. Limit or Avoid: Iodized Salt

In the United States, salt manufacturers routinely add iodine, a trace mineral, to table salt to combat iodine deficiency . For people with Graves' disease, though, high amounts of iodine aren't usually a good thing.

Iodine is an essential component of thyroid-stimulating hormone (TSH), which tells the thyroid gland to make more thyroid hormones . Large doses of iodine produce elevated TSH levels , which can worsen hyperthyroidism in people with untreated Graves' disease, Spratt explains. (Left untreated, an overactive thyroid can cause bone, heart, and muscle problems.)

Spratt says you don't need to seek out iodine if you eat a typical American diet. But if you're vegan and only eat fresh fruits, vegetables and rice, you should talk to your doctor about the best way to get the recommended iodine intake of 150 micrograms daily.

To find out if your salt contains iodine, look at the nutrition label, which would say "iodized" or "provides iodine." Some specialty salts, such as sea salt and kosher salt, usually don't contain iodine.

2. Eat: Leafy Green Vegetables

An overactive thyroid can speed up bone turnover, the natural process of breaking down and rebuilding bones. This, in turn, can increase the body's need for calcium. Not getting enough calcium can contribute to brittle bones and osteoporosis in the long run.

To avoid these complications, try to consume calcium-rich leafy green vegetables, such as broccoli, kale , and spinach - in moderation, says Spratt, as they contain iodine. Additionally, too much calcium can cause hypercalcemia, a condition found in 20 percent of people with hyperthyroidism, according to research. "I'm a big proponent of getting your vitamins and minerals from your plate and whole foods," says Spratt. First, work with your doctor to get your thyroid hormone levels under control, and then you can introduce calcium-rich foods.

Dairy products, such as milk, are sources of calcium, but they also contain iodine, according to the National Institutes of Health Office of Dietary Supplements (ODS).

3. Limit or Avoid: Seaweed

Seaweed and seaweed products, such as kelp, kombu, nori, and wakame, can be particularly high in iodine. One serving (10 grams) of nori contains 232 micrograms of iodine - about 155 percent of the recommended daily value, according to the ODS.

4. Eat: Salmon

Because bone health is so important when you have hyperthyroidism, you should also consume vitamin D, which improves calcium absorption, says Kennedy. One food that's particularly high in vitamin D is salmon: One 3-ounce serving contains about 375 IU (international units).

Not sure if you're getting enough vitamin D? Your doctor can check your levels with a blood test. "While there are many foods high in vitamin D , it's rare to get enough of it from foods alone," says Kennedy. She notes that some people may want to take a water-soluble vitamin D supplement containing 600 to 800 IU, depending on age. (Talk to your doctor before taking any supplements.)

One study showed that vitamin D, along with a selenium supplement, caused a faster response to antithyroid treatment. Taking the supplements in conjunction with treatment also resulted in better control of hyperthyroidism, a higher quality of life and even improved mood and cognition.

5. Eat: Brazil Nuts and Sunflower Seeds

Selenium plays a role in making thyroid hormones and regulating thyroid function. Though rare, thyroid eye disease (TED) - which causes progressive inflammation of the eye and can result in blindness - can develop in people with Graves' disease. According to the American Thyroid Association , research has shown that a selenium deficiency may be linked to an increased risk of TED in people with Graves' disease. Supplementing your diet with selenium may help treat it.

One study found that selenium can also have a positive effect on gut microbial diversity, which may play a role in reducing disease severity and eye involvement.

Foods that are rich in selenium include Brazil nuts and sunflower seeds. There may be another reason to eat these foods. Nuts and seeds are part of the Paleo diet, along with fruits, lean meats, seafood, and vegetables. A review found that following the Paleo diet and taking supplements can reduce thyroid antibodies and improve thyroid hormone levels.

6. Limit or Avoid: Gluten

According to a study, Graves' disease can be associated with celiac disease , another type of autoimmune disorder. People with celiac can't eat gluten , a protein commonly found in wheat, barley, and rye. (Eating gluten triggers a reaction in them that damages the lining of the small intestine.)

If you've been diagnosed with celiac disease, Kennedy recommends eliminating gluten from your diet so your hyperthyroid symptoms and hormone levels don't worsen. "But if you have not tested positive, and don't have a negative reaction to it, there's no reason to eliminate gluten from your diet," she says.

7. Eat: Berries

If you're managing an autoimmune disease such as hyperthyroidism, consider eating a diet rich in antioxidants. These substances found in fruits and vegetables can help stave off cell damage.

"Antioxidants are great, because they reduce oxidative stress and inflammation in the body, which can help autoimmune diseases ," Kennedy explains. Plus, these foods "generally just make you feel better and make your body function better," she adds.

One food group that's particularly high in antioxidants? Berries , including blackberries, blueberries , and raspberries.

8. Limit or Avoid: Caffeinated Beverages

Some of the symptoms of Graves' disease include anxiety, nervousness, rapid heart rate, and weight loss, all of which can be made worse by too much caffeine .

Energy drinks are one of the biggest sources of caffeine. "I always recommend avoiding energy drinks no matter what, because they're highly processed, high in sugar and artificial ingredients, and, obviously, high in caffeine," says Kennedy.

She also suggests limiting coffee and tea. "Even though tea is lower in caffeine than coffee, it can add up," she says.

9. Eat: Legumes

Research shows that hyperthyroidism has been linked to low levels of iron in the body, says Kennedy. Another study noted that Graves' disease can decrease iron levels.

If you suspect you're deficient in iron, ask your physician to order routine blood work to check your levels, she says.

Celiac disease, the chronic digestive disorder that often occurs together with Graves', has a higher likelihood of being the cause of iron deficiency, though, says Spratt. "Make sure you are tested for celiac disease if you are iron deficient," she says.

If you're running low, consider increasing your intake of iron-rich foods. But before you go reaching for a steak, consider this: People who eat a vegan, lacto-ovo vegetarian, or pescetarian diet are less likely to have hyperthyroidism than people who eat meat, according to a study.

One plant food that's rich in iron is beans. One cup of white canned beans contains 8 milligrams of iron, or about 44 percent of your recommended daily value.

"The more iron you can get from vegetables and nonmeat products, the better, as some research suggests decreasing your meat and poultry intake can improve hyperthyroid symptoms," says Kennedy.

Pair iron-dense foods with foods high in vitamin C to maximize your body's ability to absorb iron.

The Takeaway

While Graves' disease can't be treated solely with dietary changes, paying attention to what you eat can help you better manage the condition. Along with conventional medicine, adding certain foods - for example, ones high in calcium or vitamin D - and limiting others - like those that are high in iodine or caffeine - can be beneficial for Graves' disease.

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