How to effectively manage hypothyroidism: thyroid friendly tips

Swathi (name changed) was just like any other teenager. Cheerful, inquisitive, full of life and energy. Her world revolved around school, friends and family. She was at an age were she was changing from her quiet childish ways blooming into a young confident woman. All of 16 years and ready to conquer the world she had everything going for her. She was very conscious about her appearance and attire so when she began gaining a little pounds and turning a little plump it worried her. Her mother attributed this to teenage hormonal changes and did not take much notice of it. Swathi then joined college – her poor self esteem and waning energy levels could not match the exuberant energy of her friends. She quit college midway and instead swiftly was married. Though only 20 years she looked like she was in her 30s. Now after two years of marriage she landed at our OPD for a consultation of infertility. Does this story ring a bell for some of you? Where does the problem lie? After a thorough consultation and blood works her thyroid profile came out to be abnormal. She was diagnosed to have hypothyroidism and was put on thyroid hormone replacement. The thyroid friendly advice to manage hypothyroidism that we had given her is what I have penned down in detail below.

Thyroid gland- where is it? What does it do?

A gland whose existence is often not known to the common man has played havoc in the lives of many. Let’s begin from the start. The thyroid is a butterfly shaped gland located in the front of the neck. It should not be normally obviously visible unless there is a goitre(enlarged thyroid). Now the gland produces the thyroid hormone which is very essential for body growth and cell metabolism.
An excess of thyroid hormone is known as hyperthyroidism, while the deficiency of thyroid hormone is called hypothyroidism.
Hypothyroidism is more commonly seen amongst the population when compared to hyperthyroidism.

How to diagnose?

The doctor usually does a thorough history taking and physical examination including thyroid examination. Blood investigations including TSH values, T3 and T4 levels will be checked. The TSH is normally released from the pituitary gland in the brain. TSH( thyroid stimulating hormone) stimulates the thyroid gland to produce more thyroid hormones (T3 and T4). So an elevated TSH value and reduced T3, T4 levels indicate hypothyroidism. The converse is true for hyperthyroidism!! Sometimes only TSH values maybe elevated with normal thyroid hormone levels. This state is called subclinical hypothyroidism. The doctors usually do not treat this condition unless the individual has accompanying symptoms.

Hypothyroidism: what happens?

When the thyroid gland produces less thyroid hormones it will affect every organ of the body and literally every aspect of life. It is a hereditary condition and runs in families- more likely to occur in females so if you have a mother or sister with thyroid issues you are more likely to develop the disorder.

Why does hypothyroidism occur?

◦ Sometime the thyroid gland might be under active and produce less thyroid hormone.
◦ Deficiency of iodine in diet
◦ Sometimes certain drugs like those used to treat hyperthyroidism, certain types of cancer, lithium or even treat heart conditions can cause hypothyroidism. Many of these drugs are essential and cannot be stopped abruptly. Instead we can opt for thyroid hormone replacement.
◦ Following a radiation exposure to the head and neck region
◦ Following thyroid removal surgery- sometimes when the thyroid gland is over reactive or enlarged we recommend surgical removal of the thyroid gland. After it’s removal the individual turns hypothyroid and needs hormone supplementation.

What symptoms can hypothyroidism cause?

The thyroid gland regulates a lot of our daily activities like our heart rate, temperature as well as metabolism. Right from sleep to appetite to strength every thing can be altered. So, what are the common symptoms of hypothyroidism?
⁃ Fatigue and tiredness
⁃ Weight gain
⁃ Intolerance to cold
⁃ Hair loss
⁃ Menstrual irregularities like delayed periods or heavy bleeding
⁃ Slowness or reduced activity
⁃ Constipation
⁃ Sleep disturbances
⁃ Reduced appetite

While these are the common symptoms some people also experience memory loss, decreased interest in sexual activity (low libido), develop hoarseness of voice and sometimes experience very low moods and even depression. This was the reason why Swathi suddenly changed from the carefree happy hour lucky person to a moody and sad one.

Thyroid friendly diets- Can certain diets set right our thyroid deficiency and manage hypothyroidism?

In our country iodine deficiency was a very important cause of hypothyroidism. This led to the universal iodisation of salt in 1992 and post that all of us only consume packaged iodised salt in our daily cooking. This was a landmark event and a classic example of food fortification.
To be very honest I am not a firm believer in diets causing phenomenal transformation. Beyond avoiding cauliflower, cabbage and other cruciferous vegetables I also did not know much about the role of what’s in our plate affecting thyroid production. After thorough research these are the foods that I found to be avoided if you are having hypothyroidism.

1. Cruciferous vegetables- the common ones like cauliflower, broccoli, turnip and cabbages are a no-no. Why? Because they interfere with the uptake of iodine by the thyroid gland.Click here to read more about cruciferous vegetables
2. Processed foods- skip all packed foods, pickles, salty chips. Why? Because they tend to have excess salt and sodium.Please read my blog here for tips to reduce salt consumption. People with hypothyroidism are already at an increased risk of developing high blood pressure, the excess sodium may further increase this risk.
3. Sugary foods- all the tasty stuff that you love to snack on like biscuits, cakes and everything sweet. Why? Because as it is hypothyroidism slows down the body metabolism so this excess calorie that you eat will only result in unwanted weight gain.
4. Fried foods- fats can hamper the absorption of thyroid replacement hormones. So cut out all fried foods, nuggets, chips and all things cooked with butter and mayonnaise.
5. Coffee- now this one hit hard! Do not take your thyroid medication along with coffee. It apparently hampers thyroid replacement hormone absorption so take it only with water. Wait another 30 minutes before you can indulge in your morning cuppa coffee!
6. Excess fibre or protein rich diet- again this was very surprising to know that an excess fibre rich food like beans, peas and highly protein across diet like eggs, meat or even soya and tofu can hamper thyroid absorption. But only when consumed in large quantities. So moderation is key!

Here are a few foods that are thyroid friendly and must be eaten regularly to help manage hypothyroidism:

1. Nuts- yes all nuts except peanuts and walnuts are good for thyroid production. Sunflower seeds are also a healthy snack which is thyroid friendly. However, keep an eye on the portion size as nuts are rich in fats as well!
2. Fresh fruits and vegetables- good to relieve the constipation occurring in hypothyroidism.
3. Dairy products- milk and yogurt are good sources of vitamin D
4. Fish like salmon, tuna and sardine are rich in omega-3 fatty acids and are anti inflammatory as well protective to the heart. Since hypothyroidism can result in heart disease it’s good to include fish in your daily diet.
5. Whole grain- instead of the processed flour opt for whole grain flour. It is both anti inflammatory as well as helps relieve constipation. So choose whole wheat and brown rice as your staple.
The verdict is that diet does play an important role in regulating the thyroid hormone production. So eating a healthy balanced diet focusing on the above foods can really help regulate your thyroid levels and is definitely thyroid friendly.

Exercise and thyroid?

Though studies have not shown any direct link between exercise and thyroid, it definitely is beneficial. Incorporating a daily exercise routine of 30 minutes every day can help reduce symptoms like low mood, lack of sleep and depression and lead to an improved quality of life.

How to manage hypothyroidism through medication?

Firstly you must remember that this condition like other endocrinological diseases can only be controlled and not cured. The most likely treatment would be a prescription of levothyroxine tablet which is a form of supplemental thyroid. This tablet needs to be taken early morning one hour after waking up on an empty stomach. Wait for 30 minutes following this to consume anything. It is a lifelong medication with very minimal side effects, the dose of which should be periodically titrated depending upon the TSH values and symptoms. This medication needs to be taken only upon a doctor’s prescription and advice.
While the market is flooded with many natural therapies claiming ‘complete cure for hypothyroidism’ these are not scientifically proven nor approved. Such treatments might prove harmful for a patient in the long run. So stick to the doctors advise and follow a good balanced diet and exercise routine along with the thyroxine medication to manage hypothyroidism. 

As for Swathy, well she is doing great after her diagnosis and is able to manage hypothyroidism. She is currently a young mother and finally feels like energetic enough to run behind her toddler. Everyday is a new beginning and her thankful smile is a testimony to that.