Diabetes Self-Management Blog

We’re full throttle into January 2011 and, some might say, in the midst of the “winter doldrums.” Where I live, the weather has been cold and somewhat snowy. January doesn’t have a whole lot going for it, but it does happen to be Thyroid Awareness Month! So in its honor, I thought I’d focus on the role of nutrition in thyroid disorders this week.

Quick Thyroid Facts
To learn more about thyroid disease, please read Diabetes Self-Management’s excellent article called Thyroid Disorders and Diabetes, by Patricia Wu, MD. Dr. Wu gives a great overview of what the thyroid does and details the two most common thyroid disorders, hypothyroidism and hyperthyroidism. But as a quick summary, here are some key points about diabetes and thyroid disease:

  • Thyroid disorders are more common in people with diabetes than in people without diabetes. About one-third of people with Type 1 diabetes have a thyroid disorder, and thyroid disorders are also common in people with Type 2 diabetes.
  • Too little thyroid hormone leads to hypothyroidism, the most common type. Symptoms of hypothyroidism, or a sluggish thyroid, include feeling tired, feeling cold, weight gain, depression, dry hair and skin, and constipation.
  • Too much thyroid hormone causes hyperthyroidism, which isn’t as common as hypothyroidism. Symptoms include weight loss, rapid heartbeat, shortness of breath, sweating, muscle weakness, and diarrhea.
  • Hypothyroidism, if not treated, may lead to increased levels of cholesterol and triglycerides (blood fats), possibly raising the risk of heart disease. Hyperthyroidism can affect blood glucose control and increase the risk of osteoporosis.
  • Make sure your levels of two thyroid-related hormones, thyroxine (T4) and thyroid-stimulating hormone (TSH) are measured at least once a year.

Food and Hypothyroidism
Food is more likely to play a role in the treatment of hypothyroidism than in the treatment of hyperthyroidism, or an overactive thyroid. If you do a search on the Internet, you’ll find literally millions of Web sites focused on what to eat for your thyroid, along with plenty of “diets” for a healthy thyroid. Most of this information is geared for someone with hypothyroidism and is based on the premise that an underactive thyroid, which slows your metabolism, is responsible for your weight gain — jump-start your thyroid and you’ll soon be burning calories left and right, if these sources are to be believed. The reality is that while you may gain some weight due to a sluggish thyroid, the real treatment is to take the right type and amount of thyroid replacement, along with following a healthful eating plan and getting regular physical activity.

There are some tips for eating and hypothyroidism that you might keep in mind, however:

  • This sounds like a no-brainer, but take your thyroid medicine as directed by your physician. Skipping doses or taking it at different times of the day can prevent it from working as it should. Remember, too, that you might need to take thyroid medicine for the rest of your life, so get into the habit of making it part of your daily routine.
  • Take your thyroid medicines on an empty stomach. Food can decrease the absorption of this medicine, especially foods high in fiber (bran cereal, whole-grain toast, fruits, vegetables, beans, etc.). Don’t stop eating high-fiber foods; just eat them several hours apart from taking your thyroid medicines.
  • Also, avoid taking calcium supplements or supplements that contain iron (such as a multivitamin/mineral) along with your thyroid medicine. These too can block absorption of the medicine.
  • Iron deficiency is a cause of hypothyroidism. Women of childbearing age are more likely to be iron deficient. Ask your health-care provider to check your iron status if you have hypothyroidism.
  • Certain foods, while good for you, can affect the production of thyroid hormone. These include broccoli, cauliflower, Brussels sprouts, cabbage, and collard greens. You don’t have to avoid them, but don’t eat them at the same time that you take your medicine. Cooking these vegetables seems to lessen this effect.
  • Go easy with soy foods such as soy milk, tofu, miso, and tempeh. Soy contains a substance called genistein, which can decrease thyroid hormone production. Again, it’s not that you can’t eat soy foods, but limit them to a few times per week.
  • Eat foods that can help your body boost its production of thyroid hormone. These foods contain nutrients such as B vitamins, selenium, zinc, tyrosine, and iodine. Poultry, seafood, lean meat, whole grains, onions, beans, almonds, avocados, seeds, and low-fat dairy foods may be helpful. Go easy on fatty and sugary foods (this will help your diabetes management, too!).
  • Don’t take dietary supplements, such as iodine supplements, geared towards treating thyroid problems without first discussing this with your health-care provider. Also, don’t stop taking your thyroid medicine in the hopes of “treating” hypothyroidism by diet alone.
  • Watch your portion sizes. This seems like a no-brainer, but if you need to lose weight, cut back on how much you eat. A dietitian can help you work out a weight-loss meal plan.

Here’s to a healthy thyroid in 2011!

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Comments
  1. I do not have diabetes, I do have a thyroid problem. I take a pill every day for it. I had surgery for a pinched nerve in my wrist and then all things went from bad to worst. Neck swelled up and the more I talked the more it sounded like I was drugged out

    Posted by Cynthia |
  2. WOW! I knew that the thyroid affected a lot of other things within our body but no one ever told me my cholesterol and triglycerides could be as high as they are due to my thyroid. They always just said that they were “hereditary.” I stopped taking my synthroid back in December along with my Crestor as my muscles were really aching (and still are) in my legs - it’s frustrating as I do everything 80% of the time the right way with diet and exercise. My husband thinks I should start taking the thyroid med again but I kind of want to wait and see what bloodwork shows. I am due for this now.

    If I were to follow more of the diabetic recipes, do you think it would improve the thyroid too?

    Thank you for this information.

    Posted by Beth |
  3. Hi Beth,

    My advice is to go back on your thyroid medicine. The achiness that you were feeling is likely due to your Crestor, which is a statin, but not due to your Synthroid. Synthroid is a hormone, like insulin, and if your body isn’t making enough thyroid hormone, it needs a replacement. Most people with hypothyroidism need to take thyroid hormone for life. Using healthful recipes and eating healthful foods will help with your blood glucose, your cholesterol, and your weight, but will probably not help your thyroid make more hormone. Also, you should let your doctor know about the side effects from the Crestor, as there are other medicines that may work better for you.

    Posted by acampbell |
  4. In 1997, it was diagnosed that I had thyroid cancer and it was surgically removed. At that time I was prescribed synthroid and later it was changed over the Levloxyl, which I have taken daily ever since. I have had follow-up exams/scans using Thryogen. My latest scan a few weeks ago, revealed no reoccurrence of the cancer. My enrocrinologist lowered my intake of Levoxyl from .2 mcg to .175 mcg. I have never had any counseling regarding the dynamics of foods and my diabetes (controlled by insulin and four-times-a-day testing and injection of insulins. I do take multivitamins. I found little in the article to help me with these questions. What else do I meed top know?

    Posted by Dale Hoak |
  5. hi! Ive had hypothyroid for 40+ years, 35 of that i was on synthyroid, I did’nt feel good so I went on armour 2 gr Ive been to nutrinist, I’m still overweight, tired, foogy mind. Ive study natural medicine, I eat lots of fruits, veggies. I am a young 63 and am determine to get strong and with Gods help healthy. What else can i do to acieve my goal?

    Posted by georgia hightower |
  6. Hi. I was told that I have antibodies present that are Hashimotos and Graves. Is that possible and what exactly does that mean? Wouldn’t hypo/hyper cancel each other out?

    Posted by Kari |
  7. i take tapazole .my dr. never told me to take it on a empty stomach. i have taken it for 20 yrs and my thyroid tests are never the same. every few months he changes my dosage.could this be the reason he cant regulate my thyroid. thank you .

    Posted by pat hauer |
  8. I
    am hoping you can help me. I have type 2 diabetes, thryoid,and have to eat gluten free and interstial lung desease. I find it hard to get the grains and I fiber into a gluten free diet. Also the gluten free things seem to be high in sugar. Is there a cook book that covers all these areas? With the lung condition I have a hard time to excerise to much.I would like to feel better and lose some weight.
    Thank you.

    Posted by Donna P |
  9. hello Amy-thanks for all the interesting facts on thyroid nutrition-I am a Diabetic/Hypothyroid/hypertension. are there any sites to explain futher on thyroid diet meal plans. I would like to keep my meals on point to try to level my tsh thanks Janice

    Posted by Janice Dobson |
  10. Hi Dale,

    You mentioned that you’ve never had any counseling regarding the effect of food on your diabetes. Hopefully you’ve been reading the various nutrition articles on this Web site. However, my main piece of advice to you is to schedule an appointment with a dietitian who specializes in diabetes. It can be confusing and challenging to try and figure things out on your own, especially when you take insulin. Your doctor should be able to give you a referral, and there are likely dietitians at your local hospital or medical center. It’s time well spent and your insurance should cover the visit.

    Posted by acampbell |
  11. Hi Kari,

    It’s possible to have antibodies for both Hashimoto’s (hypothyroidism) and Grave’s (hyperthyroidism). You may not always have symptoms of either, however. And unfortunately, they don’t cancel each other out. Make sure you have an endocrinologist who is familiar with having both conditions at the same time. You’ll likely need to have frequent blood tests and you’ll need to pay attention to your symptoms so that your medication can be adjusted quickly. I found a good article on the Internet that you might find to be helpful, too: http://www.associatedcontent.com/article/5850206/autoimmune_thyroid_disease_hashimotos_pg2.html?cat=5

    Posted by acampbell |
  12. I’ve had my thyroid irradiated over 10 years ago. My Dr’s change my synthroid every year. Im tested every 3-4 months. We can’t seeem to get a good constant result from the test 4yrs ago I was diagnoised as pre-diabetic,$ 4 years ago i developed bilateral lower leg plaques. Just last Oct 2010 a dermatologist gave me an RX for a topical cream for them.For the first time in % years I can see the pink pigmitation hru the dark plaque. I have always asked my Dr’s can we succesfully treat diabetes and hypothryoidism at the same time.. so far they havent been successful!I’ve learned to live with the dissappoitment and forever hope for a cure

    Posted by cynthia Dillingham |
  13. Per your article: ■Take your thyroid medicines on an empty stomach. Food can decrease the absorption of this medicine, especially foods high in fiber (bran cereal, whole-grain toast, fruits, vegetables, beans, etc.). Don’t stop eating high-fiber foods; just eat them several hours apart from taking your thyroid medicines.

    My problem is I take my synthroid half hour before breakfast, I can’t wait to eat as long as suggested in your article. Is there a better time to take my meds. I am also a type 2 diabetic. I had be taking my synthroid in the middle of the night but was told that wasn’t a good idea.
    Thanks for any help you can give me.

    Posted by Laurie |
  14. Hi georgia,

    Are your thyroid levels regulated on the Armour? How are your blood glucose levels? Uncontrolled thyroid and diabetes can make you feel sluggish and can make it difficult to control your weight. Check with your doctor to make sure nothing else is going on in terms of your health. You might consider going back to see a dietitian for a meal plan that can help you lose weight and that also provides you with all the nutrients that you need. Finally, even though you may feel tired, don’t overlook exercise, which will give you energy, help you think more clearly, and help with your weight.

    Posted by acampbell |
  15. Hi pat,

    It’s possible that your thyroid levels aren’t regulated because of the food that you eat along with your medicine. Try taking your thyroid medicine a few hours before you eat your meal and see if that helps.

    Posted by acampbell |
  16. Hi Janice,

    It’s hard to find credible thyroid nutrition information. However, you might look at My Food My Health at . You can select your “condition,” such as hypothyroid, and then sign up for information, meal plans, and recipes. The catch is that there is a small fee. But check it out. It may be helpful for you.

    Posted by acampbell |
  17. Hi Donna,

    There’s a new cookbook out called Easy Gluten-Free by Tricia Thompson and Marlisa Brown, who are both dietitians. You might find this helpful. Also, if you haven’t already, think about meeting with a dietitian who has experience with gluten-free diets. She or he can help you with a meal plan and food choices geared towards weight loss. The American Dietetic Association’s Web site, , can help you find a dietitian in your area. You might also ask your doctor for a referral to a physical therapist or exercise physiologist regarding your interstitial lung disease and an exercise program that is based on what you’re able to do safely. It’s hard to do it all by yourself, so seek out resources in your community.

    Posted by acampbell |
  18. Hi Laurie,

    I did a little research about when to take thyroid medication. Interestingly, two studies, one published in 2007 and one in 2010, found that taking thyroid medication (levothyroxine, not natural thyroid medications like Armour) at night may actually be better, resulting in higher thyroid hormone levels. These better results may be due to that fact that even when you wait to eat breakfast, the food still interferes with medication absorption. Also, bowel motility is slower at night, resulting in better uptake of the medication. Finally, the conversion of your medication into a more “useable” form in the body seems to be more effective when it’s taken at night. Ask your physician if you can try taking your medication before bedtime instead of in the morning. He or she can then check your levels and see if there’s any improvement.

    Posted by acampbell |
  19. Dear Amy

    Thanks for writing about such an important issue this is helpful for me since I am not knowledgeable in thyroid.

    If all the test are ok would it still not be desirable to eat some food with iodine or take supplements?

    In Canada the table salt you buy is slightly iodized but I don’t use it. I use no salt which is potassium chloride to balance my Na/K slightly more in favour of K I don’t think it has I.

    Also unsure if the tonnes of sodium chloride I eat in the prepared food has any I.

    We bought some dried seaweed is that any good?

    Posted by calgarydiabetic |
  20. I was diagnosed as hypothyroid fifty years ago and had it under control for years. I never ate breakfast at that time. Years later I was told I did not need the thyroid meds and quit taking it. I finally ran into a doctor who tested for more than one hormone and went back on medication. It did not seem as effective as in the past. I had formed the habit of eating breakfast and now I think that may have lessened the effectiveness. I wait a half hour to an hour to eat but I can see that is not long enough. I will take my meds at night now. How long after I eat is good? Synthroid does not seem as effective as Armour but Armour can be hard to find. Is the difference all in my imagination?

    I’m Type 2 diabetic and never had a lot of trouble keeping my bs right. Several months ago my bs bottomed out at 50. After that I could never get my bs under good control. Finally, after being diabetic for 15 years, I was sent, for the first time, to a diabetic counselor. By following her advice as to when I ate, I saw my bs drop from 279 to 101 in FOUR DAYS!!! and no trouble keeping it there. Something about the bs bottoming out screwed up my control.

    Posted by Beverly Keenan |
  21. Thanks, Beverly. Great news! And also I’m glad you made the point that seeing a diabetes educator can be beneficial!

    Posted by acampbell |
  22. Hi calgarydiabetic,

    Yes, even if your thyroid is working as it should, you still need iodine. Iodine is needed to make thyroid hormone. In the US, the RDA for iodine for adults is 150 micrograms (mcg) per day. One teaspoon of iodized salt has 300–400 mcg of iodine, but obviously has a lot of sodium (about 2300 mg). One can get iodine from other sources, though, especially from seafood. Milk and yogurt in the US also contain iodine because it’s added to the cattle feed. I’m not sure if that’s the case in Canada, but you could likely find that out. Potatoes with the skin and eggs contain iodine. Sea plants, such as seaweed, kelp, wakame, nori, and dulse are great sources of iodine. Some multivitamin/mineral supplements may have iodine, too, if the form of potassium used is potassium iodide.

    Posted by acampbell |
  23. I have been in A-Fib for about 6 months. I have hypothyroid and diabetes. I also have severe (65 times an hour)sleep apena. I have had 2 cardio versions in the last 6 months. The first one lasted 2 wks and the second one since the 15th of Dec 2010. I noticed that my sugar levels have plumeted since the last cardio version. Do you think that my high blood sugars (170-350) were caused by the A-Fib? My cardiologist said he didn’t know. He never heard of this causing the high blood sugars. I had an A1C at 5.9 until the problems came out about Avandia and they took me off of Avandia. Since then it has been a big challeng and alot of trouble get things down to normal. I had jumped up to about A1C of 10. I have it down to 8, but is has been a very long strugle. So now they go up when I am bad. Which I try not to be bad, but I am a Chocolateholic. Hope I spelled that corect.

    Posted by sheila |
  24. Hi Sheila,

    I’m not sure either if your a-fib was caused by high blood glucose. Interestingly, though, a study published last year in the Journal of General Internal Medicine showed that people with diabetes are at an increased risk of developing a-fib. Somehow these two conditions are linked. That’s good news that you’ve lowered your A1C from 10 to 8. You don’t mention if you’re on any other type of diabetes medicine, but if not, you probably should be. And don’t think of yourself as being “bad.” No one is perfect and most people with Type 2 diabetes need medication to help with their blood glucose control. (By the way, I’m a chocoholic, too!).

    Posted by acampbell |
  25. Hi Amy,

    I am not a diabetic but am almost 4 years after having my thyroid irradiated due to severe Graves disease. I am currently at a dose of Synthroid at 175 mg daily. I have gained back all the weight that I lost when I was hyper (100 pounds) and so am almost 285 pounds and am 46 years old. I take my med in the am as instructed and wait at least one hour before eating breakfast. I am going to try switching to pm dose as you reported and see if that helps. My labs have never been normal for TSH and doctor just insists that I am doing something wrong in dosing or eating. I have been trying to eat clean and do some moderate exercise but it is not making the scale budge at all. Is there anything else I can do to try to lose weight?

    Posted by Kristi Emo |
  26. Hi Kristi,

    Hopefully switching your Synthroid dose to nighttime will help. In the meantime, you might think about seeing a dietitian to discuss the difficulty you’ve been having losing weight. Having someone review your food choices, cooking methods, and portions can really be helpful. You can also discuss your physical activity program with a dietitian. The other option is to consider joining a commercial weight management program (Jenny Craig, Weight Watchers, Nutrisystem, etc.). These programs can be helpful and can give you the jump start that you need. Finally, think about either joining a formal exercise program at your local Y or a health club, or treat yourself to a few sessions with a personal trainer. It’s hard to lose weight on your own, so take advantage of the resources that are out there!

    Posted by acampbell |
  27. I had my thyroid removed in 2006. Does your article still apply to my eating habits?My food addiction is not being managed as I would like it to be.

    Thanks for providing these articles.

    Walden Hearn

    Posted by Walden Hearn |
  28. Hi Walden,

    Yes. Even though your thyroid has been removed, I’m assuming you are taking thyroid medicine as a replacement, so the same nutrition guidelines would still apply to you. I’m not exactly sure what your food addiction is, but that may not be related to your thyroid, anyway. As with any addiction, working with a health-care professional (in your case, a dietitian and/or a behavioral health specialist) or joining a program for food addiction would be my recommendation.

    Posted by acampbell |
  29. I had a gastric By Pass over 10 years ago. i have been on the same dose which was 1.25mg, after I hit the 10 years of keeping off over 110 lbs, my body decided to start gaining weight, more dryness of skin, conspation, which before I had dumping sydrom. I am now on 1.37, and I am eating healthy and exercising. and still I am gaining weight and I am freaking out. Please advise.

    Posted by kari |
  30. Hi kari,

    I can’t be certain, of course, but it sounds like your thyroid medication dose needs adjusting. Have you talked with your doctor about this?

    Posted by acampbell |
  31. I had hyperthyroid then had it removed I am on synthetic hormones for rest of life now all blood work comes back that my dose is correct but now I feel as if its going to hypo due to constantly tired and weight is building can this actually happen to go from hyper to hypo

    Posted by sandy |
  32. Hi sandy,
    First, are there other factors that might be causing the fatigue and your weight gain? These events aren’t always due to thyroid issues. If you don’t think that’s the case, talk to your doctor about further thyroid tests, which would include free T4 and free T3. The thought is that measuring these two hormones provides a more accurate picture of true thyroid hormone levels in the body, as opposed to just have your TSH levels measured.

    Posted by acampbell |
  33. This is a great article. I have Type 1 Diabetes and Hashimotos. I went on an insulin pump and I was feeling so great. Then over the summer I have been feeling just so blah and fatigued. I am do back at the endo’s in two weeks so I have been making a list that I want to talk about. I couldn’t believe it when I read that iron can make your thyroid medicine not work properly. I have been taking my vitamins with my thyroid medicine in the morning and have been doing so since the summer. I am hoping it is as simple as that. So tomorrow I will take my iron tablet and Vitamin D at night. I am so glad I read this article. Thank you!! :0)

    Posted by Catherine |
  34. My name is Cathy, I was diagnosed with hypothyroidism at age 19. Been doing the routine blood work every 6 months and now at age 25 I’m taking 175 mcg each morning. Can a person live a full long life with thyroid issues and can I drink alcohol with hypothyroid?

    Posted by Hello Sandy |
  35. Hi Cathy,

    There’s no reason why you can’t live a long, healthy life with thyroid issues — the key, as with diabetes, is keeping it controlled. Taking your medicine and getting your levels checked regularly is important for knowing how you are doing, in the same way that knowing A1C and blood glucose levels helps people with diabetes know how they’re doing and what might need to be tweaked or changed. As for alcohol, you likely can drink it, but it’s wise to first check with your physician.

    Posted by acampbell |
  36. All the comments are a sort of helpful. However, I still would like to know if it is OK to eat shell fish while taking synthroid. Please reply to my E-Mail if you could.

    Posted by Steven West |
  37. Hi Steven,

    It should be fine to continue to eat shell fish while taking Synthroid. However, you should be sure to take your Synthroid on an empty stomach, about 30 minutes before you eat anything.

    Posted by acampbell |
  38. I have hypo thyroid some time i get sever spasam in my legs is it normal to get such thing and also my weight is out of control i have tried everything can you tell me what is the method for treating this i have also tried hcg that is the only thing that will bring down your cholesterol and also your blood sugar and no i donot do the 500 cal i do 1500 and i am beginning to lose weight.

    Posted by della |
  39. Hi della,

    I believe that leg spasms or cramps can be a symptom of hypothyroidism. Please let your doctor know if these continue. I would not advise following the HCG diet. The FDA has warned consumers against using any products containing HCG, and it’s actually against the law for companies to be selling such products. Turn to more credible sources for help for weight loss, such as meeting with a dietitian, joining a support group in your community, or signing up for a commercial program, such as Weight Watchers, for example. Also, talk to your doctor about other options that are safer.

    Posted by acampbell |
  40. My husband is facing the problem of hypothyriod and daibeties he is taking medicine thyronorm 100mcg and gluconorm sr 1mg he has to travell a lot and most of the time he is eatin food outside and now he has grown so thinner and also hungry everytime as he takes his food also he has the problem of gas allthe time and feels very tierd so please suggest wht should I do for him and his diet he is very careless about his health.aldo he has pain in his legs but he does not go for morning walk and no excercises . Please help me.

    Posted by rinku sharma |
  41. Hi rinku,

    Your husband should see his doctor to determine if his diabetes or thyroid (or both) are not controlled. When someone has hypothyroidism, weight gain may occur. You mention that your husband is losing weight, which could be due to his thyroid or his diabetes (if his blood glucose levels are running high). And feeling tired may result from both thyroid issues and diabetes. Please encourage him to go to his doctor; perhaps you can offer to go with him, as well.

    Posted by acampbell |
  42. Here is my issue. I have been on synthroid .150 since June of this year. I had been taking levoxal for the last 10 yrs since my thyroid has been removed but since being taken off the market my endo prescribed synthroid. Here is the issue, I am losing weight by choice, have changed my diet totally & working out with a trainer & doing this 5 days a wk. for the last 6 months. My endo took blood work & cholesterol levels going up, had an appointment with my GP, she also checked blood work, cholesterol levels up yet again. The only med I’m taking is the synthroid. I’m at a loss & so are my Drs & trainer. Any knowledge out there indicating that his medication can increase cholesterol levels. The irony of this is I feel better then I have in several years. Go figure!

    Posted by Nancy |
  43. Hi Nancy,

    It’s very unlikely that the Synthroid is causing your high cholesterol levels. If anything, thyroid medication often helps to lower cholesterol levels. However, it’s important to make sure that your thyroid condition is properly controlled and that you’re on the right dose of Synthroid. It may also just be a coincidence that your cholesterol is high, despite your healthy eating and exercise. This is the case for many people. Talk to your doctor about the best way to lower your cholesterol. You may need to take a cholesterol-lowering medication, such as a statin.

    Posted by acampbell |
  44. hi i am a 36 year old female with type 2 diabetes since 1 n hlf yrs and it is under control without medicines..i am also ypothyroid since 9 years back, and take thyronorm 50 evryday nefore food..since last month i have developed high bp of 160/115…can i control it without medicines..
    i hv also been told tht i am very very vit D deficient..which is 6 in level..
    will my problems be solved with weekly dose of 60k bit d3??

    Posted by chaitra |

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