Article by Registered Dietitian, Amy Bragagnini, MS, RD, CSO

I have a colleague who recently let me know that she is unhappy with her weight. She reported that she has tried for years to lose weight and, despite her best efforts, she has been unable. She finally went to the doctor and was told that she has Hashimoto's thyroiditis. This is a disorder in which the immune system turns against the body's own tissues. In people with Hashimoto's, the immune system attacks the thyroid, resulting in the thyroid gland’s inability to release adequate levels of thyroid hormones (T3 and T4). The lack of these hormones leads to a slower metabolism which results in weight gain, fatigue, dry skin and difficulty concentrating. She let me know that this is the biggest reason that she has not been able to lose weight. “I have already enlisted the help of an endocrinologist. I need someone that can help me figure out my diet. Can you help me?”

To begin, I let my colleague know that there are a few key nutrients that are important to a fully functioning thyroid. I suggested that she speak with her physician about these nutrients and see if checking her levels would be helpful. The first is selenium. Research shows that it is an integral part of a fully functioning thyroid, and if my colleague has low levels this may be impacting how well her thyroid gland functions. The next nutrient is vitamin D. One study suggested that approximately 90% of patients affected by Hashimoto’s disease were deficient in vitamin D (1). However, there is much speculation as to whether the deficiency was a cause of the thyroiditis or a result of the disease process itself. Another type of compound that can impact the synthesis of thyroid hormones is something called goitrogen. This compound is naturally released by cruciferous vegetables (cabbage, cauliflower, broccoli). When broken down, goitrogen may interfere with the synthesis of thyroid hormones. But given the many health benefits of cruciferous vegetables, I would still encourage my patients with thyroiditis to consume them; heating these vegetables can greatly reduce the negative effects of the goitrogens.

Weight changes can occur in both hyperthyroidism (weight loss) and hypothyroidism (weight gain). My colleague was saddened by her weight gain and now that she had a definite diagnosis, she was ready to implement diet and lifestyle changes. I first asked her provide a food recall for a few days. This allowed me a chance to analyze what she eats and drinks, what time of day, and assess portions of various foods. In my opinion, portion sizes can make or break a healthy diet. If you are unaware of what a regular portion should look like, I encouraged her to start checking the labels and really try to look at what one portion looks like. That way when she is at home she will be able to estimate approximately how much is on her plate, and hopefully limit her calorie intake by consuming one or two portions. This will also help her when she eats out. I saw that my colleague had a very carbohydrate heavy diet. I encouraged her to cut down on her servings of carbohydrates (bread, rice, potatoes) and increase a variety of fruits and veggies, lean protein and healthy fats. I encouraged her to introduce more omega-3 fatty acids into her diet (tuna and salmon) and to make one day per week “meatless.”  We also reviewed the importance of activity. My colleague admitted that she leads a pretty sedentary life so we brainstormed on ways she could move more. Taking the dog for a walk, riding a bike, taking the stairs and dancing were all things that she thinks she can do on a weekly basis!

References:
1. Tamer G, Arik S, Tamer L, Coksert D. Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid. 2011; 21 (8): 891-896.
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