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Review Article

Diet and thyroid – myths and facts

Ruchita Sharma, Shantanu Bharti1, K. V. S. Hari Kumar2
Departments of Medicine, and 2Endocrinology, Command Hospital, 1Department of Psychiatry, Era Medical College, Lucknow, Uttar Pradesh,
India

A B S T R A C T

Thyroid gland is located in the neck and synthesize thyroid hormones, which have an indispensable role in the metabolic functions of
the body. Iodine is an essential compound for the synthesis of thyroid hormones and is mostly derived from the environment. Other
important nutrients for the thyroid function include selenium, iron, Zinc and vitamin A. Dietary alterations of the micronutrients lead to
structural and functional alterations in thyroid function. The alternative medical practitioners and nutritionists advocate plenty of dietary
modifications without a scientific rationale. In this article, we review the role of dietary micronutrients in thyroid physiology and dispel
few myths surrounding the same topic.

Key words: Diet, goiter, hyperthyroidism, hypothyroidism, thyroid

Introduction of other dietary nutrients in the thyroid physiology.[4] The

Thyroid gland is an important endocrine gland located
in the neck and is the site for production of thyroid
hormones. The synthesis of thyroid hormones is under
the hypothalamus‑pituitary control similar to other
hormonal axes. Iodine is a major substrate for the
synthesis of thyroid hormones and is derived mostly
from the environment.[1] The relation of iodine and goiter
is known for many centuries leading to the universal salt
iodination program to limit the detrimental effects of
iodine deficiency.[2] Previous observations also suggest the
presence of goitrogenic substances in the diet, identifying
an important role of dietary constituents in thyroidology.[3]
Thyroid disorders are very common in the society, affecting
about 10-15% of the population. Universal salt iodization
helped in the prevention of goiter and other iodine
deficiency disorders. The persistence of goiter even after
the iodinization leads researchers to explore the relation
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micronutrients other than iodine, which play important
role in thyroid hormone synthesis are selenium, iron and
zinc.[5] The alterations in the dietary components may
lead to thyroid dysfunction in predisposed individuals. In
this article, we shall review the relation between diet and
thyroid and try to dispel certain myths on this subject.
Thyroid physiology and dietary constituents
The hormones secreted from the thyroid gland are
thyroxine (T4) and tryiodothyronine (T3). T3 is the active
hormone and T4 acts as the prohormone. Only 20%
of T3 is secreted from the thyroid and rest 80% comes
from T4 deiodination in peripheral organs like liver and
kidney.[6] Thyroid hormone regulates metabolic rate, body
temperature and tissue growth. The thyroid gland is made
of follicles, which are surrounded by a single layer of
epithelial cell called the follicular cell. Follicle absorbs iodine
and stores it in thyrolobulin a glycoprotein synthesized
within thyroid cells. The thyroid hormone synthesis can
be summarized in the four steps. Firstly, active uptake of
circulating iodide to cytosol by sodium iodide symporter,
secondly, oxidation of iodide by thyroid peroxidase and
iodination of tyrosine residues on thyroglobulin molecule,
creating mono and diiodotyrosines, thirdly, coupling of
iodinated tyrosine residues to form T3 and T4 and forthly
the step of proteolysis due to hydrolysis and releasing the

Corresponding Author: Dr. K.V.S. Hari Kumar, Department of Endocrinology, Command Hospital, Chandimandir ‑ 134 107, Haryana, India.
E‑mail: hariendo@rediffmail.com

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Sharma, et al.: Diet and thyroid
T3 and T4 in cytosol. Iodine remains the major nutrient
required for the synthesis of thyroid hormones. The
second important micronutrient is selenium, which forms
selenocysteine compounds and protects the thyroid from
free radical damage.[7] Research has shown that iron, vitamin
A and zinc also plays an important part of thyroid hormone
synthesis.[5] Hence, dietary intake of all these micronutrients
is essential for the functioning of the thyroid gland.
Iodine and thyroid
Iodine is essential for the iodination of tyrosine residues
leading to the formation of thyroid hormones. A detailed
discussion on this topic is beyond the purview of this
article and readers are requested to peruse the recently
published reviews.[8,9] Environmental iodine is the main
source of iodine, that is present in soil, sea water, dairy
products, seafood and eggs. Iodized salt and multivitamin
tablets containing iodine are the other sources of iodine.
Recommended dietary allowance for iodine for adult men
and women is 150 ug and for pregnant and lactating women
is 220 ug and 290 ug respectively. Urinary iodine level is
the best measure to assess the iodine level in the body and
iodine deficiency is diagnosed when the median iodine
concentration is less than 50 ug/ml in population.[10] Iodine
supplementation in the form of iodized salt and iodized
oil has proven dramatic improvement in many developing
countries. Certain population like pure vegetarian may
not reach an adequate iodine intake even in countries
considered iodine sufficient. A reduction in iodine intake
can also be related to reduced salt intake for hypertension.
Depending on availability of iodine, the thyroid gland
is able to modify the use of iodine for thyroid hormone
production. The failure of compensation in severely
iodine deficient population results in hypothyroidism and
developmental brain damage. In mild iodine deficiency,
thyroid gland adapts by hyperfunctioning and prolonged
hyperactivity leads to autonomous thyroid function.
Both the excess or deficient intake of iodine is associated
with thyroid disorders in the population. [11] Iodine
deficiency can lead to a variety of medical problems at all
ages in the humans. Children of mothers having an iodine
deficiency during pregnancy may have mental retardation,
deaf mutism, spasticity and short stature. Congenital
hypothyroidism due to iodine deficiency is the most
common cause of preventable mental retardation in the
world.[12] Other disorders include goiter, hypothyroidism
and myalgia. Iodine deficiency in pregnant women is
associated with miscarriage, stillbirth, preterm labor and
congenital disorders in babies. The consumption of excess
iodine is also associated with various thyroid disorders
like hyperthyroidism, autoimmune thyroid disease and
nodule formation. The safe upper limit of iodine intake
Journal of Medical Nutrition and Nutraceuticals, Vol 3 / Issue 2 / Jul-Dec 2014
is around 1.1 mg per day. One teaspoon of iodized salt
contains 284 micrograms of iodine and a single gram of
seaweed contains around 2 mg of iodine.
Selenium and thyroid
The thyroid gland is among the human tissues with the
highest selenium content similar to other endocrine
organs. Selenium is an integral part of selenoproteins and
critical enzymes in thyroid hormone synthesis making this
an essential micronutrient.[13] Selenoproteins (glutathione
peroxidase and thioredoxin reductase) are responsible for
the cellular antioxidative defense and protects the thyroid
gland from damage due to hydrogen peroxide and reactive
oxygen species. The key enzymes involved in the activation
and inactivation of thyroid hormones (iodothyronine
deiodinases) are also selenoproteins. Selenium deficiency
exacerbates iodine deficiency and they both in combination
contribute to the pathogenesis of hypothyroidism,
goiter, autoimmune thyroid disease and myxedematous
cretinism.[14] Selenium is found mainly in the soil and the
consumption of balanced diet gives adequate selenium
for thyroid hormone synthesis. The selenium rich foods
in the diet are mushrooms, garlic, onions, eggs, beef
liver, shellfish, wheat germ, sunflower seeds and sesame
seeds. Selenium deficiency is seen in patients with poor
gastrointestinal absorption, long term parenteral nutrition
therapy and people residing in areas where the soil content
is very low. Replacement of selenium is essential in these
patients to prevent thyroid dysfunction. In patients with
combined selenium and iodine deficiency, replacement
of selenium alone worsens the condition further due to
the peripheral conversion of T4 to T3 leading to a marked
reduction in T4. Hence, in regions of combined iodine and
selenium deficiency, iodine supplementation is mandatory
prior to the initiation of selenium supplementation.
Iron and thyroid
Several minerals and trace elements including iron are
essential for normal thyroid hormone metabolism. The
thyroid function is impaired when the deficiency of these
elements coexists in the body. Iron deficiency impairs the
synthesis of thyroid hormones by reducing the activity of
heme‑dependent thyroid peroxidase. Population studies
have revealed that nonanemic children responded swiftly
to iodine supplementation with regard to goiter and TSH
levels than anemic children.[15] Globally, iron and iodine
deficiency coexist and the authorities have developed
a double fortified salt (iodine and iron) to tackle the
problem in an effective manner.[16]
Thyroid dysfunction and dietary alterations
The thyroid disorders may be divided clinically into
four common syndromic presentations. They include
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Sharma, et al.: Diet and thyroid
hypothyroidism, hyperthyroidism, thyroid swelling (diffuse
or nodule) and thyroid cancer. Each of these thyroid
disorders has a relevant dietary alteration in the clinical
course as explained below and summarized in Figure 1.
Hypothyroidism and goitre
Iodine deficiency is the major cause for thyroid deficiency as
explained in the previous sections. Previous reports suggest
that a vegetarian diet was associated with reduced risk
of hypothyroidism than omnivorous diets in population
studies with a follow up of 6 years.[17] The presence of
goitrogenic substances in the diet is responsible for the
persistent goiter in post iodization phase. The goitrogenic
substances in the normal human diet are the vegetables
from the Brassica genus (Cauliflower, Cabbage, Broccoli,
Horseradish, Radish, Rapeseed and Turnips), cassava,
which contains cyanogenic glucosides, flavonoids and
organic residues in the soil.[18] Cabbage and cauliflower
have high concentrations of glucosinolates, bamboo shoot
and cassava were rich in cyanogenic glucosides and other
vegetables like mustard, turnip and radish are rich in
thiocyanate content. All the goitrogenic substances affect
the thyroid hormone synthesis by inhibiting the iodine
uptake and the activity of thyroid peroxidase.
Excess iodine in the diet may lead to transient
hypothyroidism, known as Wolff‑Chaikoff’s effect.[19] This
autoregulation of the thyroid hormone synthesis is done
by reducing the organification of iodine and decreasing
the uptake. This effect is short lived and thyroid gland
usually escapes from this phenomenon. Failure to escape
from the detrimental effects of iodine excess results in
hypothyroidism and goiter. The predisposing factors
Figure 1: Dietary advice for thyroid in health and disease
62
for iodine induced hypothyroidism are extremes of age,
autoimmune thyroid disease and past history of treated
Graves’ disease. Previous reports suggest that modification
of dietary constituents resulted in the normalization
of (TSH) thyroid‑stimulating hormone in children with
subclinical hypothyroidism.[20]
Graves’ disease and hyperthyroidism
Dietary alterations affect the thyroid function and may
lead to hyperthyroidism due to excess iodine consumption.
The other important management issue is consumption of
iodine free diet prior to the nuclear imaging and thyroid
radio ablation. Jod‑Basedow phenomenon describes
the occurrence of hyperthyroidism following the excess
consumption of iodine.[21] This phenomenon is seen in
patients of endemic goiter, people with multinodular
goiter, Grave’s disease and thyroid adenoma. This effect
is typically opposite of Wolff‑Chaikoff’s effect and is not
described in normal thyroid glands. The small increase
of iodine intake in patients with a thyroid disorders with
no pituitary control leads to Jod‑Basedow phenomenon.
The management of differentiated thyroid carcinoma
includes total thyroidectomy followed by ablation of
thyroid remnant. Remnant ablation is preceded by thyroid
hormone withdrawal or by therapy with recombinant
human (TSH) thyroid‑stimulating hormone prior to
dosing the patient. Another important strategy to increase
the radioiodide uptake is to create an iodine deplete
stage by giving iodine free diet. The low plasma iodide
concentration results in the increased expression of the
sodium iodide symporter and increases the subsequent
uptake of radioiodide by the thyroid gland.[22] The dietary
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Sharma, et al.: Diet and thyroid
measures to achieve a low iodine diet are given in Table 1.
The beneficial effect of a low iodine diet is well established
prior to iodine scan, but the same is not studied much
before pertechnate scan. A study published recently
suggests that low iodine diet for two weeks prior to
technetium scan is beneficial in patients with multinodular
goiter and seafood consumers.[23]
Thyroid nodule
Thyroid nodule is a common disorder in the clinical
practice and different nutritional and environmental
factors are responsible for the etiopathogenesis of the
nodule. Iodine deficiency and smoking increase the
risk, whereas alcohol consumption and use of oral
contraceptives are associated with reduced risk of goiter
and the thyroid nodule.[24] Thiocyanate in the tobacco
smoke inhibits iodine uptake by competitive inhibition
and is the mediator of the goitrogenic effect.
Thyroid cancer
The incidence of thyroid cancer has been increasing
over the past few decades for unexplained reasons.
The alterations in dietary constituents and endocrine
disruptors have been proposed as the contributing factors
in the etiopathogenesis of thyroid cancer. Population
studies exploring the link between dietary patterns and
thyroid cancer revealed interesting findings. Dietary
nitrite is an established risk factor for the thyroid cancer
especially in males. Nitrate competitively inhibits iodide
uptake, reduces the thyroid hormone synthesis leading to
thyrotropinemia and thyroid hyperplasia with a potential
to transform into thyroid cancer.[25] Nitrates also serve
as the precursors for the formation of nitrosamines and
nitrosamides which are potent carcinogenic substances.
The highest concentration of nitrates is seen in leafy
vegetables (spinach, lettuce) and beet‑root. An increased
risk of thyroid cancer was described with the consumption
of cruciferous vegetables (thiocyanate consumption),
butter, cheese, starchy food, pasta, meat and poultry
products and a decreased risk with non cruciferous
vegetables (especially carrots, green salad and citrus fruits),
iodized salt, ham and fish.[26‑28]
Miscellaneous topics
The topic of thyroid and diet is incomplete without
mentioning about the soy proteins, perchlorate and the
influence of maternal diet on the thyroid physiology.
Numerous research papers have shown that the
constituents of maternal diet during pregnancy have a
profound influence on the fetal thyroid system leading
to obesity during adulthood. Obesity and thyroid disease
are interlinked with important physiological changes in
the hypothalamo pituitary axis during weight gain. The
Journal of Medical Nutrition and Nutraceuticals, Vol 3 / Issue 2 / Jul-Dec 2014
topic of thyroid and obesity is the genesis behind a lot of
myths associated with the thyroid diet. The print literature
and internet has lead to lots of confusion in the minds of
thyroid patients about their diet. The prevalent myths and
relevant scientific facts are given in Table 2.
Soy protein and thyroid
Soy‑containing foods and supplements are widely
consumed for possible health benefits that include
prevention of cancer, dyslipidemia, cardiovascular
disease and osteoporosis. Genistein is the major soy
isoflavone which has estrogenic and goitrogenic activity.[29]
The antithyroid effects of genistein are exaggerated by the
iodine deficiency. Genistein inhibits the activity of thyroid
peroxidase in a dose dependent manner. The effects of soy
isoflavones on the thyroid are dependent on the underlying
iodine status and thyroid function. A metanalysis on the
subject concludes that soy isoflavones have no adverse
effects in euthyroid, iodine‑replete individuals. There exists
little evidence that soy foods may increase the thyroxine
dose in hypothyroidism by inhibiting the absorption
Table 1: How to take a low iodine diet
Action Examples
Avoid iodine rich foods Fish and sea food,artificially colored
foods, vitamin supplements containing
iodine, amiodarone, radiographic
contrast, cough syrup, Iodine containing
antiseptics, creams and Iodized salt
Reduced intake of iodine Cheese, milk and milk products,
containing foods egg yellow
Consume foods with low Fresh meat, vegetables, fruits, pasta,
iodine content rice, iodine free salt and use mineral
water instead of tap water
Table 2: Myths and facts
Myth Fact
Thyroid diet is a special No such natural thyroid diet exists
diet recommended for Avoid taking thyroid hormone with other
all patients products like calcium, iron, antacids,
sucralfate etc
There is no evidence that eating or avoiding
certain foods improve the thyroid function
Eating high fat diet is May harm by epigenetic alterations leading
good during pregnancy to adult obesity in the child
Thyroid patients should You can safely consume soy foods if the
avoid Soy containing daily iodine intake is adequate
foods Have soya foods preferably after boiling
Hypothyroid patients You can eat all vegetables in moderation
should not eat cabbage, Moderate the quantity and mix them with
cauliflower etc other vegetables
The goitrogenic effect is diminished after
cooking or steaming and hence do not
consume raw vegetables
Gluten containing diet Gluten free diet is advisable only for
should be avoided in patients with coexisting Coeliac disease
hypothyroidism Autoimmune thyroid disease is likely to
be associated with other autoimmune
disorders like Coeliac disease
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Sharma, et al.: Diet and thyroid
of levothyroxine. The hypothyroid adult patients need
not avoid soy foods, but have to ensure adequate iodine
content in their diet.
Perchlorate and thyroid
Perchlorate competitively inhibits the uptake of iodide
into the thyroid gland, and affects the thyroid hormone
synthesis.[30] The major contributors of perchlorate in the diet
are vegetables, dairy products, drinking water and infant food
products. The thyroid inhibitory actions of perchlorate were
utilized by using this in iodine induced hyperthyroidism.
In normal conditions, the presence of small perchlorate
levels in water and food does not lead significant change in
thyroid function due to the large iodine stores. Hence, no
dietary modification is necessary for protection against the
perchlorate induced thyroid dysfunction.
Maternal diet and fetal thyroid
Thyroid hormones also play an important role as a
regulator of fetal development and energy expenditure.
The amount and timing of thyroid hormone release are
regulated through tight regulation of genes expressed
within the hypothalamic‑pituitary‑thyroid axis. A fine
balance is maintained between the production of T3 and
T4 through tissue specific expression of the deiodinase,
iodothyronine (DIO) genes. Maternal high fat diet leads
to alterations in the hepatic histone code leading to
transcriptional and epigenetic alterations of the fetal
thyroid axis. Thus, in utero exposure to high fat diet may
lead to obesity in later life by disturbing the fetal thyroid
homeostasis.[31]
Obesity and thyroid
Thyroid hormone has a major influence on carbohydrate
and lipid metabolism. Obesity is seen in hypofunctioning
thyroid gland and is contributed by multiple factors
like reduced metabolic rate, fluid retention and
mucopolysaccharide deposition.[32] Leptin is the product
of the ob gene, that regulates the food intake and body
fat and previous reports gave conflicting results about the
relation between leptin and thyroid hormones.[33]
Conclusion
Dietary micronutrients play an important role in the
synthesis of thyroid hormones. Iodine remains the
cornerstone with increasing focus on other nutrients like
selenium and zinc. Iodine consumption is a double edged
sword with disorders emanating from both the deficiency
and excess consumption. The best advice for all patients is
to consume a healthy balanced diet, meet the daily iodine
requirement and eliminate the most potent goitrogenic
substances from the diet. There is a lot of hype behind the
64 Journal of Medical Nutrition and Nutraceuticals, Vol 3 / Issue 2 / Jul-Dec 2014
thyroid diet with limited scientific basis and it is advisable
to follow the recommendations of the treating physician.
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How to cite this article: Sharma R, Bharti S, Kumar KH. Diet and
thyroid – myths and facts. J Med Nutr Nutraceut 2014;3:60-5.
Source of Support: Nil. Conflict of Interest: None declared.

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