Graves’ disease is an autoimmune disease that can cause hyperthyroidism — or overactive thyroid.
It causes a range of signs and symptoms, that even with medications, can be difficult to manage.
Fortunately, you may be able to improve your signs and symptoms by addressing your gut health since it influences your thyroid function.
This article explains the connection between the gut and thyroid and how improving or optimizing gut health may restore thyroid function to treat Graves’ disease.
What is Graves’ disease?
Graves’ disease is the most common cause of hyperthyroidism (1).
Like Hashimoto’s thyroiditis, Graves’ disease is an autoimmune disease.
With Graves’ disease, your immune system attacks the thyroid gland and produces antibodies that stimulate the gland to produce excess thyroid hormone.
The primary hormones secreted by the thyroid are triiodothyronine (T3) and tetraiodothyronine or thyroxine (T4).
The signs and symptoms of Graves’ disease depend on its severity and the organs affected but may include (1):
- weight loss, but sometimes weight gain
- heat intolerance
- shortness of breath
- loss of libido
- fast heart rate
- eye problems
The cause of Graves’ disease isn’t completely understood, but it’s believed to be caused by various environmental factors including pregnancy, excess iodine, infections, emotional stress, and smoking that trigger immune responses in genetically susceptible people.
People with Graves’ disease are at an increased risk of developing other autoimmune conditions, especially rheumatoid arthritis (2).
The treatment for Graves’ disease focuses on controlling symptoms and reducing thyroid hormone secretion through medications, radioactive iodine treatment — which requires a low-iodine diet — or partial or complete removal of the thyroid gland (1).
Graves’ disease is caused by antibodies that activate the thyroid-stimulating hormone receptor and trigger an increase in thyroid hormone levels.
Graves’ disease and gut health
Increasing evidence suggests a link between thyroid health and the gut microbiota, the collection of the microorganisms that inhabit your gut (4).
This link is known as the thyroid-gut axis.
Alterations in the composition of the gut microbiota can lead to increased intestinal permeability — or leaky gut— which allows harmful compounds such as inflammatory proteins, food antigens, and bacteria to pass from the intestines to the bloodstream.
Here they can trigger an immune response and promote inflammation.
Indeed, one study found significantly higher levels of several markers of intestinal permeability in people with Graves’ disease than in people without the condition (4).
Further analysis revealed that higher levels of these markers were independently associated with an increased risk for Graves’ disease and more severe symptoms.
Dysbiosis — an unfavorable imbalance of the microorganisms in the gut — itself also contributes to intestinal inflammation and the development of Graves’ disease (5).
Furthermore, dysbiosis and leaky gut can decrease the absorption of nutrients necessary for thyroid health, including iodine, copper, iron, selenium, and zinc.
For these reasons, treating gut problems — which are common among people with Graves’ disease — or optimizing your gut health through your diet could be an effective strategy to improve your thyroid health and symptoms.
Increasing evidence suggests that targeting the gut microbiota through your diet may have potential as a new treatment approach for Graves’ disease.
Foods to eat and avoid
Foods rich in fiber, probiotics, and beneficial plant compounds called polyphenols are particularly helpful for promoting gut health.
In contrast, other foods can promote dysbiosis and inflammation.
Here are foods to eat and avoid to promote gut health.
Foods to eat
Emphasize these foods as they promote the feed and promote the growth of good bacteria:
- Fruits: apples, avocados, bananas, berries, cherries, grapes, pears, pineapple, melons, etc.
- Vegetables: artichokes, asparagus, beetroot, brussels sprouts, cauliflower, cucumbers, garlic, leafy greens, peppers, mushrooms, etc.
- Whole grains: barley, bulger, farrow, millet, oats, quinoa, rice,
- Fermented foods: kombucha, sauerkraut, and pickled vegetables
- Seeds and nuts: almonds, Brazil nuts, flaxseeds, pistachios, pumpkin seeds, walnuts, etc.
- Legumes: beans, peas, and lentils
- Beverages: coffee, tea, and water
In addition to these foods, include healthy proteins like fresh chicken, beef, lamb, pork, and seafood if you consume animal products.
While beneficial for gut health, you may need to avoid or limit these foods as part of an elimination diet.
Foods to avoid
Limit or avoid these foods as they can promote dysbiosis and inflammation:
- Refined grains and added sugars: bakery items, breakfast cereals, candy, cakes, cookies, desserts, flavored yogurt, ice cream, sugar-sweetened beverages
- Fried foods: chicken strips, cheese sticks, fish, french fries, etc.
- Processed meats: beef jerky, bologna, lunch meats, ham, hot dogs, pepperoni, sausage
- Boxed pasta and side dishes
To promote gut health, emphasize foods rich in fiber and polyphenols, and limit or avoid refined grains and added sugar, fried foods, and other highly processed foods.
3-day sample Graves’ disease diet menu
Here’s a 3-day sample Graves’ disease diet menu:
- Breakfast: oatmeal with almond milk, topped with sliced banana and chopped nuts
- Lunch: grilled chicken breast with roasted vegetables tossed in olive oil and garlic
- Snack: fresh fruit salad with berries, melons, and citrus fruit
- Dinner: baked salmon with lemon garlic roasted potatoes and steamed asparagus
Day 2 (vegan)
- Breakfast: smoothie made with almond milk, spinach, frozen berries, and one scoop of pea protein powder
- Lunch: chickpea and vegetable stir-fry with brown rice
- Snack: vegan yogurt with mixed nuts and seeds
- Dinner: lentil and vegetable curry with quinoa
- Breakfast: Greek yogurt with honey, mixed berries, and granola
- Lunch: steak tips with roasted vegetables
- Snack: hummus with carrot sticks, cucumber slices, and whole-grain crackers
- Dinner: pork loin with brown rice and roasted Brussels sprouts
Use this 3-day sample Graves’ disease diet menu to guide your meal planning and food choices.
Tailoring your diet
Food sensitivities and allergies are common among people with Graves’ disease.
For this reason, you may need to follow an elimination-style diet to identify the triggering foods and ingredients.
To do this, you may need to eliminate foods that are otherwise beneficial for gut health until you determine whether they trigger your symptoms.
For example, you may need to eliminate gluten-containing grains since celiac disease is common among those with Graves’ disease (6).
You may also need to eliminate dairy, though you may tolerate fermented dairy products.
The autoimmune protocol (AIP) diet — which is a paleo-type diet — may be a good place to start to identify food to which you may allergic or intolerant.
As a type of elimination diet, the API diet consists of three phases — elimination, maintenance, and reintroduction.
However, following the AIP diet correctly can be very challenging, so it’s best to seek support from a registered dietitian trained in elimination diets.
You may need to follow an elimination diet like the AIP diet to identify foods and ingredients to which you may be allergic or intolerant to improve your gut health.
The best vitamins to take for Graves’ disease
Many vitamins and minerals are necessary for proper thyroid function, and low or deficient levels may worsen your symptoms.
Iron plays an important role in both the production and metabolism of thyroid hormones (7).
Consequently, a deficiency can lead to abnormal thyroid functioning, and potentially worsen your symptoms.
Therefore, supplementation may be necessary to correct a deficiency if present and maintain normal levels.
Selenium is an antioxidant that protects the thyroid against damage from oxidative stress (9).
It’s also involved in the metabolism of thyroid hormones.
While a selenium deficiency is rare, getting optimal amounts may help restore normal thyroid function, while also enhancing the effectiveness of medications prescribed to treat Graves’ disease.
One study revealed that vitamin D levels were significantly lower in people newly diagnosed with Graves’ disease (10).
This study didn’t find any correlation between vitamin D and symptom or disease improvement, but it may be worth supplementing with vitamin D to support your overall health.
Indeed, low vitamin D levels can weaken your immune system, lead to fatigue and depressive symptoms, and cause bone and muscle issues.
A vitamin D dose between 1,000 and 2,000 IU (25 and 50 mcg) is a good place to start for most people, but larger doses are necessary if you’re severely deficient.
You can find vitamin D supplements online.
Iron, selenium, and vitamin D may be worth supplementing with to help normalize thyroid function and improve your symptoms.
The bottom line
Graves’ disease is an autoimmune condition and the most common cause of hyperthyroidism.
Increasing evidence suggests a link between the gut and thyroid — known as the thyroid-gut axis.
To this point, targeting the gut microbiota through your diet may have potential as a new treatment approach for Graves’ disease.
To promote gut health, emphasize foods rich in fiber and polyphenols and limit those that are highly processed or rich in added sugars and refined carbs.
If you have gut issues, you may need to follow an elimination-style diet like the AIP diet to identify triggering foods or ingredients.
Supplementing with iron, selenium, and vitamin D may help restore normal thyroid function and improve your symptoms.