I was diagnosed with Graves’ hyperthyroidism, an autoimmune disease, in October of 2022. I’ve been working with an endocrinologist ever since, getting regular blood draws and following my prescribed medication protocol.
Unfortunately, when I asked for lifestyle recommendations, I was told there was none to give. I was pushed to consider radioactive iodine treatment (to kill my thyroid and be on medication for life) as my first option instead.
Well, I chose not to accept that.
As a dietitian and health professional, I consider myself to have a high level of health literacy — and while I recommend heeding medical advice from licensed professionals, it’s also important to listen to your intuition. For me, that has meant taking my meds while also leaning heavily on what I can control in my everyday habits.
There’s no shortage of supplements and herbal elixirs and specialty (expensive) products marketed to improve your health, including when it comes to autoimmune disease.
For Graves’ specifically, lemon balm, motherwort, and bugleweed are often recommended. However, there’s limited evidence that’s mostly from animal and lab studies with a few positive case reports, so I wouldn’t recommend blindly supplementing.
In my attempt to find support in online communities, it appears many people with Graves’ rely on the herbal protocol of one particular chiropractor (eye roll), ditch gluten, and hope for the best, while suffering with symptoms and questioning their provider’s medical advice.
I don’t recommend this approach either.
Instead, here’s what I’ve learned in my personal experience with Graves hyperthyroidism, sharing in case anyone out there is as paralyzed and discouraged as I was upon diagnosis.
Note: This is not medical advice. I am a dietitian but I am not YOUR dietitian. Please consult a licensed medical provider who can provide personalized guidance for your autoimmune disease.
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What is an Autoimmune Disease?
First things first: let’s define some basics.
An autoimmune disease is when your body’s immune system mistakenly attacks its own cells, tissues, or organs (I know, I thought my body was supposed to be smarter than that too).
Normally, your immune system is in place to defend your body from harmful invaders like viruses and bacteria that can make you sick.
However, in autoimmune conditions, this defense mechanism becomes overactive or misdirected, leading to inflammation, tissue damage, and disruptions in normal body functions.
Autoimmune diseases can target specific organs, such as the thyroid or pancreas, or affect the entire body, as seen in conditions like lupus.
Unfortunately, autoimmune diseases are considered to be chronic and incurable. However, they can be put into remission, which means that the symptoms and active disease processes are significantly reduced or absent, even though the underlying condition still exists.
In remission, your immune system stops attacking healthy tissues, leading to a halt or reversal of inflammation and damage, allowing for improved overall quality of life and better control.
What is Graves’ Disease?
Graves’ disease is a specific type of autoimmune disorder that affects your thyroid gland, a small, butterfly-shaped organ located in the front of your neck. The thyroid is responsible for producing hormones that regulate metabolism, energy levels, and growth.
In Graves’ disease, your immune system makes antibodies that stimulate your thyroid to produce excessive amounts of thyroid hormones, a condition known as hyperthyroidism (AKA overactive thyroid).
Graves’ is the most common cause of 60–80% of hyperthyroidism cases and is most likely to affect people in their 30s-60s. Women are annoyingly 5-10 times more likely to develop it than men.
Symptoms and Complications
Common symptoms include:
- Rapid heartbeat
- Unintentional weight loss
- Unusual feelings of anxiousness
- Heat intolerance
I experienced several of these, but the one that stood out the most was heat and exercise intolerance. The summer before my diagnosis, I was training for a grueling fitness competition and we were practicing outside.
There were multiple times when I couldn’t finish the course or workout because I’d get lightheaded and hot—which was unusual for someone who has led an active lifestyle since I was 15.
There were nights when I would notice my heart beating more quickly than felt normal, so I got a fitness watch to start tracking my heart rate (and consequently implementing breathing techniques or stepping out of a workout if it got too high).
Sometimes, having Graves’ disease can lead to another condition called Graves’ ophthalmopathy, or bulging eyes. It’s also called thyroid eye disease (TED). Some people notice one becoming eye larger than the other or both eyes essentially protruding more than normal.
There’s about a 50% chance of this, and it’s most likely to occur in the 6 months before or after receiving a diagnosis.
I always bring it up at my annual eye exam (it’s important for your opthalmologist to know), but I’ve never had symptoms indicating that this is developing (like gritty eyes, double vision, pressure, or noticeable changes in my eyes).
Treatment Options
Once you’re properly diagnosed (which usually involves a thyroid scan or two plus bloodwork), you can talk treatments.
Graves’ disease treatments typically include medication to prevent the thyroid from producing too much thyroid hormone, radioiodine to kill your thyroid, or surgical removal of your thyroid.
I am currently weaning off of methizamole (or “meth” for short, which I find funny) after 2 years of a regular low dose. This is a standard Graves’ disease medication. The hope is that when I fully stop using it, my body will have chilled out and won’t return to a hyperthyroid state.
How long can you live with Graves’ disease? With proper treatment and lifestyle medicine, most people with it can live normal, healthy lives. The key to longevity and quality of life lies in early diagnosis, effective treatment, and ongoing management of symptoms.
What Causes This?
Like most diseases, autoimmune conditions cannot be pinpointed to one specific thing. It’s a combination of many risk factors and triggers.
It’s generally thought that conditions like Graves’ are a result of genetic predisposition, environmental triggers, and possibly existing immune conditions.
I can speculate about my personal experience, but I’ll never know for sure.
There is a history of thyroid conditions within my family, which means I am genetically predisposed to them. However, just because you have a genetic component doesn’t mean you’re destined to end up with something. There has to be a trigger.
That’s where my history of chronic stress comes in.
I have always believed that the years of emotional trauma in my history have been bubbling and boiling under the surface, until it manifested into an autoimmune disease related to a predisposition I already had.
This is why it’s so important to me to address my everyday habits and lifestyle factors contributing to my health in the long haul—rather than relying on a temporary medication protocol for symptom relief and doing nothing else.
So, let’s get into what I’ve discovered along the way and how I’ve applied it to myself.
6 Approaches to Promote Healing
Research shows that while medical interventions can be necessary, lifestyle interventions should be first-line treatment approaches for health concerns.
Below I’ve detailed 6 things I’ve found to be foundational for my healing and long-term wellness. Keep in mind that these aren’t one-and-done things. I plan to continuously strive to make these regular habits, even if and when I achieve remission.
1. Optimizing My Sleep
One of the biggest things I’ve uncovered is that my body performs at its best when I get 9 hours of sleep. Now, I do have two small children who regularly interrupt my sleep pattern, so it’s possible that I could do well on less sleep without that factor. But for the time being, 9 hours is what my body seems to like.
Experts recommend that adults get 7-8 hours of quality sleep per night. Why does this even matter?
Sleep is a critical time for your body to experience repair, rejuvenation, and recovery. Plenty of evidence shows that chronic sleep deprivation, or erratic sleep patterns, is associated with a higher risk of illness, infection, and disease—which can manifest physically and mentally.
If quality sleep hasn’t been your jam, here are some ways to improve your sleep hygiene (habits that help you get into a better rhythm):
- Create a consistent sleep schedule. Like a child, your body thrives on routine. Ideally, I’d like to follow a 9PM-6AM schedule myself, but that doesn’t happen most days. But this is like eating—once your body becomes used to going to bed and waking up around the same times every day, your body clock (circadian rhythm) will follow suit, even if you forget to set the alarm.
- Ditch screens too close to bedtime. I get it, screens are lifeeeeeee. There’s also research indicating that the blue light emitted from said screens disrupts your brain’s ability to secrete melatonin properly and when it’s supposed to (as you approach evening and when it’s time to go to bed). A hit of blue light may help you wake up in the morning, but it generally makes it harder to shut off your brain and fall asleep. Aim to go screen-free 1-2 hours before bed—maybe grab a book or listen to a podcast with headphones on instead.
- Avoid sleep disruptors and stimulants after noon. Blue light isn’t the only thing keeping your brain on into the late hours. Caffeine, heavy high-fat meals, vigorous exercise, and alcohol (yes, a depressant but also a sleep disruptor) can interfere with your normal circadian rhythms.
- Create a sleep-promoting environment in your bedroom. Your bed should be a place of solace, so don’t make it into your home office or the place you eat lunch. Does your room make you want to collapse and go to sleep? If not, consider ways to make it more inviting to rest. Comfy bedding, peaceful colors (I like lavenders, blues, and grays personally), low lighting, adequate window coverings, and the appropriate pillows can help.
- Start your day with light and water. Just like a plant, sprout up in the morning and get yourself some sun and water (and breakfast). Opening the curtains to let the sunrise in is a great way to align your circadian rhythm with the start of a new day. If it’s dark, or winter, some people find it helpful to get one of those Happy Lights (I used one when I lived in Michigan) in their bathroom while they get ready for the day. Drink a glass of water to help get things moving internally.
I’ve found it helpful to adopt the perspective that going to sleep is actually the start of a day, not the end of one. Doing so helps me view my sleep in a way that makes me put down the Netflix crime documentary and turn on a quiet sleep meditation more often (not every night, but the effort is there).
2. Getting Enough Exercise (But Not Too Much)
Experts recommend adults get at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity.
It’s also important to do strength and resistance training at least twice per week to help prevent lean muscle mass loss. Weight-bearing exercises also help support healthy bones.
On the other hand, there’s such a thing as getting too much exercise. More isn’t always better, as excessive exercise can actually lead to increased inflammation. So don’t worry, you don’t need to go nuts.
Here’s what a typical week of movement for me might look like:
- 1-2 days a week: Take my dog for a run (just walking most other days).
- 3 days a week: Group fitness class with my workout community, which is usually HIIT-style and incorporates both cardio and strength training.
- 1 day a week: Hitting the gym with a girlfriend and lifting heavier weights (we generally do things like weighted squats, bench press, military press, deadlifts, and pull-ups).
- 1-2 days a week: Total rest or a light walk/stretch session or a few simple core exercises (like crunches and planks).
This isn’t a prescription for everyone. To make exercise habits sustainable, they have to be things you enjoy and that make you feel good.
For some, that might mean a combination of other things like swimming, playing tennis, doing yoga, taking a cycling class, or kickboxing. Whatever healthy and committed movement is for you, do that— and do it regularly.
Don’t feel motivated or not sure what to do? I recommend finding a personal trainer for personalized guidance, joining a local workout community, or seeing if a friend wants to workout together and keep each other accountable.
3. Targeting My Gut Microbiome
There’s been a growing body of research on the association between your overall health and your gut microbiome – the community of microbes (like yeast and bacteria) living in your digestive tract.
Ideally, you want more friendly, health-promoting microbes than harmful ones that ultimately contribute to inflammation and disease. You also want diversity (lots of types of friendly germs).
Not only is a healthy gut microbiome important for your digestive health, but a good balance of these germs is crucial for things like mental wellness, heart health, and immune function. When it’s out of balance, this is called gut dysbiosis, and it may increase the likelihood of developing autoimmune conditions like Graves’.
Furthermore, hyperthyroidism can alter gut motility and the absorption of nutrients, further throwing off this delicate balance.
Interestingly, in one 2023 study, scientists discovered that Graves’ disease and the gut microbiome are connected, but they weren’t sure if one causes the other. Using advanced analysis methods and data from thousands of people, they found that certain gut bacteria might increase risk while others may protect against it.
For example, bacteria like Deltaproteobacteria were linked to higher risk (proteobacteria presence is low in a healthy gut), while Anaerostipes seemed protective (this type of microbe helps produce the short-chain fatty acid butyrate, which is associated with better gut health).
The study also found that Graves’ can affect some gut bacteria, showing a two-way relationship. This supports the idea of a “thyroid-gut axis,” where the thyroid and gut influence each other. You may have heard of the gut-brain axis, which is the same concept of a bidirectional relationship between your gut microbiome and your brain.
How to Support Your Microbiome
Therefore, supporting my gut is an important aspect of managing my Graves disease. So, what do I do to promote a healthy microbiome?
- I eat a plant-based diet. Plants aren’t just full of vitamins, minerals, and antioxidants, but they’re the only natural source of fiber—a critical nutrient that only an estimated 5% of US adults get enough of from their diet (the minimum RDA is only around 30 grams per day!). Fiber feeds friendly microbes and helps move things through my digestive system, including waste that shouldn’t be sitting there. Not getting enough fiber has been associated with a loss of microbial diversity.
- I eat natural sources of probiotics. While probiotic supplements may be beneficial in certain situations—especially when you know what specific strains you need for specific issues—you can also get them through fermented foods. Try sauerkraut, miso, tempeh, kimchi, kefir, and kombucha.
- I eat anti-inflammatory foods. The standard Western diet emphasizes ultra-processed convenience foods that are high in added sugar, salt, and saturated fat and low in fiber and other beneficial nutrients. It’s also known to promote systemic inflammation, an underlying factor in modern chronic diseases and autoimmune conditions. Instead, a minimally processed plant-based diet is full of vitamins, minerals, antioxidants, fiber, and healthy fats that support inflammation management.
4. Boosting My Antioxidant Intake
Antioxidants are compounds that help protect your cells from unstable molecules called free radicals. These cause oxidative stress, which promotes inflammation, damage, and disease within the body.
While we can’t avoid oxidative stress, we can help combat it through exercise, stress management, and optimal nutrition.
Good news! There are lots of places to find antioxidants in your diet, without having to go buy one of those antioxidant supplements. Plus, antioxidant-rich foods also provide an array of vitamins, minerals, and fiber that are important for your overall health.
Here are some great ways to boost your dietary antioxidant intake:
- Dark leafy greens, like spinach and Swiss chard
- Cruciferous vegetables, like broccoli, kale, red cabbage, cauliflower, and Brussels sprouts
- Berries, like strawberries, blueberries (especially wild blueberries), blackberries, and raspberries
- Dark chocolate, especially over 70% cacao
- Sweet potatoes
- Beets
- Nuts and seeds, like pecans, walnuts, cashews, chia and flax seeds
- Turmeric (great for stir-fries, breakfast scrambles, or making golden milk)
- Beans, like kidney beans, black beans, and chickpeas
- Green tea
I’ve made it a personal mission to eat at least a few foods from this list every day.
5. Paying Attention to Specific Nutrients
Is there a Graves’ disease diet? Not exactly—and if someone tries to sell you one, run.
However, nutrition is absolutely critical for any health concern you’re facing, and I will always advocate for a predominantly whole foods plant-based approach. (Read more in my post on why a plant-based diet is the answer to almost every modern health concern.)
In addition to optimizing the overall quality of my diet, there are certain nutrients that are important to pay attention to with Graves’ disease. Here’s why and where to get them in your diet pattern.
Vitamin D
Vitamin D plays a central role in immune system regulation. While not causative, low levels of vitamin D have been associated with autoimmune diseases, including Graves’ disease. Some studies have found that vitamin D deficiency is more likely among people with Graves’ compared to controls.
Adequate vitamin D levels can help modulate your immune response, potentially reducing the intensity of autoimmune attacks on the thyroid.
Although we can get some vitamin D from direct sunlight exposure (which should be done safely and doesn’t override the importance of sun protection), many people have vitamin D insufficiency. There are also very few foods that are natural sources of vitamin D, unless you consume vitamin D-fortified milk products, fish, and/or eggs.
However, before you add a vitamin D supplement, it’s important to get your blood levels checked. You can request this at your next wellness exam.
Knowing your blood levels of vitamin D will tell you whether your levels are adequate, if you could benefit from a maintenance supplement, or if there’s a deficiency to correct with a temporarily higher-dose supplement.
Iodine
Iodine is a key component of thyroid hormones, and the thyroid uses iodine to produce these hormones. However, in Graves’ disease, the thyroid is already overproducing hormones, and excess iodine can exacerbate hyperthyroidism by fueling overactivity.
Sometimes, people with Graves’ are advised to avoid extra iodine, the main sources of which are iodized salt, seaweed and sea vegetables, and sometimes supplements (even certain multivitamins may exceed the RDA for iodine).
Overall, there’s some limited evidence that adequate (but not excessive) iodine intake is associated with a lower Graves’ recurrence rate and a higher remission rate.
While iodine can be tricky, it plays an essential role in your thyroid health, so for most people it’s important not to totally eliminate it from your diet while also not going overboard with dietary or supplemental sources. This is where personalized support from a dietitian can be especially helpful.
Selenium
Selenium is a trace mineral that supports thyroid health and helps regulate your immune system. It’s a key component of enzymes that protect thyroid cells from oxidative stress caused by an overactive thyroid in Graves’ disease.
In some studies, selenium supplementation has been shown to reduce or prevent eye-related symptoms of Graves’. Selenium is also an antioxidant, which is helpful for managing inflammation and cellular health.
Rather than taking a selenium supplement, I prefer to get this mineral from Brazil nuts. Just one Brazil nut contains 160% of your recommended daily allowance of selenium, making it the best plant-based source.
To prevent overdosing, I don’t eat one every day, but I do try to eat a handful of them throughout the month. Dr. Michael Greger, from Nutritionfacts.org, recommends eating 4 Brazil nuts a month to get enough without exceeding limits—which could be done on 4 different days or all on one day per month, whatever’s easier to remember.
Calcium and Vitamin K2
Vitamin K2 and calcium play essential roles in preserving bone health, a common concern for people with Graves’ disease due to increased bone turnover caused by hyperthyroidism.
Calcium is a vital building block of your bones, but hyperthyroidism can lead to calcium loss, weakening bone density. Vitamin K2 complements calcium by directing it to bones and away from soft tissues, such as your arteries, preventing calcification that’s especially problematic for your cardiovascular health.
Together, these nutrients help reduce the risk of osteoporosis and fractures, which I am at a higher risk for as a woman in my late 30s.
I also get these nutrients in my diet. For example, calcium can be found in beans, almonds, fortified soy milk, calcium-set tofu, and leafy greens, whereas plant-based vitamin K2 is primarily found in fermented foods like tempeh, miso, and sauerkraut (vitamin K1 is a different form and is found in leafy greens).
I also choose to take a calcium, vitamin D, and vitamin K2 supplement all in one to support my bone health.
Iron
Iron is an essential mineral for overall health, particularly for oxygen transport and energy production.
Some research indicates that people with Graves’ are more likely to have low iron stores or be iron deficient. This could be due to several factors, especially if someone also has Celiac disease that can promote iron loss (which I do not).
An overactive thyroid can increase your body’s metabolic demands, potentially leading to iron deficiency or worsening pre-existing anemia. Low iron levels may further impact your thyroid function, as iron is necessary for making thyroid hormones.
A plant-based diet is generally lower in iron compared to an omnivorous diet, and vegetarians are more likely to have lower iron stores. Some research suggests that, because of this, the daily requirement for iron is 1.8 times higher for vegetarians. More research is needed, but the takeaway here is that it’s important to pay attention to where you’re getting your iron, and optimizing how much you get, if you’re powered by plants.
Plants contain non-heme iron, which is less bioavailable in the body (not absorbed as well) than the heme iron found in animal foods. Plus, plant foods contain other compounds that can further compete with and reduce iron absorption, like phytic acid, polyphenols, oxalate, and calcium.
Boost your iron intake on a plant-based diet by pairing iron-rich plant foods (like legumes, iron-fortified cereals, and dark leafy greens) with vitamin C sources, like citrus fruits, strawberries, and bell peppers.
Sometimes, an iron-containing supplement may be helpful, but this should be discussed with your healthcare provider first.
6. Managing High Stress Levels
We were never promised an easy life and therefore we will always be faced with stressors. Some stress is good for us when it’s acute and helps motivate us to get tasks done or to stay alert in a potentially dangerous situation.
When stress is ongoing, however, it takes a toll on our mental and physical health. Rather than always trying to avoid stress, it’s important to have stress management tools in place so we can practice healthy responses.
Chronic stress can disrupt the delicate balance of your immune system. It also triggers the release of the hormone cortisol, which can promote inflammation if it’s elevated for a long time.
When you’re stressed out, you’re less likely to sleep well, exercise, or make healthy eating choices, which can ultimately create a vicious cycle and worsen hyperthyroid symptoms.
Here are some of the ways I like to implement stress management in my life:
- Move my body regularly, whether it’s going for a walk or a workout class
- Deep breathing exercises, like box breathing (inhale for 4, hold for 4, exhale for 4, repeat)
- Listening to calming music or sleep meditations
- Stretching or doing yoga
- Spending time outside or in nature
- Snuggling with my dog
- Doing creative projects not related to work, such as painting or beading jewelry
- Reading scriptures and talking to God
- Talking to trusted friends
- Doing something silly with my kids
- Playing my guitar
- Doing some sort of light manual labor, like cleaning my house or organizing drawers and closets (hello, donation bin)
What About Soy?
When you start scouring for information about nutrition and thyroid health, you’re bound to come across articles about “goitrogens”—one of the main ones being soy (and some cruciferous and root veggies).
Goitrogens are naturally occurring compounds in certain foods that can interfere with thyroid function by inhibiting the uptake of iodine, which is essential for producing thyroid hormones.
Some headlines will probably urge you to avoid these foods if you have thyroid conditions, so what’s the deal?
For people with hypothyroidism (underactive thyroid) or iodine deficiency, excessive consumption of raw goitrogenic foods may contribute to thyroid dysfunction. However, for people with Graves’ disease, where your thyroid is on overdrive, normal consumption of goitrogens are less of a concern—especially when they’re cooked.
A 2022 review of 417 reports also concluded that “the evidence does not support classifying isoflavones as endocrine disruptors.” In other words, soy (a rich source of isoflavones called phytoestrogens—compounds that mimic estrogen in the body) is widely misunderstood and unlikely to be a problem for most people.
Soy in general is one of my favorite controversial foods and I personally eat organic tofu, frozen edamame, and fortified soymilk regularly. This is an article for another time, but the known health benefits of high-quality soy foods far outweigh any potential concern for me personally.
Bottom line? Most people with Graves’ don’t need to fear soy or other goitrogenic foods, but if you’re concerned, consult a dietitian.
Graves’ Disease Essentials: Nutrition and Lifestyle
Everyone’s journey with Graves’ disease is different. Countless people have experienced far worse symptoms than me and have required more invasive medical interventions to get their health on track before they can think about their lifestyle.
There’s definitely no shade being thrown at people who choose to approach their autoimmune disease management in a different way.
Still, lifestyle medicine is a critical element of prevention, management, and even reversal of modern disease— whether you’re suffering from something related to years of less-than-stellar health habits or have been handed something unexpected, like an autoimmune disease.
If you or someone you know has been diagnosed with Graves’ disease, I feel for you. I also encourage you to think about how you can put lifestyle modifications at the top of the list and find a provider who is willing to incorporate them into your treatment plan.
