Thyroid Medications and Your Diet

Is Your Diet Undermining the Benefits of your Thyroid Medication?

I don’t eat yogurt for breakfast anymore. And I can’t have a smoothie with kale and whey protein either. And those awesome shakes for weight loss are out too. No lattes, no cocoa, not even a bowl of cereal with milk and bananas.
I have a thyroid disease. I take a medication to keep my disease under control. Over 12 years of managing the disease, I had to learn how diet effects the thyroid and the hormones used to treat thyroid disease. Whether synthetic or natural, these medications are effected by certain foods and supplements. Thyroid disease is one of the most common autoimmune disorders and is very treatable with the use thyroid hormone replacement therapies. The medications most commonly used are synthetics and are generally completely safe and highly effective. A small percentage of people need to use a natural replacement or add in a T-3 replacement as well.
One of the most important aspects for successfully using these medications is following rules to allow them to do the most good they can. And thyroid meds have rules like many other long-term therapies.
Synthetic thyroid medications are measured in micrograms. This means that the human body can be very sensitive to the amount of medicine in the tablets. Even tiny variations in the levels can have adverse effects for the patients. Following the rules means that the medication is at its most available to the body once it reaches the bloodstream. These medications are available over a longer period of time. If a dose is skipped, the patient is unlikely notice as long as the next dose is taken. If more than one dose is skipped, then symptoms of the disease will be noticed in about two days, and it can take several days for the patient to return to feeling more normal again. And with thyroid medications a patient can’t catch up by taking more of the tablets without the risk of severe adverse reactions. The good news is that if the rules are followed and medication is taken daily, this is a rare occurrence, and most people return to a very normal life.
I have a great doctor who took the time to explain some of the requirements to me and recommended I review the patient information and do some research on my own to get the most out of the medications. I started taking the drug in 2004 after surgery to remove my right thyroid gland, and by following the rules I have dropped my daily dosage from 88 mcg to 50 mcg per day. But it was not without several adjustments in my diet, learning about drug interactions, and becoming highly aware of how I feel on a day to day basis.
The first rule of taking thyroid medications is that they have to be taken on an empty stomach, and my doctor told me to take it as soon I got out of bed. This was really hard for me. I don’t like to drink water as soon as I get out of bed, I want a cup of coffee! But I had to make the change immediately. For the first year, I experienced a tiny bit of nausea every morning after taking the pill. I don’t know if I adapted to the nausea or it went away, but it was annoying to feel sick every morning. The medication was supposed to make me feel better, not worse! The next rule was that I was not allowed to eat for at least thirty minutes after taking the pill. To get even better results, the doctor recommended not eating anything for an hour. This was to allow the optimum absorption into the bloodstream. Considering that I already had lost my appetite, an hour was an easy achievement. By the time the hour was up, the nausea was gone, and my appetite had returned.
Then I was given more information about the interactions thyroid medications have with food and supplements. On the bottle of my synthetic thyroid hormone is a label in bright yellow that says, “DO NOT TAKE ANTIACIDS OR PRODUCTS CONTAINING CALCIUM OR IRON WITHIN 4 HOURS OF TAKING THIS MEDICATION.” I had to dig into this more deeply.

The thyroid produces a hormone called calcitonin which helps regulate calcium levels in the blood. After having thyroid surgery, doctors monitor the calcium levels and may recommend supplements. Although it is unclear why or how calcium affects the medication, doctors and drug manufacturers recommend taking the calcium supplements and thyroid meds between 6 and 12 hours apart. My solution has been to take my calcium supplement before going to bed. Because magnesium helps with absorption of calcium I take a chelated supplement that includes both minerals. And the positive of taking it at night is that magnesium has some muscle relaxing properties and can actually help with a better night’s sleep. But over the years, I have also found that eating foods high in calcium within four hours of taking the pill has some adverse effects as well. I have been trying to lose some weight and get healthier, and was following a high protein regimen that included dairy based smoothies. The premise was to keep protein levels higher to stave off hunger, regulate blood sugar, etc. But the smoothie recipe was very high in calcium, and included Greek style yogurt, whey powder, and kale. Within a week I had a complication commonly found in people with hypothyroidism called frozen shoulder. For some reason the muscles seize up and spasm, and make motion difficult and painful. A little research and I discovered that I was consuming over 380 milligrams within two hours of taking the thyroid hormone. A standard single calcium tablet is 500 milligrams. This was creating what could have been a serious situation, had my body not reacted in the way that it had. This was a valuable lesson about the side effects of calcium and thyroid hormones. And after locating the drug inserts online for both synthetic and natural thyroid hormone replacement I discovered even more potential problems with foods and the drugs. For some of my friends who are taking the natural hormones there is no difference in the interactions. But the foods were very surprising! They include*
 Calcium supplements
 Dairy products
 Iron supplements
 Multivitamins containing iron
 Cottonseed meal
 Some cholesterol-lowering drugs that contain cholestyramine (Questran) and colestipol (Colestid)
 Soybean flour
 Walnuts
 Antacids
 Estrogens and Oral Contraceptives
 Medications used to treat diabetes
 Anti-coagulants
My research has extended into other drug interactions for people taking medications that treat many different diseases. Many drugs used to treat depression can have adverse reactions with grapefruit juice, diabetes drugs and gingko biloba, and more!
Before jumping on to a new diet or grabbing a prepackaged diet shake, or an herbal supplement, be sure to read and understand the label. Although most companies making supplements are ethical and honest, there are some, who may have little understanding of the dangers presented by using herbs and various foods in their products. This is truly a ”buyer beware” situation, especially for those of us with long-standing autoimmune or other health issues. We are ultimately the best at knowing what our bodies can manage and process.

Resources for more information:

The Mayo Clinic

Endocrine Web

NIH Medline Plus