DEAR MAYO CLINIC: I was recently diagnosed with hypothyroidism and have been getting conflicting information on what I should eat and drink. I love yogurt and ice cream, for instance, but one source said a calcium-rich diet was fine, whereas another said I should limit dairy. I’ve also read that I should avoid soy and iodine. But then a friend told me iodine is helpful. Can you give me some guidance on the best diet to manage my condition?

ANSWER: Hypothyroidism, or underactive thyroid, is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones. If you are diagnosed with hypothyroidism, you should take a thyroid hormone replacement as directed by your health care provider. Medication can be taken at any time that's best for you, and it is okay to take it on an empty stomach or with food, as long as you do the same thing every day.

Generally, there's no hypothyroidism diet. Although claims about hypothyroidism diets abound, there's no evidence that eating or avoiding certain foods will improve thyroid function in people with hypothyroidism.

It is true that iodine deficiency can cause hypothyroidism. But in developed countries, including the U.S., thyroid disease from iodine deficiency has been nearly eliminated by iodine additives in salt and food. While some alternative medicine practitioners recommend iodine tablets or kelp supplements, which are high in iodine, for people with hypothyroidism, eating a balanced diet makes taking supplemental iodine unnecessary. In fact, too much iodine can cause hyperthyroidism in some people.

Other supplements such as soy, taken in large amounts, may have an impact on thyroid hormone production but won't cause hypothyroidism in people who are not also iodine deficient.

Whether people who have hypothyroidism should avoid soy is a topic of debate. Soy has long been thought to interfere with the body’s ability to absorb synthetic thyroid hormone, which most people with hypothyroidism are prescribed. However, there's no evidence that people who have hypothyroidism should avoid soy completely.

Generally, it's best to wait four hours after taking thyroid medication to consume any products that contain soy. The same guidelines apply to other products that may impair the body's ability to absorb thyroid medication, including concentrated iron and calcium supplements, and antacids that contain calcium or aluminum hydroxide.

Calcium in and of itself is not harmful for patients with hypothyroidism to consume. It is calcium supplements or antacids containing calcium that can interfere with the absorption of thyroid hormone replacement medications, such as the synthetic thyroid hormones levothyroxine (Synthroid, Unithroid, others) and liothyronine (Cytomel), as well as thyroid extract supplements.

This interference happens chiefly if you take thyroid hormone replacement and calcium supplements at or near the same time. Other supplements, including those containing magnesium and iron, can have the same effect. In addition, proton pump inhibitors and some cholesterol-lowering drugs, such as those containing cholestyramine (Prevalite) and colestipol (Colestid), may affect absorption as well.   

To prevent potential interactions, use these products several hours before or after you take your thyroid medication.

Additionally, certain foods, such as walnuts or an excess of dietary fiber, also can impair the absorption of thyroid hormone replacement medication.

The best recommendation for effectively managing hypothyroidism is to take your medication as directed and avoid dietary extremes. If you have concerns, talk with your health care provider about taking a multivitamin with minerals. — Dr. Todd Nippoldt, Endocrinology, Mayo Clinic, Rochester, Minnesota

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Related Articles 

• Mayo Clinic Q and A: Mild hypothyroidism may not need treatment published 9/17/19
• Study finds similar cardiovascular outcomes for generic, brand-name drugs for hypothyroidism published 6/19/19

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Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org.

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Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org.

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Listen to the program on Saturday, July 23, at 9:05 a.m. CDT, and follow #MayoClinicRadio.

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ANSWER:
A mildly low level of testosterone alone, without any signs or symptoms, typically does not require treatment. But it would be a good idea for you to talk with your doctor in more detail about this test result. In some cases, low testosterone may be a sign of an underlying medical concern, or it could be a side effect from medication.

Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men’s bone density, fat distribution, muscle strength and mass, red blood cell production, sex drive and sperm production. The normal range for testosterone is wide, and men’s testosterone levels usually change throughout their lives.

For most men, testosterone peaks during adolescence and early adulthood. Then as men get older, testosterone levels gradually fall — typically about 1 percent a year after age 30. In a situation like yours, it is important to find out if low testosterone is a result of normal aging, or if it could be due to a medical problem.

A significant decline in testosterone levels can cause symptoms. Fatigue and low sexual interest are the most common. Some men also see changes in beard and body hair growth. Muscle wasting and a decrease in muscle strength can be a result of low testosterone, as well. Erectile dysfunction, or ED, can occur with testosterone deficiency. But, overall, low testosterone is not a common cause of ED.

Disorders that may lead to low testosterone include hypogonadism, rare conditions of the testicles or the pituitary gland in which the body does not make enough testosterone.  Other conditions that can affect testosterone levels are thyroid problems, obstructive sleep apnea, depression and excessive alcohol use.

Follow-up tests and exams usually can show if a medical condition may be contributing to low testosterone. Your doctor also should review any medications you are currently taking to see if one of them may be the source of the problem. If an underlying medical condition is identified, treatment for that disorder may be all you need to bring your testosterone level back into the normal range.

Testosterone replacement therapy may be recommended to treat hypogonadism. Apart from that, testosterone usually is not recommended for older men who are otherwise healthy, even if their testosterone levels are slightly below what is considered normal.

Taking prescription testosterone does have risks. It may stimulate noncancerous growth of the prostate, cause enlarged breasts, limit sperm production and accelerate growth of existing prostate cancer. In some men, testosterone therapy can worsen sleep apnea. Recent studies also suggest there may be a link between testosterone therapy and an increased risk of heart disease, but more research is needed to confirm this.

If after further evaluation your doctor recommends you take testosterone, it is important you set up a monitoring plan with regular blood tests to make sure the prescribed dose is correct. Too much testosterone can result in an increase in red blood cell production, a condition known as polycythemia. That can lead to other problems, including blood clotting and stroke.

In your case, because you are not experiencing any symptoms of disease, it is unlikely that testosterone therapy is necessary at this time. Talk with your doctor, though, to find out if additional follow-up testing or evaluations could be useful to better understand the cause of your low testosterone. — Todd Nippoldt, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.

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Join us Saturday, Feb. 22, at 9 a.m. CT, when we talk about men’s health.  We’ll discuss heart health with Stephen Kopecky, M.D., and prostate health with Matthew Tollefson, M.D., and we’ll talk with Thomas Osborn, M.D. about gout, a form of arthritis that affects an estimated 6 million Americans each year. Another important area regarding men’s health is testosterone. Endocrinologist Todd Nippoldt M.D., will be here to address testosterone deficiencies and testosterone therapy and respond to some of the media hype. We hope you’ll join us.

Myth or Matter of Fact: Higher testosterone levels cause baldness.

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Join us Saturday, Feb. 22, at 9 a.m. CT, when we talk about men’s health.  We’ll discuss heart health with Stephen Kopecky, M.D., and prostate health with Matthew Tollefson, M.D., and we’ll talk with Thomas Osborn, M.D. about gout, a form of arthritis that affects an estimated 6 million Americans each year. Another important area regarding men’s health is testosterone. Endocrinologist Todd Nippoldt M.D., will be here to address testosterone deficiencies and testosterone therapy and respond to some of the media hype. We hope you’ll join us.

Myth or Matter of Fact: Higher testosterone levels cause baldness.

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