Once you have graves disease do you always have it

If you have Graves’ disease — an autoimmune condition that causes hyperthyroidism, or overactive thyroid — you may already be taking medication for it. Unlike some other conditions, Graves’ disease can’t be reversed with dietary changes alone. It has to be treated with conventional medication.

“Medical intervention is always the first step with Graves’,” says Susan Spratt, MD, an endocrinologist with Duke University in Durham, North Carolina.

Once you’re being treated, though — and after your doctor has given you the green light — you can consider making nutritional changes to your diet. Some nutrients, such as calcium and vitamin D, are important for people who have Graves’ disease, whereas others, including iodine, could be potentially harmful, explains Kelly Kennedy, a registered dietitian with Everyday Health. This is also why Dr. Spratt always recommends medicine first and then dietary and lifestyle changes as a complementary treatment.

Here’s what to eat and what to avoid if you have Graves’ disease. (Just remember to always talk to your doctor before making any changes to your diet.)

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Limit or avoid: Too much iodized salt

In the United States, salt manufacturers routinely add iodine, a trace mineral, to table salt to combat iodine deficiency. For people with Graves’ disease, though, too much iodine isn’t always a good thing.

Iodine can cause your body to produce more TSH (thyroid-stimulating hormone), which tells the thyroid to make more thyroid hormone. This, explains Spratt, “is not what you want with hyperthyroidism.” (Left untreated, an overactive thyroid can cause heart, bone, and muscle problems, according to the National Institute of Diabetes and Digestive and Kidney Diseases.)

The recommended iodine intake is 150 micrograms, according to the National Institutes of Health Office of Dietary Supplements (ODS), but people with hyperthyroidism may need to consume less than that. Talk to your doctor about how much iodine you should be getting each day.

To find out if your salt contains iodine, look at the nutrition label, which would say “iodized” or “provides iodine.” Some specialty salts, including sea salt and kosher salt, usually don’t contain iodine.

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Eat: Leafy green vegetables

An overactive thyroid can speed up bone turnover — the natural process of breaking down and rebuilding bones. This, in turn, can increase the body’s need for calcium. Not getting enough calcium, in the long run, can contribute to brittle bones and osteoporosis.

To avoid these complications, try to consume calcium-rich leafy green vegetables, such as spinach, broccoli, and kale. Think salads over supplements. “I’m a big proponent of getting your vitamins and minerals from your plate and whole foods,” says Spratt.

Dairy products, such as milk, are sources of calcium, but they also contain iodine, according to the ODS.

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Limit or avoid: Seaweed

Seaweed, such as kelp, nori, kombu, and wakame, can be particularly high in iodine. One 10-gram serving of dried nori contains 232 micrograms of iodine per serving — about 155 percent of the daily recommended value, according to the ODS.

Because calcium is so important when you have hyperthyroidism, it’s recommended that you also consume vitamin D, which improves calcium absorption, explains Kennedy. One food that’s particularly high in vitamin D is salmon: One 3-ounce serving contains about 570 IU (international units).

Not sure if you’re getting enough vitamin D? Your doctor can check your levels with a blood test. “While there are many foods high in vitamin D, it’s rare you can get enough of it from foods alone,” says Kennedy, who notes that some people may want to take a water soluble supplement of 1,000 international units (IU). (Talk to your doctor before taking any supplements.)

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Eat: Brazil nuts and sunflower seeds

Selenium plays a role in making thyroid hormones and regulating thyroid function. Though rare, people with Graves’ disease can also develop thyroid eye disease (TED), which causes progressive inflammation of the eye and can result in blindness. According to the American Thyroid Association, research has shown that a selenium deficiency may be linked to an increased risk for TED in people with Graves’ disease; supplementing your diet with selenium may help treat it.

Foods that are rich in selenium include Brazil nuts and sunflower seeds.

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Limit or avoid: Gluten

A study published in March 2019 in the journal Autoimmunity Reviews found that Graves’ disease can also be associated with celiac disease, another type of autoimmune disorder in which people can’t eat the gluten (a protein) found in wheat, barley, and rye. (In people with celiac, eating gluten triggers a reaction that damages the lining of the small intestine.)

If you’ve been diagnosed with celiac disease, Kennedy recommends eliminating gluten from your diet so as not to exacerbate hyperthyroid symptoms or affect hormone levels. “But if you have not tested positive, there’s no reason to eliminate gluten from your diet,” she says.

If you’re managing an autoimmune disease such as hyperthyroidism, consider eating a diet that’s rich in antioxidants, which are substances found in fruits and vegetables that can help stave off cell damage.

“Antioxidants are great, because they reduce oxidative stress and inflammation in the body, which can help autoimmune diseases,” explains Kennedy. Plus, she adds, these “foods generally just make you feel better and make your body function better.”

One food group that’s particularly high in antioxidants? Berries, including raspberries, blackberries, and blueberries.

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Limit or avoid: Caffeinated beverages

Some of the symptoms associated with Graves’ disease include anxiety, nervousness, rapid heart rate, and weight loss, all of which can be made worse by too much caffeine.

Energy drinks are one of the biggest sources of caffeine. “I always recommend avoiding energy drinks no matter what, because they’re highly processed, high in sugar and artificial ingredients, and, obviously, high in caffeine,” says Kennedy.

Kennedy also suggests limiting coffee and tea. “Even though tea is lower in caffeine than coffee, it can add up,” she says.

Research shows that hyperthyroidism has been linked to low levels of iron in the body, says Kennedy. One study, published in August 2017 in the journal Clinical Endocrinology noted that Graves’ disease can cause a decrease in iron levels. If you suspect that you’re deficient in iron, ask your physician to order routine blood work to check your levels, she says.

If you’re running low, consider increasing your intake of iron-rich foods. But before you go reaching for a steak, consider this: People who eat a vegan, lacto-ovo vegetarian, and pescetarian diet are less likely to have hyperthyroidism than people who eat meat, according to a study published in June 2015 in the journal Public Health Nutrition. One plant food that’s rich in iron? Legumes. A half-cup serving contains 3 milligrams of iron, or about 17 percent of your recommended daily intake, according to the ODS.

“The more iron you can get from vegetables and non-meat products, the better, as some research suggests decreasing your meat and poultry intake can improve hyperthyroid symptoms,” says Kennedy.

To maximize your body’s ability to absorb iron, pair iron-dense food with foods high in vitamin C.