When living with thyroid eye disease (TED), you might wonder if your diet can affect your symptoms. Also known as “Graves’ eye disease” and “Graves’ ophthalmopathy,” TED condition can raise many questions about lifestyle and nutrition.

Although diet may not be enough to treat TED on its own, there are some foods you can avoid that may help you feel better. Note that much of this research is tied to Graves’ disease, rather than directly to TED. Because TED is often caused by Graves’ disease, you may want to avoid these foods if you have both conditions. Keep in mind that most of these foods haven’t been specifically studied concerning TED.

It’s also important to note that most of the research on food and the thyroid doesn’t focus on thyroid glands that produce too much thyroid hormone (hyperthyroidism). This is what happens in Graves’ disease and what is behind TED. Instead, the majority of research done focuses on other thyroid disorders, specifically on thyroids that don’t produce enough thyroid hormone (hypothyroidism).

With those limitations in mind, here’s what you need to know about foods to avoid with TED.

1. Foods High in Iodine

The thyroid needs iodine to work properly. Although most people can eat too much iodine and not have it affect them, some people may be more prone to thyroid problems. When people with thyroid issues eat too many foods with iodine, their thyroid can make too much thyroid hormone. This overproduction can sometimes lead to Graves’ disease and TED.

If you've already been diagnosed with TED, avoiding foods with high amounts of iodine may help you feel better. Your health care provider may recommend a low-iodine diet if they believe it may improve your thyroid condition.

Foods to avoid if you want to consume less iodine include:

• Eggs
• Salt with added iodine (most are labeled “iodized”)
• Chicken
• Beef liver
• Fish
• Shellfish
• Seaweed, both raw and dried, including kelp
• Dairy products

If you need to follow this diet and aren’t sure where to start, your endocrinologist can refer you to a dietitian with experience working with people with thyroid diseases.

2. Soy

There is mixed evidence about the impact of soy on hypothyroidism. Some research has pointed to an impact, while other studies have found no reason to avoid soy. There is some concern that soy can affect the effectiveness of levothyroxine, a medication used to treat people with hypothyroidism. However, this issue can potentially be avoided by not eating soy around the same time that you take your medication.

It’s best to talk to your doctor about eating soy. Examples of soy products include:

• Soy milk
• Many meat alternatives
• Edamame
• Soy sauce
• Miso
• Tofu
• Tempeh
• Soybeans
• Soy nuts
• Textured soy protein

In addition, lecithin is an additive that is in many foods. It may be made of soy or other ingredients. You’ll need to read the label to see if it’s in any processed foods you eat.

3. Foods and Drinks With Caffeine

Whether or not you should consume caffeine if you have TED is a bit controversial. At least one study shows that drinking a moderate amount of coffee — about two cups — every day may reduce your risk of too much or too little thyroid hormone.

However, when researchers looked at the results of several studies on coffee and heart function, they found that drinking higher amounts of coffee — usually more than three cups a day — might lead to heart arrhythmias (irregular heart rhythms). More research is needed to fully understand and confirm these findings.

Graves’ disease can also increase your chance of heart arrhythmias. If you’ve already experienced arrhythmias or if you’re concerned about them, you may want to avoid caffeine or limit how much you drink every day. You can also talk to your doctor about the potential benefits and drawbacks of caffeine.

4. Ultra-Processed Foods

Processed foods are those that have been altered from their original state through various methods, such as cooking, freezing, canning, or adding ingredients, to enhance their taste, improve convenience, or extend shelf life. Eating too much of these foods can be a problem because they:

• Raise your risk of developing some types of cancer
• Cause you to eat too much fat, salt, and sugar
• Have a lot of calories in just a little food
• Digest quickly, so you get hungry faster and may eat more

There is at least one case report that avoiding processed foods can help improve Graves’ disease and TED. In this case study, an individual made several healthy lifestyle changes, including avoiding processed foods. They were able to put Graves’ disease into remission.

Because this case study only involved one person, there’s not enough evidence to say that avoiding processed foods will help everyone with Graves’ disease or TED. However, if you consider this small piece of evidence along with the overall health benefits, reducing these foods in your diet can be beneficial.

General Diet Tips for Living With TED and/or Graves’ Disease

There aren’t any foods that effectively treat either Graves’ disease or TED. However, eating a balanced diet is important because it gives your body the nutrients it needs to feel its best. You can follow these general tips for a healthy diet:

• Avoid excess sugar.
• Avoid processed foods.
• Eat plenty of protein, including from plant-based sources like beans
• Get at least five servings of vegetables and/or fruits every day.
• Choose unsaturated fats when you can, and only eat small amounts.
• Drink at least six to eight glasses of water every day.
• Choose starchy foods that are higher in fiber, like whole grains or brown rice
• Include some dairy or dairy alternatives

If you’re not sure where to start, a dietitian can help. They can evaluate your current diet and help you make small changes that will improve your nutrition and health.

Grave’s Disease, Thyroid Eye Disease, and Gut Health

The bacteria in your gut may also affect Graves’ disease and TED. These bacteria help break down some of the foods you eat. They also interact with many of your body’s systems and their functions. We’re still learning about this. We understand some aspects well, but there are others we know less about.

Having a lot of different bacteria in your gut is better for Graves’ disease and TED than having fewer. However, more research is necessary to help us figure out which bacteria are best and how to effectively get them to live in your gut.

There are claims online about how to improve your gut health, but much of it isn’t backed by research. Currently, doctors recommend the following evidence-based strategies to improve gut health:

• Eat less sugar and fewer processed foods.
• Include foods called prebiotics in your everyday diet, which help nourish beneficial bacteria.
• Cut back on red meat.
• Eat lots of vegetables.
• Consume more fermented foods, such as yogurt, kefir, and sauerkraut.

Talk to your health care team if you’re interested in learning more about gut health and TED.

Find Your Team

On TEDhealthteam, the social network for people living with thyroid eye disease and their loved ones, members ask questions, give advice, and share their stories with those who understand life with TED.

Do you avoid any foods because of thyroid eye disease? Share your experience in the comments below, or start a conversation by posting on your Activities page.