Thyroid diet plan: what to eat, and when to have your morning chai.

Is there a special diet for an underactive thyroid?

No. The British Thyroid Foundation (BTF) says no specific foods or supplements treat a thyroid disorder, and a balanced diet is the best way to get the nutrients you need. So the thyroid diet chart on the family WhatsApp group, with no rice, no gobhi and a special qehwa, isn't backed by evidence.

An underactive thyroid (hypothyroidism) means the thyroid gland in your neck doesn't make enough hormones. The NHS lists tiredness, feeling cold, weight gain, constipation and low mood among the common symptoms. In the UK, the main cause is Hashimoto's disease, an autoimmune condition that's most common in women and usually starts between 30 and 50.

The treatment is a tablet, not a food. Levothyroxine replaces the missing hormone, most people take it for life, and regular blood tests check the dose. Good food supports your health and weight alongside it but can't replace it, so don't stop or change your tablets without your doctor.

When should you take thyroid medicine around breakfast and chai?

First thing in the morning. The NHS says to take levothyroxine on an empty stomach with a glass of water, 30 to 60 minutes before your first meal of the day, any drink with caffeine such as tea or coffee, or any other medicine, and at the same time each day.

The NHS also lists medicines and supplements that don't mix well with levothyroxine, including calcium and iron supplements, antacids and acid-reducing medicines such as omeprazole. That matters if you take iron tablets for anaemia or an antacid after a heavy dawat. The BTF advises keeping supplements at least four hours apart from levothyroxine, so ask your doctor or pharmacist how to time yours. Before Ramadan, ask your doctor how to time your tablet around sehri and iftar.

What should you eat with an underactive thyroid?

Ordinary, balanced Pakistani food. The BTF points to the NHS Eatwell Guide, which fits a Pakistani kitchen well:

• At least five portions of fruit and vegetables a day: sabzi, salad and fruit such as guava or apple.
• Meals based on higher-fibre starchy foods: roti made with chakki atta (stone-ground whole wheat flour), sensible portions of rice, daliya or oats.
• Some dairy, such as dahi, raita and milk in your chai.
• Protein from daal, chana, lobia, eggs, fish, chicken and meat.
• Small amounts of unsaturated oil: a measured spoon in the handi rather than a generous pour of ghee.
• Less sugar and fewer processed foods, such as packaged biscuits, nimco and cold drinks.

If constipation is a symptom, the NHS suggests plenty of fluids and adding fibre gradually. Daal, chana, sabzi, fruit and oats all add fibre, and so does the chokar (bran) you'd otherwise sift out of your atta.

Here's an example day. It shows the pattern, not a prescription: your portions depend on your size, activity and health.

Are cabbage, gobhi, soya or coffee bad for your thyroid?

Mostly no. Soya is the one to keep well away from your tablet.

The worry about gobhi is that the cabbage family may contribute to a goitre (a swollen thyroid) in some cases. But the BTF says intake would need to be very high before this is a real concern, so aloo gobhi or sarson ka saag with makki ki roti is fine.

The BTF also says some calcium-rich foods and supplements interfere with levothyroxine absorption, so keep milk and dahi for mealtimes and mention any calcium tablets to your doctor.

Should you use iodised salt if you have a thyroid problem?

Yes. Use iodised salt for the whole family, but less of it, and don't add extra iodine on top. Your thyroid needs a small, steady amount of iodine to make its hormones, and too little can eventually cause an underactive thyroid.

The World Health Organization says all salt that's eaten should be iodised, and adults should have less than 5 g of salt a day, just under a teaspoon. WHO calls salt iodisation and cutting salt compatible, so keep iodised salt and cut back on achar, papad, nimco and salty restaurant food.

Check the pack for the word 'iodised'. Plain pink Himalayan salt (lahori namak), rock salt and sea salt aren't sources of iodine, says the BTF. In the UK, ordinary salt isn't iodised either, and milk and dairy foods are the main sources, along with white fish.

More isn't better. The BTF says there's no need for iodine supplements if you take levothyroxine, and doctors strongly advise against kelp, sea moss and iodine drops, which carry far more iodine than you need. You don't need to avoid iodine either, unless your doctor asks you to follow a low-iodine diet, usually only before radioiodine treatment for thyroid cancer.

Does an underactive thyroid cause weight gain?

Yes, but usually less than people think. An American Thyroid Association article published by the BTF says most of the extra weight is salt and water, and in general about 5 to 10 lb (roughly 2 to 4.5 kg) may be due to the thyroid, depending on how severe it is.

Treatment may bring a small weight loss, but it's fairly common to see none. Once your levels are back in the normal range, gaining or losing weight works as it does for anyone else. If weight gain is your only symptom, the thyroid is less likely to be the whole story. And pushing the thyroid dose higher is unlikely to change weight much and may cause other problems, so never take extra tablets to lose weight.

So lose weight the way anyone would: smaller roti and rice portions, protein and sabzi at every meal, less sugar in your chai and a measured spoon of oil. Our Pakistani diet plan for weight loss has a 7-day menu, and our guide to healthy BMI for South Asians explains why the healthy range sits lower for Pakistanis. If you also have irregular periods, read our PCOS diet plan and ask your doctor to check for both.

What should you eat with an overactive thyroid?

An overactive thyroid (hyperthyroidism) needs a doctor's care first. The thyroid makes too much hormone, which can cause weight loss, a fast or irregular heartbeat, anxiety, trembling, poor sleep and sensitivity to heat. The NHS says it's about 10 times more common in women than men, and treatment (medicine, radioiodine or surgery) is usually planned with an endocrinologist, a hormone specialist.

Food plays a supporting role. Skip iodine supplements and kelp: the BTF says extra iodine is unnecessary with an overactive thyroid and can make it worse. Eat regular, balanced meals, and don't force extra food to win back lost weight, because on average it returns once the thyroid is treated. Before radioiodine treatment, follow your hospital's food instructions.

When should you see a doctor or a nutrition professional about your thyroid?

See a doctor if you have symptoms such as constant tiredness, feeling cold, weight gain, constipation or low mood. They have many possible causes, and blood tests for TSH and T4 show if your thyroid is involved. Once you're on treatment, keep up your regular blood tests and tell your doctor about every supplement you take: the NHS notes that biotin, often taken for hair and nails, can affect thyroid test results.

If you're pregnant or planning a pregnancy, tell your doctor straight away, because you'll need extra tests. Our pregnancy diet plan covers what to eat.

NutriZaika is a virtual nutrition clinic, and its 28-day plans take thyroid conditions into account and are reviewed by Nida Tu Sehar, Senior Nutrition Consultant and Clinical Lead. See our plans and prices. Signature adds a Lab Insight Review of results such as thyroid, haemoglobin and vitamin D. You can read about our thyroid and cardiometabolic care or, if you'd like a plan built around your own kitchen, choose your plan.