Is the Ketogenic Diet Safe if you have Thyroid Problems?

Is the Ketogenic Diet Safe if you have Thyroid Problems?

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Thinking about the keto diet with a thyroid problem? 

You may want to think twice. 

While there are some benefits to using the ketogenic diet for weight loss, it may come with some unwanted baggage for your thyroid. 

In this article, we will explore why the ketogenic diet may potentially be harmful to your thyroid, when it makes sense to try the ketogenic diet, and how to determine if it’s right for you. 

Today you will learn:

  • Why the ketogenic diet may help with weight loss but why it may not be safe for your thyroid. 
  • How going keto may negatively impact your thyroid.
  • Why weight loss is beneficial for your thyroid and how it impacts insulin and leptin levels.
  • Why the ketogenic diet may suppress free thyroid hormone levels and what that means for your labs and thyroid medication dose.
  • Why you need to check your thyroid lab tests before using this diet. 
  • And much more…

The Ketogenic Diet and your Thyroid

I’m not going to spend time explaining exactly how the keto diet works (there are plenty of places where you can read about that right now), instead I want to focus on its impact on thyroid function and whether or not it is safe for thyroid patients. 

As many of you probably know, I’m not a huge fan of the ketogenic diet. 

And I’m not just saying that without experience. 

I have personally used the ketogenic diet and have recommended it to many patients. 

I even have some weight loss case studies on my website outlining patients who have used it successfully. 

Despite using it with some success, it became apparent to me (back in 2013-2-14) that this diet is certainly not for everyone. 

While it potentially can be used as a great tool for certain people, I don’t think it should be universally recommended, especially for thyroid patients. 

Because this diet has hit the mainstream, it’s now common for all kinds of people to jump into this diet head first. 

This is both good and bad. 

Good in the sense that many people are losing weight, and bad in the sense that there will be a large number of people with newly diagnosed thyroid issues for the foreseeable future

When I talk about the keto diet and its impact on thyroid function, I want to talk about 2 separate groups of people. 

The first group is those who do NOT have any thyroid issues but who develop thyroid problems or thyroid lab abnormalities as a result of going on the diet. 

The second are those people who have existing thyroid disease (Hashimoto’s, those without a thyroid, those taking thyroid medication, etc.) who are considering going on the diet to see if it will help with weight loss. 

For the purposes of this article, I want to focus on the second group. 

And my recommendation to these people is to proceed with caution

Let’s talk about why.


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My Experience with the Ketogenic Diet

I attribute much of my own personal healing to changing up my diet which included being in ketosis for several months back in 2012. 

While changing my diet certainly helped improve many aspects of my health, it was certainly not perfect and I ultimately had to alter the type of diet that I was using several times in order to feel completely better. 

But because I noticed that it was so effective, I began to recommend it to certain patients. 

Because most of my patients had thyroid disease, I was able to see how they responded to this diet. 

What I found was a mixed bag. 

Some people responded very well, lost weight, had increased energy, and experienced the type of outcome that most of you are looking for. 

But a much larger percentage of people had either no reaction or a negative reaction. 

My weight loss therapies and recommendations would be considered somewhat aggressive, so when a patient’s weight is staying the same it’s never a good sign. 

I even tested the diet on my wife (I test most therapies on my family members) and she ultimately gained around 13 pounds. 

As you can imagine, she wasn’t very happy about this.

Relevant to this discussion is that at the time she went keto she suffered from high reverse T3 and thyroid resistance

You’ll find out why this is important and why understanding your thyroid function before you go keto is a good idea. 

These experiences taught me a few important things:

#1. That each person with thyroid disease requires a different and unique diet. 

#2. That it’s difficult (impossible) to make broad diet recommendations for all thyroid patients. 

And #3. Even though some diets can be helpful for many, they also have the potential to cause harm for others.

The Potential Benefits For Your Thyroid

Is the ketogenic diet all bad?

The answer is no. 

In fact, it can be a great asset and tool for many people (including some with thyroid disease). 

My goal here is not to scare you away from this diet altogether, but it is to teach you to have a healthy respect for therapies and how they may potentially impact your thyroid in a negative way. 

We’ll talk more about the negatives below, but for now, let’s focus on the positives and how the ketogenic diet may help improve your thyroid. 

#1. Keto can be great for weight loss

Believe it or not, losing weight (the right way) can actually help your thyroid to function more optimally. 

Several studies have shown that weight loss is usually associated with a decline in free T3, total T3, and an increase in reverse T3 (1). 

You might look at this and think, “why would I want to LOWER my thyroid if I’m already hypothyroid?! Wouldn’t that make me feel worse?”. 

You would think so but that isn’t the whole picture. 

What is the “standard” advice given to thyroid patients that want to lose weight?

The advice you will be given by your doctor or nutritionist is to eat less and exercise more. 

In other words, calorie restriction. 

What does this mean?

It means that the studies which show how weight loss impacts thyroid function occur as a result of weight loss from calorie-restricted diets. 

If you want to lose weight long-term, then this is absolutely NOT the way to do it because these types of diets WILL damage your metabolism and your thyroid. 

But what about the ketogenic diet? Is there something different in how keto helps you lose weight compared to calorie-restricted diets?

The answer is yes. 

If the keto diet is done correctly, and if it is not associated with significant or sustained calorie restriction, then it can help with weight loss which may then improve your thyroid. 

In this setting, it doesn’t necessarily have to be associated with a decline in free T3, total T3, or an increase in reverse T3. 

In fact, weight loss can actually promote normal thyroid function (2) as hormones such as leptin and insulin decrease. 

By virtue of carbohydrate reduction, keto tends to have a profound impact on insulin sensitivity. 

#2. Keto may help improve leptin sensitivity and leptin resistance

The second way that the ketogenic diet may positively impact your thyroid is through its influence on the hormone leptin. 

Leptin is one of the most important hormones that your body uses to help regulate your weight and your metabolism. 

As you gain weight and are unable to lose it, leptin levels will increase and you may develop what is known as leptin resistance. 

The more weight that you have on your body and the longer that it’s been there, the more likely you are to be leptin resistant. 

And leptin resistance negatively impacts thyroid function through the hypothalamus by reducing your metabolism and by reducing free T3 and free T4 levels (3). 

Any therapy which helps your body become more sensitive to leptin will help you lose weight and help improve your thyroid indirectly. 

And because the ketogenic diet can help with weight loss it may also help sensitize your brain to leptin. 

Some studies show that the ketogenic diet may actually increase leptin levels (4). 

This may seem confusing based on what we’ve discussed so allow me to explain. 

When you have mild leptin resistance (or just a few pounds to lose) an increase in leptin can paradoxically help you lose weight. 

It’s not until you have moderate to severe leptin resistance (or 50+ pounds to lose) that increasing leptin for weight loss becomes a problem. 

This is why you will see bodybuilders often talk about ways to increase leptin. 

Increasing leptin is beneficial for fat loss when you are close to your target weight. 

But the farther you get from that target weight the more you want to focus on lowering leptin (not increasing it). 

The Potential Harm To Your Thyroid

While there are certainly benefits to going keto, we have to talk about the downsides as well.

Based on my experience and reading of the research, I tend to think of this diet as potentially causing more harm than good for most thyroid patients. 

Note that I did not say ALL thyroid patients, though!

There are still some patients (perhaps you reading this) that can benefit from it. 

The reason I feel this way is that managing and balancing your thyroid is already so tenuous and difficult, to begin with. 

If you have hypothyroidism then you already know how difficult it can be to get your doctor on board with newer treatments, the use of supplements, and thyroid medications that contain T3. 

So why would you want to risk further damaging your thyroid with the keto diet when the consequence may be very difficult to deal with?

I’m not saying that it’s impossible to repair your thyroid after you damage it, but it certainly takes a long time and you better be sure that whatever therapy you are doing is worth this potential risk. 

For what it’s worth, I find that most of the time damage done to the thyroid from diets or therapies can be fixed with the right treatments or right thyroid medication. 

So the risk of long-term harm is usually minimal. 

And most people can simply stop the offending therapy (in this case diet), to normalize their thyroid function again. 

With this in mind, let’s talk about some documented ways that the keto diet can impair your thyroid. 

#1. Going keto may suppress your thyroid hormones

The first reason you want to be careful with the ketogenic diet is that it has been shown to suppress free thyroid hormone levels (5). 

This research, while done in children, mimics what I’ve seen in the real world.

There are some thyroid patients who feel well while using the keto diet but upon testing their thyroid, notice that their thyroid function declined from their baseline. 

These patients often see a decline in free T3 and total T3 and a slight rise in their TSH.  

This is a classic presentation of hypothyroidism and probably represents early damage to the hypothalamic-pituitary-thyroid axis prompted by the effects of the keto diet. 

If you start to see this sort of change in your thyroid lab tests while you are using the ketogenic diet then it is probably a good idea to stop as soon as possible. 

But, as I said previously, just because it happens to some people doesn’t mean it will happen to everyone. 

For whatever reason, there are certain thyroid patients who are at increased risk of thyroid damage when doing the ketogenic diet. 

We don’t know exactly why this happens but the following factors are likely playing a role:

  • The type and quality of fat you are consuming to get into ketosis
  • Whether or not you are restricting your calories and to what degree
  • The duration of time you’ve been on the ketogenic diet
  • Your thyroid status prior to going keto (was it optimized before starting or were you underdosed or mismanaged?)
  • Whether or not you were over-exercising, over-stressed, or over-worked while in ketosis
  • A strong family history of thyroid disease (your genetic history)

If you are eating unhealthy fats, if you are restricting your calories, if you’ve been in ketosis for a long time (6+ months), if you weren’t adequately treated with thyroid medication before you started, if you are also over-stressed/over-worked, and if you have a strong family history of thyroid disease, then you are probably more likely to experience a decline in thyroid function with this type of diet. 

This isn’t a perfect way to assess your risk of a negative outcome but it is a good way to assess whether or not you should even consider the diet in the first place. 

It stands to reason that the more risk factors you have the more likely you are to see thyroid problems when going keto. 

#2. Going keto may result in the inability of your thyroid to respond to thyroid medications

Another complicating factor when considering keto is the use of thyroid medication

Thyroid medications, such as levothyroxine, are frequently used to help boost thyroid hormone levels in cases of hypothyroidism or low thyroid function. 

These medications are so common that they are frequently at the top of the list of most prescribed medications in the United States. 

While thyroid medications can help you feel better and improve your symptoms, they come at the cost of your body’s ability to produce its own thyroid hormone. 

In other words, thyroid medication shuts down your thyroid gland in a dose-dependent manner. 

This may become an issue when you use the ketogenic diet because it can influence how much thyroid hormone your body needs. 

Because your gland is being suppressed by the medication you are taking, you aren’t able to fully respond to these new demands. 

This means you MUST address your thyroid medication (either up or down) based on these changes. 

For most thyroid patients, this may not be a big deal. 

But if you are someone that is struggling to get your doctor on board with new therapies or new diets (such as the keto diet), changes to your thyroid function can be used as ammunition to try to get you to stop. 

And, yes, this does happen. 

I’ve seen many thyroid patients undergo therapies that make them symptomatically feel better only to have their doctor recommend they stop because their doctor isn’t familiar with them. 

So, if you find that the ketogenic diet puts increased demand on your thyroid gland, you may need to alter your dose of thyroid medication to compensate. 

On the other hand, it’s also possible that the ketogenic diet may improve your thyroid function which may necessitate a reduction in your thyroid medication dose. 

#3. Going keto may cause other hormone imbalances in thyroid patients

Lastly, it’s also possible that using the ketogenic diet may negatively impact other hormones in your body which may have an indirect impact on your thyroid. 

The hormones that I am referring to here include progesterone, cortisol, and estrogen. 

All three of these hormones can be positively (or negatively) impacted by the ketogenic diet. 

Of the three listed, cortisol may be the most important. 

Cortisol is considered a stress hormone and is released during times of stress. 

From the perspective of your body, pretty much any change counts as stress. 

Changing your diet, even if it’s causing positive changes overall, is still considered a stressor on the body. 

And if this stress tips the balance towards the negative side of the spectrum, then it may cause further issues to your overall health and your thyroid. 

It is well known that there is a connection between cortisol levels and your TSH (6) such that problems in one will drag down the other. 

Again, this isn’t going to necessarily be a problem for everyone that tries the ketogenic diet, but it’s something worth considering. 

Should You Go Keto?

Your decision to use the ketogenic diet should be between you and your doctor (if you have one willing to work with you) and it should not be dependent upon the results that you see from other people. 


Each person is genetically unique which means that how you respond to any given therapy is different from the next person. 

My own personal experience suggests that the ketogenic diet is probably not ideal for the majority of thyroid patients, but somewhere between 20-25% may experience some benefit while using it. 

Determining if you fit into that 25% can be done through careful testing and monitoring of your symptoms. 

If you decide to use the ketogenic diet then you should be very cautious and closely monitor your thyroid lab tests on a regular schedule. 

Checking your TSH, free T3, free T4, reverse T3, and total T3 can and should be done 8 weeks after starting the diet and at least quarterly thereafter. 

If you find that your TSH rises, your free T3/free T4/total T3 lower, or your reverse T3 rises, then these may be early signs that your thyroid is NOT tolerating the diet. 

Before you go keto, make sure to grab a baseline set of thyroid lab tests that you can compare future results to. 

Be aware that making changes to your thyroid medication during this period of time may invalidate the accuracy of your thyroid lab tests.

In addition to checking your thyroid lab tests, if you go keto you will also want to pay close attention to how you are feeling. 

If you see an abrupt increase in your thyroid symptoms then that may be an early warning sign your thyroid is not tolerating the diet. 

It’s probably also not a good idea to stay on the keto diet long-term, even if it is working for you. 

It’s important to understand that there are no long-term studies that prove that this diet is safe or effective (7) for your overall health if done for years in a row. 

In fact, many of the proponents of the ketogenic diet (those who taught me about this diet) only use it temporarily on themselves!

Going in and out of ketosis may be superior rather than staying in ketosis without any breaks. 

It may also be better to use the ketogenic diet temporarily to help with something like weight loss and then transition to other diets which are considered safer for your thyroid. 

This can actually be done safely because the entire goal of using the ketogenic diet is to reset insulin/leptin levels and help with weight loss (at least that’s why most people use it). 

Ketogenic Diet After Thyroidectomy

Does this information apply to you if you don’t have a thyroid or if your thyroid has been destroyed with radioactive iodine?

The short answer is yes. 

All of this information is still relevant to you but you should also proceed with slightly more caution than those with a functioning thyroid. 


Because, unlike them, you are 100% reliant upon thyroid medication to support the needs of thyroid function in your body. 

And people without a thyroid are generally undertreated as evidenced by the fact that most people gain weight after their thyroidectomy and suffer from the symptoms of hypothyroidism

I say proceed with caution because if you elect to use the keto diet then you must be prepared to make changes to your thyroid medication dose. 

Again, it’s not really a reason to avoid it 100%, but you will probably need to have your doctor on board with you to help regularly check and adjust your thyroid medication as needed. 

The Low T3 Longevity Argument

Lastly, I want to spend some time on the low t3 longevity argument. 

It’s been suggested that the ketogenic diet is safe to use even if it does lower your T3 levels (or thyroid function) because some studies have shown that people who have lower thyroid function tend to live longer (8). 

While it may be true that a few studies have shown this, it doesn’t in any way prove that low thyroid function leads to a long life. 

In fact, even if it did lead to a long life, we have a number of studies that show that low thyroid function (especially low T3) is also associated with weight gain, fatigue, depression, and many other negative symptoms. 

So even if having low T3 did lead to a longer lifespan, the life that you would be living would not necessarily be of high quality. 

One potential explanation for low T3 and longevity may have to do with thyroid sensitivity. 

It may be that certain people have genes that improve thyroid sensitivity at the cellular level which means they need less thyroid hormone than the average person. 

In other words, their labs look like they have less T3 when in reality their cells are functioning as if the level was higher. 

That or any number of other explanations could potentially explain why we see that low thyroid hormone in the serum may be associated with increased longevity. 

If you are a thyroid patient already, then you can always reduce your dose of thyroid hormone temporarily to experience how you might feel with low thyroid hormone (although this wouldn’t be recommended for obvious reasons!). 

If you’ve ever done that before please reply back here with your experience! I’m sure it wasn’t a positive one. 

The bottom line?

Don’t necessarily jump in on the ketogenic diet just because you feel that it will improve your lifespan. 

Final Thoughts

The ketogenic diet isn’t all benefits without any consequences. 

If you are thinking about using this diet AND you have thyroid disease then please be cautious. 

It’s possible, and probable, that undergoing this diet may negatively impact your thyroid in a number of ways. 

If, however, you’ve tried every other therapy and no matter what you do you can’t seem to find any relief, then a trial of this diet may be in order. 

If you elect to go down this path then make sure that your doctor is on board and willing to test your thyroid lab tests regularly and adjust your medication as necessary. 

Don’t just jump into the hype of the ketogenic diet, however, because you don’t want to put yourself in a situation that ultimately makes your thyroid function worse. 

Now I want to hear from you:

Have you tried the ketogenic diet?

Did it work for you? 

Did it help with weight loss?

Did you notice any damage or changes to your thyroid?

Why or why not?

Leave your questions or comments below! 









why keto should be avoided if you have a thyroid problem

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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64 thoughts on “Is the Ketogenic Diet Safe if you have Thyroid Problems?”

  1. Thank you Dr Childs for this great article bringing awareness. The keto diet, while it has its merit isn’t for everyone. I am a 37 year old female, generally healthy, in good shape, no known thyroid issues (TSH 0.987) who went on the keto diet for about 2 months in Jul 2018 to drop the “last 5 pounds from summer vacation”. I was in deep ketosis, taking in maybe 5-10 net carbs per day. Fast forward to October, lost the weight and then some, but my hair started falling out by the handfuls, extreme fatigue and body pain set in. There were days I would lay in bed and cry because of the debilitating fatigue. Finally did a thyroid & hormone panel and found TSH at 4.4, and very high TPO antibodies. Progesterone and Estrogen also completely out of whack – both too low. Was diagnosed with Hashimoto’s (no family history of it) Thyroiditis and put on Armour Thyroid and finally feel like myself again after 6 months of living hell. I am now back to a normal, balanced diet and have maintained my weight just fine. I am not saying this will happen to everyone, but it happened to me and the ONLY change in my life was going on Keto before my thyroid gave up. If you are reading this, please be measured in your approach to Keto as with any other diet…sometimes the last 5 lbs just isn’t worth losing 6 months or more of your life. I was lucky in that I found a great functional doctor who diagnosed and treated me quickly.

    • You’re welcome and thanks for sharing your story!

      I do agree that there are plenty of people who can do just fine on the diet, but there is a small subset of people who will be worse off for even attempting the diet. Figuring out which group you fall into can be tough which is why I will usually only recommend the diet as third-line therapy.

      • I have been following you for about a year now and value your opinion. Can you please let me know what you think I should do in this situation?
        I have been on the Keto diet now for about 3 months. I’ve lost 7 lbs. My TSH was low (.276), Free T3 low (3.49) and Free T4 low(.94).
        Now 3 months later my TSH is even lower at .074, my Free T3 is lower at 3.33 and my TSH is the same .94. Three months ago my doctor started me on 50 mcg of Tirosent once a day and 5 mcg of Cytomel twice a day. When he saw the recent labs from 5/10/21, he said to just take the Cytomel once a day now. I’m so confused. If my T3 is low why would I take less of the Cytomel? Before I lost the 7 lbs, I was seeing another doctor who only had me taking 50 mcg of Synthroid and I couldn’t lose any weight no matter what I did. What do you think about all this?

        • Hi Karen,

          The short answer is your doctor is putting more importance on your TSH compared to your free T3 level. Most doctors care only for the TSH and he/she knows that if you reduce your dose of T3 then your TSH will increase which is what they want. Unfortunately, this is almost guaranteed to be associated with fatigue, weight gain, and more symptoms on your part.

  2. Great article, we need more awareness. I too developed hypothyroidism because of low carbing. I was following Atkins diet and was in Ketosis for almost 2 years. In the end I was diagnosed with General (not autoimmune) Hypothyrodism. I also was stamped as pre-diabetic, which is still total mystery to me. As far as I know ketogenic diet is the first way to go to lower your blood sugar. My sugar went down after I reintroduced carbs back to my diet. I read and study a lot, experiment with thyroid medication as you advise in your articles. Study my lab results in greatest details and use your optimum ranges as guidance. I’m a big fan of your work Dr. Childs, really apréciate all work you do to educate people and spread awareness.

    • Hi Tatiana,

      While carbs certainly play a role in treating and causing insulin resistance, there must be other factors at play as well. I frequently prescribe high healthy carb diets to patients who end up losing weight and improving their insulin/blood sugar in the process. I’ll have to write a post on that topic in the future at some point.

  3. I have subclinical hypothyroidism. Have insulin and leptin resistance weight gain around stomach. Each doctor has different ideas I’m struggling to find correct treatment for me. After being on too high a dose of dessicated thyroid extract which brought down TSH I developed tinnitus full time. Another Dr prescribed T3 only then TSH went up. I went off T3 for seven weeks TSH went down to 4 but reverse T3 is up to 480 (we have different lab results in Australia) still just in range but getting to upper level I know that’s not right but new GP said that’s in the range. Feel they don’t know how to read results properly. Do I need an endocrinologist or integrative medical doctor who recommended T3 only? I also have MTHFR gene C677T. ENT specialist said tinnitus is related to thyroid any suggestions?
    I am interested in your information my saliva cortisol was low in 2015 but no one has tested it since. You say there is a connection there. I have taken numerous supplements with no weight loss only weight gain! I am in Australia and at a loss of what to do next. No doctor seems to put it all together to give me a good result. I did have phone consultation with naturopathic doctor in USA who gave me Biothyroid then integrative Dr here said I only need T3 Liothyrione? I feel I am sensitive to medication
    You recommend your supplements I’m guessing. Thanks for your help? Do you consult personally by email?

    • Hi Susan,

      You listed several conditions that you are suffering from and not all of them are treated the same way. So some supplements can potentially help you, but you will most definitely require optimizing your thyroid medication, changing your diet, and several other therapies as well.

  4. Unfortunately, I ended my experience like your wife. I’m now trying to get off the 15 lbs I gained in a year. Fortunately, my doctor has taken me off of T4/T3 and put me on T3 only. Seems like a long road back.
    I have recently enrolled in your program.

    • Hi TM,

      Yeah! She wasn’t too happy either and I still get a little bit of flak from it to this day. Unfortunately, I tend to learn the most treating the people who are closest to me.

  5. Thank you for this article. I wish I would have read this BEFORE I tired the Keto diet. I have Hashimotos and within 2 months of trying this diet, I was in the ER with terrible stomach pains. I was diagnosed with diverticulitis. My Dr. believes it was the radical diet change that brought this on. Now, my whole life is about managing this new diagnosis as well as Hashimotos. I am so afraid to try new things or add in foods for fear of having another flare up. I would give anything to go back to just managing my thyroid.

    • Hi Lori,

      I don’t know if you can say for sure that keto caused the diverticulitis, but if you are feeling better off keto then it’s probably best to avoid it given the uncertainty.

  6. I don’t feel good on a ketogenic diet, and it does NOT help me lose weight. I was doing it last spring, and I felt worse than I had in years. Fatigue, depression, brain fog, etc. I only really needed to lose 5-10 pounds to get back to my pre-pregnancy weight, and I wasn’t planning to stay on it long term. My thyroid labs were done at the end of the time I was on it, not the beginning. They looked ok, for the most part… low normal.

    Also- I’m one of the silly heads who once asked my doctor if I could wean off my Armour thyroid and he said- sure, try it. I was trying to do other things to support my thyroid. If I could have stomached the transition, I maybe could have weaned off it successfully. However, it was so unpleasant that after 3 weeks, I started the Armour again. NOT pleasant!!!

  7. I have been on keto for a little over a month. I have been dx with insulin resistance and I have about 40 lbs to lose. I was hoping that keto would be successful when all other diets have failed. I have lost about 7lbs so far and I feel great. I am confident that this will help me. Based on your advice here, I plan on going back to Paleo once I get all of my issues resolved.

  8. I have hypothyroidism that was diagnosed about a year and a half ago, though my ND feels that it’s been lifelong. I have carried a lot of extra weight/fat my entire life and have also been battling hormone imbalance, terrible periods (though that’s been helped immensely with addressing thyroid) and iron-deficient anaemia forever, too. I take a mix of NDT and T3 – we lowered the NDT and increased the T3 and I definitely feel better that way. Anyway, I have been doing a keto diet for quite some time and definitely feel better on it, but the version of keto I do is a whole foods one, with good fats, plenty of organic veggies. I am vegetarian, so my protein sources are a bit trickier, but I’ve been advised that have my non-gmo, organic soy away from my thyroid meds. I think the key difference to traditional keto for me in my approach: it is cyclic. Twice a week I have forms of “carb ups” – mid week dinners and one day on the weekend of no restrictions. Doing things this way, along with meds has kept my thyroid numbers stable. Weight is extraordinarily stubborn, though, but I’m hopeful that will come with hormone healing and eventual reduction in inflammation (oh hi there, elevated sed rate, hs-crp, wbc and platelets, my constant “friends”!).

  9. Hi Dr. Childs.Thank you so much for this article. My first try of keto was less than 30 days back in 2 years ago. my 2nd try was last Autumn for 60 days including intermittent fasting and very little exercise. I lost weight from 63/5kg to 59kg. my aim was fat loss from belly & waistline which was very good. I was diagnosed with a large thyroid gland when I was 10. My Mum has a history of thyroid. I remember I was taking Levothyroxine pill between age 18-34. I also had partial removal of my gland at age 32. All the different GP doctors in the UK haven’t prescribed any medication since 2001.i have been given the simple blood tests to do all these years, except the last two years after I did lots of reading so now I have TPO ab, TG ab,…to get tested too. last year all factors were ok except TPO ab was 20.07 This year after 60 days keto I did the lab test after 2 months, my TSH 1.9, T4 6.8, T3 0.6, TG ab 25.69 and TPO ab 23.48. I just did another test last week which the result hasn’t arrived yet. Another experience with keto was my left eye was larger than before. I did a CT scan, nothing was wrong and it went back to normal size gradually. Now I am on low carb lifestyle most of the time and if I fall off the wagon, eating unhealthy occasionally with friends, I do fasting and carry on with healthy cyclical low carb diet, similar to the Mediterranean diet. I noticed that I had better sleep and more energy on keto and now if I do low carb correctly, also my skin eczema get much less on these diets. I must mention that I am 52. My pre menopause symptoms are much less with a low carb diet. Also I started 5:2 fasting in 2015 for six months but I believe calorie counting is not my cup of tea 😉 After all these years trying different diets to get rid of extra few pounds around my belly, I realized my body will be at peace if I cut sugar, restrict gluten and stay on low carb lifestyle. I would be more than happy if you could give me more guidance to stay healthy regarding Thyroid issue. Many thanks.

  10. I have recognizable increased stress levels recently due to losing my father. With that, I had a follow up with my endocrinologist and she noticed a slight increased with my glucose but all other labs were within normal range. ( A year ago- she remarked I had such great labs and they were the pinnacle each doctor aims for !) Now, I can’t seem to budge! Can you recommend a vitamin? Btw, I recommend your blog to others that also have thyroid issues. Thank you!

    • Hi Theresa,

      I think it’s relevant to some people, but lectins impact certain people more than others so not everyone needs to avoid them.

  11. I won’t dare try Keto. First 2X I tried low carbing I did not feel well at all but didn’t know why so I instinctively stopped. I decided to try again when I was around 3 months postpartum. BIG MISTAKE. When ketosis kicked in I started to feel horrible fatigue, brain fog and some strange sensory symptoms. I would wake up middle of the night gasping for air. Then I noticed my neck felt lumpy. I showed my doc and she diagnosed Hashimoto’s. My TSH was 67+, my FT4 very low and antibodies way off the charts. I’ll never forget she called me to tell me about my labs – I was laying down trying to nap middle of the day. She said, “How are you even functioning? In my 20 years treating patients I’ve never seen numbers like this…” She ran the tests again just to verify.

    • Hi Amy,

      Thanks for sharing your story. It’s helpful for others to see who are considering these types of diets.

  12. Dr. Child’s,
    Thank you so much for bringing this diet under examination! I have Hashimotos and my Functional Med doctor is a firm believer in Keto. But when I tried it, I landed in the ER after about 6 weeks with what I thought was a heart attack but was actually a gal bladder attack. No one warns about all that fat going through the gall bladder, which can already be sluggish for people with thyroid issues. Keto diet’s recommendation of 70% of calories from fat is too much for me! Low carb with no gluten has been working for me — lots of veggies now, less protein, and only small amounts of healthy, non-dairy fats keeps my gall bladder happy. Now if only I could lose some weight!

  13. I gained 10/15 lbs from a 90 day keto experiment and have experienced struggle losing it ever since. What is your best suggestion behind this? How did your wife lose the weight?
    Thank you.

  14. I lost 41 pounds on Keto diet. I have hypothyroid. Before I started the diet my doctor tested my free T3 which was low with just taking T4 so my doctor take me off T4 and had me take T3 only which I will say made me feel great. I went on the Keto diet in February and lost the weight. My test taken this month still looks strange to my doctor but I tell him I feel fine. T4 free= .11, T3 free=5.4, TSH=10 that’s all my doctor will test. Took my T3 meds 3 hours before test. If I test without T3 meds the readings are T4 free=.11, T3 free=1.4, TSH=33. I am taking 30mg a day dividing them in dosages of 10mg. Do you have any advice on the dosage and should I be testing without meds or with meds.

    • You should get the book “The Thyroid Patient’s Manual” by Paul Robinson. Look in to his YouTube videos and blogs.
      The book teaches you how to dose the meds using the T4, NDT, T3 or T4/T3 Thyroid Treatments. I am also bad converter of T4 meds to T3. Paul Robinson explains how to figure this out. I just bought his book, I will try to learn how to dose correctly myself, because my doctor has no idea how to do it. Here are some links to podcasts that he was in if you want to listen first.

  15. Hi Dr. Childs,

    It seems like most of the information here pertains to hypothyroidism. Does this mean that the keto diet would be okay or even beneficial for those with overactive thyroid?


  16. I’ve been on carnivore fir 2+ yrs. still battle with some fatigue. I’ve tried adding back in some carbs. Some are ok. Some cause bloating etc. Have decided eggs and dairy don’t like me. I have days when I feel ok but if I try to exercise and do a little more, I cam get real tired. Any idea where I can turn to tweak things? In 2003 I had saline breast implants. Had them removed 2018 after no results with AIP, keto etc. Feel like I’d tried everything. TPI went from 226 right before explanation to 66 2 mos after. It’s a huge deal. All implants have 40+ heavy metals/toxins…even saline implants. People should know. My question is: it mitochondria not getting adequate energy? I argue with my doc about being at upper limits of my thyroid tests. I’m tired of having to be the one ‘in the know’. Feel the best on carnivore. But not optimal. Thoughts?

  17. Hi, I have Hashimoto’s and have been keto for the last 4 years, planning to stay on it for life. All good, TSH halved. My keto involves 50-65g net carbs/day and is cyclic – I have a cheat morning once a week in which I eat what I like, though gluten-free of course. Takes 2-3 days to get back in ketosis. Each day I have lots of unstarchy vegies, nuts, some fruit including berries, not high protein (don’t eat red meat) and eat to appetite. I am easily addicted to starchy carbs/sugar, diabetes in the family, but this cyclic keto means I have no addictions any more, blood sugar is beautiful. Lost about 20kg 4 years ago, put on 10kg last year (covid restricting exercise, also cheat meal every 4 days instead of 7) but am back on track, such a relief. Exercise moderately 6 days out of 7, 30-60 mins/day, rarely get ‘tired’ days anymore. Age 64.

  18. Hi Dr. Childs,

    As for me, I’ve had hypothyroidism for 20 years. I’ve never been truly successful at losing weight. I would go on a calorie-restricted diet, lose some weight and gain it right back and then some. Yo-yo dieting. After doing this forever, I started keto in January 2021, and by April I had lost 31 pounds! I now weigh what I weighted 40 years ago! I feel great and have so much energy. I’ve just retired and work physically on my land daily. I am very thankful to have discovered clean keto. I had insulin resistance and was pre-diabetic, and now I’ve reversed all my metabolic issues. This has saved my life with no impact on my thyroid (to my knowledge).

  19. I was taking Levo 50mg through my regular doctor for 20 years. About 5 months ago switched to bovine thyroids granular 25 mg as advised by me a holistic doctor. I did not see any difference in both medications. Still cannot lose weight. I have tried keto, intermitted fasting and others, but cannot lose an oz.
    Today, my regular doctor insists that I get back on levo as my tsh shoes 0.05mcl adn t4 Free 1.0ng.
    Do you have any advise if I should continue levo or bovine?

  20. I’m a Hashimotos patient and have tried endless number of diets, including calorie count, rigorous workout regiment, buying a bunch of your products etc. All it ever did was me gaining more and more weight.
    Now on a keto diet- not pumping my body with fat but eating lots of avocados and olives etc- I’m down 25lbs in 2 months.

    • Hi Eli,

      Thanks for sharing! The litmus test as to whether a diet is working is not whether or not you can lose weight quickly but whether or not you can keep that weight off long-term 🙂 Losing 25 pounds is great if it means you can keep that 25 pounds off in 1 year from now but it’s not so great if it comes at the cost of more thyroid damage as well as the regaining of that weight in 4-6 months. Time will tell if the diet is actually beneficial to your body.

  21. Hi Dr Childs,
    my dietician put me on a ketogenic diet for 9 month and it was a big mistake. I have gained 10 pounds as well as I have lost leptin sensitivity and thyroid hormone level. Now I’m fighting to get back my hormonal imbalances for two years now, no results yet. Thank you so much for your knowledge. I wish you would teach our doctors!

    • Hi Beata,

      I experimented with my wife on the keto diet about 7 years ago and she gained 10 pounds as well! It just doesn’t work well for some people.

  22. Hello! I’ve had thyroid issues for the last 25 years with being diagnosed with Hashimotos and Celiacs in 2014. Over the years, I have eaten Paleo, Primal, various forms of keto, raw vegan and carnivore. But,I feel my absolute best when I do “Squeaky Clean” keto. It is also the only diet that brought my TPO(ab) down from 900+ to 216. Just recently (April 2021). My Dr also lowered my Tirosint dosage, my cholesterol is optimal and insulin levels are good, although I feel like the numbers are on the cusp of insulin resistance, they are lower than a year ago. I have recently been adding a couple of 24 hour fasts a week. Those are easier to do for me if I’m skc keto. The only number on my tests that is concerning to me is my weight, but because I have good numbers, my Dr isnt that concerned. What are your thoughts on the carnivore diet?

  23. I have had my thyroid removed and NOTHING worked besides keto. It was still a long process, but I lost 20 pounds and I have all the energy to exercise, go on long walks, etc. Now, I am not as strict and just maintain a cyclical low carb diet, so I eat low carb and prioritize protein, fats, and non-starchy greens most of the week. When I go out, I will give myself some grace–although it is still gluten and dairy free, and I try to be mindful of sugar. Be your own lab rat and see what works for you!

    • Hi Kennedy,

      Agreed 🙂 Do what works for you and don’t be afraid to experiment. Keto can work for some people but I personally don’t feel that it’s a great long term solution.

  24. My doc happened to add cytomel to my levothyrox at the same time I started a Keto diet. I did well. My numbers were “too good” and doc suggested I lower dose of levo, or cancel cytomel. I hate being on any meds so I let go of the cyto, and since in my heart I’m vegan(ish) I also let go of the keto. I’m still confused. Find it nearly impossible to lose weight. The levo (now synthroid) doesn’t seem to help symptoms only the numbers, and my doc is opposed to most supplements. I feel like I am between a rock and a hard place. Don’t know where to turn and would love to be off the med.

    • Hi Michele,

      I would strongly recommend looking elsewhere if you don’t feel like your doctor is willing to work with you or help you. I’ve seen thyroid patients waste literal decades of their lives with doctors like yours who won’t “allow” them to experiment or try new things to feel better. In my mind, it doesn’t make sense to let someone dictate what you can or can’t do, especially if they don’t live your life 🙂

  25. I was diagnosed with hypothyroidism 20 years ago. I have been on medication for 20 years. I felt best on naturethroid but nave not been able to get it or armor thyroid for a year or more. I have not felt well, but my doctor says my labs are good. I have been on Levothyroxine. I would love to have my nature thyroid again. I have been on keto for 10 months now and have not lost a ounce. My doctor says it is because I Am 67. Thanks for your article. I may be harming my body.

  26. What kind of diet is recommended for people with thyroid issues who also have dysbiosis?? (I’ve been reading that the two can go hand in hand.) I cried to my husband a few nights ago that I feel like I’m screwed no matter what I eat. Calorie restriction is a bad idea so if you have to maintain healthy calories you have to get them from either carbs, fats, or proteins. Well, too much fat these days is stressing out my gallbladder. If I eat too many carbs in the form of beans, bananas, potatoes, rice etc I not only gain weight but I get achy joints and constipation. Plus, I read that starches like sweet and white potatoes, wheat, rice and certain beans damage the gut lining (think GAPS or SCD diet) and feed bad bacteria. That leaves high protein which I’ve been reading is hard on the liver and kidneys and can lead to things like osteoporosis (I already have very thin bones). I’ve been diagnosed with Dysbiosis caused by yeast overgrowth and a protozoan parasite. I’m told that I need to cut carbs to starve the yeast and parasites. But I’m also told that low carb is a terrible idea for people with thyroid issues. Sooo…what DO I eat??

  27. I have been hypothyroid for twenty years and on levothyroxine (of increasing doses). I had put on weight over the last fifteen years including with menopause, and then Covid. I was also cold and tired midday. So cold only sleep would warm me.

    Finally, I found an endocrinologist (who costs an out-of-pocket fortune) who was willing to prescribe Armour and to treat to warm me up.

    Then I went on Keto. Real keto (under 30 grams carbs) for three months. I lost about 17 lbs. I was not one of those people who “feels great on Keto.” It was hard. Especially, the first six weeks. The only good feeling was a diminishment in joint pain.

    At about month four, I was on a trip in the wilderness and due to circumstances found myself having to hike ten miles a day in very high elevation – solo. That’s when I thought, to heck with Keto, I am going to carry and eat simple carbs. And, I did. I felt great! And, I gained muscle.

    After that, I kept on dieting but more low-carb than Keto. I felt much better than on Keto.

    Unfortunately, after about 8 months I just could not stomach the thought of eating animal protein and ended up eating mostly carbs and fat. I did not realize this meant I would consume (and lose) my muscle.

    I went back to eating low carb but with protein. Also, at some point, I read your blog about being careful not to stay low calorie for the long haul. So, despite the chastisement of my diet clinic, I sometimes ate more and sometimes fasted a half day.

    I continued to lose weight, having lost 45 lbs in total and kept them off the last six months.

    Three months ago, my endocrinologist told me to reduce the Armour as I was now hyper. Last week my GP had me reduce the dosage again.

    I don’t know whether losing the last twenty pounds has caused the change in my thyroid/meds.

    Now, I am trying to rebuild muscle. The fatigue after weight training is tremendous.

    In conclusion—Keto worked for me, sort of, in the short-term. I did better on low-carb. Not super low-carb (Keto). I varied calorie intake trying to preserve metabolism. Ladies—if you are post menopause please diet to lose fat but not muscle—it is REALLY hard to gain back the muscle.

    Thank you for guiding all of us. If you have tips on how to build muscle while Hypothyroid they are welcome!

    • Hi Anne,

      Thanks for sharing! One tip I would recommend is to get your testosterone level checked. Many women have low testosterone and don’t realize it and the replacement of testosterone with TRT can solve this issue and make building muscle mass much easier.

  28. Dr. Child’s,
    If you are not recommending this diet, which I have tried & failed at, are there better diets you recommend now? If not, because I believe like you said we are all individual, how would you suggest figuring out a diet that will work for me? Sustainably, long term, and for weight loss

  29. I enjoyed your article. I am 54 and still experiencing menopause symptoms. I had my thyroid totally removed in my 40’s. I have been on the same dose of Synthroid 100mcg since my thyroid was removed. My last labs almost a year ago my TSH was .8359 (normal range .3-4.9) Free T4 was 1.09 ng/ml (normal range .7-1.48) and my T3 was.86 ng/ml (normal range .35-1.93) *these are the normal ranges on my chart from doc. This is all my doc checks so I’m not sure if he is missing anything but I’m usually feeling good so no complaints except my weight kept creeping up. I am 5’6 and my weight was up to 160 lbs. I have been on Keto for about 10 weeks and lost 18 lbs. I walk a few times a week. I try to get 7-8 hours of sleep per night. I have always felt good on Keto and I use an app called carb manager to track my protein, fats, carbs and calories. I splurge occasionally but try to avoid high carb foods and eat healthy fats- avocados, nuts, etc. I go to the doc in the next couple of weeks for my annual blood work and am curious to see any changes. So far Keto is great for me and my menopause symptoms are mostly gone too (maybe one hot flash here or there). I recommend the keto strips to check your urine for ketones -Amazon. If I go out to dinner with family or friends I will have a couple of drinks, a piece of bread….enjoy life but start again on my low carbs.

    • Hi RG,

      Keto can certainly work great for some people, no doubt about it. If you are one of those people then please continue with what works for you! I just wanted to point out that it doesn’t work for everyone and that there may be better options for thyroid patients.

  30. I am 50 years old, 5’9” tall, 165lbs, and pretty active. I do strength training at a gym 3 days a week and I am a runner with training sessions 3 days a week. Running is 5 miles or less per training session with the majority of them around 3.5miles. About 5 months ago I noticed my running suffering – pace, heart rate, recovery. I had also noticed some hair loss, the development of raynauds phenomenon this past winter for the first time, resting heart rate variability, hot/cold/temperature control.

    My doctor began bloodwork. The big symptom that has been the hardest to control is high blood pressure. I have no history personally and no family history of high blood pressure.
    I started KETO 3.5 years ago (Jan 2019). I feel great on KETO. I vary between very strict on carbs to less strict. When I am strict I stay in the 10-20 net carbs. When I am not strict I am in the 30-40 net carb. I go in and out of ketosis depending on how strict I am with carbs and how strict I am with calories. I never restrict calories severely – usually between 1600 – 2500 per day.

    My thyroid number were “in the normal range”. T4=0.9, T3=2.58, TSH=3.24. The big symptom is high blood pressure. I have taken every combination of Doxazosin, Olmesartan, and Amlodipine over the last few months trying to control blood pressure. There are times I have had to take 7 doses a day of these meds to keep it in control then all of a sudden I won’t need any blood pressure medicine for a few days then blood pressure goes back up.

    All of this is making running very difficult. So frustrating. Here is my bloodwork over the last few months. Currently I am on 50mcg of Synthroid and 5mcg of Liothyronine for thyroid and 8mg of Doxazosin and 80mg of Olmesartan for blood pressure.

    Date T4 T3 TSH T3 Reverse Anti-Tg Anti-TPO ANTNU IFA
    1-Mar 0.9 2.58 3.24 11.4 0.8 1.5 Negative
    6-Apr 0.9 2.64 2.22
    2-May 1.1 4.38 0.01
    1-Jun 1.1 2.11 0.23
    17-Jun 1 2.61 0.18

  31. Hi Dr. Childs,
    I’m 41 and have been keto for a bit without significant caloric restriction or fasting. Only time restricted eating windows occasionally (16:8). I am normal weight, BMI 19.5. However, as I have gotten older I have gained a bit of subcutaneous fat that I don’t like and it is resistant to exercise and weight training. I started the ketogenic diet more for the brain benefits I had read about (I have ADHD), and thought hey I will lose that fat I don’t like as a bonus! So I am doing this keto program which tracks blood glucose, blood ketones, and diet via Bluetooth and uploads to a site where health coaches monitor and an MD oversees the health coaches. This last week everyone was to do a sardine fast, eating nothing but sardines for 72 hours. If you were hungry, you didn’t go without, you ate sardines. My BG went down to 68 and ketone up to 3.1. However, I became REALLY lethargic the second day into it, felt really cold and my clothes seemed tighter from fluid retention. All of my classmates were raving about sky rocketing energy levels and alertness. Granted, the wonderful ladies in my class are mostly postmenopausal and the majority have a higher BMI than mine. So I had my levels checked and they were: tsh: 3.9 (used to be 1.3), free t3: 2.0 (also lowest ever). I see the reference ranges for tsh to be considered low are anything above 4. So does that mean that my measurements are ok? It’s interesting that those levels coincide with the abrupt development of symptoms. Hypothyroidism runs in my family. BTW, I think my husband went to Med School with you.

    • Hi Sarah,

      Who was your husband and what year did he graduate? In regards to your experience, sustained low carbohydrate diets are known to lower T3 levels which can then increase TSH level. This may be an early warning sign by your body letting you know it needs more carbohydrates. One strategy you might consider using is to eat more carbohydrates at baseline but prolong your fasts. This allows you to get more total carbohydrates throughout the week/day but also benefit from periods of fasting and their impact on insulin/blood sugar/leptin.

      • His Name is Nathan Schreiber, and he graduated in 2014. Ok, I could do that, increase the carbs at baseline and prolong fasts. Would that mean longer than 72 hours and/or water & black coffee only? In the meantime to ameliorate the hypothyroid symptoms and since my numbers did reflect a change in more of a hypothyroid direction, if my doctor wants to treat with medication or NDT, would that be beneficial/ok?

        • Hi Sarah,

          Oh, yeah, his face definitely looks familiar! You will have to play around with your fasts to figure out what works best but trying for 48-72 hour water fasts would be a good starting point.

          You can always be aggressive with thyroid medication if you want but just be certain your doctor knows what he/she is doing so you don’t end up taking it longer than you need to. In general, though, that shouldn’t be an issue.

  32. I am currently living this. I was keto for 3 yrs. I felt great, energy through the roof, then lifestyle changes made the diet impossible to maintain. Slowly I went from full on keto to modified to not even close. I do have a healthy balanced diet but here I am 3 years later and I noticed the energy level bottom out, depression, anxiety, hair brittle and dry to some hair loss. Something felt off so I went to the Dr for blood work. I am 40 after all…. I thought maybe it was THAT stage in my life. Turns out my thyroid is enlarged and my hormone levels are on the low side. More tests have been ordered. I did some digging and found there are SEVERAL foods that are staples to the keto diet that block iodine absorption. Cauliflower, spinach, broccoli, Brussel sprouts…. I mean I LIVED off these for 3 yrs. Which leads me to a question since yours is the only article that I have stumbled across that connects the two as an effect of extended keto dieting. Have you found anything connecting the foods themselves that are contributing to the thyroid damage since it needs iodine to produce the hormones and certain food block the iodine.

    • Hi Claudia,

      What you are saying is definitely something that can occur but it would really only occur if you were already iodine deficient or not getting iodine in your diet. Usually, the goitrogenic effect of the vegetables you mentioned can be overpowered by simply taking higher doses of iodine which is why I don’t recommend avoiding them. If, however, you are NOT taking iodine and consuming massive quantities of goitrogenic foods then it certainly may cause an issue. This is one of the reasons I’m not a big fan of long-term keto dieting unless these sorts of factors are taken into account.

  33. I have been eating “keto” for over 10 years. Sometimes I just say I don’t eat sugar, avoid alternative sweeteners, no bread, pasta, oats. (I eat brown rice and black beans 1 or 2 times a month) I use olive oils and coconut and MCT oils. Meat and green vegetables. I don’t measure but I keep the carb count low, probably not enough fats, protein is optimal. I never lose weight after the initial 5lbs. What I get is more energy and a clearer mind. The two most troublesome symptoms I suffer. Ideally I need to lose 50 lbs. I respond to exogenous ketones for energy. This concerns me because I get so much energy from them that it seems like I will be punished for it in one way or another. I get more energy from exogenous ketones than I ever got from diet medications and I feel no side effects. I take Amour (over 45yrs) and liothyronine (3yrs). The addition of liothyronine gave me the energy that had been missing for 45 yrs. Could you comment on if you have ever run across research showing a relationship with ketones and thyroid, impact on thyroid, energy production, etc. I am trying to understand if taking exogenous ketones might be better than taking thyroid medications? My last labs showed T4 is in range (my T4 never moves much), T3 great (moved to a higher value in range once I begin taking meds) but after 3 years TSH is < than low range end. Dr concerned. I am afraid of losing access to T3 and thus my energy. So… I am seeking alternative energy management.


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