What is Graves' Disease?

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What Is Graves’ Disease?

Graves’ disease is an auto-immune disorder. Auto-immune disorders are conditions whereby your own antibodies attack your body. In persons affected by Graves’ disease, the immune system produces antibodies that act like Thyroid Stimulating Hormone (TSH) and stimulate the thyroid irrepressibly. Grave’s disease is often accompanied by swelling and protruding of the eyes and coarsening or reddening of the skin on the shins.

There are many factors that contribute to autoimmune thyroid disease including:

  • Family history of autoimmune disease.
  • Graves’ disease is more common in women aged 20 to 40 years and in people who have a family history of the condition.
  • Viral infections
  • Heavy Metal load in the thyroid gland, such as aluminum or mercury.
  • Nutrient/mineral deficiencies
  • Stress

*Information supplied is for educational purposes only and not intended to diagnose or treat a condition. Refer to your medical professional.

Image of Thyroid with Graves' Disease

What are Symptoms of Graves’ Disease?

  • Racing heart and/or heart palpitations
  • Weight loss
  • Irritability
  • Fatigue and insomnia
  • Brittle nails
  • Shakiness
  • Diarreogh
  • Irregular menstrual periods
  • Hair thinning (or loss of hair)
  • Shortness of breath
  • Intolerance to heat (feeling hotter than others)
  • Hair thinning (or loss of hair)

Approximately 1 in 3 people who have had Graves’ disease can develop thyroid eye disease (TED) or exophthalmos, characterised by bulging eyes. This is because the antibodies that attack the thyroid can also attack the muscles and tissues around the eyes.

Some Grave’s patients may also develop a Goitre – which is a visibly swollen thyroid gland.

Graves’ Testing and Investigation

The simplest and most accurate method for diagnosing hyperthyroidism is via blood tests. Levels of thyroid hormones thyroxine (T4) and triiodothyronine (T3) should be assessed, and one or both must be elevated for a diagnosis to be made. It is also advantageous to assess TSH levels, as the purpose of this hormone is to stimulate the production of thyroid hormones. If the pituitary gland senses the slightest excess in thyroid hormones in the blood, it will stop the production of TSH. Therefore, TSH levels will be low in individuals with hyperthyroidism.

However, each laboratory sets its own range, so there is no government standard and this is why different labs will have different ranges. Also, many factors may cause TSH suppression, which is a naturally fluctuating hormone. When unsure, it is warranted to run functional pathology, as similar symptoms may also be due to menopause, stress and adrenal issues, nervous system disorders, and poor glucose regulation. To learn about these tests Click Here.

To differentiate whether an individual also has Graves’ disease, additional testing is necessary as the very same thyroid antibodies may be present in both Hashimoto’s and Graves!

Thyroid Stimulating Immunoglobulin (TSI) and Thyroid Receptor Antibodies (TRABS) are the main specificity tests, which contribute to the exophthalmos (bulging eyes) that is typical of Graves’ disease.

Thyroid Peroxidase Antibodies (TPO) can also be assessed, as their presence indicates that the immune system has attacked the thyroid. However, 5-10% of healthy individuals will test positive for TPO antibodies, thus this cannot be relied upon alone for a definitive diagnosis of Graves’ disease.

From a Naturopathic perspective, we are not trying to diagnose a disease but to understand how and why a thyroid may be malfunctioning. TSH receptor antibodies (TRAb) are generally regarded as mediators of thyroid stimulation in Graves’ disease. Positive TRab has been detected in 80% of newly diagnosed Graves patients. 

Increased production of rT3 is often seen in patients with disorders such as fibromyalgia, chronic fatigue syndrome (CFS), Wilson’s Thyroid Syndrome, and stress. Measurement of rT3 is also valuable in identifying sick euthyroid syndrome where active T3 is within normal range and rT3 is elevated. Reverse T3—According to Dr.Holtorf rT3 should be less than 250. To learn more about these thyroid tests, Click Here.

Thyroid nuclear scan

A thyroid nuclear scan is used to help determine the cause of the excess thyroid hormone. This scan involves injecting a small amount of radioactive substance into a vein in the arm. After 20 minutes, images are taken of the thyroid (neck) area by a special gamma camera that provides information about the function and structure of the thyroid gland. These images require about 20 minutes to take.

This scan can also help in distinguishing between benign (non-cancerous) and malignant (cancerous) thyroid nodules or lumps.

This scan uses a radioactive substance, so is not suitable for pregnant or breastfeeding women. Some other pre-existing conditions may also prevent you from having a radioactive scan. Your doctor can discuss this with you.

Thyroid ultrasound

This is a non-invasive imaging method that uses sound waves to take pictures of the thyroid gland and surrounding neck structures such as lymph nodes. It allows measurements to be made of the size of the thyroid gland, and of any thyroid nodules together with a description of what the nodules look like.

What are Graves’ Disease Treatments?

What are Graves’ Disease Medical Treatments?

Anti-thyroid medications

If your thyroid hormone production is too high, an anti-thyroid medication (carbimazole or propylthiouracil) may be given. This medication reduces the production of thyroid hormones. Regular blood tests will be ordered by your doctor to check hormone levels are returning to a normal range.

Radioactive iodine

Radioactive iodine may be used to reduce thyroid hormone production by destroying some or all of the thyroid gland. This is a permanent alteration to the thyroid gland and non-reversible, and not a treatment we recommend unless all other approaches have failed.

For most patients, this is a single treatment, taken as a pill that releases radioactive iodine. The thyroid gland absorbs the iodine, and the radiation damages and destroys the thyroid cells.

Surgery

If too much thyroid hormone is being produced by the thyroid gland which cannot be controlled by an anti-thyroid medication or radioactive iodine treatment, surgery is generally recommended. For Graves’ disease, surgery involves removing all the thyroid gland – ‘total thyroidectomy’, also called TT. After a total thyroidectomy, lifelong thyroid hormone replacement therapy (levothyroxine) will be needed so that your body gets enough thyroid hormone to keep functioning.

As with radioactive iodine treatment, due to the permanency of the operation, we would consider this as a last resort if other functional medicine approaches fail. Many patients who have had a TT discover better medication management when combining a functional medicine approach that focuses on nutritional therapy, herbal medicine, and diet intervention to live a healthier life.

What are Graves’ Disease Integrative Treatments?

Graves’ disease treatment can be combined with natural medicine treatments for potentially better patient outcomes. Patients that work integratively like this experience fewer side effects to medical treatments, and experience better symptom management.

Some patients wish to try natural medicine first, before resorting to a permanent procedure such as a total thyroidectomy, in which case a fully holistic treatment model is designed for them based on current pathology, symptom picture, and history.

This preventative and holistic approach can reverse thyroid disease and avoid permanent thyroid procedures.

Nutritional Medicine

Common deficiencies that contribute to autoimmune thyroid disease include zinc, vitamin D3, magnesium, B12, and active folate (L-Methylfolate). A functional health practitioner can test for vitamin and mineral deficiencies so these can be adequately treated.

Diet

A gluten and dairy-free diet can help reduce inflammation and aid in reducing autoimmune antibodies. It is also useful to avoid any foods that specifically cause inflammation in your body (which can be detected by doing a food intolerance test).

Herbal Medicine

Botanical medicines can also help in “immune modulation” – that is, to help the immune system recognise self- from foreign antigens, and stop attacking its own tissues. Generally, a holistic approach is required to treat Graves’ disease with natural medicine, which includes diet modification, stress management, and herbal medicine.

Adrenal support is essential to help reduce stress levels, as stress is a well-recognised driver of autoimmune disease. We run 3-point saliva testing to assess adrenal hormone function, and sleep/insomnia. Click Here to learn more.

References:

The incidence of Graves’ ophthalmopathy in Olmsted County, Minnesota. Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, Gorman CA, Am J Ophthalmol. 1995;120(4) 511. 

Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism. The Thyroid Study Group. Tallstedt L, Lundell G, Tørring O, Wallin G, Ljunggren JG, Blomgren H, Taube A, N Engl J Med. 1992;326(26) 1733. 

Vogel A, Elberling TV, Hørding M, et al. (January 2007). “Affective symptoms and cognitive functions in the acute phase of Graves’ thyrotoxicosis”. Psychoneuroendocrinology 32 (1): 36–43. doi:10.1016/j.psyneuen.2006.09.012. PMID 17097812. 

Bunevicius R, Velickiene D, Prange AJ; Velickiene; Prange Jr (2005). “Mood and anxiety disorders in women with treated hyperthyroidism and ophthalmopathy caused by Graves’ disease”.Gen Hosp Psychiatry 27 (2): 133–9. doi:10.1016/j.genhosppsych.2004.10.002. PMID 15763125. 

Studies on thyrotrophin receptor antibodies in patients with euthyroid Graves’ disease. Kasagi K, Hatabu H, Tokuda Y, Iida Y, Endo K, Konishi J, Clin Endocrinol (Oxf). 1988;29(4) 357. 

Studies of thyroid function and immune parameters in patients with hyperthyroid Graves’ disease in remission. Murakami M, Koizumi Y, Aizawa T, Yamada T, Takahashi Y, Watanabe T, Kamoi K, J Clin Endocrinol Metab. 1988;66(1) 103. 

Chapter 11. Diagnosis and Treatment of Graves’ Disease Leslie J. De Groot, MD Professor of Medicine – 

http://www.thyroidmanager.org/Chapter11/chapter11.html Updated: March 5, 2008 

Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH, J Neurol Neurosurg Psychiatry. 2000;68(6) 750; Electromyographic and histological findings in the muscles of patients with thyrotoxicosis. HAVARD CW, CAMPBELL ED, ROSS HB, SPENCE AW, Q J Med. 1963;32:145; Electromyography in thyrotoxicosis. Ramsay ID, Q J Med. 1965;34(135) 255. 

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ii Gilbert, J 2012, ‘Thyroid and Menopause’, British Thyroid Foundation. Available from: http://www.btf-thyroid.org/information/articles/107- thyroid-and-menopause . [23 June 2016 iii Gilbert, J 2012, ‘Thyroid and Menopause’, British Thyroid Foundation. Available from: http://www.btf-thyroid.org/information/articles/107- thyroid-and-menopause . [23 June 2016]. 

iv Norman, J 2016, ‘Diagnosing Hyperthyroidism: Overactivity of the Thyroid Gland’, Vertical Health. Available from: http://www.endocrineweb.com/conditions/hyperthyroidism/diagnosing-hyperthyroidism-overactivity-thyroid-gland . [22 June 2016]. v http://www.ncbi.nlm.nih.gov/pubmed/22934923 and http://www.naturalendocrinesolutions.com/articles/the-role-of-leptin-in-thyroid-health/ 

vi http://www.nitekmedical.com/studies.html 

vii Toft, DJ 2016, ‘Graves’ Disease Diagnosis’, Vertical Health. Available from: http://www.endocrineweb.com/conditions/graves-disease/graves- disease-diagnosis . [23 June 2016]. 

viii Natural Endocrine Solutions 2012, Is It Possible To Eliminate The Autoimmune Response In Graves Disease and Hashimoto’s Thyroiditis? Available from: http://www.naturalendocrinesolutions.com/archives/is-it-possible-to-eliminate-the-autoimmune-response-in-graves-disease-hashimotos- thyroiditis/ . [23 June 2016]. 

ix Thyroid : Official Journal of the American Thyroid Association Thyroid Autoantibodies (TPOAb, TgAb and TRAb) Thyroid. 2003;13(1) http://www.medscape.com/viewarticle/452668_7 

x WebMD 2016, Overactive Thyroid (Hyperthyroidism). Available from: http://www.webmd.com/women/overactive-thyroid- hyperthyroidism?page=3 . [23 June 2016]. 

xi Natural Thyroid Treatment Methods Graves’ Disease & Hyperthyroidism Hashimoto’s & Hypothyroidism http://www.naturalendocrinesolutions.com/treatments/natural-graves-disease-treatment-methods/ xii https://thelucyroseclinic.com.au/eczema-in-kids-adults-what-can-you-do/#sthash.TBoxRRRh.dpuf xiii Wikipedia 2016, Signs and symptoms of Graves’ disease. Available from: https://en.wikipedia.org/wiki/Signs_and_symptoms_of_Graves%27_disease . [23 June 2016].