Hyperthyroidism & Graves: Testing & Treatments

Hyperthyroidism & Graves: Testing & Treatments

Authors: Naturopaths Bree Ponton and Kimberly Orbons, published 29th July2016.

 

Hyperthyroidism, also referred to as overactive thyroid, is a health condition which occurs due to an excessive production of thyroid hormone by the thyroid gland. This leads to an increase in metabolism, causing the body to work harder and faster. Symptoms include rapid weight loss, rapid and/or irregular heartbeat, irritability, nervousness and a host of others. Women are more commonly affected than men. (i)

 

feeling thyroid glandWhat Can Cause This?

The most common cause of hyperthyroidism is an abnormality of the immune system known as Graves’ disease. Other causes include local inflammation (thyroiditis), nodules or lumps (ii).  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 which act like Thyroid Stimulating Hormone (TSH) and stimulate the thyroid irrepressibly. The cause of Graves’ disease and auto-immune diseases in general is not well understood. However, physical and emotional stress affects the responsiveness of the immune system, and genetics also plays a role. In addition to symptoms typical of hyperthyroidism, Grave’s disease is often accompanied by swelling and protruding of the eyes and coarsening or reddening of the skin on the shins (iii).

Why Do I Seem To Have Such Fluctuating Symptoms?

In instances where Graves’ disease is the cause of hyperthyroidism, it is not uncommon for symptoms to fluctuate between those associated with over-activity and under-activity of the thyroid (iv). Moreover, symptoms associated with hypothyroidism (underactive thyroid) often mimic those of menopause and/or hyperthyroidism. Symptoms such as menstrual irregularities, sleep disturbances, mood changes and increases in cholesterol levels, reduced libido and vaginal dryness could unhesitatingly be identified as menopause, when in fact they are attributed to thyroid irregularities! Evidently, thorough investigation and testing to discern the cause of these symptoms is essential. Many people assume that hypothyroid patients gain weight, and hyperthyroid patients lose it easily, but this is not always the case as each patient is a unique individual.

LEPTIN

A recent study looked at the relationship between obesity, thyroid function, and autoimmunity and the study discussed how there is a relationship between obesity and thyroid autoimmunity, with the hormone leptin playing a key role in linking these conditions. The study discussed how “leptin resistance may mitigate leptin deficiency and enhance autoimmunity in obese subjects, and the development of resistance to the weight-lowering effects of leptin might be initiated by activation of inflammatory signalling” (v).
So what does this mean? Essentially what this is saying is that the inflammatory component of the autoimmune response might lead to leptin resistance, thus causing obesity. However, obesity itself can potentially lead to thyroid autoimmunity. With someone who already has an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, the goal is to suppress the autoimmune response, and addressing the inflammatory component is a big factor in this. By addressing the inflammatory component, this not only can help to suppress the autoimmune response, but in turn can help to correct leptin resistance, thus making it easier to lose weight.

So what does this mean? Essentially what this is saying is that the inflammatory component of the autoimmune response might lead to leptin resistance, thus causing obesity. However, obesity itself can potentially lead to thyroid autoimmunity. With someone who already has an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, the goal is to suppress the autoimmune response, and addressing the inflammatory component is a big factor in this. By addressing the inflammatory component, this not only can help to suppress the autoimmune response, but in turn can help to correct leptin resistance, thus making it easier to lose weight.

 

 

12__400x300_article-4-image-1Testing 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 (vi). However, each laboratory sets their 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, and it is an naturally fluctuating hormone. When unsure, it is best to measure a patient’s tissue speed with Thyroflex testing (vii). This assists each patient to understand how many of their symptoms are from their Thyroid metabolism, as similar symptoms may also be due to menopause, stress and adrenal issues, nervous system disorders and poor glucose regulation. Some patients will want their cortisol, leptin and estrogen tested as well as their Thyroid.

17__300x400_article-6-image-1To test the difference 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 contributes 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 (viii).From a Naturopathic perspective we are not trying to diagnose a disease, but 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 have been detected in 80% of newly diagnosed Graves’ patients (ix). 

 

An 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.

 

 

322What type of herbs may my Naturopath Recommend?

The most common herbal remedies for treatment of hyperthyroidism, particularly in those affected by Graves’ disease, are Hemidesmus, Bugleweed, Turmeric, Boswellia, Echinacea, Rehmannia or Lemon Balm. Each patient is different, so ther herbal combination will need to address your personal symptoms and test results. The main herbal actions your naturopath will choose are medicines that helps to suppress the auto-immune response, prevent the binding of thyroid antibodies to the thyroid gland, and those which can exhibit a thyroid inhibiting action particularly good for TSH irregularities and hyperthyroid symptoms. Anti-inflammatory herbs are also useful for alleviating the auto-immune response and reducing inflammation (x).

Further symptomatic relief can be sought from anti-anxiety herbs, anti-hyperhydrotic (antiperspirant) herbs, sleep-promoting herbs and cardio-protective herbs. Common choices may include passionflower, zizyphus and skullcap,  sage,  hops, valerian, kava, hawthorn, or motherwort.(xi) There are also many ways to support symptoms such as heart rate or blood pressure with natural therapies, read more here.

 

 

What about fixing this with Diet?

Gluten and dairy free is essential for autoimmunity, as the immune system recognizes gluten as thyroid as the molecular structure of gluten is very similar to that of the thyroid. There are of course many patients that get away with eating these foods; but there is much evidence for these foods as triggers, not just patient testimonies about how much better they feel from their skin to their organs. Many of our patients arrive to their first follow up at The Lucy Rose Clinic for copies of their test results already feeling better, just from diet changes. Ongoing research is still underway exactly how many of these mechanisms may improve this function, as there are MULTIPLE contributing triggers as we have discussed above. Read more about food intolerance testing here. In some instances our practitioner’s may recommend an elimination diet or a short term diet to support autoimmune protocols.

2222

There is a great ABC episode by Catalyst on gluten intolerance and the current research to provide us with the how’s and why’s patients get such symptomatic improvement as there are many allergic proteins/sugars not just gluten such as FODMAPS. It’s not just eczema but mouth ulcers, headaches and migraines, gastric function and autoimmune conditions that can be improved! It also discusses how modern farming, processing, and cooking methods contribute to the upsurge of food re activity so many people suffer with. AND we love how it encourages you to read the label of processed “healthy food” substitutes. No wonder some nutritionists are concerned re avoiding gluten, packet gluten free foods are low in nutrition so stick to the natural foods discussed . . . we know that makes sense but there are better ways of avoiding dairy wheat and sugar without relying on the packaged processed foods in supermarkets. (xii)
As well as coming to see us for a health consult, books we recommend include those by Dr David Brownstein, Dr Sandra Cabot, ‘Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health’ by William Davis.

 

 

Iodine-3THow does Nutritional Treatment help with my Autoimmune Disease?

The autoimmune inflammation response to iodine/iodide deficiency may result in Hashimoto’s and Graves’ disease, as discussed by Dr. Brownstein an International Thyroid specialist. Brownstein believes that the rise in Hashimoto’s and Graves disease is attributed to Iodine deficiency. With Hashimoto’s and Graves, adequate iodine/iodide must be administered to saturate and iodinate the lipids. It is important to note that along with the Iodine/iodide it may be necessary to address the co-factors Vitamins B2 (riboflavin) and B3 (niacin). According to Dr. G Abraham, the addition of B2 and B3 will stimulate ATP output. In the management of a patients health vitamin C, magnesium ,  Selenium and zinc are also required in therapeutic doses. Finally, the major toxic halides that prevents Iodine/Iodide uptake are Bromine, Chloride & Fluoride so all patients need to check for intake /exposure of these halides and get their levels tested before taking anything or starting a treatment.

 

(The guidelines above come from Dr. David Brownstein’s book “Iodine-Why you need it, why you cannot live without it” 4th edition)
Specialist in thyroid health such as Dr. Brownstein and Dr. John Hart in Sydney have recommended levels Vitamin D levels >150. From a thyroid perspective Vitamin D is essential for the communication between thyroid hormones and cells. Even if everything else is working perfectly (and it rarely is!) if the patient is Vitamin D deficient then the thyroid hormone is not being recognized by the body, and is less effective. Vitamin D levels need to high for our antibody patients as it’s essential for immune system regulation, so ask one of our practitioners what would be a good results or a good daily dose for you.

 

 

heart stethascopePositive Conclusions

If hyperthyroidism is left untreated or is improperly treated, it may eventually lead to complications such as atrial fibrillation, congestive heart failure, miscarriage and osteoporosis (due to rapid calcium loss from the bones) (xiii).

There are many natural therapies options available to support Hyperthyroidism and Graves Disease. It is important to seek appropriate treatment and rest as much as possible to maximize the chance for a return to optimal health. Optimizing and regulating Thyroid health leads to a reduction of symptoms for quality of life and disease prevention.

 

 

ABOUT THE AUTHORS:

 

Bree Ponton, Gold Coast The Lucy Rose Clinic

Naturopath Bree Ponton,  The Lucy Rose Clinic Gold Coast

Bree Ponton

Bachelor of Health Science (Naturopathy)

Throughout her life, Bree became progressively more interested in health. More importantly, however, her opinion of the definition of true health has changed.

After beginning a career in personal training, Bree quickly grew tired of the predominantly superficial nature of the industry. Her understanding of the value and significance of having a balance within all aspects of health and hormones developed rapidly, and she began studying Naturopathy. During the years at university Bree experienced a dramatic journey, growing and changing into an health professional with a passion for her career in the health industry and hormonal health.

 

Naturopath Kimberly Orbons, Adelaide, The Lucy Rose Clinic

Naturopath Kimberly Orbons, The Lucy Rose Clinic Adelaide

Kimberly Orbons 

Adv Dip Naturopathy, Adv Dip Western Herbal Medicine

Head Naturopath Kimberly Orbons is passionate about encouraging and empowering each person to facilitate their own good health with Nutrition, Herbal Medicine and preventative lifestyle management. Using a combination of diagnostics and symptomatology to identify the different metabolic processes contributing to disease allows her to treat the root or cause of poor health, providing relief of symptoms and long term recovery.

Kimberly believes it is extremely important to build a personalized healing plan, taking all the complexities of a patient’s health and illness into consideration. Her consults have a strong focus on client care and treating each patient as an individual, and may therefore co-ordinate with other medical treatments. The goal is to establish each patient’s ability to live in the best possible state of health, naturally. Her mentors in clinical practice include Founder Lucy Herron, Dr. David Brownstein, Naturopath Angela Hywood and Dr. Sarah Wine. Since achieving her qualifications in 2007 she has extensive clinical experience, and also 3 years managing the natural health sections and seminar within pharmacy.

Kimberly works closely with our CEO Lizzy Herron and our Naturopathic Consultant Mandi White and all The Lucy Rose clinical staff to ensure our patients are provided with the best and most up to date health services and quality health advice. She has actively contributed to our online media, patient guidelines, patient support and informational services for the past 3 years and enjoys providing excellent free to access health data to patients across Australia daily.

REFERENCES & RECOMMENDED READING

Dr. David Brownstein’s book “Iodine-Why you need it, why you cannot live without it” 4th edition
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.
i Wikipedia 2016, Hyperthyroidism. Available from: https://en.wikipedia.org/wiki/Hyperthyroidism . [22 June 2016].
ii Gilbert, J 2012, ‘Thyroid and Menopause’, British Thyroid Foundation. Available from: http://www.btf-thyroid.org/information/articles/107thyroid-and-menopause . [23 June 2016

iii Gilbert, J 2012, ‘Thyroid and Menopause’, British Thyroid Foundation. Available from: http://www.btf-thyroid.org/information/articles/107thyroid-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/gravesdisease-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-hashimotosthyroiditis/ . [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-thyroidhyperthyroidism?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].

HYPERTHYROIDISM & GRAVES TESTING & TREATMENT

HYPERTHYROIDISM & GRAVES TESTING & TREATMENT