Published August 25 2014
For those who have a hyperthyroid condition it is common to have cardiac symptoms such as an elevated pulse rate and heart palpitations. I had both of these symptoms when I was diagnosed with Graves’ Disease, and I was foolish enough to let them go unmanaged for a few months before choosing to take a natural approach. Many people are in a similar situation, as they know they need to do something to manage the symptoms while trying to address the cause of the problem, but they can’t decide whether or not to take medication, or to choose supplements and herbs to manage the hyperthyroid symptoms. The goal of this article is to provide some information which hopefully will make your decision easier.
While many people with hyperthyroid conditions who are reading this are already taking medication or herbs to manage the cardiac symptoms, for those who aren’t doing so, I want to quickly discuss why it’s important to manage these symptoms in hyperthyroidism and Graves’ Disease. As you probably already know, a high pulse rate means that the heart is working faster. And while it’s fine for this to happen for short periods of time (i.e. while doing aerobic exercise), you do not want your heart rate to be beating rapidly 24 hours per day for many weeks or months. Although having a myocardial infarction (heart attack) in people with hyperthyroidism is rare (1) [1] (2) [2], it still is a risk. In addition, atrial fibrillation is common in people with hyperthyroid conditions, as it occurs in 10 – 15% of patients with hyperthyroidism (3) [3] (4) [4]. Unmanaged hyperthyroidism also increases the risk of thyroid storm (5) [5] (6) [6]. Speaking of which, in the past I wrote a brief article entitled “Thyroid Storm and Natural Hyperthyroid Treatment Methods [7]“.
So hopefully you understand the risks associated with unmanaged hyperthyroidism. I realize that many people reading this already are well aware of the risks, but others don’t realize how important it is to get the cardiac symptoms under control quickly. What I’d like to do now is discuss the pros and cons of managing the symptoms with prescription drugs and herbs.
Managing the Hyperthyroid Symptoms With Prescription Drugs
There are essentially two different types of medication used by medical doctors to manage the symptoms of hyperthyroidism. Antithyroid drugs (also known as thionamides) such as methimazole, carbimazole, and propylthiouracil (PTU) are commonly used. All antithyroid drugs prevent the formation of thyroid hormone by inhibiting the organification of iodine to tyrosine residues in thyroglobulin and the coupling of iodotyrosines (7) [8]. PTU also inhibits the conversion of T4 to T3 (7) [8].
Beta blockers are also commonly recommended to people with hyperthyroidism and Graves’ Disease. Propranolol is the most common beta blocker recommended to people with these conditions, although others are commonly used as well such as metoprolol and atenolol. Both propranolol and atenolol were found to be equally effective in one clinical trial (8) [9], although another study comparing propranolol and metroprolol showed that while both were effective in managing the symptoms of hyperthyroidism, propranolol caused a highly significant increase in serum reverse T3 concentrations (9) [10].
Benefits of Antithyroid Drugs and Beta Blockers
Without question the main benefit of taking prescription drugs is that they are more potent than nutritional supplements and herbs when it comes to managing the hyperthyroid symptoms. Although the herbs bugleweed and motherwort effectively managed the cardiac symptoms when I was diagnosed with Graves’ Disease, and also do a great job of managing the symptoms with many of my patients, for some people the herbs aren’t potent enough to manage the symptoms. Plus, typically the drugs will also work faster than taking bugleweed, motherwort, L-carnitine, or other herbs/supplements.
The Risks of Taking Antithyroid Drugs and Beta Blockers
There are a few risks when it comes to taking prescription medication. First of all, side effects are much more common when taking either antithyroid medication or beta blockers. In fact, while many of my patients take prescription medication to temporarily manage the hyperthyroid symptoms and do fine, it’s not uncommon to work with a patient who can’t tolerate the antithyroid medication and/or beta blockers.
Common side effects of Tapazole (Methimazole) include stomach upset, nausea, vomiting, and a mild rash/itching (10). Other symptoms include headaches, dizziness, muscle or joint pain, swelling, and hair loss (10) [11]. PTU can cause some of the same side effects (11) [11]. Beta blockers also can cause numerous side effects. For example, some of the common side effects of propranolol include vomiting, diarrhea, constipation, stomach cramps, rashes, fatigue, dizziness, impotence, and sleeping problems (12) [12].
But the concern with taking antithyroid medication doesn’t just have to do with the side effects. Numerous studies have shown that all types of antithyroid medication can cause damage to the liver (13) [13] (14) [14] (15) [14] (16) [15]. This doesn’t mean that people shouldn’t take antithyroid medication, but those that do should have the liver enzymes monitored regularly by their medical doctor. PTU seems to be more toxic to the liver (17) [13], which is one reason why other antithyroid drugs such as methimazole are usually recommended first. In addition, when comparing the efficacy of PTU and methimazole it was shown that methimazole was much more effective in managing hyperthyroidism (18) [16]. However, since methimazole has been considered to have clearer evidence of teratogenicity (producing fetal malformation) than PTU (19) [17] (20) [18], the latter is typically recommended during the first trimester of pregnancy.
In an article I wrote entitled “Milk Thistle and Thyroid Health”, I wrote about the hepatoprotective benefits of this herb. As a result, if someone is taking antithyroid medication they might want to consider taking milk thistle to help protect the liver. And for those who might be leaning towards receiving radioactive iodine after reading the information in this article, just remember that there are risks with receiving radioactive iodine (RAI) as well. One study involving 239 patients with hyperthyroidism showed that long term treatment with methimazole was superior to RAI (21) [19], and while RAI is commonly recommended as a primary treatment for hyperthyroidism and Graves’ Disease by endocrinologists who practice in the United States, in other countries it is very common for medical doctors to do everything they can to try to have the patients preserve the health of their thyroid gland.
What are the risks of taking beta blockers? Well, in addition to some of the common side effects I listed above, one has to be aware of drug-nutrient interactions. Truth to be told, not all drug-nutrient interactions are known, but it is known that certain beta blockers such as propranolol can cause decreased levels of coenzyme Q10 (22) [20] (23) [21]. Fortunately beta blockers don’t seem to have the same toxicity to the liver as antithyroid medication. However, you never want to abruptly stop taking beta blockers, as this can lead to cardiac problems, and in some cases even a heart attack. And so your medical doctor should slowly wean you off of this medication.
Benefits of Taking Supplements and Herbs
Of course the main benefit of taking herbs and nutrients such as bugleweed, motherwort, lemon balm, and L-carnitine is that side effects are rare. While some people find the taste of the liquid herbs to be unpleasant, most people don’t experience side effects when taking them. With that being said, a small percentage of people are sensitive to certain herbs such as bugleweed and motherwort, and so this can cause symptoms. Recently I encountered one person who had an allergic reaction to bugleweed and therefore had to stop taking this. But once again, this isn’t common. Another benefit is that these supplements and herbs usually don’t cause elevated liver enzymes, which is common with antithyroid medication. Elevated liver enzymes is indicative of damage to the cells of the liver.
The Risks of Taking Supplements and Herbs
As I mentioned earlier, one of the main risks of trying to manage your symptoms with supplements and herbs is that in some people they aren’t potent enough. And this doesn’t always correlate with the severity of the condition. For example, I’ve seen some people with extremely elevated thyroid hormone levels do great on bugleweed and/or L-carnitine, whereas others whose levels were not as high didn’t do as well. Similarly, one can’t just go by how high of a pulse rate they have, as I’ve worked with patients who had a heart rate that was greater than 120 beats per minute and were able to normalize these levels with the bugleweed and/or L-carnitine. On the other hand, I’ve had patients with a pulse rate of 90 beats per minute who didn’t respond to bugleweed or L-carnitine. And so it can be challenging to predict who will respond to these herbs.
What Should YOU Do to Manage YOUR Hyperthyroid Symptoms?
Of course it is ultimately up to you as to whether to take prescription medication to manage the hyperthyroid symptoms, or instead to take a natural approach. When I work with someone who has hyperthyroidism or Graves’ Disease, if they are already taking medication and aren’t experiencing any side effects then usually I will advise them to continue taking it…unless if they prefer not to take the drugs. On the other hand, if someone isn’t doing anything to manage their hyperthyroid symptoms I will give them the different options they have, and frequently they will give the natural approach a try. But it does depend on the situation, as if someone has an extremely high pulse rate then it might be a good idea to take the medication to manage the symptoms. Just keep in mind that both medications such as antithyroid drugs as beta blockers, as well as supplements and herbs such as L-carnitine, bugleweed, and motherwort don’t do anything to address the underlying cause of the condition. The obvious goal of following a natural treatment protocol is to restore the health of the person so they won’t need to rely on the medication or herbs. But in the meantime it is important to effectively manage the hyperthyroid symptoms.
In summary, it’s important for people with hyperthyroidism and Graves’ Disease who are experiencing a high pulse rate and/or palpitations to manage these symptoms. They can do this either by taking antithyroid medication and/or beta blockers, or they can choose to manage their symptoms naturally with L-carnitine, bugleweed, and/or motherwort. Although natural treatment methods aren’t just about symptom management, there are risks with unmanaged hyperthyroidism, and as a result, while restoring one’s health back to normal it is important to keep the cardiac symptoms under control.