In this Q&A episode, Dr. Eric Osansky answers listener questions specifically focused on hyperthyroidism, including Graves’ disease, toxic multinodular goiter, thyroid eye disease, and subacute thyroiditis. He starts by discussing the transition from methimazole to natural agents such as bugleweed, why there isn’t a single protocol that works for everyone, and the importance of managing elevated thyroid hormone levels while simultaneously working to restore underlying health.
Dr. Eric tackles a wide range of practical concerns, including methimazole dosing and long-term use, lowering Graves’ antibodies, exercising with hyperthyroidism, nervous system dysregulation, block-and-replace therapy, Graves’-related anxiety, and natural and conventional approaches to thyroid eye disease and double vision. He also discusses muscle weakness, thyroid nodules, berberine, and why having one autoimmune condition such as Graves’ can increase susceptibility to developing another autoimmune condition. Throughout the episode, he repeatedly returns to the importance of identifying and removing triggers, healing the gut, supporting immune health, and recognizing that supplements alone aren’t a substitute for addressing the underlying factors contributing to autoimmunity.
Most importantly, Dr. Eric emphasizes balancing the risks and benefits of conventional and natural approaches rather than viewing them as mutually exclusive. Managing hyperthyroidism safely is important, but the long-term goal is to improve overall health and, when possible, achieve remission rather than simply control thyroid hormone levels indefinitely. If you want practical answers to common hyperthyroid and Graves’ disease questions, you’ll get a lot out of this episode.
Click Here to listen to it on the Save My Thyroid podcast
Dr. Eric Osansky:
In this episode, I am going to answer multiple questions related to hyperthyroidism. While I wish I could answer all of the questions sent to me, I choose questions that I think can benefit a lot of people.
Since there were so many questions, I’ve decided to do this in two parts. As the previous episode focused on hypothyroidism, Hashimoto’s, and other more general thyroid-related questions, in this episode, I will answer questions related to hyperthyroidism, including Graves’, toxic multinodular goiter, and other hyperthyroid-related questions.
Let’s get started.
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I am currently taking methimazole. I would like to transition to your protocol. How should I go about it?
It’s a simple question. I get a lot of questions that are similar to this. There is not one protocol that I have for everyone with hyperthyroidism. John is taking methimazole, so it sounds like John might want to switch to a more natural way of managing symptoms. That might be what John means by “protocol.” Maybe he is not really talking about a full-blown protocol for restoring his health. Maybe he is. He might just be also referring to getting to the point where he’s not taking the methimazole.
I can’t tell anybody here to stop taking methimazole, to start taking bugleweed. I will say when someone is taking antithyroid medication and is interested in making the transition to bugleweed, I can’t tell them to stop taking methimazole and to take bugleweed. I wouldn’t say that even if I could do that. Bugleweed, L-carnitine, the natural agents aren’t effective in everyone.
Usually, if I’m working with someone one-on-one, what I would do is tell them to continue taking the antithyroid medication and add bugleweed. The dosing depends on the person. It also depends on the bugleweed. It depends on the thyroid numbers. There are a number of factors to look at. There is a podcast episode, “How Much Bugleweed Should I Take?” You can visit the website and search for “bugleweed” and check out that episode.
Once someone is on methimazole and bugleweed, as the numbers improve, as the numbers go a little bit hypo, the prescribing doctor, typically an endocrinologist, will reduce the dose of methimazole. The person will want to stay on the same dose of the natural agent and continue that pattern until the prescribing doctor keeps on reducing the dose of methimazole, and the person is now relying on let’s say bugleweed, not the methimazole. Eventually, as your health improves, the goal would be to also get off the bugleweed.
I took bugleweed for nine months, 2008 into 2009. I haven’t taken it since 2009. It’s a common question. People ask me if I’m still taking bugleweed. I haven’t taken bugleweed since 2009. The goal is not to be on bugleweed long-term. Some people are definitely on it longer than nine months. The goal isn’t to be on bugleweed permanently.
As far as protocol to restore your health, I definitely would recommend other podcast episodes. I also have books related to hyperthyroidism, Natural Treatment Solutions for Hyperthyroidism and Graves’, which is in its third edition; as well as The Hyperthyroid Healing Diet.
I have been told my hyperthyroidism is viral, silent, subacute. Can you explain this in more detail, including how to prevent it in the future and whether it can eventually result in autoimmune thyroid disorders?
It sounds like Mel has what’s called subacute thyroiditis, which is usually caused by a virus and is usually transient. It usually lasts a few months. Many of these people will become hypothyroid. Many times, that’s temporary, and the person eventually will have normal thyroid hormone levels.
Not everybody will follow that pattern. Some people will be hypo and stay hypo because there will be damage to the thyroid gland. Depending on how much damage takes place, I wouldn’t say it’s always permanent, but someone could have it for quite a long time.
It is possible to get multiple bouts of subacute thyroiditis. It’s viral. If you have it one time, you could definitely have it again in the future. The goal is to optimize your immune system. A lot of what I talk about when it comes to Graves’ also applies to subacute thyroiditis. The difference is with Graves’, it’s autoimmune, and with subacute thyroiditis, it’s not.
Can it eventually result in autoimmune thyroid disorders? Can subacute thyroiditis transition to Graves’ or Hashimoto’s? It typically does not do that. Someone who has subacute thyroiditis might have the genetics for Graves’ and Hashimoto’s. Viruses are potential triggers, like EBV, for example. It’s not impossible, but usually, in most cases, someone who has subacute thyroiditis won’t switch over to Graves’ or Hashimoto’s.
I’ve been diagnosed hyperthyroidism. Due to the drastic loss of weight, I’m not able to sleep. After two months of taking methimazole, 10mg, three times a day, my lab results still didn’t show any improvement.
Her primary doctor increased the dosage to 20mg for another three months. 20mg, three times a day, that’s a lot, 60mg a day.
I started taking it, but I’m still thinking about any possible side effects. I need your advice.
Everything is risk versus benefit. For many people, 10mg three times a day, 30mg a day total, would be plenty. Some people only need 10mg a day or 5mg a day. Others need 20mg. Some people certainly do need more than 30mg. Everybody is different. 60mg is extremely high, but I understand the recommendation. If you were taking 30mg a day in divided doses, and you weren’t getting results, then I can understand your doctor getting more aggressive.
As far as side effects, obviously, you want the practitioner to monitor your liver enzymes. They can do that just through a liver panel, hepatic panel, or CMP that looks at AST and ALT.
Alkaline phosphatase is more specific to the bone turnover when it comes to hyperthyroidism. I am briefly bringing that up because a lot of people asked about alkaline phosphatase. I do have a separate episode on that. When it’s elevated, it’s usually more related to bone turnover than liver.
AST and ALT are what you want to look at. There is a marker, GGT, that I like to look at, but you have to order that separately.
Looking at a CBC with differential to make sure the white blood cell count isn’t depressed. Those are some of the signs on a blood test you’d want to look for.
Of course, there are other concerns and risks. You might become hypo on such a high dose. If that’s the case, the doctor would reduce the dosage to 40-50mg per day. A lot of potential side effects with methimazole. Doesn’t mean you shouldn’t take it. Some people do need it. Different people have different side effects. It could cause skin reactions, headaches. You could easily do a search. Visit Drugs.com or other websites that are reputable and look at some of the side effects of methimazole.
Without question, there is a greater risk of stress on the liver with a higher dose. Everything comes down to risk versus benefits. Not everybody who takes methimazole, even higher doses, will have elevated liver enzymes. It’s just something to consider.
It’s tough when you’re taking a higher dose. 30mg is not a crazy high dose, but it’s not low. Your lab results aren’t showing any improvement. Your doctor essentially doubles the dosage. If you do continue taking it, hopefully that does help. Hopefully, you’re also doing things to address the cause of the problem while taking the methimazole.
I was diagnosed with Graves’ and TED (thyroid eye disease) in May. I have had double vision since the last few days of 2025. My right eye dropped in March and remains lower than normal. My TED ophthalmologist says I can have surgery to realign the right eye when Graves’ goes into remission, which he said has a time frame of 18 months to three years.
What can be done to lower the Graves’ antibodies, which I assume are causing the TED? I have started the AIP diet. I had a bad case of EBV in 2018. I have occasional flares. I am guessing it might be a trigger. Otherwise, I have not identified another trigger yet. Any insight you can lend is appreciated. I’ll do everything I can to hasten remission, so I can have surgery sooner to fix my double vision.
Debbie is looking to get the surgery for the double vision, but in order to do that, the doctor is saying that Graves’ needs to go into remission. Essentially, she wants to know what she can do to lower thyroid antibodies. I think there is another double vision question later about what can someone do. Are there things someone can do naturally for double vision? I’ll wait for that question because that is also a common question.
When it comes to lowering the Graves’ antibodies, I have a number of different episodes and articles on my Substack newsletter. You can subscribe by visiting Substack.com and searching for my name. I also created a shortcut, SaveMyThyroid.com/GravesNewsletter. I have a specific article on how to lower Graves’ antibodies.
It really all comes down to finding and removing triggers. There are different types of triggers. You could have food triggers such as gluten. Stress could be a trigger. Infections, toxins and toxicants. You want to do things to heal the gut.
I would go ahead and listen to some of the podcast episodes and/or read that article on Substack about lowering Graves’ antibodies. Of course, I talk about that in my books as well, Natural Treatment Solutions for Hyperthyroidism and Graves’ Disease, 3rd edition preferably, or The Hyperthyroid Healing Diet, which focuses more on using diet and lifestyle to heal Graves’.
It’s not easy necessarily to lower and normalize Graves’ antibodies, but it’s definitely possible to do that. There are other ways to try to do it more quickly, not necessarily getting into remission, but using things like LDN to modulate the immune system. That doesn’t work in everybody. Sometimes, someone could take that and within a few months might have normal antibodies. That might allow you to get the surgery sooner, if that’s what you choose to do.
LDN doesn’t work in everybody, and it’s not addressing the cause of the problem. When you try to address the cause of the problem, it will take longer than a few months to lower and normalize those thyroid antibodies.
Like I said, I have a lot of episodes. I have a six-part podcast series about a year and a half old, but the information is still relevant. I discuss in six parts how to lower thyroid antibodies. It’s six parts because it’s not easy. I dedicate an episode to a trigger, one on food, one on stress, one on chemicals, one on infections, one on healing the gut, and an overview. If you really want a comprehensive overview of lowering thyroid antibodies, I would check out that six-part series. If you want something quicker, I have single episodes on lowering antibodies, too. Also, that Substack article.
I am a newly diagnosed Graves’ patient. Looking back, I can say I’ve had Graves’ symptoms since September of last year. I love to lift weights, go to yoga, and walk my dog. Since my diagnosis, I have not been able to do any of those things. My nervous system goes through the roof any time I do. I live in Phoenix, so the heat adds another element. I’m on methimazole, and we’re still trying to get my dosage adjusted to my needs. I’m feeling very down lately because I can’t do the things I love anymore. Do you have any suggestions for someone like me?
You want to get your thyroid under control. You’re working on that with the medication, so that’s one thing.
You have mentioned that your nervous system goes through the roof any time you do exercise. When someone is dealing with hyperthyroidism, whether it’s Graves’ or a different type of hyperthyroidism, you do want to be careful with working out. It doesn’t mean that you can’t work out at all. If it’s unmanaged hyperthyroidism, and you have elevated resting heart rate, you want to be more cautious. Assuming the hyperthyroidism is managed, most people can walk, and most people can do mind/body meditation such as yoga. Weightlifting is also fine as long as someone is not going to extreme with any of these.
You mentioned specifically that your nervous system goes through the roof any time you try to do these. In addition to trying to get your thyroid under control, I would work on your nervous system. You said that you can’t even do yoga, even though yoga is a type of mind/body medicine. Maybe that’s not a good fit for you at this time.
You might want to start out by doing some vagus nerve exercises. I’m not sure if I have a podcast episode on vagus nerve exercises. I might. The podcast is now about five years old, so I don’t remember every single episode. I know that as of recording this, I also did some interviews with practitioners who talk about regulating the nervous system. One is Dr. Tricia Pingle, who by the time this episode comes out, the one with Dr. Pingle will be out. Dr Roseann Capanna is also another interview; that one won’t be released until after this one is released. Those are two episodes you probably want to listen to.
On my website NaturalEndocrineSolutions.com, if you search “vagus nerve” there, you will see an article on vagus nerve exercises, like vigorous gargling, cold showers or plunges, humming, singing out loud. Some of these sound silly, but they do activate the nervous system.
Some people need to go beyond the vagus nerve exercises. That’s where Dr. Tricia Pingle or Dr. Roseann can potentially help. There are companies like Primal Trust or the Gupta Method. There are others that help with nervous system regulation. It sounds like that’s what you might need to focus on for a few weeks or even a few months.
I know it’s frustrating. I enjoy working out and walking, lifting weights. I don’t do yoga, but the lifting weights and walking, I do quite frequently and other things from an exercise standpoint. It would be frustrating to me if I couldn’t do any of these things.
If your hyperthyroidism is under control with the methimazole, and it might not be there yet, and if it’s not, once it is under control, that very well might help. If that’s not the case, it sounds like you might have to do some more things for your vagus nerve.
How long can I stay on low dose methimazole, 5mg per week, without damaging my body? I seem to have reached a roadblock that I can’t seem to overcome. My endocrinologist is ready to cut out my thyroid if I give in.
We don’t want that. 5mg per week is a really low dose. Even 5mg per day is a low dose. I do have a podcast episode, I forget the exact title, but it’s along the lines of how long can I continue or stay on antithyroid medication. In the article, I talk about the research. There are at least five articles I reference in that podcast episode, where taking low dose methimazole, let’s say 5mg or 10mg daily for many years seems to be safe.
It depends on the person. Obviously, if someone is reacting to methimazole, then it’s not a good fit to be on there for a long time, or even a short time if it’s elevating liver enzymes, lowering white blood cell count, or causing other symptoms.
If someone is tolerating it well, there are people who have been on methimazole for 10-15 years or longer. These are research studies that have looked at this. This is not an ideal situation of course. We would want someone to get to the point where they don’t need the methimazole. If it’s a choice between being on 5mg of methimazole per week, even if that’s for many years to come, and saving your thyroid, or even 5mg of methimazole per day. If the person is tolerating it well, if it were me, I’d rather be on that and keep my thyroid. Of course, I would continue to work on restoring my health and trying to overcome that roadblock.
I am one of the people who have gone from hypo to hyper several times now. Right now, after being on just 2.5mg of methimazole, I am super hypo again. How does add back work? Is it worth trying? Can it be done with natural desiccated thyroid?
It sounds like you’re asking about block and replace therapy. I’ll finish this and explain what this is.
I wanted only to do natural ways for the thyroid, but bugleweed and lemon balm did not work out. No luck with finding an endocrinologist who will consider outside the box options. I can’t afford to work with you right now.
Block and replace therapy is when someone is hyper, and then they take methimazole. Even lower doses cause hypothyroidism. It’s a catch-22. If they don’t stay on methimazole, they become hyper. If they go on methimazole, they are hypo.
Block and replace therapy involves adding a small amount of thyroid hormone. This person would be taking 2.5mg of methimazole. That usually makes her super hypo. The thyroid hormone level sounds low, and TSH is high. She would be adding some thyroid hormone replacement. That would help to counteract the hypothyroidism.
Obviously, it’s not addressing the cause of the problem, but it’s helping manage the symptoms while trying to restore one’s health. It’s more commonly done in other countries. Not as common in the U.S. I’m pretty sure I have a podcast episode and a blog post on this topic. You can listen to that.
I interviewed Dr. Angela Mazza recently. She wasn’t a big fan of block and replace therapy. It doesn’t mean that it’s not an option in some cases. There are others who are big fans of block and replace therapy.
Can it be done with natural desiccated thyroid? Theoretically, it can. Usually, finding a doctor who recommends block and replace therapy is not easy. I don’t know any who will recommend desiccated thyroid or will allow you to take desiccated thyroid. They most likely would recommend levothyroxine. Then you’d have to talk them into prescribing desiccated thyroid. They most likely don’t have experience. There might be someone out there who does have experience, but I’m not aware of who that person might be.
What is the best way to calm Graves’-related anxiety?
The best way is to address the Graves’. Even before addressing the cause of the Graves’, lowering the thyroid hormone levels, even if it’s through antithyroid medication or preferably someone can do it naturally through bugleweed, the hyperthyroidism definitely can cause anxiety. So can the inflammation associated with Graves’, which can take more time to address. Those are the two best ways.
One is to balance the thyroid hormone levels and address the autoimmune component of Graves’, which will help with the inflammation. Balancing the thyroid hormones is usually a much quicker process. That might by itself help with the anxiety. If you’re still experiencing symptoms, then you might want to- It’s not that you might want to. In my opinion, you definitely want to address the autoimmune component of Graves’. It will just take more time to do that.
It seems to me this organ’s abnormalities appears to be, I can only say vague. The one drug use to treat hyper and the opposite hypo is strange to me. Let me know if this is wrong. The only drug simply restricts the production or encourages hormone production. A magic pill. Any studies that compare treatment with no treatment? Any studies looking at side effects? I’m guessing there are not any available. In your experience, has non-treatment led to Graves’?
It’s not a magic pill. There is a time and place for both antithyroid medication and thyroid hormone replacement. Unmanaged hyperthyroidism or hypothyroidism is not something to take lightly. I am not saying everybody needs to be on medication. I took bugleweed. I avoided medication. Not everybody is able to do that. Especially if someone has really high or low thyroid hormone levels, you don’t want to take that lightly.
That doesn’t mean non-treatment will lead to Graves’. If someone has a non-autoimmune hyperthyroid condition, and they don’t treat it, it won’t lead to Graves’. If you have elevated thyroid hormone levels, it could affect the heart, bone density, not to mention all the symptoms someone could potentially have with that.
There are studies that look at side effects with treatment and without treatment. Not as much with thyroid hormone replacement although it’s not like that’s completely harmless. Definitely more concerns with antithyroid medication, it seems, like methimazole, PTU, carbimazole.
In my opinion, the risks of unmanaged hyperthyroidism are greater than the risks of managing it with medication. If someone is not tolerating the medication, the prescribing doctor will find out relatively quickly. The person will find out relatively quickly. It depends. If the person is experiencing certain symptoms, they will know before the doctor. If it’s liver enzymes or white blood cell count that’s being affected, you’ll have to wait until the next blood test.
There is of course risks and benefits to both. That’s why you want to try to keep an open mind. I didn’t take the medication when I was dealing with Graves’, but I would have if I had to. If the bugleweed didn’t work, I wasn’t completely opposed to taking antithyroid medication.
Perhaps some methods, treatment, or supplements for TED? What can one do about double vision? Prism glasses are an option of course, but is there something better?
I have a number of episodes on TED. Double vision can be challenging to treat naturally. It doesn’t mean that a natural approach can’t help, but it doesn’t always help. That’s true with any treatment, whether it’s natural or conventional. Nothing is 100% effective. I will say double vision is more challenging with a natural approach.
Remember, TED, like Graves’, is an autoimmune condition. It’s when the immune system attacks the tissues of the eyes. If someone is dealing with Graves’ and/or TED, you still want to find and remove triggers and heal the gut.
There are supplements. I have a TED Bundle. I think the website is TEDBundle.com. With that, it has selenium, which you can take on its own without the bundle. It also has a product, SMT-BerbALA, which has berberine and alpha lipoic acid. Both have been shown to help with TED. There is another product, SMT-Immune, which helps modulate the immune system and reduce inflammation. That in some people helps greatly. It’s not addressing the cause of the problem.
I would not recommend for someone to take my TED Bundle indefinitely. You still want to find and remove triggers. Usually, you’re doing that through things like an elimination diet, managing stress, doing some functional medicine testing. This relates to the lowering antibodies question. Any of those episodes will also benefit you because that’s what we’re trying to do: optimize the immune system.
With double vision, there is a time and place for conventional treatment. Of course, I will be a little biased and try to address the cause of the problem. Tepezza is not a natural treatment, but it is more effective for the bulging than the double vision. I haven’t had a lot of people on Tepezza, but I have had a couple where it didn’t help with double vision but did help with bulging. I have had others take it for just bulging. There are side effects with Tepezza, like hearing loss and tinnitus.
I am taking 2.5mg of methimazole every day. Is it okay to take herbs for my liver and my thyroid? Liver Detox and Thyroid Calming from Herb Pharm.
I can’t specifically give recommendations, but I can say I work with a lot of people who take methimazole and also take herbs to support liver and thyroid. If you’re taking bugleweed and methimazole at the same time, you want to be aware that if you’re taking bugleweed, if it’s doing what it’s supposed to do, which it doesn’t with everybody, but if it is effective, then your thyroid hormone levels will lower. Then you might need less methimazole. That’s not a bad thing. Most people are happy with that. You want to make sure you get regular thyroid panels to keep up with that.
I do have a question about my own experience with Graves’. I don’t hear about this issue linked to Graves’ but wonder if it’s something you’re familiar with. When I was diagnosed many years ago, I presented with the usual symptoms but also with severe weakness in my quadriceps in both legs. Although I responded quite quickly after treatment with PTU, the quad weakness has persisted and worsened, making everyday movements difficult. On a neurological exam, myopathy was diagnosed, but no source could be identified. Because this myopathy seems to have been timed so clearly with my Graves’ diagnosis, I wonder if it is related and if you know anything that might improve it. Targeted exercises don’t make much of a difference.
It sounds like you took the PTU, so I’m guessing the thyroid hormone levels are in balance. That’s the first thing: making sure the thyroid hormones are in balance. I am pretty sure I have a separate episode talking about muscle weakness and loss of muscle mass, which are very common with hyperthyroidism and Graves’. If someone is experiencing this, the first thing you want to do is balance the thyroid hormones. Once they are balanced, then resistance exercise will make a greater difference.
If someone is currently hyper, the resistance exercise is not going to hurt necessarily, but it’s not going to help as much as if the thyroid hormone levels were in balance. If your thyroid hormone levels were already in balance from the PTU, it seems like there’s something else.
Could the inflammation associated with Graves’ be a factor? Potentially. I can’t say that everybody with Graves’ has a myopathy. There are a number of things that could cause a myopathy. You would hope the MD would look at some other medical causes.
What I’m trying to say is there are underlying causes, things like Lyme, other infections that they probably wouldn’t look at on a neurological exam or other autoimmune conditions potentially. That’s always a potential concern. When looking at that, I’d also think out of the box. Is there Lyme? Is there bartonella? Is there mold? Those are things that most conventional medical doctors will overlook. Those could be triggers for Graves’.
When you say it’s at the same time that the Graves’ was diagnosed, it could be possibly related to the Graves’ directly. The Graves’ might be causing the myopathy. It could also be something that triggered the Graves’ is causing the myopathy. Finding and removing the triggers could potentially help. That’s what I would do. Other natural healthcare practitioners, too.
It’s about addressing the cause of the problem. If you are already balancing the thyroid hormones, doing exercises, you’re already doing things that I would recommend. It sounds like you might have to do more detective work.
When your T3, T4, TSH, and antibodies for Graves’ are normal for the first time in a year of treatment, how long should you consider on methimazole or bugleweed? How long does the weaning off usually take?
The weaning off is different for everybody. If someone is taking methimazole or bugleweed, typically, when everything is normal, let’s say someone is taking 5ml of bugleweed twice a day. Reduce the dose in half is what I would recommend if I am working with someone. That’s what I personally did. Now you’re taking 2.5ml twice a day. See what the next thyroid panel looks like. Make sure the antibodies are still negative. Maybe then do 2.5ml once a day. It’s a gradual process.
Once everything is normal, it can take a few months before someone is completely off of everything. It depends. You could try to do it quicker. With the methimazole, same thing. You want to be careful with getting off too quickly.
The key is the antibodies are normal. If the antibodies are normal, not as great of a risk. My guess is you probably are on a lower dose of methimazole. I don’t know if you’re taking methimazole and bugleweed since you brought up both. It could take a few months before the weaning off of either the methimazole or bugleweed takes place.
I was diagnosed in December 2025 with Graves’. I was taking methimazole for six weeks before I was then diagnosed with Hashimoto’s. I have been on 75mcg of levothyroxine for three months. I have been training myself to heal my gut, eat nutrient dense food, get great sleep, and reduce stress. I am wondering if there is a protocol or steps to follow or milestones that need to be achieved, so I can eventually stop taking synthetic drugs and revert to self-management. Is that even possible if I have both antibodies?
Lynn has antibodies for both Graves’ and Hashimoto’s. Now she is more hypothyroid, it sounds like, since she is on 75mcg of levothyroxine.
It is possible. It’s more challenging, in my experience, to get someone off of thyroid hormone replacement compared to antithyroid medication. When you’re on something like levothyroxine or desiccated, that means there is damage taking place to the thyroid gland. It takes time for that thyroid gland to heal. Someone might be on thyroid hormone replacement for many years sometimes. Some people might need to be on it permanently.
My goal is to try to get someone to the point where they don’t need it. I can’t tell someone to stop taking it, but if they are doing regular thyroid panels, and everything looks good, and their prescribing doctor reduces the dose of what they’re taking, if they don’t need it, they don’t need it.
I wouldn’t say it’s too late. I would say it’s possible. It’s going to take time. There is not a set protocol for everybody. If there is a general set protocol, it’s find triggers, heal the gut. The triggers vary from person to person. Healing the gut varies from person to person.
This really all comes down to the immune system. As I mentioned earlier, you might want to listen to the podcast episode on lowering antibodies. Either that six-part series or the article on Substack. A lot of that applies to Hashimoto’s. The six-part series on the podcast is not specific for Graves’; that’s just thyroid antibodies. Honestly, that information would also help with other autoimmune conditions, too, but this podcast is about thyroid.
Can you tell me more about selenium and hyperthyroidism?
Selenium is something I commonly recommend, especially with Graves’, but even if someone has non-autoimmune hyperthyroidism, they usually have oxidative stress. Selenium can help.
If you want to test for selenium, I do a lot of hair testing. It’s not perfect, but I like looking at the selenium levels. If you want to look at it in the blood, there’s RBC selenium.
All of these nutrients are important. When it comes to thyroid health, selenium is one of the more important minerals.
I have recently been diagnosed with Graves’ but have been living with symptoms of thyroid issues since 2009. I am wondering about dry mouth.
Not everybody has a dry mouth. You want to make sure you’re well hydrated, have sufficient omega-3 fatty acids. You can do an omega-3 index test through a company like OmegaQuant. Make sure you are incorporating the basics.
There are other autoimmune conditions such as Sjögren’s syndrome, where you not only have dry mouth but dry mucus membranes. If you have dry eyes, which you don’t, but others may, that’s very common. That doesn’t mean you have Sjögren’s. But if someone has dry eyes, dry mouth, dry mucus membranes, it doesn’t mean you have Sjögren’s, but you could do some testing. You can test for those auto antibodies.
In relation to being overweight with Graves’, I have corrected my diet, tried to exercise daily, done several parasite cleanses. How can I determine the root cause of my disease? I recently read about childhood trauma and Graves’ connections. If this is the trigger, is there a way to overcome Graves’, or is it something I just have to keep fighting?
This is kind of a two-part question. Finding the root cause is about finding triggers. Parasites could be a potential trigger. It’s not perfect for parasites, but with testing, there could be other imbalances. I like to do adrenal testing, sometimes gut-related testing, sometimes mold testing. It really depends.
Doing a health history, I get an idea of what testing to recommend. Sometimes, I need to do additional testing. I don’t do all the necessary tests. With testing, you just don’t know, and the health history is not perfect. I definitely have episodes talking about finding triggers on the podcast.
With the childhood trauma question, if this is the trigger, yeah, you definitely can overcome this. It’s not necessarily easy. Childhood trauma dysregulates the nervous system, so you probably need some vagus nerve exercises and very well might need to go beyond that. Maybe get some brain and nervous system retraining. Maybe some therapy on top of that as well. If it is a trigger, you can overcome this.
I’ve had Dr. Amie Apigian talk about the biology of trauma. I mentioned there will be some other episodes, one that is about to be released. One with Dr. Tricia Pingle. There are episodes on regulating the nervous system, too. Check those out.
How does being on PTU for so long affect your mental health? I have been on PTU for 17 years. I’ve read that long-term use lowers your serotonin. There was a study they did on rats that it changed their brain chemistry. Is this reversible if I start little by little switching from PTU to motherwort?
Honestly, I have not heard of anybody being on PTU for 17 years. The studies I mentioned, there have been a lot of people on methimazole for a long period of time, 15+ years. PTU, not as common.
From my experience working with patients, to be fair, first of all, a lot more of my patients have been on methimazole. I have also worked with Graves’ patients since 2009, so I have had a good amount on PTU. I don’t know if I’ve worked with anybody who’s been on PTU for that long. Honestly, that’s something I haven’t done research on, PTU specifically and mental health. Even lower doses of methimazole long-term do not necessarily have that impact. Methimazole and PTU are not exactly the same. I might honestly need to do some research on this.
I would say chances are, it is reversible. That probably wouldn’t be in the research. If someone is on PTU for a long time, and then they stop it, there is probably nothing out there. I can’t tell you to stop the PTU.
I will say you wouldn’t want to switch from PTU to motherwort because motherwort affects the cardiovascular symptoms. If you were to do that, you would want to look into something like bugleweed or higher amounts of L-carnitine, which I have episodes of my podcast about.
Unfortunately, I don’t recall anybody on PTU that long. If I have had people on PTU that long, then I don’t remember them bringing up cognitive symptoms. I work with a lot of people, so it is possible. I’ll have to do some research on this.
Castor oil is used for Graves’. It’s also something that seems viable for people. It would be good to get more clarity on that, if possible.
I forget her last name because she changed it. Her first name is Carrie. It used to be Vitt. If you visit my website and search “castor oil,” you’ll see that interview. She is definitely a proponent of castor oil packs.
I asked a question about castor oil packs to Dr. Angela Mazza, more specifically for nodules and goiters, not for Graves’. Dr. Mazza didn’t think there was evidence. There really isn’t any research.
My perspective on castor oil packs is that I would have realistic expectations. It’s not going to reverse your Graves’ condition. I would make sure you follow the instructions that Carrie or someone else who is an expert gives when it comes to castor oil packs. She and others recommend using it on the liver first, and then the thyroid.
Remember that Graves’ is more of an immune system condition. When I hear about castor oil packs for the thyroid, it is usually for thyroid swelling or nodules, not necessarily addressing the autoimmune component of Graves’.
Lorene has had hypertension, high blood pressure and Graves’ for about two years. The doctor put her on methimazole, 2.25mg a day. That’s an unusual dose. A low dose of methimazole every day. Changed my diet. No gluten, sugar, dairy, or soy. I take some supplements, as per my functional medicine doctor here in TN. I’m now in remission for four months. The endocrinologist took me off of my meds. My functional medicine doctor agreed.
My recent bloodwork for my TSI [the auto antibodies associated with Graves’] is now .85. All other thyroid bloodwork is perfect. Now my endocrinologist wants me back on methimazole again because the TSI is a little bit above the range. My functional medicine doctor says I’m still in range. I feel great. Should I judge the TSI results to start my meds again?
Tough situation. Most labs will use a range. It depends on the lab. TSI is also a percentage. If the percentage is less than 140%. This is using completely different units of measurement. Most labs would say it should be .55 or less. You’re at .85. You are mildly elevated. It is still a potential risk of being hyperthyroid. I could understand your endocrinologist wanting you to be back on a low dose of methimazole.
I can’t tell you what you should do. Should you be on it? If it were me, I don’t know. I never took methimazole in the first place, so maybe I would go back on bugleweed. Even for someone who was on methimazole, but is no longer, that’s an option, too: to look at bugleweed or L-carnitine and get some guidance from the functional medicine doctor.
As long as someone has elevated thyroid antibodies, even if they’re mildly elevated, there is still a concern of becoming hyper. It doesn’t guarantee you’ll become hyper again, but that is where your endocrinologist is most likely coming from.
I’m not saying not to take the methimazole, but a compromise maybe would be to take something like bugleweed or L-carnitine and then continue to work on your immune system. Maybe do a little bit more than you have in the past. Diets and supplements are great, but many times, we need to go beyond that.
I was diagnosed with toxic nodule hyperthyroidism in 2024, which has been treated with carbimazole. However, I would like to stop the medication eventually. They have told me my only alternative is removal of the thyroid. I wondered if diet alone would help replace the carbimazole. I am currently breastfeeding my seven-month-old. Having a busy lifestyle means I haven’t been having the best of diets and would like to improve this. I haven’t found anything online related to toxic nodule and diet.
I do have some episodes related to toxic multinodular goiter.
Diet alone probably won’t help. You could try. If you don’t have my book The Hyperthyroid Healing Diet, as I mention in the book, many people need to go beyond diet and lifestyle. Doesn’t mean 100% need to.
There is obviously risk of stopping the medication. I can’t tell you to do that. You have to do that on your own. I understand a lot of women who are pregnant or breastfeeding don’t want to take medication. You also have a busy lifestyle. The answer is diet might help replace it, but unlikely.
Bugleweed is a good alternative, but there is no evidence with bugleweed and breastfeeding. I would usually recommend not to take bugleweed when breastfeeding. L-carnitine is probably a safer bet, but the problem is with hyperthyroidism, usually you’re taking higher amounts of L-carnitine, and there is no evidence showing if there is any problems taking 2-4g of L-carnitine for someone who is breastfeeding.
I don’t have a great answer as far as what you should do. Diet alone is unlikely to help. If it does help, you wouldn’t want to stop the carbimazole completely. Let’s say you follow the recommendations in The Hyperthyroid Healing Diet, and things start moving in the right direction. The prescribing doctor should reduce the dose of the carbimazole until you no longer need it. That won’t be a quick process. Unfortunately, I don’t have a quick solution when it comes to this.
I would really like to know how you can find out what keeps antibody levels high in Graves’ and what you can do to lower them.
Check out my podcast on lowering thyroid antibodies and/or my Substack.
I have a question about thyroid nodules, an increasing number, and diffuse Graves’ that only shows on a thyroid scan. Is it necessary to remove the thyroid with nodules and Graves’ to decrease the cancer rate? How might this be treated better without removing the thyroid?
You will get a biased opinion. Everything is risk versus benefit. Not everybody with thyroid nodules needs to get thyroid surgery. The question is why do you have the nodules in the first place and ideally try to address the cause of the thyroid nodules. That being said, if the nodules have certain characteristics, if they’re really large and are solid, that doesn’t mean that they’re malignant, but there is a greater risk of that. You could still monitor the thyroid nodules. Do an ultrasound six months later while trying to address it naturally. I do have some episodes on the podcast about thyroid nodules.
Just like anything else, it does take time to accomplish this. I am not telling you not to get the surgery and treat it naturally. That is a decision you’ll need to make.
Thyroid cancer is not rare; it definitely happens. Most of the people I work with who have thyroid nodules don’t have thyroid cancer. The odds are you probably don’t either, but there is always that risk. Most cases of thyroid cancer are also slow growing, so in most cases, it’s not something you need to address quickly.
There are always exceptions. There are other types of thyroid cancer that are more aggressive. That’s why I don’t feel comfortable telling anybody just to do things naturally, or don’t worry about thyroid cancer. I would say don’t stress about it though.
Check out the podcast episodes on addressing thyroid nodules. Dr. Angela Mazza talks about radiofrequency ablation (RFA), which is not radioactive iodine. This is using frequencies to shrink thyroid nodules. That’s also an option to consider in some cases.
Would berberine be beneficial to Graves’, specifically to help calm down the immune system?
I like berberine. It helps with blood sugar. There are a number of studies showing it can benefit the gut microbiome. There are some studies showing it can help with TED. Like Graves’, TED is autoimmune.
That said, I can’t say I recommend berberine to everybody I work with. I don’t recommend it to most people I work with. There is a time and place. For TED, it is part of my TED Bundle, the SMT-BerbALA that I mentioned earlier has berberine and alpha lipoic acid. If someone has TED, that’s something to consider.
Can someone with Graves’ benefit from SMT-BerbALA? Alpha lipoic acid reduces oxidative stress. They can. There are a lot of beneficial supplements. It all comes down to trying to prioritize which supplements someone needs. There is no shortage of supplements that can help, but it doesn’t mean people need to take all of those supplements. Then they will end up taking 20-30 supplements, which does happen. People who come to see me are already taking that many things because they read about it or watched videos about it or chatted with ChatGPT or another AI program about that.
I like berberine. I just wouldn’t say that everybody with Graves’ needs to take it. You want to find and remove triggers, heal the gut. Berberine is not going to do that.
If you are fluctuating between hyperthyroidism and hypothyroidism, block and replace therapy is not recommended. I have been fluctuating drastically. I’m on methimazole because unfortunately bugleweed did not work for me.
This is the other question on block and replace therapy I was referring to. I think in some cases, it’s worth getting if they are on methimazole and become hypo with even lower doses of methimazole. Then they stop taking it, and they become hyper. Definitely check out the podcast episode on block and replace therapy.
I have TED, and I wonder if you have any particular advice. My Graves’ happened first. The TED alerted me to test for Graves’. The Graves’ is under control now with methimazole, and my TED seems fairly stable. I am reluctant to use meds like prednisone or Tepezza because they have bad side effects. I am following your diet and restricting myself to a healthy regimen. Any advice?
It sounds like you’re doing a great job so far. Continue to work on improving the immune system, which I have spoken about with other questions. I mentioned the TED Bundle. Even besides the supplementation, checking out those episodes on lowering the thyroid antibodies. When talking about lowering antibodies, it’s about improving the immune system because that’s how you lower thyroid antibodies. You want to continue doing things to optimize your immune system.
Can the inflammation on the muscles behind my eyes ever go back to normal? I bought your book where you talk about an anti-inflammatory diet, and I have been following it. My eyes are still bulging. Some days, it seems like they are so out. Even when sleeping, my eyes don’t close enough.
You definitely have a lot of inflammation. Some people I work with can’t close their eyes. Diet alone probably won’t resolve the inflammation. The TED Bundle I mentioned earlier might help. It’s all about finding and removing triggers, which does take time.
Some people of course will resort to things like prednisone and Tepezza, which definitely can help greatly. That’s up to you. There are risks and benefits with both medications.
There is also no guarantee that the natural agents will work, like the TED Bundle. It takes time to find and remove triggers. Depending on the severity, sometimes, the natural approach doesn’t always work or work completely. Someone might still have some mild bulging, for example.
Yours sounds like it’s not mild if you can’t close your eyes completely. It’s up to you what you want to try. There is no perfect answer. The prednisone will work quicker. The Tepezza infusions are every three weeks. You have to get approved. There are side effects to both of those. I have not had a lot of people take Tepezza, but a few people, where it’s greatly helped with their eyes, mainly the bulging, not so much the double vision, as I mentioned earlier. I have also had people take the TED Bundle, and it helped greatly. Doing things to address the cause of the problem while taking that, too. That’s also an option. It’s up to you to decide.
Since my first episode of Graves’ back in 2008, I have cold urticaria and some other skin reactions at times. Also some mysterious gastric episodes that come and go. I have been in remission from Graves’ since 2017 although I have had some persistent low antibodies. Only looking at MCAS and noticed symptoms improve. I generally feel better if I take an antihistamine. Wondering about the connection with my thyroid.
I’ve had a few practitioners, like Dr. Meg Mill and Beth O’Hara, who unfortunately is no longer with us. They talked about histamine and MCAS (mast cell activation syndrome), which can be challenging. I had Dr. Julie Greenberg on the podcast. She is a naturopathic dermatologist.
The #1 thing I would say is gut health. Focus on the gut. Doesn’t mean there can’t be other things. Mold for example and MCAS is huge. Looking at some mold. Stealth infections like Lyme and bartonella can be a factor.
You mentioned some mysterious gastric episodes. Addressing gut health. What is causing gut imbalances? Are there mold and mycotoxins causing the dysbiosis? Do you have SIBO? I wish I could give you a quick an easy answer.
As you know, MCAS, which I don’t know if you have, is complex. Even histamine intolerance without MCAS can be a little complex. If you are not working with someone, even though you’re in remission from Graves’, maybe working with a different health care practitioner on the MCAS and your overall gut health.
Does your thyroid reduce in size once your hyperthyroidism is treated? Does red light therapy help?
Common questions. I get a lot of questions about the red light therapy as well as goiter size. Most times, yeah. I had a mild goiter, and it completely resolved. If someone has a severely enlarged thyroid, so a severe goiter, it might not completely resolve. It depends. If someone has more mild to moderate enlargement of the thyroid, that usually resolves, decreasing and normalizing.
Red light therapy, there isn’t any evidence on red light and hyperthyroidism. Even with hypothyroidism. Just about all the studies look at laser therapy, not red light. I have a red-light unit, so I’m definitely a fan of them. There is nothing specific to hyperthyroidism. The studies that are out there show that laser therapy specifically can help with hypothyroidism and Hashimoto’s. There is nothing that I’m aware of showing that getting a red light panel can help with your thyroid, whether you have hypo or hyper.
Did you taper off bugleweed, or did you stop cold?
I did not just stop cold. When everything looked great, I was taking 5ml twice a day. Then I reduced it to 2.5ml twice a day. Waited until the next thyroid panel, which still looked really good. Ideally, you want it to be a little bit on the hypo side. Even if it’s looking good, as long as it’s not hyper, you don’t want to reduce it. Then I reduced it to 2.5ml twice a day, then 2.5ml once a day. I think I might have then done 2.5ml every other day. It was a gradual process.
She also asked what food I added back in first with the AIP diet. I didn’t follow an AIP diet. I’ve mentioned this. There was no AIP diet back in 2008, so I followed a modified paleo diet. I wasn’t a big egg eater back then, so I wasn’t eating eggs. But I was eating nuts and seeds.
I honestly don’t remember the first food. Was it eggs? It’s not like I loved eggs. For most people, it is eggs. They reintroduce eggs first if they enjoy eating eggs.
What is a good path to take? Any advice of both holistic and western medicine that has helped reduce my thyroid levels to an extent. They are still stuck at a low level, enough to keep me on medication. It just won’t go down anymore. Open to any suggestions. I have a Graves’ diagnosis, and I am at the tail end of my first relapse.
I do have some episodes on roadblocks. If someone is hitting a roadblock, usually you haven’t removed the trigger, or you need to do more detective work to find the trigger. I would work with someone. I know I will be biased because I work with people. I am not saying you need to work with me.
If you have done everything you feel from a diet and lifestyle standpoint, and you have reached a roadblock, if you haven’t done any functional medicine testing, that’s something to look at. If you already have, you might need to dig deeper and do additional testing.
I am more conservative with testing. I don’t have everybody spend thousands of dollars on functional medicine testing. If I recommend a few initial tests, and maybe we don’t find the answers, or maybe we do find what I think are the answers, but the person is still not progressing, in this situation, we might retest just to see, to make sure we resolved the situation. If someone had H-pylori, you want to do a retest to make sure it’s gone. It’s not always easy to treat. There is a time and place for doing additional testing as well.
Patty has had Graves’ going on two years. She was just diagnosed with RA. She has high antibodies for both, and she is waiting to see a rheumatologist. Currently treating with 5mg of methimazole and Celebrex for pain relief. Do you have any information for people who have both Graves’ and RA?
I have a podcast episode on multiple autoimmune conditions. It’s really about the susceptibility of having one autoimmune condition. If you don’t address the autoimmune component, you are at risk of developing others, which is what happened to you. That’s why you always want to address the autoimmune component.
What you want to do with both Graves’ and RA or other autoimmune conditions is find and remove triggers and heal the gut. I know I sound like a broken record, but that’s really what you want to do. There is no magic solution. Just trying to find the root cause.
There could be overlap. The same triggers for Graves’ could be also causing the RA. You could also have different triggers, so that’s where it can get challenging. Honestly, most people have multiple triggers. The hope is that if you do some initial testing, you find the answers for both the Graves’ and RA.
What herbs or natural supplements do you use in treating multinodular goiter and hyperthyroidism?
Check out some of the podcast episodes on this. With multinodular goiter, hyperthyroidism, bugleweed, L-carnitine to manage. If someone has toxic multinodular goiter, which is hyperthyroidism associated with multinodular goiter, we want to manage it and find out what’s causing the multinodular goiter. Usually, it’s problems with estrogen metabolism or insulin resistance. Overall inflammation could also be a factor. I do have some episodes that are related to that.
I would like more information on the autoimmune disorder called Graves’. I think that’s what I need to beat. Sadly, with chemicals being released into the skies and poison being sprayed around our homes, it’s hard to avoid being affected.
It’s about finding and removing triggers. Detoxification plays a role in that. Check out the six-part series. One of those episodes focuses on toxins and toxicants. I will recommend listening to them all if you have the time.
Someone mentioned the new clinical trial drug, IMVT 1402-2502, which removes Graves’ antibodies. It’s only in the USA so far.
From what I understand, it’s still in trials. From what I understand, this drug lowers IgG, so it will lower your antibodies and potentially get rid of them. There are no long-term studies on that. It’s not addressing the cause of the problem. Is it going to be a long-term solution for Graves’? Maybe it is a better option than methimazole if it is well tolerated and addressing the immune system. That might be something, where someone can take it instead of methimazole. As far as permanently removing the Graves’ antibodies, I am skeptical of that.
I recently came out of the hospital and was told that my thyroid was causing my heart issues. I have a goiter. I’m still not fixed on getting my thyroid removed. I’m frustrated and confused about the information I’m getting from both. I’m concerned about my health, and I’m not sure. Yes, I’m sure I don’t want my thyroid removed.
She said her TSH was depressed. Her T4 was good. I think her T3 might be a little bit high.
I was diagnosed with hyperthyroidism in 2008, Graves’ about three years ago. Taking 30mg of methimazole, 25mg of metoprolol, the beta blocker. just started this.
Immune system. That’s really what it comes down to. I have given this answer a lot. You’re taking methimazole and a beta blocker, so you’re doing what you can to manage the hyperthyroidism. The thyroid can cause heart issues.
I did things from a diet and lifestyle standpoint. I did testing to remove triggers.
The same answer applies to a lot of these questions: finding and removing triggers. I don’t want to keep pitching my books. The podcast has a lot of free information, so take advantage of the podcast and my Healing Graves’ Naturally Substack newsletter.
If you want to go beyond that, definitely look at the books, Natural Treatment Solutions for Hyperthyroidism and Graves’ and The Hyperthyroid Healing Diet.
