Although it’s a wonderful feeling to help someone with hyperthyroidism avoid radioactive iodine and thyroid surgery, there are certain precautions you need to take when trying to restore your health. This is true whether you have Graves’ disease, or a different hyperthyroid condition (i.e. toxic multinodular goiter). In this blog post I’m going to specifically focus on five precautions you should take when trying to reverse your hyperthyroid condition through a natural treatment approach.
Precaution #1: Safely manage your symptoms. Although not everyone with hyperthyroidism experiences an elevated resting heart rate, many people do. Some people have a resting heart rate between 80 and 100 beats per minute, while others have a resting heart rate well over 100 BPM. I’ve worked with some patients whose resting heart rate was around 150 BPM when they weren’t taking anything.
Without question there is a risk of uncontrolled hyperthyroidism. When I was dealing with Graves’ disease back in 2008/2009 I was able to effectively manage my symptoms by taking bugleweed and motherwort. Some people choose to manage their symptoms by taking antithyroid medication and/or beta blockers. Others prefer to manage their symptoms naturally like I did. Others attempt to manage their symptoms with bugleweed, motherwort, and/or other herbs but are unable to do so, and need to resort to taking the medication.
In any case, while there might not be as big of a concern if your resting heart rate is slightly elevated, if it is moderately or severely elevated (i.e. greater than 90 BPM) then you want to do something to manage the symptoms. This might involve taking antithyroid medication [1] (i.e. Methimazole) and/or beta blockers, or in some cases nutritional supplements and herbs such as bugleweed [2], motherwort, lemon balm, and/or L-carnitine.
Precaution #2: Monitor your liver enzymes. Many people with hyperthyroidism have elevated liver enzymes. This is especially true for those who take antithyroid medication such as Methimazole or Propylthiouracyl (PTU). However, some people with hyperthyroidism have elevated liver enzymes even when not taking antithyroid medication.
Ordering a liver function panel is a good idea for anyone with hyperthyroidism. This can be ordered separately, although it’s also part of a comprehensive metabolic panel. The two main liver markers it tests for are alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Alkaline phosphatase is also commonly elevated, although an elevation of this enzyme doesn’t always indicate a problem with the liver.
I wrote a separate article that focused on these liver markers, and in the article I also discuss what you can do to lower elevated liver enzymes. The name of the article is entitled “How To Decrease Liver Enzymes in Hyperthyroidism and Graves’ Disease [3]“.
Precaution #3: Monitor your white blood cell count. Agranulocytosis is a serious condition involving a severe lowering of the white blood cell (WBC) count, which is also known as leukopenia. There are a few different drugs that can cause this condition, with one of them being antithyroid medications (1) [4]. An absolute neutrophil count of <500/μl while taking antithyroid drugs establishes the diagnosis (2) [5].
The way agranulocytosis is diagnosed is through a complete blood count (CBC) with differential. This is also a good reason to obtain this test prior to being on antithyroid medication, and then again thereafter, as if someone has a normal WBC count prior to taking the meds but then it becomes depressed after being on the medication, then it’s highly likely that the medication is what caused the decrease. In this case the antithyroid medication needs to be stopped.
Precaution #4: Don’t overexert yourself. Although I’m in favor of people being active, those with hyperthyroidism shouldn’t overdo it. The problem is that many people don’t realize that they are overexerting themselves. This is especially true for those who exercise on a regular basis. For example, prior to being diagnosed with Graves’ disease I was overtraining [6], but at the time I didn’t realize this. And while I don’t think this was the sole reason why I developed Graves’ disease, overtraining causes dysregulation of the immune system and weakens the adrenals [7], and so without question it could have been a contributing factor.
Upon being diagnosed with hyperthyroidism I definitely took it easier, and the same is true with many of my patients. But some people still work out too hard AFTER being diagnosed with hyperthyroidism. While most people with hyperthyroidism are able to do some light walking and weightlifting while trying to restore their health, you should be cautious about engaging in activity that will significantly result in an increase in your heart rate. This is true even for those who are taking antithyroid medication, beta blockers, and/or herbs (i.e. bugleweed, motherwort) to help lower the resting heart rate.
Precaution #5: Be aware of thyroid storm signs and symptoms. Thyroid storm is a rare state of acute hyperthyroidism that can be life-threatening, and some of the potential triggers include trauma, myocardial infarction, surgery, an infection [8], and iodinated contrast medium (3) [9]. This is especially a concern in cases of uncontrolled hyperthyroidism, such as someone who refuses to take antithyroid medication to manage their symptoms. Some of the clinical manifestations of thyroid storm include fever, cardiac arrhythmias, vomiting, and impaired mental status (3) [9].
If you are experiencing any of the symptoms I mentioned above it is critical to visit the nearest emergency room. Treatment of thyroid storm usually involves decreasing the thyroid hormone levels with antithyroid medication and lowering the resting heart rate by taking beta blockers [10]. If someone is unable to tolerate antithyroid medication they might receive large amounts of potassium iodide to inhibit thyroid hormone production, or therapeutic plasma exchange (4) [11].
Share These Precautions With Your Healthcare Practitioner
In addition to taking the precautions I mentioned in this blog post, I really do think it’s wise for those with hyperthyroidism to work with a competent natural healthcare professional. Some may think I’m “tooting my own horn”, and while I do work with people who have hyperthyroidism and Graves’ disease, I’m not mentioning this here as a way to promote my practice. The truth is that many functional medicine doctors are capable of helping people with Graves’ disease improve their immune system health. However, besides the fact that not everyone with hyperthyroidism has Graves’ disease, many healthcare professionals are afraid to work with people who have hyperthyroidism.
This is one of the reasons why it’s much more common to see functional medicine practitioners who see people with hypothyroidism/Hashimoto’s. Another reason is because more people have hypothyroidism than hyperthyroidism. But the primary reason is because most healthcare practitioners are uncomfortable working with hyperthyroid patients. This is also true with many endocrinologists, and is one of the reasons why they commonly recommend radioactive iodine [12] and thyroid surgery to many of their hyperthyroid patients as the primary treatment option. They feel that it’s easier (and safer) to manage hypothyroidism when compared to hyperthyroidism.
If you happen to be working with a chiropractor, naturopath, or a different healthcare practitioner who doesn’t have a lot of experience working with hyperthyroid conditions, I urge you to share this blog post with him or her. Even if they tell you that they are comfortable with treating hyperthyroidism naturally, I’d still ask them to read this blog post so that they understand the importance of having their patients with hyperthyroidism take these precautions. Because while it’s important to address the underlying cause of your condition, you want to be safe while taking a natural treatment approach.