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7 Things Most Endocrinologists Don’t Know About Hyperthyroidism and Graves’ Disease

For those with hyperthyroidism and Graves’ disease who choose to see an endocrinologist, it can be very frustrating being told that the only three treatment options someone has are 1) antithyroid medication [1], 2) radioactive iodine, and 3) thyroid surgery.  Without question there is a time and place for conventional medical treatment, and while antithyroid medication such as Methimazole and PTU commonly causes side effects, they usually do a wonderful job of lowering thyroid hormone levels.  There are even situations when more extreme treatment methods such as thyroid surgery are necessary.  But while conventional treatment methods are sometimes necessary, it’s ludicrous that most endocrinologists don’t do anything to address the cause of the condition.

Why do most endocrinologists only give three treatment options to their hyperthyroid patients, and not try to address the cause of the problem?  One obvious reason is the training they receive in medical school.  But this isn’t the only reason, as these days there are many medical doctors who practice functional medicine, and most of these medical doctors were also brainwashed while attending medical school.  Perhaps two of the main characteristics that result in some medical doctors practicing functional medicine are 1) having an open mind, and 2) being willing to deviate from the norm.  In other words, having a closed mind and/or being afraid of deviating from the norm are probably the main two reasons why most endocrinologists refuse to practice functional medicine, and thus fail to address the cause of the hyperthyroid condition.

One more thing I’ll say here is that I’m not suggesting that endocrinologists shouldn’t prescribe antithyroid medication, recommend surgery in some cases, etc.  What I am suggesting is that more endocrinologists should practice functional medicine, while utilizing conventional medical treatment whenever necessary.  In fact, even if an endocrinologist chooses to recommend antithyroid medication to EVERY patient with hyperthyroidism, but at the same time does things to address the cause of the condition, this would dramatically reduce the number of patients who ended up receiving radioactive iodine or thyroid surgery.

So what I’d like to do now is discuss 7 things most endocrinologists don’t know (or won’t admit) about hyperthyroidism and Graves’ disease.

1. The autoimmune component of Graves’ Disease can be reversed.  Please keep in mind that this isn’t just my opinion, and of course it’s important to elaborate on the meaning of “reversed”.  I’m not suggesting that Graves’ disease can be permanently cured.  I’ve been in remission from Graves’ disease since 2009, and while I would love to say that I permanently cured my Graves’disease condition, the truth is that for those with Graves’ disease who restore their health, there is always a possibility of experiencing a relapse if you don’t do a good job of maintaining your health and are exposed to specific triggers.

When I say the autoimmune component can be reversed, this means that by removing the autoimmune trigger and healing the gut, and doing other things to reduce proinflammatory cytokines [2]and increase regulatory T cells [3], the autoimmune response can be suppressed.  This admittedly isn’t an easy process, as there are times when finding the trigger can be challenging, and many people struggle making the necessary dietary and lifestyle changes.  But if someone is willing to take responsibility for their health AND their autoimmune triggers are detected and removed, then it is very possible to achieve a state of remission and maintain your health thereafter.  In other words, the goal should be to achieve a state of PERMANENT remission.

2. Eating healthy can play an important role in your recovery.  Over the years I’ve had numerous patients bring up diet to their endocrinologists.  In most cases an endocrinologist will tell the patient that diet isn’t a factor in the development of their condition, and because of this, eating well won’t do anything to improve their thyroid and immune system health.  The truth is that certain foods can be a trigger, but this doesn’t mean that food is a trigger in everyone with hyperthyroidism and Graves’ disease.

That being said, certain foods are inflammatory, and since Graves’ disease is an inflammatory condition, it makes sense to avoid anything that will promote inflammation.  Once again, this doesn’t mean that everyone will achieve remission by eating whole healthy foods, but it will be very difficult to restore your health if your diet consists mostly of refined foods, fast food, etc.  In the past I’ve mentioned the triad of autoimmunity [4], and one component of this triad is a leaky gut.  I’ve also mentioned in the past how the research demonstrates that gluten [5]causes a leaky gut in everyone.  As a result, it makes sense for anyone with Graves’ disease (or any other autoimmune condition) to avoid gluten while trying to restore their health.

3. There are natural agents that can lower thyroid hormone levels.  Every now and then a patient will tell me that their endocrinologist is familiar with bugleweed [6], which is an herb that has antithyroid properties.  But many endocrinologists aren’t familiar with bugleweed.  L-carnitine can also lower thyroid hormone levels when taken in higher doses, but most endocrinologists also aren’t aware of this.  Earlier I mentioned how some people do need to take antithyroid medication, as while many of my patients do fine taking natural agents such as bugleweed, this approach isn’t effective in everyone.

You may wonder whether or not you should take antithyroid medication, or give an herb such as bugleweed a try.  When I was dealing with Graves’ disease I chose not to take antithyroid medication, but this doesn’t mean that this is the best decision for everyone.  If you’re currently taking antithyroid medication, aren’t having any negative side effects, and are concerned that bugleweed won’t effectively manage your symptoms then by all means continue taking it.  On the other hand, if you’re taking antithyroid medication and are experiencing side effects then you might want to give bugleweed a try.

If you were recently diagnosed with hyperthyroidism and haven’t taken any antithyroid medication then you might choose to start with bugleweed and see if it helps, and if not you can always switch to the medication.  Those who are familiar with my “Graves disease story” know that I started with bugleweed and a few weeks later added motherwort to further help with my heart palpitations.  Some people with hyperthyroidism take lemon balm and/or L-carnitine.  Lithium [7]is another option, although I can’t say it’s something I commonly recommend to my patients.

4. Genetics isn’t the main reason why people develop Graves’ disease.  Although some endocrinologists will flat out tell their Graves’ disease patients that they don’t know why they developed this condition, other doctors will blame their patient’s Graves’ disease condition on genetics.  While it’s true that genetics is a factor, it isn’t the most important factor.  Earlier I mentioned the triad of autoimmunity, and the three components of this triad are 1) a genetic predisposition, 2) an environmental trigger, and 3) a leaky gut.  So while you do need to have a genetic predisposition to develop Graves’ disease or any other autoimmune condition, you also need to be exposed to at least one trigger, and according to the triad of autoimmunity you also need to have a leaky gut.  Similarly, in order to achieve a state of remission you need to remove any triggers and heal the gut.

The truth is that most people who have the genetics for Graves’ disease won’t develop this autoimmune thyroid condition.  In fact, when conducting the case history during an initial consultation, it’s not uncommon for the patient to tell me that they are unaware of any family members who have been diagnosed with Graves’ disease.  If Graves’ disease was solely a genetic condition then I would imagine that when conducting my initial consultations a lot more family members would be mentioned as having Graves’ disease.  If you’re wondering if there is any family history of Graves’ disease in my case, as far as I know there isn’t anyone in my family who has been diagnosed with Graves’ disease.  Once again, I’m not denying that genetics isn’t a factor, but only that it’s not the main factor.

5. Chronic stress and adrenal imbalances can be the primary factor in the development of Graves’ disease.  While genetics isn’t the main factor in the development of Graves’ disease, chronic stress and compromised adrenals seem to be major culprits in many people.  It admittedly can be challenging to confirm this, as correlation doesn’t always mean causation.  In other words, just because someone dealt with a lot of stress prior to developing Graves’ disease doesn’t mean that stress was the trigger.

That being said, I’m pretty sure stress was the main reason why I developed Graves’ disease.  And while I can’t say that stress is the main factor in everyone I work with, it’s common for people I consult with to tell me that in their opinion, stress was their primary trigger.  Keep in mind I’m not just referring to emotional stressors.  Physical stressors can also be a culprit.  For example, while emotional stress was a factor in my situation, prior to being diagnosed with Graves’ disease I was overtraining, which also will negatively affect the adrenals over time.  So in my case I’m pretty confident that it was a combination of emotional and physical stressors that wrecked havoc on my adrenals, and set the stage for my Graves’ disease condition.

6. Some people with hyperthyroidism benefit from iodine supplementation.  This is going to be a bit controversial, as I’m sure that many people reading this blog post agreed with the first five things listed here, but can’t believe that I listed iodine [8]as potentially being beneficial for hyperthyroidism.  First of all, I’d like to say right off of the bat that not everyone does well when supplementing with iodine, and I don’t have all of my patients take iodine.  In fact, even if you’re open to taking iodine, it is wise to first test to determine if you have an iodine deficiency, and even if you’re deficient in iodine you need to increase your antioxidant status and start with small doses.

Most endocrinologists will advise their patients with hyperthyroidism and Graves’ disease to avoid iodine, not only in supplement form, but food sources as well.  The reason is because iodine is a precursor to thyroid hormone, and so they’re concerned that taking iodine will exacerbate one’s hyperthyroid condition.  But many decades ago, before radioactive iodine treatment was commonly recommended, Lugol’s solution was used to manage the symptoms of hyperthyroidism.  And if someone is unable to take antithyroid medication and bugleweed isn’t helping to lower their thyroid hormone levels, there are times when iodine supplementation should be considered…especially if your endocrinologist is pressuring you to receive radioactive iodine.

7. Radioactive iodine doesn’t “cure” Graves’ disease.  I think it’s safe to say that many people with Graves’ disease reading this understand that radioactive iodine isn’t a cure.  But that won’t stop many endocrinologists from labeling it as a cure.  While they can make an argument that in many cases radioactive iodine will be a permanent solution for hyperthyroidism, remember that Graves’ disease is primarily an immune condition, not a thyroid condition.  So just to clarify, radioactive iodine treatment many times will permanently eliminate hyperthyroidism, but it will do absolutely nothing for the autoimmune component of Graves’ disease.  And it’s obviously the same concept with thyroid surgery.

Why is this significant?   The reason why this is important to understand is because having one autoimmune condition increases the likelihood of developing other autoimmune conditions in the future.  Thus, if someone receives radioactive iodine, but nothing has been done to remove the autoimmune trigger and heal the gut, then you can’t conclude that Graves’ disease has been cured.  In fact, earlier I mentioned how I don’t consider Graves’ disease to be completely curable due to the genetic component, and thus I mentioned how I try to help my patients achieve a state of “permanent remission”.   On the other hand, someone who receives radioactive iodine shouldn’t be considered to be in remission, because while their hyperthyroidism very well may never return, the autoimmune component hasn’t been addressed.

As for those who have toxic multinodular goiter [9], I still wouldn’t consider radioactive iodine to be a “cure”, mainly because it doesn’t do anything to address the underlying cause of the condition.  So while there might not be the same concern as with Graves’ disease (a risk of developing other autoimmune conditions in the future), there still is an underlying cause of toxic multinodular goiter.  And not addressing this can lead to other health issues in the future.  It’s also worth mentioning that I’ve worked with patients who had toxic multinodular goiter AND thyroid autoantibodies.

If you have a hyperthyroid condition and have seen an endocrinologist, please share your experience in the comments section below.  If you had a negative experience please let me know!  If you happened to have a positive experience with your endocrinologist please let me know!  And if there is anything else you’d like to add regarding what most endocrinologists don’t know about hyperthyroidism please feel free to share this as well.