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Can Shingles Trigger Graves’ Disease and Hashimoto’s?

Although I’ve been in remission from Graves’ disease since 2009, this doesn’t mean that I haven’t had some close calls regarding a relapse. One of these was in September of 2016, when I experienced my very first bout of shingles.  It was a very stressful year, as besides selling our house and moving into a new one, which was a very stressful process, that summer I broke my fifth metatarsal and was in a walking boot for a couple of months.  I’m sure the chronic stress that year was a big factor in weakening my immune system.

While I’m sure many reading this already know what shingles is, and some probably have experienced it themselves, for those unfamiliar with shingles I’ll briefly explain what it is.  Shingles is caused by the same virus that causes chickenpox…the varicella-zoster virus.  After someone gets chickenpox this virus stays dormant in the body in the nerve roots.  Years later the varicella-zoster virus can become active, thus causing shingles.

Shingles presents as a painful rash along the skin, and it usually affects one side of the body.  This was the case with me when I was dealing with shingles.  I also experienced persistent headaches a few days before the rash appeared, and since I rarely get headaches this was the first sign that something was wrong.  Most cases of shingles will last 2 to 4 weeks.

My case wasn’t too severe from both a pain-perspective and a duration perspective.  The concern I had was that the virus was around my auditory (hearing) nerves and did temporarily affect my hearing, and like many others with shingles, I was concerned that it would affect my eyes.  Yet another concern was that it might cause a relapse of my Graves’ disease condition, which fortunately didn’t happen, and I’ll elaborate on this later in this post.

Other Symptoms Associated With Shingles

I mentioned how in my case I had headaches, which not everyone with shingles experiences.  I then developed the rash.  Before getting the rash some people experience an increase in fatigue, and some will also have a slight fever.  There might be tingling sensations under the skin.  The rashes turn into small blisters and may or may not itch.  This stage can last up to five days.

After this stage the blisters dry up, and it can take two to ten days for this to happen.  As I mentioned earlier, shingles usually runs its course in two to four weeks, although some people do experience further complications.  I also should add that while shingles can develop anywhere on your body it most commonly affects the neck and chest.  And as I mentioned earlier, it can also affect the eyes and ears.

About The Varicella-Zoster Virus

Varicella-zoster virus is a member of the herpes virus family.  You no doubt are familiar with some of the other members of this family, which include herpes simplex virus type 1 and 2, along with Epstein-Barr and cytomegalovirus.  All of these viruses are very common, and just as is the case with varicella-zoster, these other viruses stay inactive in your body, but they can become active if your immune system becomes weakened.

What Triggers Shingles?

Just as a reminder, shingles is caused by reactivation of the varicella-zoster virus.  But since most people have this virus in their body (in a dormant state) why do some people get shingles and others don’t?  The main reason is due to a weakened or compromised immune system.  This is one reason why shingles is more common in the elderly, but my experience proves that it can affect anyone, as I was 45 years old when I had shingles.  And there’s no doubt in my mind that chronic stress was what weakened my immune system, as I mentioned in the opening paragraph.

Why Didn’t My Graves’ Disease Condition Return?

Infections are a potential trigger of autoimmune conditions such as Graves’ disease and Hashimoto’s, and this includes viruses.  But how can infections trigger autoimmunity, and why didn’t I suffer a relapse of my Graves’ disease condition when I was dealing with shingles?  Luck certainly played a role, but perhaps another reason relates to the Th1/Th2 balance of the body, which I discussed in a past blog post entitled “Should You Get Tested For Cytokines? [1]”.  But just to briefly summarize here, most autoimmune conditions involve a shift toward the Th1 pathways, which is often referred to as “Th1 dominance”.  Th1 cytokines are involved in the eradication of intracellular pathogens.  In other words, the same type of immune response that kills infections can also drive autoimmunity.

However, many cases of Graves’ disease have been found to be “Th2 dominant” in the literature.  I personally didn’t have my cytokines tested when I was dealing with Graves’ disease, but assuming I was Th2 dominant, and if shingles causes a Th1 dominant state, then this may explain why I didn’t experience a relapse.  Of course this is just a theory, and there can be other factors that prevented a relapse from occurring.  As another example, according to the triad of autoimmunity [2], a leaky gut is a necessary component of an autoimmune condition.  As a result, if someone has a healthy gut and gets any type of infection that leads to a Th1 response, this shouldn’t lead to autoimmunity.

Balancing the immune system involves more than just Th1 and Th2, as in past articles and blog posts I’ve also discussed Th17 cells and regulatory T (Treg) cells [3], which also need to be in balance to prevent autoimmunity from developing.  While Tregs play an important role in preventing autoimmunity and can also benefit people with viral infections by suppressing tissue damage caused by virus-specific T cells (1) [4], lowering the T cell numbers can also make it more challenging to eradicate the infection.  Similarly, Th17 cells also play a role in eradicating infections, but too many Th17 cells can lead to autoimmunity.

This is what can make shingles and other viruses challenging to treat in someone who has Hashimoto’s thyroiditis, which is typically a Th1 dominant condition.  Normally with Hashimoto’s you want to do things to increase Tregs in order to dampen both the Th1 and Th17 response, but this can also make it challenging to eradicate infections.   If this is confusing to you then join the club, as many practitioners also find this to be complex, and there’s still a lot we don’t know about managing infections in autoimmunity.  With regards to viruses, probably the best approach is to take something to inhibit or decrease the replication of the virus, and then incorporate dietary and lifestyle changes to improve the health of the immune system.

Does The Research Show Any Relationship Between Shingles and Thyroid Autoimmunity?

Although there is research showing that Epstein-Barr [5] and other viruses can be triggers of autoimmune thyroid conditions, I wasn’t able to find any evidence specifically showing that shingles can trigger Graves’ disease or Hashimoto’s. However, there is evidence [6] that other autoimmune conditions are associated with varicella-zoster, including lupus, rheumatoid arthritis, and inflammatory bowel disease. But this doesn’t mean that shingles can’t be a potential trigger, although as I suggested above, since viruses cause a shift towards a Th1 dominant state it probably is more likely to trigger Hashimoto’s thyroiditis. However, it’s important to mention that like Hashimoto’s, Graves’ disease also involves an imbalance between Th17 and Treg cells, which is associated with the reactivation of varicella-zoster. So in all likelihood shingles can cause the development of Hashimoto’s autoantibodies in some cases, and perhaps even Graves’ disease autoantibodies.

Can You Get Shingles More Than Once?

I’m not a big fan of seeing medical doctors, and initially I wasn’t going to see one when I developed shingles, but my wife strongly urged me to go, and so I reluctantly went.  The doctor I spoke with also had experience with shingles, as he told me that he had it three times!  I mention this because some sources will say that those who get shingles will usually only get it once in their lifetime.  But since the virus remains dormant in your body it is possible to have multiple reactivations.  This is yet another reason to constantly work on improving your immune system health.

What Is Post-Herpetic Neuralgia?

Although most people who get shingles fully recover, which fortunately includes myself, a small percentage (10 to 20%) experience something called “post-herpetic neuralgia”.  This is characterized by severe pain from the nerve damage caused by the virus.  This pain can last from a few weeks to a few years in some cases, and the risk of getting this is almost 30% higher in people older than age 50 (2) [7].  Later in this post I’ll discuss some natural treatment alternatives that can treat and prevent post-herpetic neuralgia.

Conventional Treatment Options For Shingles

Not surprisingly, conventional treatment options don’t do anything to improve the health of the person’s immune system, but instead are aimed at stopping the virus from replicating.  Most medical doctors will treat shingles with antiviral medication.  It is advised to start antiviral therapy no later than 72 hours after the rash starts, and this potentially can help to speed up recovery time and also help with the pain.  It can also reduce the chance of developing post-herpetic neuralgia.

There are times when antiviral medication is warranted, but of course everything comes down to risks vs. benefits.  Although losing your vision or hearing is rare due to shingles, it’s a possibility, and so if the virus has affected the auditory or visual nerves then this might be a situation when it’s wise to take the medication.  If someone is dealing with severe pain then this might be another reason to consider the antiviral meds, not only to help with the pain, but it can reduce the chances of developing post-herpetic neuralgia.

The antiviral meds most commonly given include acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir Novartis). Just as is the case with other medications, side effects are possible with these antiviral drugs.  For example, some of the common side effects of acyclovir include nausea, vomiting, diarrhea, loss of appetite, stomach pain, headaches, lightheadedness, and swelling in your hands and feet (3) [8].  In rare cases this drug can cause kidney problems (3) [8].

It’s also important to mention that if someone is experiencing a lot of pain, some doctors will recommend corticosteriods (i.e. Prednisone) to help.  This very controversial, even in the literature, and the reason for this is because while these drugs might help to lessen the severity of the pain, corticosteroids suppress the immune system, which isn’t a good thing when dealing with an active viral infection.  So in most cases it’s probably a good idea to steer clear from corticosteroids, as there are other things you can take if the pain is severe.

Combining Conventional vs. Natural Treatment Options

Below I’ll talk about natural treatment options for shingles, but I should add that you don’t necessarily have to choose between conventional and natural treatment options.  If you decide to stick solely with a natural treatment approach that’s fine, but if you choose to take antiviral meds you still want to do things to improve the health of your immune system.  This is important not only to prevent shingles from coming back in the future, but of course keeping your immune system healthy will reduce the likelihood of other viruses in your body from reactivating, along with preventing new infections from developing.

Should You Consider Getting The Shingles Vaccine?

Yet another controversial topic is whether people should get the shingles vaccine.  As of writing this blog post there are two vaccines for shingles.  Zostavax has been in use since 2006, and involves the use of an attenuated (weakened) live virus).  According to the CDC this vaccine reduces the risk of developing shingles by 51% and post-herpetic neuralgia by 67%, and protection last for about five years (4) [9].  It is recommended for people 60 through 69 years of age.

A new shingles vaccine called Shingrix was licensed by the FDA in 2017, and this involves a dead virus.  This is the preferred vaccine according to the CDC, as according to them this vaccine is more than 90% effective at preventing shingles and post-herpetic neuralgia (5) [10].  They also claim that protection stays above 85% for at least the first four years after being vaccinated (5) [10].

Of course everything comes down to risks vs. benefits, and while I’m not a big fan of vaccines, this ultimately is a decision you need to make.  The truth is that the shingles vaccine very well might help to reduce the likelihood of getting shingles, and the overt side effects of the vaccine seem to be minimal.  But you shouldn’t overlook the “inactive” ingredients included in these and other vaccines, as this is where a lot of the controversy lies.  There is also some controversy as to whether vaccines should be administered in those with autoimmune conditions, and while the CDC doesn’t list autoimmunity as a contraindication, many health experts would disagree with this.

As you probably know, your immune system doesn’t instantly become unhealthy once you reach age 50, which is when the CDC recommends people to get the new shingles vaccine.  That being said, many people aged 50 or older have an unhealthy immune system because they don’t eat well, don’t get sufficient sleep, do a poor job of managing their stress, etc.  In this case the shingles vaccine may help, but of course it won’t do anything to improve your immune system health.  In fact, even if you decide to get the shingles vaccine you should do things to improve your immune system health, which I’ll discuss towards the end of this blog post.

Natural Treatment Options For Shingles

Just as is the case with all other viruses, you can’t eradicate the varicella-zoster virus from your body.  When it’s active the goal is to do things to slow down the replication in order to put it in an inactive state, while improving the health of the immune system to prevent it from reactivating in the future.   So what I’m going to do is divide the following into two parts, as I’ll first discuss some herbs and nutrients that can help inhibit viral replication, and then I’ll discuss a few things you can do to improve your immune system health.

Herbs and Nutrients To Prevent Viral Replication

Although I’m listing multiple herbs and nutrients below, this doesn’t mean that those with shingles should take all of them.  What I’ll do is first list herbs and nutrients that have been shown to help with the varicella-zoster virus in the literature, and then I’ll list other natural agents with antiviral properties.  It’s important to understand that the lack of studies for certain agents doesn’t mean that it can’t have antiviral activity against varicella-zoster.  For example, quercetin is listed below, and while I couldn’t find any studies which showed that it has antiviral activity specifically against varicella-zoster, I also didn’t come across any studies which demonstrated that it lacked antiviral activity against this virus.  Perhaps future studies will be conducted to determine whether quercetin and other natural agents can be beneficial for preventing replication of the varicella-zoster virus.

Licorice root.  I really do like the herb licorice, and while I commonly recommend licorice root to my patients who have depressed cortisol levels, this herb also has antiviral activity. One study showed that licorice has low antiviral activity against varicella-zoster compared with acyclovir (6) [11].  Licorice root can potentially increase blood pressure, and so if someone has a history of hypertension taking this herb wouldn’t be a good idea.

Resveratrol.  I don’t usually recommend resveratrol [12]for anti-viral purposes, but I came across one in vitro study that showed that resveratrol can inhibit the replication of the varicella-zoster virus (7) [13].

Vitamin D.  I’ve spoken about the importance of vitamin D [14] numerous times in past articles and blog posts, and a few studies show that it might affect the course of shingles and post-herpetic neuralgia (8) [15] (9) [16].

Vitamin C.  A few studies have shown that administering vitamin C intravenously can help with the pain of shingles and post-herpetic neuralgia (10) [17] (11) [18].  One of these was a case report where the patient didn’t respond to conventional treatment, but IV vitamin C resulted in an immediate reduction in the pain.

Quercetin.  Although quercetin is known for its anti-histamine properties, it also has antiviral activity.  Unfortunately I wasn’t able to find any studies showing that it can inactivate the varicella-zoster virus, but there is evidence of it helping with other types of viruses (12) [19] (13) [20].

St. John’s Wort.  Although this herb is commonly known for its anti-depressive properties, it also has antiviral properties (14) [21], but I also wasn’t able to find evidence of it helping with varicella-zoster.  There are a lot of herb-drug interactions involving St. John’s Wort, and so I’d be cautious about taking it on your own.

Lysine.  Although there is evidence that lysine can inhibit the replication of herpes simplex virus (15) [22] (16) [23], I couldn’t find evidence of it helping with varicella-zoster.  Once again, this doesn’t mean that it can’t be of benefit, but I’m not sure if taking lysine will prevent the onset of shingles.

Other natural agents.  Other natural agents that have antiviral properties, although not necessarily against varicella-zoster, include garlic, turmeric, monolaurin, and certain essential oils.

Can Ozone Therapy and UV Light Help With Shingles?

I can’t say I have much experience with ozone therapy, and while there is some evidence that ozone can help with the inactivation of viruses (17) [24], I couldn’t find anything specific related to shingles, although you might want to check out this video [25].  I did come across a study that showed that broad band ultraviolet light B (UVB) might play a role in the prevention and treatment of post-herpetic neuralgia (18) [26].

How To Improve Your Immune System Health

There are many different things you can do to improve your immune system health.  While I just listed a few nutrients and herbs that can help to inhibit viral replication, I don’t recommend loading up on supplements to improve your immune system health.  This doesn’t mean that supplements can’t play a role, but you want to make sure you cover the basics:

1. Improve your stress handling skills.  Although eating a healthy diet probably should be on top of this list, I started with stress because this is a big reason why many people develop shingles.  This was true in my case, and I’m pretty sure it was the case with the medical doctor I saw who had shingles three separate times.  Sure, chronic stress isn’t the only reason for the reactivation of viruses, but it’s a big reason.  As a result, you want to make sure you block out time for stress management on a regular basis.

2. Get sufficient sleep.  If you don’t get sufficient sleep then this will compromise both your adrenals and immune system.  Once again, supplements can help in some cases, but even when this is the case you only want to take supplements on a temporary basis.  In the past I wrote an article where I discussed how to get optimal sleep without taking supplements [27], and if you haven’t read this I definitely would do so when you get the chance.

3. Eat well.  Eating healthy whole foods is important for optimal immune system health.  I probably don’t have to talk much about this here, and I have written plenty of articles and blog posts on my website related to this topic.  However, I should say that while I commonly recommend restrictive diets such as the autoimmune Paleo (AIP) diet [28], it’s common for people to get stressed out about this diet when trying to restore their health.  Just keep in mind that an AIP diet isn’t meant to be a long-term diet, and of course the most important factor is to try to eat mostly whole foods while avoiding fast food, refined foods and sugars, etc.

4. Improve your gut health.  Since 70 to 80% of the immune system cells are located in the gastrointestinal tract, it makes sense that you would need a healthy gut to have a healthy immune system. Of course eating well is the big key to having a healthy gut, although infections, Candida overgrowth, and certain chemicals (i.e. glyphosate [29]) can cause intestinal dysbiosis, and so these need to be addressed.  To achieve optimal gut health I recommend following the 5-R protocol [30].

In summary, many people will develop shingles, which can be a very painful condition.  Varicella-zoster is the virus associated with shingles, and the main risk factor for developing shingles is a weakened immune system, with stress being a big factor.  Some people with shingles develop post-herpetic neuralgia, which is characterized by severe pain from the nerve damage caused by the virus. Conventional treatment options for shingles usually involve taking antiviral medication, and the new shingles vaccine is commonly recommended for people aged 50 and older.  Natural treatment options can also help, and even if you choose to take antiviral drugs you can combine this with natural treatment methods, and you still want to do things to improve the health of your immune system.

I hope you enjoyed this blog post, and if you have had shingles in the past please feel free to share your experience in the comments section below.