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Bugleweed vs. Methimazole: Which One Should You Take?

Last week I put together a brief presentation entitled” bugleweed vs. antithyroid medication”, and because of its popularity I decided convert it into a blog post.  I’m also working on a research-based blog post on how antithyroid medication affects the gut microbiome…and so stay tuned!

If you would prefer to watch the video Click Here [1]

Here is the edited version of the transcript:

Many know that I personally dealt with Graves’ disease. I was diagnosed in 2008 and I’ve been in remission since 2009. Since then, I’ve worked with a lot of people who have hyperthyroidism and Graves disease. Many of these people choose to take antithyroid medication, such as methimazole, sometimes PTU, and there’s also carbimazole. Some places in different countries use carbimazole, which converts into methimazole. So I’m definitely not opposed to my patients taking antithyroid medication. That being said, when I dealt with Graves’ disease I personally did not take antithyroid medication. I took the herb bugleweed and I also took motherwort. I started out with bugleweed.

And the bugleweed did help. I definitely noticed a difference in my resting heart rate and palpitations. But I was still experiencing some palpitations even while taking bugleweed, and so I added motherwort. There are a few different scenarios that I wanted to discuss to give you a better idea of whether you should take bugleweed or antithyroid medication…because I get asked all of the time, “Should I take Bugleweed? Should I take Methimazole or a different type of antithyroid medication?” So let’s talk about the different scenarios.

Scenario #1: Someone is already taking antithyroid medication and they’re doing fine and are okay with staying on the meds: In this case I’ll encourage them to stay on the medication because they’re doing fine with it and the medication is working. The one thing about antithyroid medication is that it is almost always effective. The problem with antithyroid medication is that side effects are common. So if the person’s feeling okay, if their liver enzymes are okay, if their white blood cell count is looking good, then I’m certainly not going to talk them out of taking the medication. In fact, I never tell someone to stop taking a medication because it’s prescribed by someone else. In addition, I’m not a medical doctor, so I won’t tell someone to stop taking medication. And in this scenario, I think it’s probably a good idea for them to continue taking the antithyroid medication.

Scenario #2: Someone is already taking antithyroid medication and they’re doing fine but they don’t want to stay on the medication. Of course nobody wants to stay on the medication. In most cases of hyperthyroidism, antithyroid medication should only be taken temporarily to manage the symptoms. But let’s look at a scenario where I have a patient that starts up care with me and they’re on, let’s say, methimazole, and everything’s going well, but they don’t want to stay on the medication.

Once again, I’m not going to tell them to stop taking the medication, but if they want to make the transition to bugleweed, then what I’ll usually do is I’ll have them take both the medication and herb at the same time.  Again, I’m not going to tell them to stop the medication, but I’ll have them add the bugleweed. And then over time they’ll need to do follow-up blood tests. And the goal is to not necessarily become hypothyroid because that’s not a good thing either, but to get their numbers towards the hypothyroid side. And then the prescribing doctor will typically reduce the dosage of the antithyroid medication based on the thyroid panel results. And then eventually the goal is to just be on the bugleweed and then the next goal is to not be on the bugleweed.

So again, like I mentioned, I was diagnosed with Graves’ disease in late 2008, and I took bugleweed and I took motherwort. I was on bugleweed a little bit longer because again, I started that before the motherwort. So I was on bugleweed for about nine months and I have not been on bugleweed since 2009. So I was on it for a while, but I’ve haven’t taken it since then. Nobody wants to stay on the medication. And again, you don’t want to stay on the bugleweed either. You want to get to the point where you don’t need either one of these, but there are some people that absolutely don’t want to be on the medication.

So once again, you could argue that nobody wants to be on the medication, which is true, but many people are actually okay with it because they know it comes down to risks vs. benefits. And the medication is helping to prevent them from getting an arrhythmia or going into thyroid storm. So some people are perfectly fine taking the medication, but then there are those who fit under scenario #2 who absolutely don’t want to take medication. And like I said, in that case, I can’t tell them to stop taking the medication, but we could put them on bugleweed and this can help them get off the antithyroid medication sooner under the guidance of the prescribing doctor.

Now of course, there are some people who will just take themselves off of the medication or reduce the dose on their own. And that’s up to them, as I can’t control what the person does, but all I’m saying is I’d never tell someone to stop taking antithyroid medication.

Scenario #3: Someone is already taking antithyroid medication and is experiencing side effects.  So for example, maybe they’re taking methimazole and are experiencing side effects. And so when this is the case, once again, I’m not going to tell the person, “You’re experiencing side effects so you should stop taking the antithyroid medication.” What I would do is tell them to go see the prescribing doctor.

Usually, it’s an endocrinologist. The downside of course, is that many endocrinologists will say, “if you can’t take the antithyroid medication, then you need to get radioactive iodine or thyroid surgery”, which isn’t always the case. There are other options. So another option is to take bugleweed, which is what this discussion is about, bugleweed vs. methimazole or bugleweed vs. antithyroid medication. But another option is to switch to a different type of antithyroid medication.

So if someone is on methimazole or carbimazole and they’re getting some type of side effect, so maybe they’re experiencing a rash or dizziness or some other type of symptom. Again, maybe it’s affecting their blood test, the liver enzymes, the white blood cell count, etc. So if this is the case, they could try switching to PTU. And some people absolutely don’t want to do that because they might have read that PTU can put more stress on the liver, which is true in some cases, but there are people who don’t do well on methimazole, but they do perfectly fine on PTU. So, taking a different type of antithyroid medication is at least an option to consider.

But of course, there are natural approaches such as bugleweed. And there’s also L-carnitine. I haven’t spoken about L-carnitine yet here, but L-carnitine when taken in higher doses (i.e. 2000 to 4,000 milligrams per day), also has antithyroid properties. I do find the bugleweed to be more effective, but I’ll add that it depends on the person, and it depends on the brand of bugleweed. Not all herbs are the same, as there are different qualities of herbs, different potencies. So if someone takes bugleweed and it doesn’t seem to work, then maybe it’s not a good quality herb, or it could be a lower potency.

So a lot of people will take Herb Pharm Bugleweed or Thyroid Calming Formula, which has a 1:5 extract ratio. Herb Pharm has good quality herbs, but they’re not high potency. So, that’s also something to consider. When I dealt with Graves’ disease, the bugleweed I took was a 1:2 extract. And therefore, I commonly recommended it to my patients, but I’ll have people who start working with me and they’re already taking Herb Pharm and they might be doing okay on it. So if someone’s taking Herb Pharm bugleweed and it’s doing a good job of managing their symptoms then that’s great. If not, then we might need to switch them to a different brand of bugleweed.

So, that’s another thing to consider. But if someone’s taking antithyroid medication and experiencing side effects, then it probably would be good idea to check with your prescribing doctor and either switch to a different type of antithyroid medication or take a natural approach. I’ll add that there are a few other options. I have written an article on cholestyramine [2], which is not specifically used for hyperthyroidism. It’s used for some cases for chronic diarrhea, also for toxic mold to bind to mycotoxins [3]. But it can also bind to thyroid hormone. I’ve had a very small sample size in my practice take cholestyramine, and it does seem to be effective.

Again, it does require a prescription, but another option is to be on the cholestyramine. And then low dose naltrexone or LDN [4]for those with Graves’ disease is another option. So if you have a condition such as toxic multinodular goiter, then LDN wouldn’t be a good option because it’s for the autoimmune component of not just Graves’ but other autoimmune conditions. The problem with LDN is it is hit or miss. So LDN doesn’t work on everybody, but again, it’s just something else to consider.

Scenario #4: Someone is hyperthyroid and they’re not doing anything to manage their symptoms.  So in this scenario they’re not taking antithyroid medication, they’re not taking herbs or other natural agents such as L-carnitine. So in this case, I will recommend for them to consider taking bugleweed. Now there are times when I might bring up the medication.  But if they’re not doing anything, many times the reason for this is because they don’t want to take the medication. This is assuming they are overtly hyperthyroid.  If someone has subclinical hyperthyroidism [5], where the TSH is depressed, but their  thyroid hormone levels look good, that’s a completely different scenario.

But if someone is overtly hyperthyroid and they’re not doing anything, it’s usually because they don’t want to take the medication. And they either are unfamiliar with natural symptom management methods, such as bugleweed and L-carnitine, or perhaps they’re familiar, but they are just cautious about self-treating themselves, which I think is wise. You want to be cautious about self-treating your condition. So in this case, I’ll bring up the different options, but many times they’ll want to take a natural approach. And in this situation, of course, I don’t have to worry about them stopping the antithyroid medication because they’re not taking antithyroid medication.

And so these are the four main scenarios I wanted to discuss. I will add that there are other scenarios besides these.  A fifth scenario is if someone is already taking bugleweed and let’s say the bugleweed is working, then of course I would say that everything’s great and they should continue taking the bugleweed. With all of these scenarios, we want to address the underlying cause. So these are just ways of keeping safe while you’re addressing the cause of the problem. It’s important for me to mention that.

And another scenario that I didn’t list here is if someone’s taking bugleweed, but it’s not working. I mentioned earlier, it might be because the quality of the herb isn’t great, or it could be the potency isn’t strong enough. But let’s say if they’re taking a good quality herb, the potency is high enough, they’ve been on it for, let’s say, a month or two, and it’s not working. Many times you’ll see changes before then.  I noticed an improvement in my hyperthyroid symptoms within a few weeks of taking the bugleweed. But again, let’s say someone has taken it longer, a month, two months, and they’re not feeling better. And then maybe on top of that they do another thyroid panel and it’s not improving, or it’s getting worse. Then in that situation, you probably would want to consider taking the medication or maybe cholestyramine or low dose naltrexone.

I’ll add that everything comes down to risks vs. benefits. So I realize that there are some people that absolutely do not want to take the medication, but if it will prevent you from receiving radioactive iodine or thyroid surgery, then it is something to consider.  Again, so I took bugleweed when I was dealing with Graves’ disease, but if I absolutely had to, I would have taken the medication. If let’s say a month or two went by and there was no change in my symptoms and the blood tests weren’t improving and especially if they were getting worse, I would’ve considered taking the medication. So I’m definitely not opposed to the medication, as there’s a time and place for it, and I would have resorted to taking the medication if I absolutely had to.

What’s Your Experience With Bugleweed?

If you have taken bugleweed I’d love to hear what your experience has been.  Did it successfully help to manage your hyperthyroid symptoms?  If so please let me know in the comments below! And if you tried taking bugleweed and it didn’t help also feel free to let me know! Thank you for sharing your experience with everyone.