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Should You Take Antithyroid Medication?

Although many of my patients with hyperthyroidism take methimazole, or a different type of antithyroid medication (i.e. PTU, carbimazole), when I was dealing with Graves’ disease I chose not to take medication.  The truth is that in some cases it is a wise choice to take antithyroid medication, and the goal of this blog post is to discuss this.  I will discuss the benefits and risks of taking antithyroid medication, as well as the benefits and risks of natural antithyroid agents.  So the goal of this blog post isn’t to convince those with hyperthyroidism to take the same approach I did and avoid antithyroid medication.  In fact, while it’s great when people can manage their symptoms naturally, one reason why I decided to write this is because there are some people who probably should take the medication, but refuse to do so, and as a result are putting their health at risk.

If you’re interested in learning about the different types of antithyroid medications I’d recommend checking out an article I wrote in 2017 entitled “Comparing The Different Types of Antithyroid Medications [1]”.  In the United States methimazole is usually prescribed by most endocrinologists.  If someone is unable to tolerate methimazole then Propylthiouracil (PTU) might be prescribed, although some people react to both types of antithyroid medication.  Another scenario when PTU is usually given is during the first trimester of pregnancy.

What Are The Benefits of Taking Antithyroid Medication?

So let’s go ahead and take a look at some of the benefits of antithyroid medication:

What Are The Risks of Taking Antithyroid Medication?

Now that you know some of the benefits of taking antithyroid medication, let’s take a look at some of the risks:

What Are The Benefits of Taking Natural Antithyroid Agents?

What I’d like to do is take a look at some of the benefits of natural antithyroid agents.  Bugleweed is the most popular antithyroid agent, and this herb is the most effective in lowering thyroid hormone levels.  L-carnitine also has antithyroid properties when taken in higher doses (i.e. 2 to 4 grams).  Lithium [11]also has antithyroid properties.

What Are The Risks of Taking Natural Antithyroid Agents?

So let’s take a look at the risks of taking natural antithyroid agents:

Choosing Between Medication and Natural Antithyroid Agents

So should you take antithyroid medication, or should you choose to manage your symptoms naturally?  Sometimes it can be a challenge to decide whether you should take antithyroid medication such as methimazole, or an antithyroid herb such as bugleweed.  As you know, when I was diagnosed with Graves’ disease I decided to take bugleweed, and if it didn’t help to manage my symptoms I would have considered taking methimazole.  Similarly, if one of my patients consults with me and initially they’re not taking anything to manage their symptoms, taking bugleweed is an option to consider.  Of course there is a risk they will take it and it won’t help, which means they might go a few additional weeks with an elevated heart rate.  But there is also a chance they can take methimazole and experience negative symptoms and/or an elevated heart rate.

It’s also important to mention that some people feel more comfortable taking antithyroid medication, and that’s perfectly fine.  If someone is taking methimazole and is doing well with it and it’s not causing elevated liver enzymes or a low WBC count then there’s nothing wrong with them continuing to take it.  Sometimes a patient of mine is taking methimazole when first consulting with me, and they’re doing fine with it, but they prefer to take bugleweed.  When this is the case I can’t tell the person to stop taking the antithyroid medication, but what some people do is to take both the methimazole and bugleweed at the same time, and the goal of doing this is to try to wean off of the methimazole sooner (under the guidance of their medical doctor).

The Risks of Uncontrolled Hyperthyroidism

While I can understand someone wanting to do everything they can to avoid taking medication, you also need to consider the risks of uncontrolled hyperthyroidism. So if you happen to be dealing with hyperthyroidism and aren’t doing anything to lower the thyroid hormone levels, while you certainly can try taking a natural approach with an herb such as bugleweed, if this doesn’t work (and assuming the dosage was high enough), then you should consider taking the medication.

It’s also worth mentioning that some people refuse to take antithyroid medication but are fine with taking a beta blocker. This of course can help to lower the heart rate, which is very important, and some beta blockers [12] also can affect the conversion of T4 to T3, which is also a good thing in someone who has hyperthyroidism. However, just keep in mind that elevated thyroid hormone levels also have a negative effect on bone density, and so if you’re taking a beta blocker and still have high thyroid hormone levels, you still should consider taking something with antithyroid properties. Once again, natural antithyroid agents are an option to consider, but if they aren’t effective, then you should consider taking the medication.

Whether you take methimazole, bugleweed, or something else, eventually the goal is to be off of all antithyroid agents.  I personally took bugleweed for approximately 9 months, and I haven’t been on it since 2009.  The duration of taking bugleweed of course depends on the person.  While I took it for 9 months, others need to take it for a shorter period of time, and there are some people who take it for a longer period of time.

What Have You Done To Manage Your Hyperthyroid Symptoms?

For those with hyperthyroidism, including Graves’ disease, toxic multinodular goiter, and other types of hyperthyroidism, I’d like to know what you have done to manage your hyperthyroidism symptoms.  Did you take antithyroid medication such as methimazole, PTU, or carbimazole?  Or did you take natural antithyroid agents such as bugleweed, L-carnitine, lithium, etc.?  Perhaps you didn’t take anything with antithyroid properties, but took something else such as a beta blocker or motherwort.  Either way I’d love to hear about your experience in the comments section below.  Thank you!