As the leading cause of hyperthyroidism, Graves’ disease represents a basic defect in the immune system, causing production of immunoglobulins (antibodies) which stimulate and attack the thyroid gland, causing growth of the gland and overproduction of thyroid hormone. Similar antibodies may also attack the tissues in the eye muscles and in the skin on the front of the lower leg.
Facts
- Graves’ disease occurs in less that 1/4 of 1% of the population, but as many as 3% to 4% of asymptomatic populations have been found to have suppressed TSH levels suggestive of subclinical Graves’ disease.
- Graves’ disease is more prevalent among females than males.
- Graves’ disease usually occurs in middle age, but also occurs in children and adolescents.
- Graves’ disease is not curable, but it is a very treatable disease.
Who develops Graves’ disease?
Although Graves’ disease most frequently occurs in women in their middle decades (8 times more than men), it also occurs in children and in the elderly. There are several elements contributing to the development of Graves’ disease. There is a genetic predisposition to autoimmune disorders and infections and stress play a part. Graves’ disease may have its onset after an external stressor In other instances, it may follow a viral infection or pregnancy. Many times the exact cause of Graves’ disease is simply not known. It is not contagious, although it has been known to occur coincidentally between husbands and wives.
How is Graves’ disease treated medically?
The selection of treatment will include factors such as age, degree of illness, and personal preferences. Generally speaking, from least invasive to most invasive, the treatments include:
- Anti-thyroid drugs that inhibit production or conversion of the active thyroid hormone (20-30% effective, often used to control mild cases)
- Radioactive iodine (I-131), which destroys part or all of the thyroid gland and renders it incapable of overproducing thyroid hormone
- Surgery, in which most of the thyroid gland is removed, renders it incapable of overproducing thyroid hormone.
The latter two treatments result in a 90-95% remission rate of the disease. In a few cases the treatments must be repeated. In all cases lifetime follow-up laboratory studies must be done, and in almost all cases lifetime replacement thyroid hormone must be taken.
What are the complications of the disease?
Graves’ disease usually responds to treatment and, after the initial period of hyperthyroidism, is relatively easy to treat and manage. The more serious complications of prolonged, untreated, or improperly treated Graves’ disease include weakened heart muscle leading to heart failure, osteoporosis, or possible severe emotional disorders.
Signs, symptoms & indicators of Hyperthyroidism
Rapid pulse rate
Counter Indicators
Normal/slowed pulse rate
Low TSH
High T3 free level
Elevated free T4
Elevated DHEA level
Women with primary hyperthyroidism have elevated DHEA-S levels.
Counter Indicators
(Mildly) elevated TSH or normal TSH
(Very) frequent stools or normal stool frequency
Having loose/having very watery stools
Counter Indicators
Having hard stools
(Tendency to/very) infrequent stools
Heart racing/palpitations
Poor tolerance of heat
Counter Indicators
Good tolerance of heat
Strong appetite
Fatigue on light exertion
Bulging eyes
Vision disturbances
Irritated eyes
Counter Indicators
Eyes bulge not from hyperthyroidism
Inner trembling
(Occasional) daytime sweating
Cold spells
Counter Indicators
Low body temperature
Inability to work under pressure
Irritability
Impatient/hostile disposition
Trouble concentrating
Poor muscular strength
Brittle fingernails
Thyroid diseases may produce brittle nails or splitting of the nail bed from the nail plate.
Hot flashes between period or constant hot flashes
Weak sexual desire
Excess perspiration
Unsound sleep
(Frequent) difficulty falling asleep
Conditions that suggest Hyperthyroidism
Anemia, Megaloblastic
Hyperthyroidism is one of the minor causes of B12 deficiency.
Low Progesterone or Estrogen Dominance
Elevated estradiol and depressed bioavailable testosterone have been cited as the cause of sexual dysfunction common in hyperthyroid individuals.
Low Testosterone Level
Elevated estradiol and depressed bioavailable testosterone have been cited as the cause of sexual dysfunction common in hyperthyroid individuals.
Low Testosterone Level, Female
Elevated estradiol and depressed bioavailable testosterone have been cited as the cause of sexual dysfunction common in hyperthyroid individuals.
Elevated SHBG
Elevated levels of SHBG may be observed with hyperthyroidism. This results in a decrease in bioavailable testosterone.
Counter Indicators
Counter Indicators
Female Hair Loss
Hyperthyroidism can cause hair loss. Hair loss associated with thyroid disorders is easily treated.
Bulging eyes from hyperthyroidism
Risk factors for Hyperthyroidism
Cigarette Smoke Damage
A study of 132 pairs of twins (264 subjects) showed that smoking can have negative effects on the endocrine system, causing a 3- to 5-fold increase in the risk of all types of thyroid disease. The association was most pronounced in autoimmune disorders (Graves’ disease and autoimmune thyroiditis), although there was still a strong association for non-autoimmune thyroid disorders.
Hyperthyroidism in family members
Hypercalcemia
In all the causes of hyperparathyroidism except high protein levels, elevated levels of ionized calcium occur also.
Having elevated TT4 level
Tremors
Hyperthyroidism can cause tremors. If this is the case, then the hyperthyroidism must be treated, not the symptom of tremors.
Copper Deficiency
Although supportive data is limited, a report from a study group of hyperthyroid women suggests that copper status should at least be investigated in women with hyperthyroidism.
“Thyroid and immune system health are crucially dependent upon copper. As far as I can see now, copper deficiency is the most important factor in the development of hyperthyroidism. Virtually all hypers in the hyperthyroidism group have found that copper supplementation reduced their symptoms, usually within hours or a few days at most. Most have reported that within three to six months of beginning copper supplementation, they have been able to significantly reduce their intake of antithyroid drugs. While copper is the big story in hyperthyroidism, it is not the whole story. If it were, it would have been discovered years ago. Proper copper metabolism interrelates with and depends upon many other nutrients.” [John Johnson, iThyroid.com]
Absence of hyperthyroidism
Recent unexplained weight loss
Counter Indicators
Recent unexplained weight gain
Hyperthyroidism suggests the following may be present
Hyperthyroidism can lead to
Recommendations for Hyperthyroidism
L-Carnitine
In a double-blind, placebo-controlled trial, 50 women with normal thyroid function were given thyroid hormone and randomly assigned to three groups: placebo for six months; placebo for two months followed by 2gm or 4gm per day of L-carnitine for months three and four, then placebo for months five and six; or 2gm or 4gm per day of L-carnitine for the first four months followed by two months of placebo. Clinical symptoms such as palpitations and biochemical parameters worsened when patients took placebo, and returned to baseline or improved minimally during L-carnitine treatment. Bone loss is normally experienced during a hyperthyroid state, but bone mineral density improved throughout the trial in all patients taking L-carnitine. The authors suggest the supplement may be useful for both preventing and treating hyperthyroidism. [J Clin Endocrinol Metab 2001;86(8): pp.3579-94]
Kelp / Seaweed
Please see the link between Hyperthyroidism and Iodine.
Caffeine/Coffee Avoidance
Caffeine can worsen symptoms such as fast heartbeat, nervousness, and difficulty concentrating.
Gluten-free Diet
Some doctors recommend the complete avoidance of gluten/gliadin and dairy products when this allergy is suspected in cases of Graves’ disease or other autoimmune disease.
Dairy Products Avoidance
One doctor reports that taking calcium without magnesium is one of the worst things you can do if you have hyperthyroidism because this increases any magnesium deficiency and increases the heart rate and likelihood of arrhythmia. This is one of the reasons why dairy products, which are high in calcium and low in magnesium, need to be restricted until magnesium levels are replenished.
Raw Food Diet
Most people who try a raw food diet for hyperthyroidism find it makes symptoms worse. However, I am aware of one person with hyperthyroidism who achieved a normal thyroid state on a raw food diet.
Conventional Drugs / Information
Because of the importance of controlling hyperthyroidism and preventing it’s effects (on bone loss, for example), the use of conventional drugs to accomplish this should be considered strongly. In some cases, when using thyroid medication to support a poorly function thyroid, the only necessary action would be to lower the dose in order to prevent hyperthyroid symptoms.
Plant Sterols / Sterolins (Phytosterols)
With Grave’s disease (hyperthyroidism), the body has become confused and sets up an autoimmune attack on the thyroid gland. When this autoimmune reaction is reduced, there is an opportunity for unhampered thyroid production and metabolism. Sterols and sterolins balance the immune system by decreasing the specific immune factor (Interleukin-6) responsible for the autoimmune reaction. As a result, thyroid function may be allowed to return to a more normal state.
Thyroid Medications
Thyroid medications should obviously be avoided with hyperthyroidism. However, there are cases where one would be taking thyroid medication for hypothyroidism, but just be taking too much and would need to reduce the dose – not avoid it entirely.
Test for DHEA
Some doctors report finding that a high percentage of patients with autoimmune disorders, such as Graves’ disease, are also deficient in DHEA, and should be tested.
Hydrochloric Acid (Trial)
Some doctors report that 50% of patients with autoimmune disease are also hypochlorhydric.
Flouride
Starting in the 1930s and continuing through to the late 1950’s sodium fluoride was used to lower the activity of the thyroid gland for those suffering from hyperthyroidism.
For Many, 3-fluorotyrosine became the treatment of choice in hyperthyroidism. Within 6 to 8 weeks patients became symptom-free, and employment-ready. (1937) Litzka and May were able to document and supply evidence for all claims. Between Jan.1, 1935 and October 1936, May further cured 501 patients successfully with fluorotyrosine.
Around the same time (1932) Gorlitzer von Mundy, being aware that fluorides also get absorbed through the skin, began fluoride treatments of hyperthyroid patients in Austria by prescribing 20 minute baths containing 30ccm (0.03l) HF per 200 liters of water. He reported on his successful treatment spanning over 30 years and involving over 600 patients at a 1962 symposium on fluoride toxicity organized by Gordonoff in Bern, which was also attended by other world-leading experts including the great George Waldbott, Steyn, and others.
The fact is that in ALL cases but one, fluoride produced reduced plasma bound iodine, even at 0.9 mg/day – a fact of great importance when one considers the current knowledge on sub-clinical hypothyroidism. In ALL cases but 1 the Basic Metabolic Rate (BMI) decreased. This was achieved sometimes within 20 days. To evaluate this properly, one needs to understand how anti-thyroid agents work. It is well known in the field of endocrinology that PTU and Methimazole, the two drugs currently used in the treatment of hyperthyroidism, sometimes can take a few months to kick in, due to the thyroid storing large amounts of iodine. Galetti seems to complain about the fact that it took so long, concluding that it was “effective only occasionally among people subjected to massive doses of this substance” (This besides the fact that 6 of 15 patients were completely healed!…The average “massive” dose meaning 6mg NaF (2.9 F-) daily. One patient was clinically cured by 2.72mg F-/day over a period of four month period…
Flluoride is no longer used for hyperthyroidism treatement, only because there are stronger anti-thyroid drugs like Tapazole and PTU. However, treatment such as this might mean that one would not have to be on conventional medication for life.
May W – “Antagonismus zwischen Jod und Fluor im Organismus” Klin Wochenschr 14:790-792 (1935)
May W – “Behandlung der Hypothyreosen einschließlich des schweren genuinen Morbus Basedow mit Fluor” Klin Wochenschr 16:562-564 (1937)
Galetti, PM;Joyet, G – “Effect of Fluorine On Thyroidal Iodine Metabolism in Hyperthyroidism” J Clin Endocrinol 18:1102-1110 (1958)
Selenium
On June 22, 2001 Dr. Barbara Gasnier reported the findings at the 83rd Annual Meeting of the Endocrine Society in Denver, Colorado that selenium supplementation may prevent progression of autoimmune thyroid disease, especially during the onset of the disease.
According to the researchers, selenium deficiency appears to contribute to the development and maintenance of autoimmune thyroiditis because of its effect on the function of selenium-dependent enzymes, which can modulate the immune system.
Selenium supplementation with 200mcg of sodium selenite may improve the inflammatory activity seen in patients with autoimmune thyroiditis, but whether this effect is specific for autoimmune thyroiditis or may also be effective in other organ-specific autoimmune diseases remains to be investigated. Selenium supplementation may lower free radical activity, which contributes to inflammation.
It appears that taking selenium without iodine will result in a decrease in production of Thyroxine (T4), although there may be an initial transient increase in T4 to T3 conversion and hence higher T3 and seemingly worse hyperthyroidism.
Copper
A significant number of people with hyperthyroidism have reported improvement, even the absence of symptoms, after long term copper supplementation. Some felt better within hours of taking copper, and were eventually able to discontinue their antithyroid medication. On average, the body needs about 2.5 – 3mgs of copper per day. In hyperthyroidism, two to three times this amount (5 – 9mgs) per day is reasonable.
Lithium (low dose)
In 1972, Mayo Clinic researchers published the first clinical investigation of lithium treatment for Graves’ disease. Using high-dose lithium for 10 individuals, they reported that thyroid hormone levels fell by 20-30% within five days.
Twenty-six years later, in a review of more than 10 successful trials of lithium therapy for Graves’ disease, the authors wrote: “a small number of studies have documented its [lithium’s] use in the treatment of patients with Graves’ disease… it’s efficacy and utility as an alternative anti-thyroid [treatment] are not widely recognized…”. They also note lithium’s rapid effect: “Lithium normalizes [thyroid hormone] levels in one to two weeks…” But they also caution that “toxicity precludes its use as a first-line or long-term therapeutic agent.” Dr. Jonathan V. Wright, MD suggests that If they’d just added flaxseed oil and vitamin E to their treatment, they would have basically eliminated the risk of toxicity.
Iodine
Iodine use is often contraindicated in hyperthyroidism. However, very high doses of Iodine for short periods (about thirty drops daily of SSKI for three weeks) have sometimes produced favorable results in Graves’ disease. Because of the possibility of causing a ‘thyroid storm’ (an acute hyperthyroid state), this therapy should only be attempted under close supervision by a doctor experienced in its use.
Surgery
The type and cause of hyperthyroidism, along with symptoms will determine if surgery is necessary. You should work with a specialist to make sure the right course of action is being taken. Surgery is usually reserved for cases of cancer, enlargement causing difficulty swallowing, and where radioactive iodine was ineffective or where there were side effects to antithyroid medication.
Neural Therapy
Neural Therapy to the thyroid gland may help normalize its function and stabilize or shrink nodules.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Weakly counter-indicative |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
Glossary
Hyperthyroidism
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Immune System
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Antibody
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Asymptomatic
Not showing symptoms.
Subclinical
Not manifesting characteristic clinical symptoms. Pertaining to a disease or condition.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Iodine
A essential mineral that is an integral part of the thyroid hormones, thyroxin and triiodothyronine which have important metabolic roles and govern basal metabolism. The best known iodine deficiency symptom is goiter. Other iodine deficiency problems are reduced vitality, hypothyroidism, inability to think clearly, low resistance to infection, loss of control of the muscles of the mouth resulting in mouth contortion and drooling, defective teeth, tendency to obesity and cretinism which is a congenital abnormal condition marked by physical stunting and mental deficiency.
Osteoporosis
A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.
DHEA
Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Cobalamin
Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Testosterone
The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.
Protein
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Copper
An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.
Metabolism
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.