Hyperthyroid conditions can be caused by autoimmune disease (Graves' disease), as well as by toxic goiter, or (rarely) thyroid cancer.
Thyroid storm (acute, severe hyperthyroid symptoms) is a medical emergency and requires immediate referral to the emergency department.
Radioactive Iodine Ablation
The purpose of this treatment is to destroy all or part of your thyroid gland. The procedure depends on the strong tendency of the thyroid gland to absorb iodine from the blood, which allows concentration of the radioactive iodine in the thyroid tissues, while sparing other tissues of the body from the effects of the radioactive iodine.
Over the next several months after administration of the radioactive iodine, the cells of the thyroid will be destroyed by the radiation and the thyroid tissue will shrink. Unfortunately, as the cells of the thyroid are destroyed, they may release even more T4 (in the same manner as early Hashimoto's thyroiditis). This may exacerbate the symptoms of hyperthyroidism, including exophthalmos. This treatment is contraindicated in pregnancy.
Since there is no way to turn off the radioactive iodine when the size of the thyroid gland has been reduced to such a size that it produces "normal" levels of T4, the usual end result of treatment with radioactive iodine is near complete destruction of the thyroid gland and the subsequent need for life-long supplementation with exogenous prescription T4 and/or T3 (see treatment of hypothyroidism).
ThyroidectomySurgery to remove all (total) or part (sub-total) of your thyroid gland can also be considered. While more precise than the use of radioactive iodine, this procedure may also result in the subsequent need for life-long supplementation with exogenous prescription T4 and/or T3 (see treatment of hypothyroidism).
Other potential problems with this surgical procedure is damage to adjacent structures in your throat, especially damage to the recurrent laryngeal nerve that controls your voice or to the parathyroid glands that are critical to controlling the amount of calcium in the blood.
This drug interferes with the thyroid biochemistry, reducing the production of hormones. Long-term therapy may lead to remission of the disease, and may also be used both prior to subtotal thyroidectomy or radioactive iodine ablation of the thyroid and after [RxList].
Patients taking propylthiouracil need to have regular liver function tests, since propylthiouracil is hepatotoxic. Because of its lower side-effect profile than propylthiouracil, methimazole is generally preferred.
This drug also interferes with the thyroid biochemistry, reducing the production of hormones. Methimazole has the advantage of being less hepatotoxic than propylthiouracil, but has the disadvantage of being contraindicated in the first trimester of pregnancy. [RxList].
Beta-blockers help reduce many of the acute symptoms of hyperthyroidism, such as rapid or irregular heartbeat, high blood pressure, tremors, anxiety, irritability, heat intolerance, and sweating by blocking the body's sympathetic (fight or flight) response. They do not relieve other symptoms such as exophthalmos.
Beta-blockers, especially non-specific ones, are relatively contraindicated in people with asthma, since they can trigger an asthma attack and reduce the effectiveness of rescue inhalers. They also must be used cautiously in people who have diabetes.
When beta-blocking drugs are contraindicated, calcium channel-blocking drugs can be prescribed instead to control symptoms of hyperthyroidism.
Treatment for Exophthalmos
It is critical to reduce T4 and T3 levels into the normal range. Doing that alone sometimes will allow exophthalmos (Graves' ophthalmopathy) to spontaneously resolve over a period of several years. Other interventions are often necessary, including special prismatic glasses to correct double vision, or even eye surgery.
Iodine and Lithium
An old treatment that is no longer recommended is a combination of high doses of iodine (which has the paradoxical effect of suppressing thyroid function) and the antipsychotic drug lithium (which is a thyroid toxin).
Since lithium is extremely toxic and its use must be very carefully monitored, Dr. Weyrich does not recommend this treatment.
Naturopathic and Alternative Treatment
General Auto-Immune Protocol for Graves' Disease
Since Graves' disease is an auto-immune process, it makes sense that protocols aimed at eliminating the triggers of auto-immune processes would be beneficial. Dr. Weyrich has successfully used these protocols, along with herbs discussed below, to treat Graves' Disease.
Briefly, these protocols involve testing for intestinal hyperpermeability, food hypersensitivities, gluten sensitivities, and dysbiosis (see discussion in Thyroid Lab Testing), and then taking appropriate corrective action.
Herbal Treatments for Graves' Disease
Certain herbs (Lycopus virginicus, Leonorus cardiaca, and Melissa officinalis) have been historically used to treat Graves' Disease, and Dr. Weyrich has successfully used these herbs, along with the general auto-immune protocol discussed above, to treat Graves' Disease. Do not try this at home without professional guidance.
Immune modulators such as vitamin-D and Low Dose Naltrexone have also been found to be effective (although the evidence is anecdotal, since funding for research for products that cannot be patented is extremely limited).
The use of Low Dose Naltrexone (LDN) in treating autoimmune, neuroinflammatory, and certain microbial diseases and cancers was pioneered by the late Dr. Bernard Bihari [Bihari2003], [Bihari2013].
[LdnResearchTrust_conditions] reports that Graves' disease is a condition that LDN could help. Personal communication from a collegue indicates that LDN is highly effective in cases of Graves' disease. There is also anecdotal evidence that suggests that LDN may be effective against thyroid cancer, but see note below regarding the conventional treatment of thyroid cancer.
Please see [LDN_Story] for an excellent documentary video, and [Elsegood2016] and [Moore2008] for books.
Dr. Weyrich notes that these reports are considered anecdotal, and without expensive double-blind placebo-controlled trials (which are unlikely to be funded, since LDN is a generic drug that cannot be patented), these results cannot be proven to be anything more than "spontaneous remissions"; however, given the low cost (less than $40/month) and extremely low side-effect profile, a therapeutic trial may be in order.
The main caveats are that patients cannot also be being treated with extended release opiates for pain control and cannot be organ transplant recipients. This is an off-label use, and as such is not likely to be covered by insurance.
Dr. Weyrich has been trained in the use of Low Dose Naltrexone (LDN) and offers these protocols as a complement to other therapies. Dr. Weyrich has not attempted to treat Graves' disease with LDN, but considers it an important option in future cases.
Hippocrates, the "father of modern medicine", said "first look to the spine" for the cause of disease. In some cases, treatable problems with the spine can reduce blood flow to the brain and nerves of the autonomic nervous system that regulate the function of the thyroid, adrenal, and digestive systems. For additional information regarding the relationship between the spine and thyroid disease, please see Dr. Weyrich's discussion on the The Spinal Connection.
NutritionAccording to [Domino2017], "nutritional supplementation with L-carnitine may act as an antagonist of thyroid hormone and reduce hyperthyroid symptoms as well as decrease bone demineralization" [no source referenced].
Toxic goiter results from prolonged iodine deficiency that causes enlargement of the thyroid gland, followed by repletion of iodine that results in overactive production of T4 by the enlarged thyroid gland. In this case, combining methimazole or propylthiouracil with a protocol to suppress TSH levels may be effective in avoiding the need for surgery or radioiodine ablation.
Conventional (allopathic) treatment of thyroid cancer has a high success rate, so Dr. Weyrich does not recommend naturopathic or alternative treatments of thyroid cancer that lack sufficient evidence of safety and effectiveness against this serious disease. Treatments above may however be useful as adjunctive support after conventional (allopathic) treatment.
See also treatments for the hypothyroidism that results from surgical or radiation ablation of the thyroid gland as a consequence of conventional (allopathic) treatment of thyroid cancer. Note that in the case of thyroid cancer, or post-thyroid ablation, physicians may choose to suppress TSH levels in the hope of discouraging the growth of any thyroid tissue that was missed by the surgical treatment.
- [Bihari2003] Bernard Bihari, Kamau B Kokayi. Dr. Kamau B. Kokayi Interviews Dr. Bihari. Global Medicine Review. September 23, 2003, WBAI in New York City Text: http://www.lowdosenaltrexone.org/gazorpa/interview.html.
- [Bihari2013] Bernard Bihari. Low-dose Naltrexone for Normalizing Immune System Function. Altern Ther Health Med. 2013 Mar-Apr;19(2):56-65. PMID: 23594453. Text: http://todayspractitioner.com/wp-content/uploads/2013/10/Bernard-Bihari-MD-Low-dose-Naltrexone-for-Normalizing-Immune-System-Function-athm_19_2_bihari_56_65.pdf.
- [Domino2017] Frank J Domino, et al. The 5-minute Clinical Consult. Wolters Kluwer (2017). Amazon.
- [Elsegood2016] Linda Elsegood. The LDN Book: How a Little-Known Generic Drug - Low Dose Naltrexone - Could Revolutionize Treatment for Autoimmune Diseases, Cancer, Autism, Depression, and More. Chelsea Green Publishing (2016). Amazon.
- [LDN] Low Dose Naltrexone Home Page. Text: https://www.lowdosenaltrexone.org. Accessed: 07/26/2019.
- [LDN_Story] LDN Research Trust. The LDN Story. Text: https://vimeo.com/131314110. Accessed: 09/16/2016.