Treating Hyperthyroidism
In This Chapter
- Managing mild hyperthyroidism naturally
- Managing with Tapazole or PTU
- Mixing natural and prescription medications
- Considering radiation and surgery
For those who are hypothyroid, treatment is relatively easy; all that’s required are pills supplying the hormones they’re missing. Since these are the same hormones normally made by the thyroid, their bodies simply welcome the boost the medication provides.
But if you’ve been diagnosed as hyperthyroid, you effectively need to combat your body’s natural ability to produce thyroid hormones, which is a trickier process. It can be successfully achieved via low-impact remedies, antithyroid medication, radioactive iodine, and/or surgery—and the help of an experienced doctor who carefully monitors your progress.
This chapter will guide you through the options so you can make the best choices for your long-term health.
Low-Impact Remedies
If you get tested as soon as you notice hyperthyroidism symptoms, the disease might be detected at a sufficiently early stage for your excess T4 and T3 levels to be relatively mild. This doesn’t occur often with Graves’ disease, but it does with other forms of hyperthyroidism such as Plummer’s. If you’re being treated by a doctor familiar with natural medicine, identifying your condition early on provides an opportunity to try gentle remedies to keep the hyperthyroidism from becoming worse.
The advantages to this approach are that the risks of side effects are near zero, and it’ll cost much less than prescription medication. If your condition can be stabilized, you may be able to stay on the non-intrusive treatment until the disease burns itself out over 2-3 years. At the end of this process, your thyroid might return to normal; or you might become hypothyroid, in which case you’d simply start taking thyroid medication (as described in Chapters 8 and 9).
Fluoride
Fluoride is famous for fighting tooth decay. However, it can also combat hyperthyroidism. That’s because your thyroid’s hormone production is dependent on iodine, and fluoride’s chemical composition is so similar to iodine that your thyroid can’t tell the difference between the two. Your thyroid will therefore absorb any fluoride in your bloodstream. The more fluoride your thyroid takes in, the less room there is for iodine, and the more likely it is that the fluoride will block iodine from your thyroid’s hormone construction sites. The result is a substantial reduction in thyroid hormones.
In fact, some speculate that the current hypothyroidism epidemic is in part due to fluoride being added to the water supply of many communities (see Chapter 22). But what’s important for you is that fluoride is an effective suppressor of T4 and T3 overproduction. It’s also relatively harmless.
Fluoride was frequently used to treat hyperthyroidism in the past. It isn’t anymore, possibly because there’s no financial incentive for drug companies to champion its use when there are much more expensive alternatives. But if you can find a doctor who’ll agree to monitor its use, you’ll discover fluoride can be purchased cheaply from virtually any drugstore; in numerous forms (chewable tablets, gels, lozenges, etc.); and generally causes no complications in moderate dosages, even if you take it daily for several years.
L-Carnitine
Carnitine is an amino acid present in virtually every cell of your body. It’s made by your body, and is also present in red meat, diary products, nuts and seeds, and a variety of other foods. Moderately increasing its levels in your bloodstream is likely to have no side effects.
Carnitine’s function is to transport fats to your mitochondria so they can transform them into energy. At an appropriate dosage determined by your doctor, though, it has the additional effect of interfering with your T3’s ability to penetrate cell membranes, and with your thyroid’s responsiveness to TSH. Both of these actions serve to reduce hyperthyroidism.
Carnitine is commercially available under the name L-carnitine. It’s inexpensive, and can be purchased in multiple forms (tablet, capsule, liquid) from most health food stores.
Goitrogens
Some of the healthiest foods in the world can reduce your T4/T3 count. Cruciferous vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, and kale are loaded with the compound indole-3-carbinol. When eaten in normal amounts, these vegetables are unlikely to impact your thyroid. But if you eat an unusually large quantity of them—more than two cups (100 grams) raw or five cups cooked daily—or if you take indole-3-carbinol in a concentrated form via tablets or capsules, you’ll inhibit your thyroid’s ability to absorb iodine, and that will result in your thyroid making less of its hormones.
Similarly, soy-based foods such as tofu, tempeh, edamame, yuba, miso, and soy milk are packed with compounds called isoflavones. If you consume a lot of soy products—more than two servings (100 grams) of soy food or six ounces of soy milk—or if you take concentrated isoflavones via tablets or capsules, they can stop iodine from being digested properly, which will keep it from entering your bloodstream where it can be absorbed by your thyroid.
These foods are sometimes referred to as goitrogens because they have the ability to spur hypothyroidism, which in turn can lead to goiters (see Chapter 5).
If you’re hyperthyroid, though, a reduction in T4/T3 levels is a good thing. Since cruciferous vegetables have many other health benefits, including reducing your risk of cancer, and soy products can lower your cholesterol, go ahead and enjoy eating a lot of these foods.
Crash Glanding
Other foods touted as reducing thyroid hormone levels include the seaweed Sargassum, and the herb bugleweed (Lycopus virginica). In my experience, however, these aren’t effective for managing hyperthyroidism.
While You’re Waiting …
Low-impact remedies can be very effective, but you have to be patient to experience their effects. That’s because your thyroid has already made and stored a large amount of its hormones, and it’ll take 4-6 weeks for those existing supplies to be used up. All the remedies can do is reduce the subsequent amount of hormones your thyroid produces. You should therefore allow for 4-6 weeks before noticing a difference in how you feel.
That doesn’t mean you need to suffer while you wait, though. You can, and should, take steps to manage your symptoms. You can use prescription medication to do this, and options are described later in this chapter. But natural remedies are available for this purpose as well.
For example, you can typically slow down your heart rate by consuming more mag-nesium. You can do this in part by eating magnesium-rich foods, such as legumes (adzuki beans, black beans, peas), dark green leafy vegetables (spinach, kale), nuts and seeds (almonds, cashews, pumpkin seeds), and whole grains. Alternatively, or in addition, you can take magnesium in concentrated form via pills.
It also helps to cut down or stop drinking caffeinated beverages, such as soda and coffee, that both reduce magnesium and raise your heart rate.
As another example, if you’re experiencing anxiety, you may be able to calm it with theanine, an amino acid commonly present in tea (and one of the reasons people find tea soothing). You might also benefit from kava-kava, a beverage made from the plant of the same name, which relaxes without affecting mental clarity.
As with the antithyroid remedies, the advantages to these symptom dampeners are that they’re low-cost, readily available, and have almost no side effects.
Prescription Medications
The primary medication for treating hyperthyroidism is Tapazole. There’s also a generic version called methimazole. A secondary option is propylthiouracil, or PTU. PTU is an older drug, and it’s available as a generic exclusively (i.e., there’s no brand name).
Tapazole and PTU are called antithyroid medications because they work by fighting against your thyroid’s natural functions. Specifically, they disrupt the process your thyroid uses to turn iodine into hormones. They’re very effective at reducing T4 and T3 production, regardless of the form and severity of your hyperthyroidism.
Therefore, if your condition has gotten beyond the early, mild stage described in the previous section, these medications are typically your best choice for managing your hyperthyroidism. Once your condition is stabilized, you can usually stay on them until the disease runs its course over 2-3 years. At that point your thyroid might return to normal; or you might become hypothyroid and simply go on thyroid medication.
Tapazole vs. PTU
Tapazole has several highly significant advantages over PTU:
- It produces results faster, typically returning your hormone levels to normal in 4-6 weeks. PTU may take 3-4 months to do the same thing.
- It needs to be taken only once a day. PTU has to be taken two or three times a day.
- It will have virtually no effect on any subsequent attempt for treatment using radioactive iodine. PTU reduces the odds of subsequent radiation being effective.
- It has fewer serious side effects.
You’d typically turn to PTU if you were allergic to Tapazole or found Tapazole to be ineffective for you. PTU is also preferable for treating Graves’ disease during the first trimester of pregnancy, because Tapazole has a greater chance of causing birth defects during the first three months of fetal development. Otherwise, Tapazole is the best treatment choice for most people.
Tapazole and PTU Side Effects
Both Tapazole and PTU share some side effects. When taking either of them, there’s up to a 13 percent chance you’ll experience itching, rash, hives, joint pain, arthritis, fever, abnormal taste sensations, nausea, or vomiting.
There’s also a tiny (0.2-0.5 percent) chance of developing agranulocytosis, which causes a reduction in the white blood cells that fight infection—and a very serious chink in the armor of your immune system. Your doctor should periodically test for this. Further, if you get a sore throat or other infection while on either medication, see your doctor right away so she can run a white cell count on your blood; and don’t take the medication again until the lab results arrive and show that you’re okay.
In addition, PTU has one major side effect that resulted in a 2009 FDA warning: the potential to cause severe liver damage. While this rarely occurs, when it happens it can completely shut down the liver; and it’s led to 13 deaths and 11 liver transplants to date. That means if you’re on PTU, both you and your doctor need to pay special attention for telltale signs of liver problems, such as a yellowish tinge to the skin or eyes.
Doctors who favor radioactive iodine as a first-line treatment for hyperthyroidism point to PTU’s drawbacks, arguing radiation is a more convenient and safer approach. And in this case, a reasonable argument can be made.
When it comes to Tapazole, however, it’s been my experience that as long as you have a knowledgeable doctor to monitor you, using this medication creates few complications; and its benefits far outweigh the risks.
Thyroidian Tip
Natural versus prescription medication doesn’t have to be an either/or choice. Most of my patients do extremely well starting off on low to moderate doses of Tapazole (prescription medication) in combination with fluoride and L-carnitine (low-impact remedies). After a few months, I’m able to wean most of them off the Tapazole, at which point they do fine on the fluoride and L-carnitine alone—which are inexpensive and have virtually no side effects.
While both Tapazole and PTU are very effective, they take a while to kick in. As mentioned previously, you have to wait 4-6 weeks to improve on Tapazole, and 3-4 months on PTU.
Further, your doctor may decide to put you on a dosage of medication that keeps you marginally hyperthyroid. This is often a good strategy if you have one or more goiters, because your TSH has to remain low for the goiters to shrink. But it means you’ll still have some remaining symptoms.
Then again, you might be allergic to both Tapazole and PTU. In this case, you’ll want some help getting through each day until you’re ready for either radioactive iodine treatment or surgery.
In all such situations, you’ll require medications to suppress key hyperthyroid problems. Most commonly, you’ll need to lower your heart rate. This can be accomplished by a beta blocker, which is a drug that blocks the effects of adrenaline, making your heart beat more slowly and with less force. It also helps reduce your blood pressure and improve your blood’s circulation. The best beta blockers for hyperthyroidism include atenolol and propranolol.
You may also be suffering from severe anxiety. This can be managed with anti-anxiety medicines such as benzodiazepines, which include Valium, Xanax, Dalmane, and Tranxene. These can be taken regularly several times a day, or only when you feel you need them. However, be aware they can cause drowsiness, affecting how well you drive and decisions you make. Also, they shouldn’t be mixed with alcohol or other sedating substances.
Then again, you might do fine on natural remedies that have virtually no side effects, such as magnesium for lowering heart rate, or theanine or kava-kava for calming anxiety.
Block-and-Replace Therapy
If you’re on antithyroid medication such as Tapazole, your doctor will monitor you via periodic checkups for 2-3 years until your hyperthyroidism starts petering out on its own. Your doctor will then gradually withdraw your treatment as your thyroid hormone levels lower.
At that point either your thyroid will return to normal, in which case you’re home free, or your levels will continue falling, making you hypothyroid. If it becomes clear you’re heading in the latter direction, an experienced doctor won’t just withdraw treatment and let you plummet into hypothyroidism, but instead will start putting you on low doses of thyroid hormones while you’re still being treated for hyperthyroidism.
I call this “driving with the parking brake on,” because it allows your doctor to control how quickly you’re moving in both directions. It ensures your T4 and T3 levels don’t jump up again, while at the same time gently eases you into your new hypothyroid state. It’s officially called block-and-replace therapy, because your doctor is blocking the disease at the same time that she’s replacing any lack of hormones.
After several months or so, your doctor can stop the antithyroid medication entirely, and simply treat you for being hypothyroid. The latter is a cause for celebration, because it essentially means you’re out of danger. Once you’re hypothyroid, all you have to do is take thyroid medication every morning to maintain healthy hormone levels.
Some doctors are so enthusiastic about block-and-replace therapy that they advocate using it for the entire medication process. Studies don’t support this view, though; while it does no harm, this approach doesn’t shorten the duration of treatment or improve the outcome. That said, if your T4/T3 levels are continually fluctuating between being too high and too low, block-and-replace therapy is typically the perfect solution.
Radiation and Surgery
Most doctors in Europe greatly prefer using medication to treat hyperthyroidism. In America, however, the first choice of most doctors is radioiodine ablation. This uses radioactive iodine to destroy a substantial percentage of the thyroid’s cells, making it too small to overproduce hormones.
This works because the thyroid is the only gland in your body that absorbs iodine. When you’re given iodine that’s radioactive (via pill or injection), the iodine will be ignored by the rest of your body and travel straight to your throat, where it’ll be eagerly absorbed by your thyroid cells. The radiation will then kill off the cells.
If your doctor recommends this strategy, he’ll probably tell you that there’s no risk of developing cancer from it. However, a major study of 2,500 patients followed over 10 years (through 2002) concluded that those who underwent this procedure were later struck by cancer at a 20 percent higher rate than those who didn’t. That’s a highly significant difference.
Another disadvantage is that your doctor will err on the side of making you hypo-thyroid. While that’s a much safer condition than hyperthyroidism, it’s not as good as returning to normal thyroid function; and the latter happens as much as 70 percent of the time for those who choose the medication route.
On the positive side, radioiodine ablation takes 6-18 weeks, while it typically takes 2-3 years of medication and skilled monitoring by your doctor to manage your hyperthyroidism until the disease ends itself naturally.
Further, radioiodine ablation is a tremendously useful option if you’re allergic to Tapazole, or if Tapazole simply doesn’t happen to work for you. Plus radiation is a straightforward way to reduce the size of goiters, especially if they won’t shrink on their own.
I’ve also found some patients like the apparent finality of radiation over the gradual monitoring and adjustment process of medication. In practice, however, for roughly one out of five patients radioiodine ablation doesn’t do the job the first time, requiring a second dose … and increasing the risk of cancer down the line.
In the vast majority of cases, I prefer the medication route for my patients. I find it works with few complications, and it creates no further risk of cancer. But both approaches have positives and negatives.
Finally, you have the option of getting half or all of your thyroid surgically removed. This is considered a last resort, however. While an operation will end your hyperthyroidism, it risks doing damage to your parathyroid glands and vocal chord nerves (see Chapter 13).
Hyperthyroid Patient Stories
It can be easier to understand treatment options when they’re viewed within the context of people’s lives. The following are true stories of patients who were struggling with hyperthyroidism. They were all restored to full health via medication.
Weary of Radiation
Martha had undergone radioiodine ablation treatment for her Graves’ disease … twice. She was still hyperthyroid.
About 20 percent of patients have to return for a second dose of radiation before their T4 and T3 levels fall to normal or hypothyroid levels. But a second treatment not being enough either was pretty unusual. I didn’t blame Martha for being frustrated. Further, her doctor was now recommending surgery. Concerned about the risk of complications, she sought me out for a fresh perspective.
Martha was stable on high doses of both Tapazole and the beta blocker atenolol. I told her I’d like to try a slightly different approach for a month and see what happened. After she agreed, I kept Martha on her current medications, but added low doses of fluoride (to block iodine) and lithium (to ease her anxiety). On her first retest, Martha’s T4 and T3 levels were in the normal range for the first time in years. She also felt much less anxious.
We moved forward with a medicine-based treatment. Martha continued to improve, and we were able to lower her dosages over the next several months while keeping her T4/T3 levels steady.
Supermeds
Rebecca had a severe case of Graves’ disease. Her TSH was <0.01 mIU/L—essentially off the charts—and her free T4 was a sky-high 5.9 ng/dL. I explained that managing her hyperthyroidism would be like stopping a train. It would take the strength of Superman to abruptly bring it to a halt, but after that a simple wheel chock could hold it in place.
I prescribed a high 60 mg daily of Tapazole over the first six weeks to slow down the disease. After that, I was able to bring the dosage down to 10 mg daily for maintenance.
Block and Replace
Peter came to see me for management of his Plummer’s disease after unceasing anxiety and panic attacks. His previous doctor had prescribed 20 mg of Tapazole daily, which ended up making Peter hypothyroid. His doctor then prescribed a low dose of Synthroid, which made the hyperthyroidism come back worse than ever.
Afraid of getting even worse, Peter did nothing for six months. Then the misery of his symptoms led him to seek me out for a second opinion. Considering his experiences, I told Peter he’d probably do well on block-and-replace therapy. I prescribed 5 mg of Tapazole and 75 mcg of Synthroid. Within a month, Peter told me he felt like himself again.
Over the following months we made minor adjustments. After Peter had been stable for a full year, I very gradually tapered him off both the Tapazole and Synthroid. He remained healthy. I have Peter keeping a sharp eye out for symptoms, though, and schedule him to see me every six months, just in case there’s a recurrence.
The Least You Need to Know
- If your hyperthyroidism is mild, it can be treated with natural remedies such as fluoride, L-carnitine, and goitrogens.
- If your hyperthyroidism symptoms are severe, they can be treated with Tapazole (or its generic version methimazole), or PTU.
- To avoid wild swings toward the end of your hyperthyroidism, your doctor should use block-and-replace therapy.
- If medication isn’t effective, you can be treated with radioiodine ablation, which employs radioactive iodine to reduce your thyroid’s size; or with surgery.