Overview
Hyperthyroid conditions can be caused by autoimmune disease (Graves' disease), as well as by toxic goiter, or (rarely) thyroid cancer.
A thyroid storm (acute, severe hyperthyroid symptoms) is a medical emergency that requires immediate referral to the emergency department.
Conventional Treatment
Radioactive Iodine Ablation
This treatment aims to destroy all or part of your thyroid gland. The procedure depends on the thyroid gland's strong tendency to absorb iodine from the blood, which allows the radioactive iodine to be concentrated in the thyroid tissues while sparing other body tissues from its effects.
Over the next several months, after the radioactive iodine is administered, the radiation will destroy the thyroid cells, and the thyroid tissue will shrink. Unfortunately, as the thyroid cells 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 radioactive iodine cannot be turned off when the thyroid gland has been reduced to such a size that it produces "normal" levels of T4, the usual result of treatment with radioactive iodine is near total destruction of the thyroid gland and the subsequent need for life-long supplementation with exogenous prescription T4 and/or T3 (see treatment of hypothyroidism).
Thyroidectomy
Surgery 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).
Another potential problem 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 regulating the amount of calcium in the blood.
Propylthiouracil
This drug interferes with thyroid biochemistry, reducing thyroid hormone production.
Long-term therapy may lead to remission of the disease.
It may be used before and/or after subtotal thyroidectomy or radioactive iodine ablation of the thyroid
[
RxList].
Patients taking propylthiouracil need regular liver function tests since it is hepatotoxic. Because of its lower side-effect profile than propylthiouracil, methimazole is generally preferred.
Methimazole (Tapazole)
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
Beta-blockers help reduce many 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. However, 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.
Calcium Channel-Blockers
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. Sometimes, doing that alone will allow exophthalmos (Graves' ophthalmopathy) to spontaneously resolve over 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 highly toxic and its use must be very carefully monitored, Dr. Weyrich does not recommend this treatment.
Naturopathic and Alternative Treatment
General Autoimmune Protocol for Graves' Disease
Since Graves' disease is an autoimmune process, it makes sense that protocols aimed at eliminating the triggers of autoimmune processes would be beneficial. Dr. Weyrich has successfully used these protocols and herbs discussed below to treat Graves' Disease.
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. Dr. Weyrich has successfully used these herbs and the general autoimmune protocol discussed above to treat Graves' Disease. Do not try this at home without professional guidance.
Immune Modulators
Immune modulators such as vitamin-D and Low-Dose Naltrexone have also been effective (although the evidence is anecdotal). See the discussion of anecdotal evidence supporting the use of LDN on BUGBUG the treating hypothyroidism page).
[LdnResearchTrust_conditions] reports that Graves' disease is a condition that LDN could help. Personal communication from a colleague 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 the note below regarding the conventional treatment of thyroid cancer.
Please see [LDN_Story] for an excellent documentary video, and [Elsegood2016] and [Moore2008] for books.
The main caveats are that patients cannot also be concurrently treated with extended-release opiates for pain control and cannot be organ transplant recipients. Treating hyperthyroidism using LDN 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.
Spinal Manipulation
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 Spinal Connection.
Nutrition
According 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
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.
Thyroid Cancer
The 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 severe disease. The treatments above may, however, be helpful 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.
References