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”.  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:

• Antithyroid medication is usually effective in helping to manage the symptoms of hyperthyroidism.  In most people with hyperthyroidism, antithyroid medication does a good job of lowering thyroid hormone levels, which in turn will help with the symptoms of hyperthyroidism, including an elevated heart rate, palpitations, tremors, weight loss, loose stools, etc.
• Taking antithyroid medication can prevent many people from receiving radioactive iodine or thyroid surgery.  As you know, most endocrinologists recommend either antithyroid medication, radioactive iodine, or surgery to their patients with Graves’ disease and toxic multinodular goiter.  While all three of these options aren’t ideal, antithyroid medication is the least invasive of these, and many people have preserved the health of their thyroid gland by temporarily taking antithyroid medication.  So while it’s not offering a permanent solution in most cases, at the very least it can buy you time while trying to address the cause of the problem.
• Some people who take antithyroid medication will go into remission.  I just mentioned how antithyroid medication doesn’t offer a permanent solution, yet there are some people who take it and go into remission.  The problem is that many of these people who go into remission eventually relapse, and when this happens the endocrinologist is even more likely to pressure the person to receive radioactive iodine or surgery.  I realize that many people don’t know about natural treatment methods pertaining to hyperthyroidism, and so they’re just following the advice of their doctor and not trying to address the cause of the problem while taking the medication.  Of course most people reading this know that they should also be doing things to improve their health, and not just do things to manage their symptoms.

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:

• Antithyroid medication frequently causes side effects. This is one of the primary problems with antithyroid medication, as while over the years I’ve had many patients take it without experiencing symptoms, I also have had a lot of patients who did experience one or more symptoms.  Some of the more common symptoms associated with methimazole/Tapazole include stomach upset, nausea, vomiting, skin rash/itching, headaches, dizziness, muscle/joint/nerve pain, swelling, and hair loss (1).  The symptoms are similar with other types of antithyroid drugs, including PTU (2).
• Antithyroid medication can cause an elevation of liver enzymes.  Both methimazole and PTU commonly cause an elevation of liver enzymes, which is an indication of damage taking place to the liver (3).  The three main enzymes commonly affected include alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP). For more information on these enzymes you can check out my article entitled “How To decrease Elevated Liver Enzymes in Hyperthyroidism and Graves’ Disease“.
• Antithyroid medication doesn’t address the autoimmune component of Graves’ disease.  While some people with Graves’ disease do seem to get into remission while on antithyroid medication, it’s not because antithyroid medication removes the autoimmune triggers and corrects the underlying imbalances.  In addition to lowering thyroid hormone levels, methimazole does have some immunosuppressive effects (4), and as a result, some people who take it might experience a lowering of thyroid stimulating immunoglobulins, which are the antibodies associated with Graves’ disease.  The problem is that because it’s not addressing the cause of the autoimmunity, over time the person is likely to experience an elevation of these antibodies again, along with hyperthyroidism.
• Antithyroid medication doesn’t address the underlying cause of other types of hyperthyroidism.  If someone has a non-autoimmune hyperthyroid condition such as toxic multinodular goiter, taking antithyroid medication on a temporary basis may help to manage the symptoms, but just as is the case with Graves’ disease, it of course isn’t doing anything to address the underlying cause of the condition.

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 also has antithyroid properties.

• Natural antithyroid agents can help to manage the symptoms of hyperthyroidism.  When natural antithyroid agents effectively lower thyroid hormone levels it’s wonderful, as I know that when I took bugleweed it felt good to avoid taking medication while I was addressing the cause of the problem.
• Natural antithyroid agents don’t cause the same side effects as antithyroid medication.  This perhaps is the most important benefit of taking natural antithyroid agents, as side effects aren’t nearly as common as they are with antithyroid drugs.  This doesn’t mean that people never experience side effects, as it’s possible to react to any herb, and bugleweed is no exception.  And there are some people who experience side effects with other natural antithyroid agents (i.e. lithium).  But it’s still a lot less frequent when compared to antithyroid medication.
• Natural antithyroid agents usually don’t cause elevated liver enzymes.  This is yet another important benefit of taking natural antithyroid agents, as rarely does someone need to stop taking them due to the stress they’re putting on the liver.
• Mentally it feels good to avoid antithyroid medication.  As I mentioned earlier, when I took bugleweed for my Graves’ disease condition it felt good to avoid taking medication.  This isn’t meant to make those who are currently taking medication to feel bad or discouraged, as everything comes down to risks vs. benefits, and if someone has to take methimazole but at the same time they’re able to address the root cause of their condition then they should still feel pretty good about themselves.

What Are The Risks of Taking Natural Antithyroid Agents?

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

• Natural antithyroid agents aren’t as effective as antithyroid medication.  There is no question that antithyroid medication is more effective in lowering thyroid hormone levels when compared to natural antithyroid agents.  For example, bugleweed is probably the most effective natural antithyroid agent for hyperthyroidism, and I see it work approximately 70-75% of the time.  But of course this means that 25-30% of the time it isn’t effective in lowering thyroid hormone levels.  Antithyroid medication such as methimazole is more likely to work, but as you know, it’s also more likely to cause side effects.
• Natural antithyroid agents don’t address the autoimmune component of Graves’ disease.  While it’s great to use natural antithyroid agents to lower thyroid hormone levels, just remember that it’s not doing anything to improve the health of the immune system for those who have Graves’ disease.  So you still need to find and remove the autoimmune triggers, as well as correct other underlying imbalances.
• Natural antithyroid agents don’t address the underlying cause of other types of hyperthyroidism.  Just as is the case with Graves’ disease, taking natural antithyroid agents don’t address the underlying cause of other hyperthyroid conditions, such as toxic multinodular goiter.

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 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!