Recently I found out that a patient of mine was misdiagnosed with Hashimoto’s thyroiditis by her medical doctor.  Most of my patients with Hashimoto’s and Graves’ disease who see me for the first time have already been diagnosed with an autoimmune thyroid condition.  And both conditions usually aren’t too difficult to diagnose.  But I’m sure there are some people who don’t understand how both of these autoimmune thyroid conditions are diagnosed, and they simply take the word of their endocrinologist or primary care physician.  And so I figured I’d put together a post that discusses how both of these conditions are diagnosed.

What’s disturbing is that the person who was misdiagnosed with Hashimoto’s wasn’t even hypothyroid at the time of her diagnosis, yet she was put on thyroid hormone replacement.  Now to be fair, many people with Hashimoto’s thyroiditis have subclinical hypothyroidism, where their TSH is elevated and their thyroid hormone levels are within the lab reference range.  But in this person’s case, her TSH was 1.18 uIU/mL at the time of her diagnosis.  In addition, she didn’t have any thyroid antibodies tested.  Yet she was told she had Hashimoto’s and was put on thyroid hormone replacement, which she was taking since 2014.

Although it’s upsetting that this person was misdiagnosed with Hashimoto’s, I think it’s safe to say that most people who were told they have an autoimmune thyroid condition have received the appropriate diagnosis.  But it’s also safe to say that this person isn’t the only one who has been misdiagnosed with an autoimmune thyroid condition.  And even if only a small percentage of people are misdiagnosed every year, I want to try to reduce the incidence of this, which is why I’m putting together this post.

Diagnosing Hashimoto’s Thyroiditis

According to the American Thyroid Association, this is how Hashimoto’s thyroiditis is diagnosed (1):

“The diagnosis of Hashimoto’s thyroiditis may be made when patients present with symptoms of hypothyroidism, often accompanied by a goiter (an enlarged thyroid gland) on physical examination, and laboratory testing of hypothyroidism, which is an elevated thyroid stimulating hormone (TSH) with or without low thyroid hormone (free T4) levels. TPO antibody, when measured, is usually elevated.  Occasionally, the disease may be diagnosed early, especially in people with a strong family history of thyroid disease. TPO antibody may be positive, but thyroid hormone levels may be normal or there may only be isolated mild elevation of serum TSH. Symptoms of hypothyroidism may be absent.”

So let’s break down their diagnosis:

• Patient presents with symptoms of hypothyroidism, often accompanied by an enlarged thyroid gland (goiter)
• Laboratory testing shows an elevated TSH, with or without low thyroid hormone levels
• TPO antibodies are usually elevated

They also mention that when diagnosed early, TPO antibodies may be positive, but thyroid hormone levels might be normal or there may only be a mild elevation of serum TSH, and that symptoms of hypothyroidism might be absent.  So you don’t need to have symptoms of hypothyroidism to be diagnosed, and the TSH might be slightly elevated, but TPO antibodies usually are positive.  Unfortunately they didn’t mention anti-thyroglobulin antibodies, which are also associated with Hashimoto’s, as there are cases when TPO antibodies are negative but someone has positive anti-thyroglobulin antibodies.

Is a Thyroid Ultrasound Necessary?

Some sources will also mention the value of doing a thyroid ultrasound in coming up with a diagnosis.  One study showed that reduced thyroid echogenicity was a valid predictor of thyroid autoimmunity (2).  However, one can argue that positive ultrasound findings aren’t necessary to diagnosis Hashimoto’s if someone has an elevated TSH and either elevated TPO and/or thyroglobulin antibodies.

Summary of Hashimoto’s Thyroiditis Diagnosis

So when putting everything together that I mentioned above, it should be clear how Hashimoto’s thyroiditis is diagnosed, as the following two factors both need to be present:

• Elevated TSH
• Elevated thyroid peroxidase antibodies and/or anti-thyroglobulin antibodies

Normal TSH In the Presence of Elevated Thyroid Antibodies

But what if someone has elevated thyroid antibodies but their TSH is perfectly fine?  Or if their TSH is within the laboratory reference range, but higher than optimal, yet the person has one or more elevated thyroid antibodies?  Well, from a medical standpoint neither of these patients will probably be diagnosed with Hashimoto’s, although they do have the antibodies associated with Hashimoto’s.  In this situation most medical doctors won’t give thyroid hormone replacement, but even if the person doesn’t need to take thyroid hormone replacement, it doesn’t mean that the immune system should be ignored.

In fact, for those who have read my book “Hashimoto’s Triggers”, the very first chapter discusses the timeline of Hashimoto’s.  In this chapter I discuss the following four stages of Hashimoto’s.  I’ll list the stages below, but you can actually access the first chapter of my book for free by visiting Amazon.com and searching for my book on Hashimoto’s (or you can click here), and on the left side of the page click on “Look Inside”, and you’ll be able to check out the first chapter of my book.

The Autoimmunity Timeline

Stage #1: Pre-autoimmunity. This is the most critical time to prevent an autoimmune condition from developing.  The pre-autoimmune stage is essentially when, over time, a person’s body becomes more susceptible to developing autoimmunity.

Stage #2: Silent autoimmunity. In this stage, the autoimmune process has already started. However, there has been very little or no tissue damage (i.e., to the thyroid gland), and, therefore, no symptoms are present, and the basic thyroid panel results are negative at this point (i.e., normal TSH and thyroid hormone levels).  The person is usually in the silent stage for many years.

Stage #3. Symptoms are present with some tissue damage. Although stage #2 might involve some tissue damage, it’s minimal, but stage #3 is when this damage reaches the point where the person begins to experience symptoms. Once again, it can take many years for this to happen.

Stage #4. Symptoms are present and there is greater tissue loss. This is the “final” stage of autoimmunity, as it’s when the person’s symptoms will usually worsen, there is greater tissue loss, and the thyroid blood tests are positive. Although some people might be diagnosed with an autoimmune thyroid condition in stage #3, many people with Hashimoto’s won’t be diagnosed until they reach stage #4.

So when someone has a normal TSH and elevated thyroid antibodies, this is considered to be stage #2, which is silent autoimmunity.  Some may say that there is no concern because the person might never progress to stage #3.  While this may be true, many people WILL progress to stage #3, and eventually stage #4.  As a result, I think it’s crazy to ignore the immune system if someone has elevated thyroid antibodies, even if the TSH and thyroid hormones are within the optimal range.

By the way, if you want to learn more about the optimal reference ranges of the TSH and thyroid hormone levels, last month I released a video entitled “How To Read Your Thyroid Panel Results”, where I discuss the optimal reference ranges.  I also created separate videos you might want to check out on the three main types of thyroid antibodies.

Diagnosing Graves’ Disease

So let’s take a look at how the American Thyroid Association says that Graves’ disease is diagnosed (3):

“The diagnosis of hyperthyroidism is made on the basis of your symptoms and findings during a physical exam and it is confirmed by laboratory tests that measure the amount of thyroid hormones (thyroxine, or T4, and triiodothyronine, or T3) and thyroid-stimulating hormone in your blood. Clues that your hyperthyroidism is caused by Graves’ disease are the presence of Graves’ eye disease and/or dermopathy, a symmetrically enlarged thyroid gland and a history of other family members with thyroid or other autoimmune problems, including type 1 diabetes, rheumatoid arthritis, pernicious anemia, or painless white patches on the skin known as vitiligo.

The choice of initial diagnostic testing depends on cost, availability and local expertise. Measurement of antibodies, such as thyrotropin receptor antibodies (TRAb) or thyroid stimulating immunoglobulins (TSI), is cost effective and if positive, confirms the diagnosis of Graves’ disease without further testing needed. If this test is negative (which can also occur in some patients with Graves’ disease), or if this test is not available, then your doctor should refer you to have a radioactive iodine uptake test (RAIU) to confirm the diagnosis.”

Their diagnosis explanation is a bit lengthy, as they start out by explaining how hyperthyroidism is diagnosed, and then they give “clues” on how your hyperthyroidism is caused by Graves’ disease (i.e. thyroid eye disease, dermopathy), before finally mentioning that Graves’ disease is either diagnosed by positive TRAB or TSI, or by a radioactive iodine uptake test (if the thyroid antibodies are negative).  One thing I’m happy that they mentioned is that the radioactive iodine uptake test should be done only if the thyroid antibodies are negative.  Unfortunately many endocrinologists recommend this test to all of their Graves’ disease patients.

About the Radioactive Iodine Uptake Test

As I just mentioned, the radioactive iodine uptake test is commonly recommended by endocrinologists to aid in the diagnosis of Graves’ disease.  This test involves taking a very small amount of radioactive iodine, and the scan shows how much of the radioactive iodine is absorbed by the thyroid gland. A high uptake reading is usually present in Graves’ disease, although it can also be high in toxic multinodular goiter.

So what’s the problem with having everyone with Graves’ disease do this test?  Well, the good news is that the amount of radioactive iodine is so small that it won’t cause significant damage to the thyroid gland.  However, if the person has hyperthyroidism and also tests positive for TRAB and/or TSI, then this confirms that the person has Graves’ disease.  Some endocrinologists will argue that the RAI uptake test is still necessary to see if there are hot or cold nodules.  Thyroid nodules that absorb the radioactive iodine (hot nodules) are usually not malignant, while thyroid nodules that do not absorb the radioactive iodine (cold nodules) have a 5% chance of being malignant (4).

So the radioactive iodine uptake test can’t reveal if someone has cancerous thyroid nodules.  If someone has hot nodules they probably are benign, and if someone has cold nodules there is a slightly higher risk of the thyroid nodule being cancerous, but still only 5%.  So to me it makes sense to pass on this test and do a thyroid ultrasound, which also won’t confirm if thyroid nodules are malignant or benign, although sometimes you can get a good idea by the characteristics of the nodule on an ultrasound.

What If Graves’ Disease Antibodies and The RAI Uptake Test are Both Negative?

If antibodies associated with Graves’ disease are negative and the RAI uptake test isn’t elevated then the person probably doesn’t Graves’ disease.  If they have overt hyperthyroidism then they might have toxic multinodular goiter or subacute hyperthyroidism.  For those who have been diagnosed with toxic multinodular goiter, in the near future I’m going to be creating an updated blog post on this topic.

But one thing I didn’t mention was the role of eye symptoms in diagnosing Graves’ disease.  Of course there are many different types of eye symptoms one can have, and just because someone has hyperthyroidism in the presence of certain eye symptoms doesn’t confirm that they have Graves’ disease.  For example, many people have dry eyes.  However, if someone has hyperthyroidism in the presence of eye bulging, eye swelling, or other more extreme symptoms, this probably means the person has Graves’ disease, even without testing the thyroid antibodies or doing an RAI uptake test.

So let’s take an example of someone who has hyperthyroidism, along with the symptoms of thyroid eye disease, yet the antibodies associated with Graves’ disease are negative.  Should this person get the RAI uptake test to confirm the presence of Graves’ disease?  It admittedly is a tougher call in this situation, but in my opinion I’d still say “no”, as if the person has hyperthyroidism AND the symptoms of thyroid eye disease then they probably have Graves’ disease.

Graves’ Disease vs. Hashitoxicosis

One other thing I should mention is that every now and then I’ll come across someone with hyperthyroidism and their thyroid stimulating immunoglobulins are negative, yet they have positive TPO and/or thyroglobulin antibodies.  If this person has thyroid eye disease then they probably have Graves’ disease, as it’s very common for people with Graves’ disease to also have TPO antibodies, and many also have thyroglobulin antibodies.  But one also has to rule out hashitoxicosis, which I discussed in a 2019 blog post.  I won’t get into detail about hashitoxicosis here, as you can read the blog post for more information, but I will say that people with hashitoxicosis will typically have hyperthyroidism with elevated TPO and/or thyroglobulin antibodies, and they will have a normal TRAB and TSI.  If they do a radioactive iodine uptake test this will be negative.

Summary of Graves’ Disease Diagnosis

So in order for Graves’ disease to be diagnosed, the following need to be present:

• Depressed TSH
• Elevated TSH receptor antibodies and/or thyroid stimulating immunoglobulins

However, Graves’ disease is also is commonly diagnosed by hyperthyroidism and an elevated radioactive iodine uptake test.  And as I also mentioned, if someone has hyperthyroidism and thyroid eye disease, there is a pretty good chance they have Graves’ disease, even without testing the thyroid antibodies or doing the RAI uptake test.

Subclinical vs. Overt Hyperthyroidism

You may have noticed that I didn’t include elevated thyroid hormone levels in my summary.  And the reason for this is because some people have “subclinical Graves’ disease” (5), where they have a depressed TSH, an elevated TRAB or TSI, but their thyroid hormones are normal.  This isn’t too common, although I’ve had some patients with subclinical Graves’ Disease.  But once again, regardless of whether someone has subclinical Graves’ disease or subclinical Hashimoto’s thyroiditis, you want to address the autoimmune component.  I also should mention that some people have subclinical hyperthyroidism without positive thyroid autoantibodies.

How Long Have You Been Diagnosed With An Autoimmune Thyroid Condition?

I’d like to know how long you have been diagnosed with an autoimmune thyroid condition for, and so please let me know in the comments below.  And while I’m hoping that nobody reading this has been misdiagnosed, if you were and would like to share your story please feel free to post it below so that others can learn from your experience.  Thank you!

A lot of people are in a state of panic over coronavirus disease 2019 (COVID-19).  Many supplement companies have sold out of immune enhancing supplements such as elderberry, silver, and even zinc.  While taking supplements can help to support the immune system, keep in mind that you can take a dozen different immune-related supplements and still end up out of commission due to a viral infection (and not just coronavirus).  What I plan on doing is to first discuss five things you can do to improve your immune system health without taking any supplements.  That being said, while I personally focus on diet and lifestyle factors, I do take some supplements to support my immune system health, and so for those who want to add a few supplements for additional support, towards the end of this blog post I’ll list a few nutritional supplements that I’m taking to support my immune system.

So let’s take a look at five ways to improve your immune system health without taking any nutritional supplements or herbs:

1. Try not to get stressed out.  These are stressful times for most people, and for good reason.  Many people are afraid of getting COVID-19, while others are stressed out due to the impact the virus has had on their job or business.  Some people are stressed because their spring break vacation had to be cancelled.  Some are stressed due to all of these reasons.  Look, I’d be lying if I told you that I wasn’t more stressed than usual, as while I’m not afraid of getting coronavirus, there is no question that this has had a negative impact on my practice so far.  I was also planning on visiting my parents for spring break and it looks like this won’t happen.  On top of this my father is 82, lives in NY, and isn’t in the best state of health, and so while I’m not panicking like many others are, I’m still concerned about his health.  But I’m in no position to complain, as I realize that many people have it much worse than I do.

The problem is that stress suppresses the immune system.  This not only can make you more susceptible to coronavirus, but other infections as well.  So what can you do?  After all, we’re talking about some big problems here.  Even if you’re in a situation where you can’t get rid of the stressful situation, which describes many people reading this, you can do things to improve your stress handling skills.  For example, if you are out of work I understand you probably are concerned about paying your bills.  While things might look bleak now and in the near future, it will get better, and you can use this time to improve your health…especially your stress handling skills.  Practice deep breathing and meditation, yoga, or a different type of mind body medicine.  Take a hot bath and do some reading.

2. Eat healthy.  If you live in the United States, as well as some other countries that might be facing a lockdown, you probably have done quite a bit of shopping to make sure you have enough food to last for at least a few weeks, if not longer.  While I understand people wanting to stock up on certain non-perishable foods, you want to try your best to eat healthy during this time.  I realize this can be a challenge, especially when there are “slim pickings” at some grocery stores, with food hoarding a big reason for this.  This past Tuesday morning my wife went to Trader Joes right when they opened, and while there was grass fed beef and organic chicken available, she mentioned that one woman took half the packages of organic chicken that were on the shelves.

Of course it would be great if you can eat organic meat and produce, but either way, the priority is to eat whole healthy foods.  In other words, if you are unable to purchase organic food, at the very least try to eat whole healthy foods.  And if you have to purchase non organic fruits and vegetables you can refer to the Dirty Dozen and Clean Fifteen lists, which can be found on the website for the Environmental Working Group (www.EWG.org).  This list should be updated soon for 2020.

3. Get sufficient sleep.  Getting sufficient sleep is important for optimal immune system health (1).  I would aim for at least 7 to 8 hours sleep each night.  And this doesn’t mean 7 to 8 hours in bed, but actual sleep time.  So for example, if you go to bed at 10 and don’t fall asleep until 11, I wouldn’t count this period as one hour of sleep.  I’m sure this stressful situation with COVID-19 is interfering with many people’s sleep, which is another reason why it’s important to block out time for stress management.

4. Stay active.  Another downside of being home most of the time for many people is that they will become inactive.  I’m going to miss going to the gym, but I’m fortunate to have a treadmill in my home.  Others might be even more fortunate and have exercise equipment in their home.  But even if you don’t have any equipment in your home this doesn’t mean that the only option is to hang out and be on electronics all day.  Of course you want to be cautious about any exercising you do, as you don’t want to overtrain or hurt yourself.  But you also don’t want to be sedentary.

Research shows that regular exercise increases immunity and reduces the risk of infection when compared to a sedentary lifestyle (2) (3).  Most people know that elderly individuals are more susceptible to coronavirus (as is younger people with certain co-morbidities).  However, middle-aged and elderly individuals who participate in moderate-intensity exercise are less likely to develop an infection when compared to those who are sedentary (4).

5. Reduce your toxic load.  Numerous studies demonstrate that heavy metals can have a negative effect on the health of the immune system (5) (6).  This shouldn’t be surprising, and the truth is that other chemicals will have a negative effect on immune system health.  And please don’t overlook the impact that electronic pollution can have on your immune system.  At the very least you want to spend your resting hours free from electromagnetic fields, and so consider unplugging the Wi-Fi at night, as well as any electronics in your bedroom.  And try to avoid being on electronics one to two hours before going to bed.  In January I wrote a detailed blog post on how to reduce your toxic load, which I would recommend to check out.

5 Basic Supplements To Support Your Immune System

Before I discuss a few of the basic supplements you can take to support your immune system, just remember to focus on improving your immune system health through diet and lifestyle.  Also, you of course want to make sure you take good quality nutritional supplements and herbs.  If you’re not sure how to choose good quality supplements please check out my blog post from 2015 entitled “How To Choose Quality Supplements and Herbs For Your Thyroid Condition”.

1. Vitamin D.  I’ve spoken about vitamin D in numerous articles and blog posts.  Healthy vitamin D levels are important for a healthy immune system (7), and while some people are able to maintain healthy levels through getting regular sun exposure, supplementation is frequently necessary to correct a vitamin D deficiency.  Also, you always want to take vitamin K2 when supplementing with vitamin D, as this helps to guide calcium into the bone.  Ideally I would recommend to first test for vitamin D in the blood before supplementing with vitamin D3, and while I’m sure many people reading this already have done this, others haven’t and understandably don’t plan on visiting a lab anytime soon with everything going on.   You might want to check out this video I put together entitled “How To Boost Vitamin D To Optimal Levels“.

2. Zinc.  Although all of the minerals are important for optimal health, zinc is perhaps the most important mineral when it comes to immune system health.  Once again, testing would be ideal, and while there are numerous ways to test for zinc, including doing an RBC zinc test or looking at zinc on a hair mineral analysis, a low alkaline phosphatase on a comprehensive metabolic panel can also be an indication of a zinc deficiency (8).  You want to be careful about supplementing with very high doses of zinc for a prolonged period of time (i.e. >50mg), as this can lead to a copper deficiency, which can also compromise the immune system.

3. Vitamin C.  Many people take vitamin C can to prevent and/or reduce the severity of the common cold, and research shows that vitamin C has an anti-viral immune response at the early time of infection against the influenza virus, which is associated with the flu (9).  More recently I’ve been recommending liposomal vitamin C due to its superior absorption and bioavailability, although another option is to take a whole food vitamin C supplement.  That being said, most of the research involves using “regular” vitamin C in the form of ascorbic acid, and so even this can help to support the immune system.  Unfortunately there isn’t a good test out there for vitamin C.  The organic acids test from Great Plains Laboratory does have a metabolite related to vitamin C, but it’s not the most accurate marker.

4. Selenium.  Selenium can help to support the immune system and to prevent viral infections (10) (11).  It is a cofactor for glutathione peroxidase, which can help to decrease the oxidative stress associated with infections.  If recommending selenium separately I’ll usually recommend for my patients to take 200 mcg of selenium, although some multivitamins have a good amount of selenium, including a multivitamin I commonly recommend to my patients.  Since selenium toxicity is a concern you want to be cautious about taking too much selenium.

5. Probiotics.  Having a healthy gut is necessary for a healthy immune system, and the research shows that probiotics can support the immune system (12).  When choosing a probiotic supplement you want to make sure that you use a company that’s third-party tested, as a few years ago Consumer Labs discovered that many probiotic supplements don’t include the ingredients listed on the bottle.  The truth is that it’s a good idea to use companies that utilize third-party testing for all of your supplements.  In addition, you want to choose a probiotic supplement that lists the specific strains, and not just the species.  Two of my favorite probiotic supplements are Xymogen ProbioMax Daily DF and Designs for Health ProbioMed.

The Truth About Other Immune Enhancing Supplements

Of course there are other supplements that can support immune system health, including elderberry, colloidal silver, and monolaurin.  I mentioned these in a recent article I wrote on the “coronavirus and thyroid health“.  Just keep in mind that nobody has an elderberry deficiency or a deficiency in colloidal silver.  Once again, this doesn’t mean that these can’t be beneficial, as I’ve been taking silver since being diagnosed with chronic Lyme disease in 2018.  But if you have a deficiency in vitamin D, zinc, or any other nutrient, then without question this needs to be addressed in order to have optimal immune system health.  One nutrient I didn’t mention above that’s also very important for optimal immune system health is vitamin A.

What Are You Doing To Keep Your Immune System Healthy?

I’d love to hear what you’re doing to maintain your immune system health.  Are you focusing more on diet and lifestyle factors?  Are you taking certain supplements to support your immune system?  Perhaps you’re doing both of these, which is the approach I take.  Please share what you’re doing for your immune system in the comments section below.

Update on My Overcoming Infections Masterclass

Before all of this chaos involving COVID-19 happened I was planning on having an overcoming infections masterclass, which focuses on the different infections that can be triggers of thyroid and non-autoimmune thyroid conditions.  So this IS NOT a masterclass that focuses on COVID-19.  Originally I was hoping to launch this in March, but it looks like it will be sometime in April that this will be available.  If you want to be notified immediately when it’s released you can sign up for my “Overcoming Infections” VIP waitlist by clicking here.

Although most cases of thyroid eye disease are mild, some people with this condition do experience moderate to severe symptoms.  This can include symptoms such as eye bulging, pain, difficulty closing the eye, and double vision.  While the goal should be to address the underlying cause of the problem, there are situations when conventional treatment is necessary.  On January 21st 2020 a new medication was approved by the FDA that looks very promising for those with moderate to severe thyroid eye disease.

Whenever I write a blog post related to conventional medical treatment I’m sure there are some people who question why a natural-related site would put out such content.  The obvious reason is because while the focus of this website will always be on “natural solutions”, there is a time and place for conventional medical treatment, and I think it’s important to keep an open mind.  Everything comes down to risks vs. benefits, and while I’ve had success using natural treatment methods in people with thyroid eye disease, more severe cases are less likely to respond to a natural treatment approach.

So while I would like to say that everyone with thyroid eye disease can benefit from natural treatment methods, unfortunately this isn’t the case.  I admit that sometimes it can be challenging to know when conventional treatment is necessary, as I’ve had some people with moderate cases of thyroid eye disease respond to a natural treatment approach, but I’ve also had others who didn’t respond.  Not surprisingly, many people prefer not to receive corticosteroids, even when their eye symptoms are severe, but I’m sure some will be more open to this new treatment option I’m about to discuss.

The Relationship Between IGF-1R and Thyroid Eye Disease

Graves’ disease is an autoimmune condition that involves the binding of thyroid stimulating immunoglobulins to the TSH receptor, which causes the excess secretion of thyroid hormone.  The autoimmune component is also responsible for the development of thyroid eye disease.  And while the same thyroid stimulating immunoglobulins might play a role in thyroid eye disease, it’s not as simple as these antibodies attacking the tissues of the eyes.  I also should mention that a small percentage of people who don’t have Graves’ disease develop thyroid eye disease.

Insulin-like growth factor 1 (IGF-1) is a 70-aminoacid polypeptide hormone with endocrine, paracrine, and autocrine effects (1).  It is produced in the liver, and it acts to provide an inhibitory feedback signal on growth hormone secretion in the hypothalamus (1).  IGF-1 has different roles in the initiation and progression of different diseases, as in some cases it can help with cell survival, but in other cases it can lead to the development of cancer (2).

A 2012 journal article discussed the role of the insulin-like growth factor 1 (IGF-1) receptor in the development of thyroid eye disease (3).  Fibroblasts are cells that produce connective tissue proteins, and they also play a role in the development of thyroid eye disease.  The journal article discusses how elevated levels of the IGF-1 receptor have been found in orbital fibroblasts as well as B and T cells from patients with Graves’ disease (3).  Apparently IGF-1R forms a complex with the TSH receptor, and inhibiting this complex can greatly help people with thyroid eye disease.

What Is Teprotumumab?

Teprotumumab (the brand name is Tepezza) is the new medication that can help people with thyroid eye disease.  The way it works is by binding to the IGF-1R, which causes degradation of the antibody-receptor complex I mentioned above.  This in turn has been shown in trials to decrease proptosis, double vision, and other symptoms associated with moderate to severe cases of thyroid eye disease.  Unlike other non-surgical options for thyroid dye disease (i.e. corticosteroids), teprotumumab can stop the progression of thyroid eye disease.

Teprotumumab vs. Other Thyroid Eye Disease Treatments

Glucocorticoid therapy and orbital radiation can help to reduce orbital inflammation.  However, unlike teprotumumab they don’t do anything to stop the progression of thyroid eye disease.  Surgery is sometimes indicated for severe cases of thyroid eye disease, as some receive orbital decompression, while others will receive eye muscle surgery and/or eyelid surgery.  But the research shows that teprotumumab can be as effective as surgical intervention.  So while taking teprotumumab usually shouldn’t be the first treatment option for those with thyroid eye disease, if someone has a severe case and surgery is recommended it makes sense to give teprotumumab a try first.

That being said, it’s important to mention that teprotumumab is only effective during active thyroid eye disease.  This usually lasts from 6 to 24 months, although in some cases it can be present for up to three years.  Inactive thyroid eye disease is usually stable, and since significant improvement is less likely, surgery is commonly indicated for severe cases.

What Does The Research Show?

Both phase 2 and phase 3 trials show that patients treated with teprotumumab improved significantly compared with the placebo group (4) (5).  Even though the treatment consists of 8 intravenous infusions given every 3 weeks, many people showed improvement after only 6 weeks (3 infusions), and the phase 2 trials showed that 71.4% of teprotumumab-treated patients had ≥2 mm reduction in proptosis at week 24 (5).  For the most part teprotumumab was well-tolerated, but I’ll discuss some of the common side effects shortly.

Dosing and Administration

As I briefly mentioned when discussing the research, teprotumumab has to be administered through intravenous infusions, which of course is a major inconvenience.  The good news is that it’s only given once every 3 weeks for a total of 8 infusions.  The dose depends on the patient’s weight, and the starting dose used in the studies is 10 mg/kg, followed by 20 mg/kg.

Side Effects and Contraindications

These are some of the potential side effects of teprotumumab:

• Muscle cramps
• Spasms
• Nausea
• Hair loss
• Diarrhea
• Fatigue
• High Blood pressure
• Hearing problems
• Taste changes
• Headache
• Dry skin

As for the contraindications, since teprotumumab can cause harm to a fetus it is contraindicated during pregnancy, and therefore cycling women receiving treatment should use effective contraception during treatment, and for 6 months after the last dose (6).  Teprotumumab can also worsen inflammatory bowel disease (Crohn’s disease and ulcerative colitis), and because it can cause hyperglycemia (increased blood sugar) those with diabetes need to be cautious when taking this medication, and should be under the guidance of a competent healthcare practitioner.

Are There Long Term Side Effects?

Because teprotumumab is new there are no long term studies, and because of this some people might be hesitant to take it.  In fact, if I had severe thyroid eye disease the lack of long term studies would make me think twice about taking this medication.  But if I had moderate or severe thyroid eye disease that was getting worse and the only other option was surgery I still might choose taking this medication.

Obviously one also has to consider the common side effects I listed above, but it’s the same situation with antithyroid medication.  Many people don’t want to take methimazole and other types of antithyroid medication due to common side effects, and this also described me when I was diagnosed with Graves’ disease.  But there are certain situations when the benefits of taking methimazole are greater than the potential risks, and while I’m not a big fan of this drug, I think it’s safe to say that a lot more people with hyperthyroidism would receive radioactive iodine and thyroid surgery if it wasn’t available.  And the hope is that teprotumumab will help many people with severe cases of thyroid eye disease avoid surgery.  I’ll add that from the trials side effects seem to be less common when compared to antithyroid medication, and not as severe.

Does Teprotumumab Address The Cause of Thyroid Eye Disease?

Most people reading this probably know that the answer to this question is clearly “no”.  Teprotumumab doesn’t remove the triggers associated with the autoimmune component.  On the other hand, neither does antithyroid medication, and there are some people who need to take methimazole or a different type of antithyroid medication for symptom management.  The truth is that most people with thyroid eye disease won’t need to take teprotumumab, but some people with moderate to severe cases might want to consider it.

Because teprotumumab doesn’t address the cause of the problem some people might be hesitant to take it, which I understand.  As I mentioned earlier, everything comes down to risks vs. benefits.   When I was dealing with Graves’ disease I chose not to take methimazole and instead took the herb bugleweed.  If bugleweed didn’t successfully lower my thyroid hormone levels I would have considered taking methimazole, and even though side effects are common with methimazole, if someone is trying to avoid radioactive iodine and thyroid surgery they might need to take antithyroid medication on a temporary basis.  Similarly, while I can understand someone wanting to try taking a natural treatment approach for their thyroid eye disease condition, if it doesn’t help AND the eye symptoms are severe they might want to consider teprotumumab.

Where Can You Learn More About Teprotumumab?

For those who want to learn more about Teprotumumab I’ll include a few links below that you might want to check out.

https://www.ncbi.nlm.nih.gov/pubmed/31971679

https://www.tepezza.com/

https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-thyroid-eye-disease

Anti-thyroglobulin antibodies are one of three main types of thyroid autoantibodies, and they are commonly associated with Hashimoto’s thyroiditis.  However, it’s not uncommon for those with Graves’ disease to also have elevated anti-thyroglobulin antibodies (along with elevated TSH receptor antibodies).  In this blog post I’m going discuss anti-thyroglobulin antibodies in detail.

So why do anti-thyroglobulin antibodies develop?  Well, anti-thyroglobulin antibodies develop when there is damage to thyroglobulin, which is a glycoprotein secreted by follicular cells of the thyroid gland.  The most common reason for damage to thyroglobulin is from the autoimmune process of Hashimoto’s Thyroiditis.

According to the triad of autoimmunity, in order for an autoimmune condition to develop you need 1) a genetic predisposition, 2) exposure to an environmental trigger, and 3) a leaky gut.  In the past I wrote a blog post on thyroid peroxidase (TPO) antibodies, and I discussed how there can be genetic variations of the TPO gene, which in turn can affect thyroid hormone production.  As for thyroglobulin, the research suggests that there is a possible correlation between thyroglobulin gene polymorphisms and thyroid autoimmunity (1) (2).  In other words, having variations in the thyroglobulin gene can increase the risk of someone developing Hashimoto’s thyroiditis.

Anti-thyroglobulin Antibodies: Hashimoto’s vs. Graves’ Disease

As I mentioned in the opening paragraph, anti-thyroglobulin antibodies are more closely associated with Hashimoto’s thyroiditis, although they are also common in those with Graves’ disease.  As for their prevalence, it depends on the source, as one source stated that the prevalence of anti-thyroglobulin antibodies was 60-80% in Hashimoto’s and 50-60% in Graves’ disease patients, where another source stated that they were identified in 70-80% of those with Hashimoto’s, and 30-40% of Graves’ disease patients (3).  What’s the significance of having elevated anti-thyroglobulin antibodies?  Well, besides confirming the presence of an autoimmune response, having elevated anti-thyroglobulin antibodies usually means that damage is taking place to thyroglobulin.  And since thyroglobulin plays an important role in thyroid hormone production, if sufficient damage to thyroglobulin takes place this can eventually result in hypothyroidism.

Of course we also need to keep in mind that many people with both Hashimoto’s and Graves’ disease have anti-TPO antibodies, which also can lead to hypothyroidism.  And while having anti-TPO and/or anti-thyroglobulin antibodies doesn’t guarantee that the person will develop overt hypothyroidism, I think it’s safe to say that if someone has both of these thyroid antibodies there is a greater chance of them developing overt hypothyroidism in the future when compared with someone who only has one of these thyroid autoantibodies.  Many people with Hashimoto’s don’t present with overt hypothyroidism, as while many will have an elevated TSH, their thyroid hormone levels are commonly within the lab reference range, although frequently below the optimal reference range.  Either way, the goal is to do things to improve the health of the person’s immune system so that further damage to the thyroid gland doesn’t take place.

What is The “Normal” Reference Range of Anti-Thyroglobulin Antibodies?

Although different labs commonly have different reference ranges, as of 2020, the range of anti-thyroglobulin antibodies according to both Labcorp and Quest Diagnostics is <1 IU/mL.  However, other labs use different methodologies which can result in different reference ranges.  For example, if you visit the Labcorp website and do a search for anti-thyroglobulin antibodies, the methodology currently used is called “Immunochemiluminometric assay (ICMA)”.  On the lab reports they specifically say that it’s “measured by Beckman Coultor Methodology”.  However, I had a patient get the anti-thyroglobulin antibodies tested at a different lab that used the “Rouche Elecays electrochemiluminesence method”, and the reference range was 0-115 IU/mL.

In addition, on the lab report it stated that “Thyroglobulin antibody results cannot be compared across different methods.”  So even if the units of measurement are the same between labs (i.e. IU/mL), due to different testing equipment, chemical reagents used, and analysis techniques you can’t necessary compare results from different labs, which is one reason why it’s a good idea to try to use the same lab on a regular basis.

As an example, in May of 2019 I had a patient who tested the anti-thyroglobulin antibodies through Vibrant America and had a value of >4,000 IU/mL.  In August of 2019 she retested the anti-thyroglobulin antibodies at Labcorp and had a value of 43.2 IU/mL, and two months later she retested them through Vibrant America and the value was once again >4,000 IU/mL.  Of course ultimately you want the thyroid antibodies to normalize regardless of which lab you use, but I’m just using this example to demonstrate why you can’t always compare the same marker using different labs.

Serum Thyroglobulin vs. Anti-Thyroglobulin Antibodies

It’s also important to mention that there is a separate test for serum thyroglobulin.  Once again, thyroglobulin is a protein produced by the cells of the thyroid gland, and normally its concentration in blood is low.  But there are a few factors that can increase serum thyroglobulin levels.  First of all, having elevated anti-thyroglobulin antibodies can cause an elevation in serum thyroglobulin levels.  Second, it can also be elevated in some cases of thyroid cancer, including thyroid adenoma, thyroid papillary and follicular cancer.  So in some cases thyroglobulin is used as a tumor marker.

A third reason why serum thyroglobulin can be elevated is because someone has an iodine deficiency.  This is an overlooked cause of elevated serum thyroglobulin levels, but numerous studies shows that thyroglobulin can be used as a functional biomarker of iodine status (4) (5) (6).  I usually don’t rely on this marker to determine if someone has an iodine deficiency, as I like urinary iodine testing.  But some feel that thyroglobulin is a superior marker because it reflects long-term iodine intake.

Additional Information On Anti-Thyroglobulin Antibodies

Before talking about how to lower anti-thyroglobulin antibodies, it’s important to mention that most conventional medical doctors, including endocrinologists, don’t pay much attention to thyroid antibodies.  Some don’t test them at all, while many medical doctors will test them initially for diagnostic purposes.  But since most medical doctors don’t do anything to improve the health of the person’s immune system, they won’t typically retest the thyroid antibodies to see if they decrease.

It’s also worth mentioning that there isn’t always a correlation between high anti-thyroglobulin antibodies and the severity of the autoimmune process.  In other words, if someone has anti-thyroglobulin antibodies that are 100 IU/mL, while someone else has anti-thyroglobulin antibodies that are 1,000 IU/mL, this doesn’t mean it will be more challenging to restore the health of the person with the higher thyroid antibodies.  It really does come down to finding triggers and correcting other imbalances.

For example, if someone has very high anti-thyroglobulin antibodies and their triggers are found and removed relatively quickly, it’s likely for the thyroid antibodies to normalize faster than someone who has much lower anti-thyroglobulin antibodies and the triggers aren’t found and addressed.  This should make sense, although as I’ll mention below, sometimes removing the triggers doesn’t stop the inflammatory process associated with the autoimmune component.

How To Lower Anti-Thyroglobulin Antibodies

I just mentioned how lowering thyroid antibodies comes down to finding and removing triggers, along with correcting other underlying imbalances.  I also mentioned how if someone finds and removes their triggers relatively quickly then their thyroid antibodies can normalize quickly.  That being said, I don’t want to give anyone the impression that restoring the autoimmune component of someone with Hashimoto’s or Graves’ disease is a quick and easy process, as this usually isn’t the case.  For example, if someone finds their triggers quickly, it still usually takes time to lower and normalize their thyroid antibodies.  And of course if it takes awhile for someone to find their triggers it will take a longer amount of time to restore their health.

But either way, the first step to lower anti-thyroglobulin antibodies is to find and remove your triggers.  Sometimes this is as easy as changing your diet and eliminating certain food allergens, but many times it’s more complex than this.  Testing is usually required to find the triggers, and at times it can be challenging to know what testing is needed.  I deal with this in my practice on a daily basis, and I’ve discussed this in past articles and blog posts, as I try to be more conservative when it comes to testing because I don’t want the person to spend more money than they have to, but I also don’t want to be too conservative and miss something important.

Don’t Forget To Incorporate The 5-R Protocol

In addition to finding and removing autoimmune triggers, since a leaky gut is part of the triad of autoimmunity, it makes sense to do things to heal the gut.  In the past I have spoken about the 5-R protocol, which involves the following 5 components:

1. Remove the factor that’s causing the leaky gut.

2. Replace (i.e. digestive enzymes, stomach acid, dietary fiber)

3. Reinoculate (with pre- and probiotic foods and supplements)

4. Repair the gut

5. Rebalance through stress management, adequate sleep

It’s also important to mention that while removing the triggers and healing the gut will frequently resolve the inflammatory process, this isn’t always the case.  There is a transcription factor called Nuclear Factor Kappa B (NF-kB), and the deregulated activation of NF-kB may contribute to autoimmunity and inflammation (7).  What happens is that NF-kB becomes chronically activated, and sometimes outside help is needed to inactivate it.

Some of the natural agents that have been shown to inhibit NF-kB include turmeric, resveratrol, vitamin D, ginger, and omega-3 fatty acids.  While many people  with autoimmune conditions take one or more of these, remember that you also need to find and remove the triggers (and heal the gut).  While taking some natural anti-inflammatory agents initially can be beneficial, the point here is that in some cases it might be even more important to take them AFTER the triggers have been removed and the gut has been healed.

This is just one of the many complexities of autoimmunity, and admittedly when a patient of mine has followed my recommendations, yet their antibodies haven’t significantly lowered, there are times when I will question whether all of their triggers have been found and removed.  But in some cases the triggers may have been found and removed, but the chronic activation of NF-kB is still present.  The challenge is that there is no way to measure NF-kB outside of a laboratory setting, and so if someone has followed a natural treatment protocol and their autoantibodies are still elevated, the practitioner and patient has to decide whether further testing is the best option, or if the person should instead do things to inhibit NF-kB.

What’s Your Experience With Anti-Thyroglobulin Antibodies?

If you currently have elevated anti-thyroglobulin antibodies, or have had elevated anti-thyroglobulin antibodies in the past, I’d love to hear if you have done anything to try to decrease them.  Did changing your diet help?  Perhaps there was another trigger you found that was responsible for your elevated anti-thyroglobulin antibodies.  If you have elevated anti-thyroglobulin antibodies but haven’t had any success lowering them, feel free to share your experience as well.  Thank you!

Can Infections Cause Elevated Anti-Thyroglobulin Antibodies?

This time last week I wasn’t planning on writing a blog post related to viruses, but with a lot of people concerned about the new type of coronavirus I figured I’d go ahead and put this together.  The truth is that we’re all exposed to viruses, some more virulent than others.  In fact, before the most recent type of coronavirus was discovered, there were 6 other human coronaviruses (HCoVs) identified, and a few of them are associated with the common cold.  So there is a pretty good chance you have been exposed to a type of coronavirus.

That being said, some types of coronaviruses are highly pathogenic, which I’ll discuss in this blog post.  Human coronaviruses affect the respiratory system, and with the new type of coronavirus, there are now seven known human coronaviruses that have been identified:

• HCoV-229E
• HCoV-NL63
• HCoV-OC43
• HCoV-HKU1
• Severe acute respiratory syndrome coronavirus (SARS-CoV)
• Middle East respiratory syndrome coronavirus (MERS-CoV)
• 2019 Novel Coronavirus (2019-nCoV)

The first four coronaviruses listed above circulate in the human population, and are responsible for approximately one-third of the common cold (1).  However, in severe cases these viruses can cause life-threatening pneumonia and bronchiolitis (2).  This is especially true in the elderly, children, and those with a weakened immune system.  Although these four coronaviruses are most commonly linked to respiratory illnesses, they also have been linked to enteric and neurological diseases (2).

SARS-CoV and MERS-CoV are more virulent coronaviruses, and they share some similarities with the most recently identified coronavirus.  SARS-CoV first emerged in 2002–2003 in Guangdong, China, and resulted in a type of pneumonia marked by a fever, headache, and eventually the onset of respiratory symptoms such as cough and pneumonia, which later develop into life-threatening respiratory failure and acute respiratory distress syndrome (3).  Similar to the most recent type of coronavirus identified, SARS-CoV was highly transmissible among humans, and as a result it quickly spread across 29 countries, infecting more than 8,000 individuals with a mortality rate of about 10% (4).

The MERS-CoV epidemic was discovered in Saudi Arabia in 2012.  It had similar clinical symptoms as SARS-CoV but with a much higher mortality rate of about 35% (5).  However, even though it had a higher mortality rate than SARS-CoV, it has been geographically limited to the Middle East.

What Do We Know About The Most Recently Identified Coronavirus?

The 2019 Novel Coronavirus (2019-nCoV) was first detected in Wuhan, China.  Just as is the case with the other coronaviruses, it seems like it was initially spread from an animal to a human, but because it is spreading so quickly, and since not everyone infected has had exposure to animal markets, it seems as if it is highly transmissible among humans.  This shouldn’t be surprising when you consider that the other coronaviruses can also be transmitted from person to person.

As of 2/5/2020, at least 562 people have died in China, with 27,378 people being infected globally.  The United States has 12 confirmed cases of the virus, and many other countries have people who are infected.  The most common symptoms include fever, cough, and shortness of breath.  Symptoms seem to occur anywhere between 2 and 14 days after exposure to the virus.

Can Coronavirus Affect Thyroid Health?

Since 2019-nCoV was recently identified it is unknown whether or not it affects thyroid health. But it’s worth mentioning that while SARS-CoV primarily affects the respiratory system, the research shows that a substantial number of patients with SARS developed abnormalities in thyroid function (6) (7).  However, there hasn’t been much research in this area, as a small study involving five SARS autopsies demonstrated the pathology of the thyroid gland.

The next question you may have is whether coronavirus can trigger thyroid autoimmunity.  I haven’t seen any evidence of any of the coronaviruses triggering Graves’ disease or Hashimoto’s.  However, Th17 cells are associated with autoimmunity, and a 2018 study showed that MERS-CoV infection in humans is associated with an increase in Th1 and Th17 cytokines (8).  But once again, I couldn’t find any research that showed any direct relationship between any coronaviruses and thyroid autoimmunity, let alone other autoimmune conditions.

What Treatment Options Are Available?

In the conventional medical world there is no treatment available for coronaviruses, including the new type, which is why many people are panicking.  Don’t get me wrong, as I’m not suggesting that there is no reason to be concerned, but there is more than you can do than to just wash your hands frequently and minimize contact with others.

1. Improve your immune system health through diet and lifestyle factors.  Eat mostly whole foods, organic whenever possible.  Try your best to reduce stress in your life, and even if this isn’t possible you can still work on improving your stress handling skills.  Make sure you get sufficient sleep, as this is also necessary for optimal immune system health.

2. Enhance your immune system health by improving your gut microbiome.  In order to have a healthy immune system you need to have a healthy gut.  And so you want to do things to increase the health of your gut microbiome.  Not only is eating well important, but probiotic foods and supplements can help, as can prebiotics.  And of course try to avoid gut disrupting medications and other environmental chemicals, including antibiotics, proton pump inhibitors, and glyphosate.

3. Take colloidal silver.  Silver has antiviral properties, and while I couldn’t find any studies which showed that silver is effective against human coronavirus, I did come across a study that showed that it was effective against feline coronavirus (9).

4. Take resveratrol.  Resveratrol also has anti-viral properties, and one in vitro study showed that resveratrol effectively inhibited MERS-CoV (10).

5. Licorice root.  Glycyrrhizin, which is the active component of licorice root, has been shown to interfere with SARS-CoV replication (11).  However, the study showed that higher concentrations were needed, and it’s important to mention that glycyrrhizin can increase blood pressure, and so anyone with a history of hypertension will probably want to avoid taking licorice root.

6. Black elderberry.  Elderberry is commonly taken to help support the immune system for those who have the common cold, and so it shouldn’t be surprising that there is evidence that it might help with the replication of coronavirus (12).

What Happened With SARS-CoV and MERS-CoV?

Since these both are more similar to the recently identified coronavirus (especially SARS-CoV), you might be wondering what happened to these two viruses.  Well, I mentioned earlier that MERS-CoV has been contained in the Middle East.  As for SARS-CoV, this virus spread to more than two dozen countries in North America, South America, Europe, and Asia before it was contained (13).  And according to the CDC, since 2004 there hasn’t been any known cases of SARS reported in the world.

Do You Want To Learn More About Infections?

Since being diagnosed with chronic Lyme disease in 2018 I’ve been more fascinated with all different types of infections, and I’ve decided to put together an “Overcoming Infections Masterclass” for those with thyroid and autoimmune thyroid conditions.  If you want to be notified immediately when it’s released you can sign up for my “Overcoming Infections” VIP waitlist by clicking here.

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!

2020 is here, and many people are already doing things to improve their health.  Most of this is centered around diet and exercise, as many are striving to eat a healthy diet, and of course the fitness clubs are usually packed in January and February.  While eating well and exercising regularly are both important, it’s also a good idea to focus on reducing your toxic load.  The truth is that eating certain foods can support detoxification, and even exercise can play a role, but there are other things you can and should do, which I’ll discuss in this blog post.

How do environmental toxins relate to thyroid health?  There are a few different ways.  First of all, healthy thyroid hormone levels are important for detoxification.  In addition, and as I’ll mention later in this post, phase 2 detoxification is important in order to detoxify thyroid hormone from the body, along with other hormones.  In addition, most of the conversion of T4 to T3 takes place in the liver, and if the liver isn’t working efficiently due to an increased toxic load then this conversion can be negatively affected.  And finally, certain environmental toxins (i.e. mercury) can be a trigger for the autoimmune thyroid conditions Graves’ disease and Hashimoto’s.

When it comes to reducing your toxic load, there are 3 things you need to focus on:

1. Reduce your exposure to environmental toxins

2. Increase your elimination of environmental toxins

3. Support phase 1 and 2 detoxification

There is overlap between #2 and #3, and I must admit that supporting phase 1 and 2 detoxification can be complex, and my goal is to try to keep the information in this blog post easy to understand.  And so while I’ll talk about some of the basics of phase 1 and 2 detoxification, if you want to learn more about these in greater detail please check out part 1 and part 2 of my blog posts on “How To Optimize Detoxification”.  So let’s start off by discussing what you can do to reduce your exposure to environmental toxins.

How To Reduce Your Exposure To Environmental Toxins

It makes sense that in order to reduce your exposure to environmental toxins, you need to be aware of the different types of chemicals you’re exposed to on a frequent basis.  To make it simple, there is indoor air pollution and outdoor air pollution.  You of course have much more control over the environmental toxins you’re exposed to indoors, especially those inside your home, and so this will be your main focus, although I’ll also discuss some ways to minimize your exposure to outdoor air pollution (besides staying indoors!).

Different Sources of Indoor air Pollution:

• The food you eat.  Pesticides and herbicides are found in larger amounts in non-organic fruits and vegetables, hormones and antibiotics are commonly fed to livestock, eating too much fish can be toxic (especially larger fish such as tuna, king mackerel, and swordfish), and of course more and more foods are being genetically modified.  Glyphosate is another big problem, as this is the active ingredient in the herbicide Roundup, and many processed/refined foods have glyphosate.
• The water you drink.  Try your best to avoid drinking tap water, as well as water out of plastic bottles.  Also, remember that just because something is BPA-free doesn’t mean that it’s free of xenoestrogens.  So if you regularly drink water out of BPA-free plastic bottles you should still switch to glass or stainless steel.
• The indoor air you breathe.  Of course there are a lot of different factors that can affect the air quality, some of which I’ll be discussing below.
• The cleaners and cosmetics you use.  These are yet another common source of chemical exposure, as there are plenty of chemicals included in cleaners, soaps, shampoos, shaving cream, toothpaste, etc.  The good news is that there are natural options for just about all of the cleaners and cosmetics you use.
• Carpeting.  Carpets contain numerous environmental chemicals, including VOCs and formaldehyde.  Even in low concentrations these chemicals can have a negative impact on your health.
• Mold.  Genetics plays a role as to how people will react to mold, as some people have difficulty eliminating mycotoxins produced by mold, which in turn can cause numerous symptoms.
• Dry cleaning.  Tetrachloroethylene is one of the common chemicals used in the dry cleaning industry.  According to the Agency for Toxic Substances & Disease Registry, “Exposure to very high concentrations of tetrachloroethylene can cause dizziness headaches, sleepiness, incoordination, confusion, nausea, unconsciousness, and even death”(1).
• New furniture.  Polybrominated diphenyl ethers (PBDEs) also known as flame retardants, are commonly found in furniture such as couches and mattresses.  Studies show that flame retardants can cause hormone disruption, thyroid cancer, and neurological toxicity (2) (3) (4).

How To Reduce Your Exposure To Indoor Air Pollution

The obvious way to reduce your exposure to indoor air pollution is to address the sources listed above.  Eat organic food, drink purified water and/or a good quality spring water out of a glass bottle (i.e. Mountain Valley Springs), use natural cleaners and cosmetics, etc.  If you have carpeting then consider replacing it, although I realize this isn’t always an option.  If you bring home dry cleaning don’t immediately put it in your closet, as ideally you want to let it air out first.  You might also want to consider using an organic dry cleaners.  If mold is an issue then remediation might be necessary, or in some cases moving might be the best option.  If you have new furniture you probably won’t rush to replace it, but if you’re thinking about purchasing new furniture in the future then consider purchasing more natural furniture.  For example, if you’re looking for a new mattress, there are natural and organic mattresses to choose from.

If there is a lot of indoor air pollution that you can’t address, then look into getting an air purification system.  An example would be if you happen to be renting, and therefore replacing the carpeting isn’t an option.  Blueair and IQAir are examples of good quality HEPA air purification systems.  Also look into getting one or more house plants, as the research shows that they can remove indoor air pollutants (5). If mold is an issue then getting an air purification system and/or house plants isn’t going to help much, but these can be good options for other sources of indoor air pollution.  One more thing I should mention is to not wear your shoes inside your home, as this can make a big difference.  In fact, one study showed that when shoes were worn inside the homes, heptane, acetic acid, nonane and styrene concentrations were statistically higher than that when shoes were out of the homes (6).

Now let’s take a look at some of the different sources of outdoor air pollution:

Different Sources of Outdoor air Pollution:

• Transportation: cars, buses, trucks
• Fuel consumption in stationary sources
• Industrial processes
• Solid waste disposal
• Chemical dumps
• Aerial spraying of farms
• Forest fires

How To Reduce Your Exposure To Outdoor Air Pollution

While you obviously won’t be able to completely eliminate your exposure to these outdoor air pollutants, there are a few things you can do to reduce your exposure to them.  First of all, for those who walk, jog, or ride a bike on a busy road, consider doing this in a park or a greenway so that you aren’t constantly inhaling the fumes from the cars and trucks while exercising.  I realize this might be an inconvenience, but it’s your health we’re talking about.  Another thing you can consider doing in the future is to move to a different location.  For example, if your home is located near a busy road or highway, you need to consider the negative impact this will have on your health over the years.  Even if you spend most of your time indoors you’ll still be exposed to the fumes from the cars and trucks passing by, and if you have a porch or backyard and spend time there the chemicals will have an even greater impact on your health.

Landfills are another source of outdoor air pollution.  Landfills generate different kinds of toxic chemicals which include carbon monoxide, hydrogen sulfide, xylene, dioxin, and polycyclic aromatic hydrocarbons (7). And research shows that people living closer to landfills experience more medical conditions when compared to those living far away from landfill sites (8) (9).  So this is yet another example of how the location of your home can contribute to your increased toxic load.

Let’s Not Forget About Heavy Metals

In order to reduce your toxic load you also want to reduce your exposure to heavy metals, including mercury, aluminum, lead, arsenic, and cadmium.  Many people still have mercury amalgams, and thus should consider working with a biological dentist (you can visit the website IAOMT.org to find one), as they will take the proper precautions to remove them.  Fish and vaccines are other common sources of mercury.  Aluminum is another toxic metal that is commonly high, and many people are exposed to aluminum through cooking with aluminum pots and pans, consuming food and beverages from aluminum cans, cooking with aluminum foil on a frequent basis, and using deodorants that have aluminum.  Some sources of lead exposure include cigarette smoke, tattoos, lead-based paints, and ceramic glazes.  Arsenic exposure is also common, as it’s found in foods such as chicken (due to the feed) and brown rice, in the drinking water, and it’s also found in pesticides and herbicides.

How To Increase Your Elimination Of Environmental Toxins

While you want to do everything you can to reduce your exposure to environmental toxins, the truth is that you still will be exposed to chemicals inside and outside of your home.  So you also want to do things to increase your body’s elimination of environmental toxins, and here are four things you can do to help with this:

1. Support glutathione production through food and supplementation.  I’ll briefly mention glutathione when discussing phase 2 detoxification, as one of the pathways involves “glutathione conjugation”.

2. Stay well hydrated.  Drinking plenty of water can help with the excretion of toxins.

3. Incorporate infrared sauna therapy.  Although sweating in general or during exercise can help with the elimination of toxins, sauna therapy seems to be more effective.  Steam saunas and dry-heat saunas can also aid in the elimination of toxins, but apparently infrared saunas utilize a unique heating element that makes it more effective.  More healthcare practitioners recommend far-infrared sauna therapy to their patients, although there are some practitioners who claim that near-infrared has the greatest tissue penetration.  I personally have used a far-infrared unit for over four years and have been happy with it.

 4. Consider doing coffee enemas.  Unlike everything I’ve discussed so far to help with the elimination of environmental toxins from the body, I can’t say that I personally do coffee enemas.  And while some practitioners don’t advocate coffee enemas due to the lack of published research, this doesn’t mean that they can’t be of benefit.  For example, Gerson therapy is a well known natural treatment regimen for cancer, and they aggressively use coffee enemas to help restore the health of people.  It’s important to understand that coffee enemas are not primarily used to empty the bowels, as they supposedly help support liver detoxification by increasing glutathione production.

I’m sure some people reading this are wondering if colon hydrotherapy can effectively remove toxins, and the answer is “yes”.  However, just as is the case with coffee enemas, there is controversy over the use of colon hydrotherapy.  The late Dr. Walter Crinnion was an expert on detoxification, and he is the author of the book “Clean, Green, and Lean”.  He was also my instructor for a detoxification and biotransformation class I took while going through my masters in nutrition degree, and he told us that if there was only one method he can use to remove toxins it would be colon hydrotherapy.  However, some are concerned about whether colon hydrotherapy has a negative effect on the gut microbiome.

Should Binding and/or Chelating Agents Be Used?

While it’s important to support phase 1 and phase 2 detoxification, sometimes it can be beneficial to use certain binding and/or chelating agents. This especially can be beneficial for heavy metals. For example, if someone is trying to detoxify mercury (i.e. after getting their mercury amalgams removed), they might choose to eat cilantro and/or chlorella to bind to the mercury, and perhaps take NAC or alpha lipoic acid. There are also prescription chelating agents such as dimercaptosuccinic acid (DMSA) and dimercaptopropane 1-sulfonate (DMPS). Ethylenediaminetetraacetic acid (EDTA) is another prescription chelator that is more commonly used for lead and cadmium. These prescription chelating agents can be taken orally or administered intravenously.

Getting back to some of the natural agents, silica can help bind to aluminum. Modified Citrus Pectin can help with the excretion of cadmium and lead. Zeolite and bentonite clay can not only bind to heavy metals, but to mycotoxins as well. The same is true with activated charcoal.

I need to let you know that there are risks of taking some of these agents…especially prescription chelating agents. One concern is redistribution of the heavy metals in different areas of the body. For example, one case report involving a person who received intravenous EDTA showed that they exhibited increased tissue lead burden after treatment (10). This is why it’s important to have healthy glutathione levels when doing any type of chelation therapy.

Another concern is the loss of minerals. For example, one study showed that EDTA chelation not only causes the excretion of lead and cadmium, but zinc and calcium as well (11). While taking a multimineral supplement is a good idea when using such chelating agents, this is yet another reason why it’s wise to work with a healthcare practitioner.

Support Phase 1 and Phase 2 Detoxification

Phase one detoxification involves the liver transforming fat soluble compounds into reactive intermediates, and in phase two these reactive intermediates are turned into water soluble molecules that are excreted in the bile and feces.  Cytochrome P450 enzymes play an important role in the biotransformation process, and while genetics can affect these enzymes, certain nutrients, herbs, and drugs can speed up or slow down these enzymes.  I discuss the specific nutrients in the blog posts I wrote on ” How To Optimize Detoxification”.  Having healthy levels of antioxidants is important for phase one detoxification, and of course you want to do as much as you can through diet (i.e. fruits, vegetables, green tea, etc.), but sometimes supplementation is necessary.  In the ” How To Optimize Detoxification” blog posts I also talk about downregulating the phase one enzymes through nutrients and herbs such as resveratrol, polyphenols, pomegranate, and garlic.

As for phase two detoxification, there are six different pathways:

1. Glucuronidation.  This pathway actually plays a role in the detoxification of thyroid hormone, along with other hormones.  Triiodothyronine (T3) influences some of the enzymes involved in this pathway.  In addition to thyroid hormone being important for glucuronidation, some of the nutrients and herbs that support this pathway include omega-3 fatty acids, magnesium, quercitin, curcumin, milk thistle, and hawthorn.

2. Sulfation.  Vitamin B6 and molybdenum are important cofactors, and a deficiency in either one of these can lead to food or chemical sensitivities.

3. Methylation. I’ve written a separate article on this topic entitled “Methylation, MTHFR, and Thyroid Health“.  But I’ll say here that three important nutrients that support methylation include folate, vitamin B12, and vitamin B6.

4. Glutathione Conjugation.  I already discussed how to increase glutathione levels above.

5. Amino Acid Conjugation.  This pathway requires amino acids such as glycine, taurine, and glutamine.

6. Acetylation.  Nutrients which support this pathway include vitamin C, B1, B2, B5, magnesium, and lipoic acid.

Once again, if you want to learn more about phase one and phase two detoxification I’d check out the following blog posts:

How To Optimize Detoxification Part 1

How To Optimize Detoxification Part 2

What About Electronic Pollution?

Electronic pollution, including electromagnetic fields (EMFs) is without question a concern, and this deserves its own blog post.  Over the last couple of years I’ve learned a great deal about electronic pollution, and so while I have written about this on a very basic level in the past, I definitely feel the need to come out with an updated blog post on this, especially with the advent of 5G.

What Have You Done To Reduce Your Toxic Load?

I’m sure many people reading this have done things to reduce their toxic load, and so please feel free to share your experience in the comments section below.  What have you done to reduce your exposure to environmental toxins?  What have you done to increase your body’s elimination of environmental toxins?  Whether your experience was positive or negative I’d love to hear from you.

Some people with thyroid and autoimmune thyroid conditions experience joint and/or muscle pain, and the goal of this blog post is to discuss some of the most common causes, along with natural treatment suggestions.  I should mention that of the “7 causes” listed below, some of them can cause both joint and muscle pain, while others are more likely to cause either muscle or joint pain.  For example, certain infections can cause muscle and/or joint pain, whereas nutrient deficiencies are more likely to affect the muscles, but usually don’t result in joint pain.  In any case, whether you have joint pain, muscle pain, or both of these I do think it’s a good idea to read this entire blog post.

So let’s take a look at 7 common causes of joint and muscle pain:

1. Thyroid Hormone Imbalances.  Although I can’t say that most of my patients with hypothyroidism and Hashimoto’s experience joint and/or muscle pain, some people do.  And while low thyroid hormone isn’t always the primary cause of joint and/or muscle pain, it’s a factor that shouldn’t be ignored.  There is a condition called “hypothyroid myopathy”, but keep in mind that this is much more common in those people with “overt” hypothyroidism (thyroid hormone levels below the lab reference range).  Many people with Hashimoto’s have thyroid hormone levels that are less than optimal, but not low enough to result in muscle pain and weakness.

It’s also important to mention that people with hyperthyroidism are more likely to develop adhesive capsulitis, also known as “frozen shoulder” (1).  I actually wrote a separate blog post on this entitled “Is Hyperthyroidism Causing Your Frozen Shoulder?”  Another thing I should mention is that for those with hyperthyroidism who are taking antithyroid medication such as Methimazole, sometimes this can result in joint pain (2).

2. Arthritis.  This of course is a very common cause of joint pain.  Rheumatoid arthritis is an autoimmune condition, and as I’ve mentioned numerous times in the past, someone with Graves’ disease or Hashimoto’s thyroiditis is more likely to develop other autoimmune conditions.  One study showed that there is an increased risk of thyroid dysfunction among those with rheumatoid arthritis (3).  Another study looked at the prevalence and risk of other autoimmune conditions in those with Graves’ disease and Hashimoto’s, and found that rheumatoid arthritis was the most common coexisting autoimmune disorder (4).  It’s worth mentioning that infections can potentially cause rheumatoid arthritis, including Porphyromonas gingivalis, Proteus mirabilis, and Epstein–Barr virus (5).

The Relationship Between Arthritis and the Gut Microbiome

It’s also important to mention that a few studies show a correlation between a disrupted gut microbiome and both rheumatoid and osteoarthritis (6) (7) (8).  So while many people associate arthritis with “old age”, having a healthy gut microbiome can be one of the main factors preventing you from developing both rheumatoid arthritis and osteoarthritis.

There is also some research that shows a possible connection between environmental toxins and arthritis.  One study showed that the concentrations of heavy metals in serum samples of those with rheumatoid arthritis and healthy control individuals differed significantly, as it showed that heavy metals may contribute towards the development of rheumatoid arthritis (9).  Another study found a significant positive, linear association between the persistent environmental contaminant Perfluorooctanoate (PFOA) and reported diagnosis of osteoarthritis (10).  Yet another study showed an association between exposure to some pesticides (including glyphosate) and rheumatoid arthritis in male farmers (11).

3. Infections.  This is an overlooked cause of both muscle and joint pain.  Lyme disease is notorious for causing migrating muscle and joint pain, but other infections associated with bacteria can also cause joint pain, including Staphylococcus aureus, Streptococcus pneumonia, and Mycobacterium tuberculosis (12).  Viruses can also cause joint pain, including parvovirus, hepatitis B, hepatitis C, and Epstein-Barr (13).  The research shows that some people with “viral arthritis” will have positive rheumatoid factor and antinuclear antibodies, but mentions that viral arthritis is milder than osteoarthritis or rheumatoid arthritis (13).  There is also some evidence that certain parasites can cause reactive arthritis, including Blastocystis hominis (14) (15).

Earlier I mentioned that having a disrupted gut microbiome can be a factor in the development of both osteoarthritis and rheumatoid arthritis.  Well, a healthy gut is also necessary for a healthy immune system, which is necessary to keep infections in check.  This is one reason why you want to do everything you can to improve the health of your gut.

4. Trauma.  Of course trauma can cause muscle and/or joint pain, and while the connection is usually made between muscle and/or joint pain and major traumas (i.e. a car accident), sometimes minor traumas are overlooked as potential causes.

5. Nutrient Deficiencies/Exposure to food allergens.  Eating a healthy diet will reduce the chances of developing muscle and/or joint pain for multiple reasons.  First of all, certain nutrient deficiencies can make it more likely that you will experience muscle pain.  While muscle cramping is common with a magnesium deficiency, a severe deficiency in this mineral can sometimes lead to persistent and severe pain (16). Calcium and vitamin D deficiencies can cause abnormal muscular function, including pain and weakness (17).  Although a potassium deficiency can cause muscle cramps, while doing research for this blog post I came across a case study which showed that a patient developed painful muscle cramps due to overeating mangos, and the author suspected this might be due to an excess of potassium (18).  Of course it’s also possible that the person had a food allergy or sensitivity to mangos, which in turn resulted in muscle cramps.

I’ve had some patients whose joint and muscle pain resolved upon eliminating gluten and/or dairy from their diet.  And so if you have muscle and/or joint pain and nothing you’ve tried has worked to eliminate the pain, in addition to considering the other factors I discussed in this blog post, make sure that you follow an anti-inflammatory diet for at least 30 days to see if this helps.

6. Overtraining.  There are many negative consequences of overtraining, and muscle and joint pain is one of these.  While it’s not unusual to be sore a day or two after an intense workout, it’s not normal to have pain persist for a week or longer.  As I discussed in past blog posts, overtraining also puts a lot of stress on your adrenals and immune system.  So while I definitely encourage people to exercise, make sure you don’t overdo it.

8. Poor posture/sleep habits.  Since I’m a chiropractor I felt the need to mention this, as having poor posture and/or sleep habits can lead to muscle pain.  I actually experienced this recently, as this past summer I went on an 11-day road trip with my older daughter and I forgot to bring my own pillow.  The pillows I used during this trip were horrible, and by the time we arrived home my neck was in a great deal of pain.  I’m sure it didn’t help that we went on a lot of roller coasters on our trip, but I think the pillows were a greater culprit, and this is the case with a lot of people.  Similarly, some people have low back pain due to the mattress they’re sleeping on.

Unfortunately many people sit all day…even those who work from home, and this can put a lot of stress on your neck and back.  But what can you do if you have to spend a lot of time on your computer?  I’ll discuss some tips below.

Is There A Relationship Between Fibromyalgia and Thyroid Health?

I didn’t list fibromyalgia as one of the causes of muscle pain in those with thyroid conditions, but without question some people with thyroid and autoimmune thyroid conditions also have fibromyalgia…most commonly those with Hashimoto’s.  In fact, a 2017 journal article mentioned that the prevalence of fibromyalgia is approximately 2-7% in the general global population and is 30-40% in those who have Hashimoto thyroiditis (19)!  This topic deserves its own blog post, and perhaps I’ll expand on this in the future, but I did want to briefly mention it here since fibromyalgia is so common.

Natural Treatment Solutions For Joint and Muscle Pain        

Correct any thyroid hormone imbalances.  If low thyroid hormone levels are causing muscle and/or joint pain, many times correcting this imbalance will eliminate the person’s pain.  However, the same can’t be said for most people with hyperthyroidism who have a frozen shoulder.  In other words, lowering the thyroid hormone levels many times won’t resolve the person’s shoulder pain and lack of mobility.  Once again, for more information I would read the blog post I wrote on this.

Address arthritis.  So how do you address conditions such as rheumatoid arthritis and osteoarthritis?  Well, in severe cases the damage caused from arthritis might not be able to be completely reversed, but this doesn’t mean that nothing can be done for the autoimmune component. Just as is the case with Graves’ disease and Hashimoto’s, the goal is to do everything you can to improve the health of the immune system.  If you have any type of immune system condition you want to eat a healthy diet and do other things to improve your gut microbiome health, address any infections, reduce your exposure to environmental toxins, etc.

Eradicate infections.  The truth is that not all infections can be completely eradicated.  For example, Epstein-Barr can’t be eliminated from your body, but you can do things to get it back into a dormant state.  It’s a similar situation with chronic Lyme disease.  For more information on Epstein-Barr and Lyme disease I would check out some of the blog posts on my website.

Correct nutrient deficiencies.  While eating a healthy diet is important for maintaining healthy nutrient levels, doing this alone usually isn’t sufficient to correct nutrient deficiencies.  Supplementation is almost always required.  In addition, it’s important to correct the cause of the nutrient deficiencies.  Poor absorption due to numerous factors can result in nutrient deficiencies.  Certain medications, including birth control, can result in nutrient deficiencies.

Minimize exposure to common food allergens.  Eating any type of inflammatory food can potentially cause muscle and/or joint pain.  And even if gluten, dairy, or another food allergen isn’t responsible for your muscle or joint pain, these allergens can negatively affect your health in other ways (i.e. can cause gut inflammation).  And if this is the case it will be very challenging to achieve an optimal state of health.  So if you haven’t done so already you might as well clean up your diet and take a break from the common food allergens.

Reduce your toxic load.  I mentioned how antithyroid medication can sometimes cause joint pain, and I also discussed the relationship between certain environmental chemicals and arthritis.  As a result, you want to do everything you can to reduce your exposure to environmental toxins.  Also, if you began experiencing muscle or joint pain shortly after starting a medication, it’s possible that this is responsible for the pain.  This might seem obvious, but sometimes the person doesn’t make the connection, especially if they don’t experience muscle and/or joint pain until a few days or weeks after starting the medication.

Don’t overtrain.  While regular exercise is important, please don’t overdo it.  If you’re not sure if you’re overtraining then it probably is best to work with a certified personal trainer, even if it’s just for a single session.

Improve your posture and sleep habits.  If your job involves sitting for prolonged periods of time there are a few things you can do.  First of all, try to take frequent breaks.  Set an alarm on your phone or computer to remind you to get up and walk around, or at the very least stand up at your workstation and stretch.   Another option is to invest in a standing desk, or you can take it a step further and get a treadmill desk, which is what I have.  Proper ergonomics is important, as you want to make sure the top of your computer screen is at eye level, make sure you have a ergonomic-friendly chair, and adjust your keyboard to a height where your elbows are bent approximately 90 degrees.

What’s Your Experience With Muscle and Joint Pain?

Have you experienced muscle and joint pain due to any of the factors I discussed in this blog post?  If so, please feel free to share your experience in the comments section below.  If you’re still experiencing muscle and/or joint pain please let me know!  And if you have dealt with muscle and/or joint pain but it’s a thing of the past please let me know!  Thank you!

Everyone at Natural Endocrine Solutions would like to wish you and your family a Happy Thanksgiving.  We are so thankful for the opportunity to serve you.  Many of you know that in the summer of 2018 I was diagnosed with chronic Lyme disease.  Although my symptoms weren’t too severe, I did experience some neurological symptoms, and one of the things that entered my mind was how my state of health would be in 2019 and beyond.

I’m thrilled to report that I currently feel great, and I have been feeling pretty good for most of 2019.  Although my practice doesn’t focus on Lyme disease, over the years I have worked with thyroid and autoimmune thyroid patients with Lyme disease who had debilitating symptoms, and so I’m of course grateful that I feel as good as I do.  I know many people reading this have certain health challenges, whether it’s dealing with Graves’ disease, Hashimoto’s, a non-autoimmune thyroid condition, or another health issue.  But regardless of our state of health, we all have things we can be grateful for, and I’d love to hear what you’re thankful for in the comments section below.

Happy Thanksgiving!!!

Both people with hypothyroidism and hyperthyroidism can experience anxiety.  Although one would suspect that the imbalance in thyroid hormone levels is the main reason for anxiety in those with thyroid and autoimmune thyroid conditions, there can be many other causes, and some people have multiple factors causing or contributing to their anxiety.  In this blog post I’ll discuss 4 main factors that can lead to anxiety.

Before discussing these four factors, it’s important to understand that there can be overlap, and sometimes we don’t know specifically what’s responsible for the person’s anxiety.  You’ll understand what I mean when reading through the four factors.  Of course if someone recently was diagnosed with Graves’ disease and they experienced anxiety shortly thereafter, there probably is a good chance that the elevated thyroid hormone levels were responsible for the anxiety, although this isn’t always the case.

A few days ago I sent an email letting my email subscribers know about an upcoming “Anxiety Summit”.  And while there will be a few dozen presenters discussing different topics, most of these topics fall under these four categories I’m going to discuss in this blog post.  With that being said, let’s take a look at the four main factors that can cause anxiety:

1. Thyroid hormone imbalances.  Most people reading this know that I see a lot of people with thyroid and autoimmune thyroid conditions.  And while I do have some patients with hypothyroidism and Hashimoto’s who experience anxiety, it is far more common in my hyperthyroid patients.  As far as the research that looks at the relationship between anxiety and thyroid health, one study looked at the psychiatric manifestations of Graves’ disease, including anxiety, and while resolving the hyperthyroidism associated with this condition may help, the authors also mentioned that a substantial number of patients have an altered mental state even after successful treatment of hyperthyroidism, which suggests that there might be other factors involved (1).  Another study looked at the relationship between anxiety and thyroid function in patients with panic disorder, and found that those with more severe panic attacks had a higher TSH, and that the severity of anxiety correlated negatively with free T4 levels (2).  In other words, the lower the free T4 levels, the greater the person’s anxiety.  Yet another study looked at the prevalence of anxiety and depressive symptoms among patients with hypothyroidism (3), and showed that psychiatric comorbidities such as depressive disorder, anxiety disorder, and disturbances in memory and learning are common in patients with hypothyroidism (3).

2. Inflammation.  Proinflammatory cytokines are associated with autoimmune conditions, such as Graves’ disease and Hashimoto’s, but the research also shows that they are present in generalized anxiety disorder (4).  Some of the research questions whether the inflammation can actually cause anxiety, but research suggests that proinflammatory cytokines can cause anxiety by modulating the metabolism of neurotransmitters, including dopamine and serotonin (5).  Another study showed that inflammation can affect anxiety-related brain regions including the amygdala, insula and anterior cingulate cortex, which may result from cytokine effects on monoamines and glutamate (6).

The problem is that a lot of things can cause inflammation.  This includes eating inflammatory foods, chronic stress, infections, poor oral health, environmental toxins, nutrient deficiencies, etc.  While taking certain supplements might help if someone has one or more nutrient deficiencies (i.e. vitamin D3, omega-3 fatty acids), many times this isn’t sufficient.  As a result, some detective work is usually needed to find the source of the inflammation.

3. Gut Dysbiosis.  In 2009 a journal article was written on the gut-brain axis (7), and since then there has been other articles that have discussed the connection between the influence of the gut microbiota on the brain, and vice versa.  The microbiota and the brain communicate with each other via various routes including the immune system, tryptophan metabolism, the vagus nerve and the enteric nervous system, involving microbial metabolites such as short-chain fatty acids, branched chain amino acids, and peptidoglycans (8).  There are many factors that can affect the gut bacteria earlier in our lives, as well as in adulthood.  This includes but isn’t limited to the food we eat, stress, infections, gut disrupting medications (i.e. antibiotics, PPIs), and gut-disrupting chemicals (i.e. glyphosate).

Based on what I just said, it shouldn’t be surprising that certain infections such as parasites (9), along with having a Candida overgrowth (10) and small intestinal bacterial overgrowth (11) have been associated with anxiety and other mood disorders in the research.  While addressing these infections and/or overgrowth of yeast and bacteria can potentially resolve anxiety, it’s not always that simple.  For example, if someone has parasites and takes prescription drugs, this may get rid the parasites, but the antibiotics will also harm the good bacteria in the gut.  Also, while SIBO and a Candida overgrowth might cause anxiety, there is question whether this is related to inflammation and/or decreased nutrient absorption (10).

4. Nutrient deficiencies.  Certain nutrient deficiencies can cause anxiety.  Let’s take a look at some of them.

Thiamine. Thiamine (vitamin B1) has been used to treat patients with anxiety, with a dosage of 250 mg/day used (12).

Selenium.  Although I commonly recommend selenium to help support the immune system and increase glutathione production, a few intervention studies show that selenium can improve mood and diminishes anxiety (13) (14).

Magnesium.  Magnesium has many important roles in the body, and since it has a calming effect it shouldn’t be surprising that it also can play a role in helping some people with anxiety (15).

Vitamin D.  Research shows that a vitamin D deficiency can play a role in anxiety (16) (17) (18).  Keep in mind that vitamin D also has anti-inflammatory effects, and so this very well might be how it helps to reduce anxiety (by reducing inflammation).

Omega-3 fatty acids.  The research shows that omega-3 supplementation can lower anxiety (19) (20), although it might accomplish this by reducing inflammation.

Folate and SAMe.  Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme involved in the metabolism of folate, as it converts 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate.  Having polymorphisms (genetic variations) of MTHFR is common, and they can play a role in anxiety (21).  Both folate and SAMe play an important role in methylation, which in turn is important for the production of neurotransmitters.  As a result, in some people with an MTHFR polymorphism, supplementing with methylated folate and/or SAMe might help with anxiety, although it’s worth mentioning that sometimes this can also worsen a person’s anxiety.

Can Taking Herbs Help With Anxiety?

While addressing the factors discussed in this blog post should help with most cases of anxiety, some people choose to take herbs and other natural agents.  While it’s fine to take herbs on a temporary basis to help decrease anxiety, you also want to make sure to correct any underlying imbalances causing or contributing to the anxiety.  That being said, here are some of the herbs and other natural agents (other than those nutrients mentioned above) that can help to decrease anxiety:

Kava.  A few studies show that kava can help with generalized anxiety disorder (22) (23).

Ashwagandha.  Ashwagandha is an adaptogenic herb, and a few studies show that it can help to reduce stress and anxiety (24) (25).  Some reading this might be concerned that ashwagandha is a member of the nightshade family, and I discussed this in a past article entitled “Should Ashwaghanda Be Avoided in Those With Graves’ Disease and Hashimoto’s Thyroiditis?”.

Rhodiola.  Rhodiola rosea is another adaptogenic herb, and a few studies show evidence that rhodiola can help with anxiety symptoms (26) (27).

Gamma-aminobutyric acid (GABA).  GABA is the primary inhibitory neurotransmitter known to counterbalance the action of the excitatory neurotransmitter glutamate (28), and a few studies show that it can help with anxiety (28) (29).  It’s worth mentioning that phenibut is a form of GABA that has a phenyl group, which in turn allows it to easily pass through the blood-brain barrier (30).

Valerian root.  This herb is commonly used for the treatment of insomnia and anxiety, as it modulates the GABA-A receptors (31).

L-theanine.  One study suggests that chronic (8-week) L-theanine administration is safe and has multiple beneficial effects on depressive symptoms, anxiety, sleep disturbance and cognitive impairments in patients with major depressive disorder (32).  However, a more recent study did not support the efficacy of L-theanine in the treatment of anxiety symptoms in Generalized Anxiety Disorder (33).  I’ll add that I’ve had some patients experience a reduction of anxiety when taking L-theanine.

Lavender.  The two primary terpenoid constituents of lavender essential oil, linalool and linalyl acetate, may produce an anxiolytic effect in combination via inhibition of voltage-gated calcium channels, reduction of 5HT1A receptor activity, and increased parasympathetic tone (34).  A few studies show that Lavender oil can be an effective and well tolerated alternative to benzodiazepines for reducing generalized anxiety (34) (35).

What’s Your Experience With Anxiety?

For those reading this who have dealt with (or currently deal with) anxiety, I’d love to hear about your experience.  Do you know what caused your anxiety, and can you share what did you do to overcome it?  Perhaps you incorporated one or more of the factors I discussed in this blog post, or did you do something I didn’t mention?  If you’re currently experiencing anxiety what are you doing to help with it?  Thank you for sharing your experience with everyone!