Many people with hyperthyroidism want to know what foods they should and shouldn’t eat.  While there is no hyperthyroidism diet that fits everyone perfectly, in this blog post I will discuss five diet tips that can benefit people with different types of hyperthyroid conditions.  So whether you have Graves’ disease, toxic multinodular goiter, or a different type of hyperthyroid condition, most of the information in this blog post will benefit you.

In addition to the 5 hyperthyroid diet tips I’ll be discussing, for those with hyperthyroidism who are struggling to gain weight, I’ll also discuss this later in this post.  While I realize that not everyone with hyperthyroidism will lose weight, when I was dealing with hyperthyroidism I lost a lot of weight, and many of my hyperthyroid patients are concerned about weight loss.  And if you happen to follow a vegetarian or vegan diet I’ll also discuss this below.

Hyperthyroidism Diet Tip #1: Eat whole foods.  I know that many people reading this understand that it’s important to eat a diet consisting of mostly whole foods.  But there are also many people with hyperthyroidism who don’t eat well.  Some people might think they are eating well when they aren’t, but hopefully after reading this you’ll understand what types of foods you should eat, and which ones you should avoid.  It should be obvious that you should try your best to avoid fast food, including fried food, as well as refined foods.  By refined foods I mean highly processed foods, as these foods are stripped of their nutrient content and fiber.  White flour and white sugar are common examples of refined foods.

But the truth is that many foods that are perceived as being healthy are actually unhealthy.  For example, while you might understand that pasta from white flour is unhealthy, how about pasta made from brown rice?  Similarly, while eating pizza at most popular pizza chains is unhealthy, how about eating homemade pizza with all organic ingredients?  Let’s take it a step further and assume the ingredients will be gluten free as well.

I’m not going to lie to you, as I’ve had my share of pizza since being in remission from Graves’ disease in 2009.  And I’ve had other “healthier versions” of unhealthy foods.  But there are a few things you need to understand.  First of all, just because a specific food includes organic ingredients doesn’t mean it’s healthy.  Similarly, just because something is gluten free also doesn’t mean it’s a healthy choice.  I gave the example of pizza earlier, but there are many other examples.  Growing up I would almost always have an unhealthy bowl of sugary cereal for breakfast, and these days there are many organic and gluten free versions of cereals, but this doesn’t mean that they are a healthy choice.

Once again, I’ll admit that over the years I have indulged in some of these “healthier versions” of unhealthy foods.  And the truth is that eating these foods on an OCCASIONAL basis is fine for most people.  The problem is that many people eat these foods on a DAILY basis.  Another thing I should add is while I indulge in unhealthy foods every now and then, when I was trying to restore my health in 2008/2009 after being diagnosed with Graves’ disease, I was very strict with the diet.  I’m sure you’re wondering which foods you can specifically eat, and I’ll discuss this shortly.

Hyperthyroidism Diet Tip #2: Eat organic whenever possible.  As I mentioned earlier, just because something is organic doesn’t mean it’s healthy.  So when I say to “eat organic”, of course I’m referring to whole healthy foods.  Sure, if you indulge in something refined then it would be great if this was organic as well.  When it comes to fruits and vegetables, try your very best to eat organic, but you also might want to check out the “Dirty Dozen” list from the Environmental Working Group.  This lists the top 12 fruits and vegetables with the greatest amount of pesticides.  There is also the “Clean Fifteen” list, which has the top 15 fruits and vegetables with the least amount of pesticides.

These aren’t perfect lists, but they still can be helpful.  For example, if you are unable to purchase all organic fruits and vegetables then I would try to avoid foods on the Dirty Dozen list, and stick to those on the Clean Fifteen list.  It’s also important to understand that organic doesn’t mean that the food is free from chemicals.  For example, if a product is certified organic this means that it is grown with no synthetic herbicides, pesticides, or fertilizers, which of course is great news.  So pesticides and herbicides used on organic produce are not synthetic.  But one potential problem is drift, as organic farms are frequently located near conventional farms, and so the pesticides from non-organic farms are likely to contaminate organic farms.   That being said, it still is a good idea to do everything you can to reduce your exposure to synthetic pesticides and herbicides.  And while organic food isn’t perfect, it still has less chemicals than non-organic food.

Hyperthyroidism Diet Tip #3: Eat a wide variety of vegetables.  Over the years I have looked at a lot of food diaries from my patients, and one of the main things I’ve noticed is that many people don’t eat a sufficient amount of vegetables.  And the few who do eat plenty of vegetables seem to eat the same veggies over and over again.  The truth is that most people need to eat a wider variety of vegetables, including myself.  And the reason for this is because the bacteria in our gut feeds off of different fibers in the vegetables we eat.  In other words, eating a greater variety of vegetables will improve the diversity of your gut microbiome, which is one of the keys to optimal health.

So how many different vegetables should you eat?  Well, in 2018 I attended a 6-week online course hosted by probiotic expert Dr. Jason Hawrelak, and he recommended to eat 40 different vegetables per week!  Just to clarify, he wasn’t saying that we should eat 40 servings of vegetables per week, but 40 different types of vegetables.  The truth is that most people don’t eat half this amount on a weekly basis.  So in a perfect world everyone would eat 10 to 12 servings of vegetables per day, and 40 different kinds of veggies per week.

Of course we don’t live in a perfect world, but you should still strive to eat as many different kinds of veggies each week.  I’d say that most people who actually eat vegetables eat 5 to 10 different kinds of vegetables per week.  If this describes you then I would suggest to add a new vegetable once per week, or at the very least once every other week.  If you do this then within a few months you will greatly increase the variety of veggies in your diet.

Hyperthyroidism Diet Tip #4: Consider an autoimmune Paleo (AIP) diet.  This hyperthyroid diet tip is specific to those with Graves’ disease, which is an autoimmune hyperthyroid condition, although some people with other types of hyperthyroid conditions may also benefit from such a diet.  The purpose of an autoimmune Paleo diet is to avoid inflammatory foods, as well to avoid foods that will interfere with gut healing.  A big reason for this is because according to the research, everyone with an autoimmune condition has a leaky gut.  There are numerous factors that can cause a leaky gut, and food is one of them.

So what foods are allowed in an AIP diet?  What I’d like to do is compare the AIP diet to a “standard” Paleo diet, which includes the following:

• Vegetables
• Fruit
• Eggs
• Nuts and seeds
• Meat and fish
• Coconut products
• Healthy oils
• Green tea and herbal teas

An AIP diet is even more restrictive, as it excludes eggs, nuts, seeds, and the nightshade vegetables (tomatoes, eggplant, peppers, white potatoes).  For some people this might seem like an impossible diet to follow, and without question it is very challenging.  However, you need to understand a few things.  First of all, the AIP diet is not meant to be permanent.  I recommend following this diet for a minimum of 30 days, although some people will follow it for a few months.  In addition, the goal of this diet isn’t to restrict calories.  That being said, I would make sure you eat plenty of vegetables, as some people who follow an AIP diet will eat mostly meat and a small amount of veggies, but you really want to do the opposite.

One of the main concerns with following the AIP diet in those with hyperthyroidism is that because this diet is restrictive it can result in weight loss.  Many people with hyperthyroidism are already losing weight, and they don’t want to shed additional pounds.  I understand this concern, but as I mentioned earlier, the goal of the AIP diet isn’t to restrict calories.  In addition, loading up on carbohydrates might prevent you from losing weight, but you should focus more on nutrient density than eating empty calories.

Hyperthyroidism Diet Tip #5: Avoid genetically modified foods.  Genetically modified organisms are usually engineered to be more resistant to pesticides such as Roundup, and are therefore called “Roundup Ready” crops. Glyphosate is the active ingredient in Roundup. So when you eat genetically modified foods you are being exposed to high levels of glyphosate residues.  It’s worth mentioning that glyphosate might be used on other non-GMO crops such as wheat.  In fact, a 2013 paper by Anthony Samsel and Stephanie Seneff suggested that the increased prevalence of Celiac disease might be due to the use of glyphosate to desiccate wheat and other crops prior to the harvest (1).

What’s the concern with glyphosate?  There are a lot of concerns, as the research shows that glyphosate can cause neurotoxicity and oxidative stress (2), it can promote the growth of human breast cancer cells (3), can have a negative effect on cardiovascular health (4), and can inhibit cytochrome P450 (5), which plays a vital role in detoxification.  In addition, there is evidence that glyphosate can disrupt the gut microbiome (6) (7).

Should Those With Hyperthyroidism Eat Goitrogenic Foods?

Goitrogenic foods can potentially inhibit thyroid hormone production by interfering with the uptake of iodine.  As a result, many people with hypothyroidism and Hashimoto’s are concerned with eating goitrogenic foods, which include broccoli, Brussels sprouts, cabbage, cauliflower, millet, soybeans, spinach, strawberries, and sweet potatoes.  But how about those with hyperthyroidism?  Some recommend goitrogenic foods to those with hyperthyroidism as a way of lowering thyroid hormone levels.  The problem is that this usually doesn’t work, as in the past I tried lowering thyroid hormone levels by having patients eat larger amounts of these foods, especially raw cruciferous vegetables.

I recommend for my hyperthyroid patients to eat plenty of cruciferous vegetables, but only because they are very nutrient dense and help to detoxify the body.  But I wouldn’t expect to lower your thyroid hormone levels by eating large amounts of these foods.  Of course if anyone reading this has had success managing their hyperthyroidism by eating goitrogenic vegetables please feel free to share your experience in the comment sections below.

What Foods Can You Eat To Gain Weight?

As I mentioned earlier, one of the concerns with following a restrictive diet is that many people with hyperthyroidism are already losing a lot of weight.  So a common question I get asked is what foods can someone with hyperthyroidism eat to gain weight?  The truth is that it will be difficult to gain weight through diet if someone has elevated thyroid hormone levels.  For example, when I was dealing with Graves’ disease I lost over 40 pounds, and it wasn’t until I started lowering the thyroid hormone levels until I finally began to gain weight.  So as I mentioned above, I would focus on nutrient density, eating plenty of vegetables, as well as healthy fats, and at the same work on normalizing your thyroid hormone levels.

What If You’re a Vegan or Vegetarian?

While most of my patients are omnivorous, I also have worked with many vegetarians and vegans over the years.  The good news is that those who are vegetarians and vegans can receive good results when following a natural treatment protocol.  The bad news is that it can be even more challenging to eat a “healthy” vegetarian or vegan diet when trying to restore your health.

This is especially true for those with Graves’ disease who are vegetarians and vegans.  As I mentioned earlier, an AIP diet can be beneficial for those with an autoimmune condition.  Many people who eat meat find an AIP diet to be very challenging, and so I’m sure you can imagine that this diet would be even more difficult to follow for someone who doesn’t eat meat (or fish).  A few years ago I wrote an article entitled “Vegetarians, Vegans, and The Autoimmune Paleo Diet“, and if you’re a vegetarian or vegan with Graves’ disease I definitely would recommend reading this when you get the chance.

A Summary of What To Eat When Dealing With Hyperthyroidism

When dealing with any health condition you want to eat a diet consisting of healthy foods, while avoiding the refined foods and sugars. If someone has Graves’ disease then they should consider following a strict AIP diet for a minimum of 30 days, whereas if someone has a non-autoimmune hyperthyroid condition (i.e. toxic multinodular goiter) a “standard” Paleo diet should be fine. I’ll add that while many people benefit from avoiding grains and legumes (both are excluded from an AIP and Paleo diet), some people are able to eat small amounts of these foods with no problem while trying to restore their health.

So hopefully you have a better idea as to what to eat when dealing with a hyperthyroid condition.  The truth is that a lot of the information in this blog post applies to everyone, and not just those with hyperthyroidism.  After all, we should all eat whole healthy foods, eat organic foods, including a wide variety of vegetables, and it also is a good idea to do your best to avoid genetically modified foods.  If you have anything you’d like to share regarding your experience with diet and hyperthyroidism please feel free to do so in the comments section below.

Hashimoto’s thyroiditis is an autoimmune thyroid condition which involves destruction of the thyroid cells by the immune system.  Hashimoto’s is typically diagnosed by the presence of an elevated thyroid-stimulating hormone (TSH) and elevated thyroid peroxidase and/or thyroglobulin antibodies.  Sometimes the thyroid hormone levels will be low or depressed, although this isn’t always the case, as many cases of Hashimoto’s are subclinical, which can make the condition more challenging to diagnose.  Women are affected with Hashimoto’s more frequently than men, and most women are diagnosed between the ages of 30 to 50 years old, although I have worked with patients younger and older than this age range.

The goal of this blog post is to discuss 7 things people with Hashimoto’s thyroiditis should know about treating their condition naturally.  Some of these I’ve discussed in greater detail in other articles and blog posts, but I figured I’d put together an updated post which included some of the main things you should know about Hashimoto’s.  I’ve also included links to some blog posts I’ve written in the past which go into greater details.

1. Finding the autoimmune triggers of Hashimoto’s can be challenging.  In order to reverse the autoimmune component of Hashimoto’s (or any other autoimmune condition) it is necessary to find and remove the autoimmune triggers.  There are many different factors that can trigger an autoimmune response, including food allergens (i.e. gluten, dairy), stress, infections, and chemicals.  The two main ways I look for triggers in my patients with autoimmune thyroid conditions are through a thorough health history and by ordering certain tests (i.e. blood tests, adrenal saliva test, comprehensive stool panel).  Not everyone will need to order the same tests, as while some functional medicine practitioners require all of their patients to order the same tests, I determine which tests someone needs based on the person’s health history.

As many reading this already know, I’ve written a book called “Hashimoto’s Triggers”, which is the most comprehensive book on finding and removing the triggers associated with Hashimoto’s.  Of course I’m a tad biased since I’m the one who wrote the book, but I think after reading it you’ll agree that it’s quite comprehensive.  I do need to warn you that it’s a very thick book (over 500 pages), but you don’t need to read the entire book to benefit from it, as I designed it so you can easily pick and choose to read the chapters that are of interest to you.  As of writing this blog post the Kindle version of the book is only $3.99 (it’s also available in paperback).

2. Diet alone usually isn’t the solution.  I mentioned that food allergens such as gluten and dairy can be triggers, and while eating a healthy diet consisting of whole foods is important for anyone looking to restore their health, eating well alone usually won’t be sufficient to reverse the autoimmune component of Hashimoto’s.  So just to clarify, if you eat a lot of inflammatory foods then it will be difficult, if not impossible for you to achieve a state of optimal health.  However, you probably will need to do more than eat well to restore your health.

For example, a small percentage of people with Hashimoto’s are able to achieve a state of remission by avoiding gluten alone, while many others who follow a strict autoimmune Paleo (AIP) diet don’t notice much of an improvement in their symptoms and lab results.  This doesn’t mean that an AIP diet can’t be beneficial in some people with Hashimoto’s, as even if food isn’t a trigger, an AIP diet is anti-inflammatory and can aid in gut healing.  So by all means make sure you avoid common food allergens and eat well overall, but if doing this doesn’t help much with your hypothyroid symptoms or test results please don’t get discouraged, as this probably means that you have other triggers that need to be detected and removed.

3. Don’t overlook the impact of infections and chemicals.  Many people with Hashimoto’s focus on avoiding potential food triggers such as gluten, dairy, and corn.  Although this is a wise thing to do, as I mentioned earlier, changing one’s diet alone usually isn’t sufficient to reverse the autoimmune component.  While food can be a trigger, please don’t overlook the impact that infections and chemicals can have on your immune system.

We live in a toxic world, and all of the chemicals we’re exposed to are a big reason for the increased prevalence of autoimmunity.  Obviously you won’t be able to completely eliminate your exposure to environmental chemicals, and so the next best thing is to do everything you can to reduce your exposure to them.  This includes purchasing organic food, drinking purified water, using natural household products, consider purchasing an air purification system, etc.  It’s also important to do things to help with the elimination of toxins from your body, including eating plenty of vegetables, consider using an infrared sauna to sweat out the chemicals from your body, and perhaps even incorporating enemas and colonics.

As for infections, these include bacteria such as H. pylori, viruses such as Epstein-Barr, and parasites such as Blastocystis Hominus.  Just as is the case with environmental chemicals, we’re all exposed to bacteria, viruses, and parasites.  While I do recommend natural antimicrobial agents at times to my patients to help combat infections, the best thing you can do to minimize the negative impact of certain pathogens is to always work on improving the health of your immune system.

4. A healthy gut is necessary for optimal immune system health.  According to the triad of autoimmunity, in order for an autoimmune condition to develop one needs 1) a genetic predisposition, 2) exposure to an environmental trigger, and 3) an increase in intestinal permeability (a leaky gut).  Since most of the immune cells are located in the gut, it makes sense that having a healthy gut is a requirement for a healthy immune system.  So what can you do to optimize the health of your gut?  I discuss this in great detail in my book, but one of the main things you can do right away is read my blog post entitled “What Is The 5-R Protocol?”  As I discussed in this post, you need to remove the factor that is causing the leaky gut, followed by replacing certain factors (i.e. digestive enzymes, dietary fiber), reinoculate with prebiotics and probiotics, repair the gut, and rebalance your body.

5. Some people with Hashimoto’s need to take thyroid hormone replacement.  I realize that this doesn’t relate to treating Hashimoto’s naturally, but I thought it was important to bring up.  Many people reading this are already taking thyroid hormone replacement such as levothyroxine, or natural desiccated thyroid hormone (i.e. Armour, Nature-Throid).  On the other hand, there are some people with Hashimoto’s who don’t need to take thyroid hormone replacement.  That being said, there are also people who should be taking thyroid hormone replacement but refuse to do so.

When I was dealing with Graves’ disease I chose not to take antithyroid medication, which is commonly recommended by endocrinologists to manage hyperthyroidism.  I took an antithyroid herb called bugleweed, but unfortunately there is no herbal replacement for thyroid hormone.  Once again, I’m not suggesting that everyone with Hashimoto’s needs to take thyroid hormone replacement, but you need to understand that having sufficient levels of thyroid hormone is very important.  Thyroid hormone affects every cell and tissue in the body, and as a result, it can be harmful if someone has depressed thyroid hormone levels, especially for a prolonged period of time.

6. Numerous factors can be responsible for the fatigue people with Hashimoto’s commonly experience.  One of the most common symptoms people with Hashimoto’s experience is fatigue.  Many times this is due to low or depressed thyroid hormone levels.  However, there can be other factors responsible for the fatigue.  This includes compromised adrenals, certain infections, and even nutrient deficiencies.  So if you balance your thyroid hormone levels and yet are still experiencing fatigue, then this is a clear sign that something else is responsible for your low energy levels.  As a result you might need to focus on improving the health of your adrenals, or perhaps there is an underlying infection such as Epstein-Barr, or a deficient nutrient (i.e. iron, vitamin B12) that is causing your fatigue.

7. Some people with Hashimoto’s initially present with hyperthyroidism.  Although most people with Hashimoto’s will eventually experience overt or subclinical hypothyroidism, initially hyperthyroidism is common due to the destruction of the thyroid follicles, which causes the release of thyroid hormones into the bloodstream.  This transient state of hyperthyroidism can be mistaken for Graves’ disease, as the person’s thyroid panel might also be consistent with a hyperthyroid pattern (depressed TSH and elevated thyroid hormone levels).  This is referred to as Hashitoxicosis, where the person has Hashimoto’s antibodies, tests negative for thyroid stimulating immunoglobulins (the antibodies associated with Graves’ disease) but presents with hyperthyroidism.

What Have You Done To Treat Naturally Treat Your Hashimoto’s Condition?

Hopefully you found the information in this blog post to be helpful.  I’d like to know what you have specifically done from a natural standpoint for your Hashimoto’s condition, and so please feel free to share your experience in the comments section below.  Have you tried finding your autoimmune triggers?  Did doing so help with symptoms such as fatigue and brain fog?  What have you done for gut healing?  Thank you for sharing your experience with everyone!

Many patients with Graves’ disease experience hair loss, and while this might not be the most concerning symptom someone with this condition has, it is still very distressing for many people.  This is especially true since Graves’ disease (as well as most other autoimmune conditions) is more common in women, and I can tell you that over the years I have worked with many women with Graves’ disease who were stressed out the most over their hair loss.  I’ve written other blog posts and articles on hair loss, but I wanted to put together an updated post that focuses on Graves’ disease and hair loss, because while I do see hair loss in people with hypothyroidism and Hashimoto’s thyroiditis, it is more common in those with hyperthyroid conditions.

When I begin working with someone who has Graves’ disease, of course I want to address the underlying cause of their condition, but initially I want to make sure the person is safe since it’s quite common to have an elevated resting heart rate.  Many endocrinologists will try to lower the person’s resting heart rate through the use of antithyroid medication (i.e. methimazole, PTU) and/or beta blockers (i.e. propranolol, atenolol).  Natural antithyroid agents such as bugleweed and high doses of L-carnitine are also an option to lower the thyroid hormone levels, while herbs such as motherwort and hawthorn can act as natural beta blockers.

It’s worth mentioning that sometimes taking antithyroid medication or herbs will help to decrease the person’s hair loss, while other times the person will experience more hair loss upon taking these.  I’ll talk more about this later in this post, but before we specifically discuss Graves’ disease and hair loss I want to make sure you have taken the necessary steps to start lowering your thyroid hormone levels.  So if you have uncontrolled hyperthyroidism then this needs to be addressed first.

Why Do People With Graves’ Disease Commonly Experience Hair Loss?

The main reason why people with Graves’ disease experience hair loss is due to the thyroid hormone imbalance.  While either high or low thyroid hormone levels can result in hair loss, as I mentioned earlier, it seems that high thyroid hormone levels more commonly result in hair loss.  Based on what I just said here, it might seem obvious that in order to stop the hair loss you simply need to lower the thyroid hormone levels.  While normalizing the thyroid hormone levels will usually cause the hair loss to stop, it frequently will take a good amount of time for this to happen.

The Impact of Antithyroid Medication and Herbs on Hair Loss

I’ll add that taking antithyroid medication such as methimazole or PTU can either improve or exacerbate the hair loss.  I’ve worked with Graves’ disease patients who took methimazole and had an improvement in their hair loss, while others had their hair loss worsen upon taking antithyroid medication.  Some people with Graves’ disease don’t experience any hair loss until they start taking antithyroid medication.  Frequently what happens is that the person takes too high of a dosage of methimazole, which can make them hypothyroid, and this can also cause hair loss.

Bugleweed is an antithyroid herb that can also help to lower thyroid hormone levels.  Because this herb isn’t as potent as antithyroid medication it’s less likely to cause a huge “swing” in thyroid hormone levels over a short period of time.  As a result, taking bugleweed usually doesn’t cause hair loss as much as antithyroid medication does, although you also need to keep in mind that bugleweed isn’t effective in everyone with hyperthyroidism.  In other words, taking bugleweed doesn’t always lower thyroid hormone levels.  Antithyroid medication is more effective, but there is also a greater risk of side effects.

As I’m sure you know, antithyroid drugs and herbs don’t do anything to address the cause of the problem, and so while they might help with hair loss by lowering the thyroid hormone levels, it’s still important to address the underlying cause of the condition.  In other words, if all you do is take antithyroid medication or herbs, this might temporarily help with hair loss associated with Graves’ disease, but once you stop taking these thyroid hormone-lowering agents the hyperthyroidism is likely to return, along with the hair loss.

What Are Other Causes of Hair Loss?

Although elevated thyroid hormone levels are the most common cause of hair loss in people with Graves’ disease, this doesn’t mean that there can’t be other causes as well.  Let’s look at some of the other common causes of hair loss in people with Graves’ disease:

• Nutrient deficiencies.  Nutrient deficiencies are common in those with Graves’ disease, and nutrient deficiencies can cause hair loss in general.  In fact, many people who are suffering from hair loss will take nutritional supplements on their own to see if they will help.  Some of the nutrient deficiencies that can cause or contribute to hair loss include zinc, iron, selenium, biotin, and gamma-linolenic acid (1).  When looking to address nutrient deficiencies, it’s important to look into factors that can cause these deficiencies.  Remember that Graves’ disease is an autoimmune condition, and since most of the immune system cells are located within the gastrointestinal tract, having a healthy gut is necessary for optimal immune system health.  But many people with Graves’ disease have an unhealthy gut, which in turn can affect nutrient absorption.  For example, H. pylori is a potential trigger of Graves’ disease, and numerous studies show that H. pylori can affect iron absorption (2) (3), which can result in hair loss.  Other causes of malabsorption (i.e. Celiac disease, inflammatory bowel disease) can also affect the absorption of nutrients that play a role in hair loss.  It’s also important to mention that overdosing with certain nutrients can cause hair loss.  This includes selenium, vitamin E, and vitamin A (4).  So while it’s important to correct nutrient deficiencies, you want to make sure not to take very high doses of certain nutrients, especially over a prolonged period of time, as this can lead to a toxicity that results in hair loss.
• Sex hormone imbalances.  Imbalances of the sex hormones (estrogen, progesterone, testosterone) can cause hair loss.  Elevated thyroid hormone levels will commonly cause sex hormone imbalances.  Frequently correcting the hyperthyroidism will resolve the sex hormone imbalance, although sometimes additional action will be required to balance the hormones.
• Alopecia areata.  Alopecia areata is an autoimmune condition that causes hair loss on the scalp, face, and sometimes on other areas of the body.  A 2018 study showed that alopecia areata is significantly associated with Graves’ disease and Hashimoto’s thyroiditis (5).  However, it’s important to mention that frequently alopecia areata will develop first, many times in childhood, although it’s also possible for thyroid autoimmunity to precede alopecia areata.

Please keep in mind that it’s very possible for those with Graves’ disease to have more than one factor causing hair loss.  For example, while hyperthyroidism is the most likely cause, the person might also have nutrient deficiencies that are a factor.  In this situation not only will the thyroid hormone levels need to be balanced, but the nutrient deficiencies need to be addressed as well.  As I mentioned earlier, if someone has hyperthyroidism that leads to sex hormone imbalances, lowering the thyroid hormone levels may resolve the sex hormone imbalances, although this isn’t always the case.

Can Diet Alone Help With Hair Loss?

I mentioned how nutrient deficiencies are a potential cause of hair loss.  Because of this you may wonder if eating a nutrient dense diet can correct such nutrient deficiencies, and thus resolve the hair loss problem.  Although it’s important to eat nutrient dense foods, many times supplementation is necessary to correct nutritional deficiencies, and then once this has been accomplished the goal should be to maintain healthy nutritional levels through diet (although I’ll add that sometimes supplementation is still necessary).  Just remember that having a healthy gut is necessary for the optimal absorption of nutrients.

How Long Does It Take To Reverse Hair Loss?

As for how long it takes to reverse hair loss, this of course depends on the person, as well as the cause of the hair loss.  If hyperthyroidism is the sole cause of the person’s hair loss it can take a few weeks to a few months before the hair loss stops.  The same thing applies to sex hormone imbalances.  Moderate to severe nutrient deficiencies will take time to correct, and so if this is responsible for the hair loss then it will usually take longer for the hair loss to stop and grow back.  Based on what I’ve said here, while some people start noticing their hair loss improving within a few weeks of taking measures to correct their hyperthyroidism, for some people it will take a few months before they notice a significant improvement.

What Can You Do To Help With Graves’ Disease Hair Loss?

After reading this post you probably have a pretty good idea what you can do to help with your hair loss, but I’ll list them below in bullet point format:

• Correct the hyperthyroidism.  This is the most common cause of hair loss in those with Graves’ disease, but of course even if someone isn’t experiencing hair loss it’s important to lower the thyroid hormone levels.
• Balance the sex hormones.  Once again, correcting the hyperthyroidism many times will help to balance the sex hormones.  But when this isn’t the case you might need to do other things.  One thing I didn’t mention earlier when discussing sex hormones is that having healthy adrenals is important in order to have healthy sex hormones.  And many people with Graves’ disease have adrenal problems.  So while many doctors will resort to giving bioidentical hormones to their patients with sex hormone imbalances, evaluating the adrenals is a good first step before doing this.
• Correct nutrient deficiencies.  I’ve also discussed how many people with Graves’ disease have nutrient deficiencies, and certain nutrient deficiencies can cause hair loss.  I also explained how it’s important to address the cause of the nutrient deficiencies, and how overdosing with selenium, vitamin A, and/or vitamin E can cause hair loss.

What’s Your Experience With Hair Loss?

If you have Graves’ disease and have dealt with hair loss please feel free to share your experience in the comments section below.  Are you still experiencing hair loss, and if not, how long did it take for your hair loss to stop and grow back?  If you took antithyroid medication, did this improve or worsen your hair loss?  Did you take any nutritional supplements, or do anything else naturally that helped?  Thank you so much for sharing your experience with everyone.

Most people reading this understand the importance of the thyroid gland, as it produces the thyroid hormones, which of course I’ll be discussing in this blog post.  The truth is that all of these markers I’ll be discussing either directly or indirectly affect the thyroid hormones, which play an important role in regulating metabolism, gene expression, brain development, reproductive health, bone health, and wound healing.

For most of the markers I’ll list the lab reference ranges according to Labcorp and Quest Diagnostics, which are two of the most well known labs in the United States.  Just keep in mind that different labs will have different reference ranges, which is why you usually want to pay attention to the optimal reference ranges I have listed below.  For some markers I haven’t listed optimal reference ranges, simply because I don’t know what the optimal reference range is for every single marker.

It’s also important to mention that some markers will have different ranges for males and females, as well as different ranges based on the age of the patient.  For example, according to Quest Diagnostics, the lab reference range for free T4 for those 2 to 12 years in age is 0.9-1.4 ng/dL, but those people over 20 years old should have a reference range between 0.8-1.8 ng/dL.  For simplicity sake I only listed the reference ranges for adult females.

THYROID STIMULATING HORMONE (TSH)

The production of thyroid hormones is regulated by thyroid stimulating hormone (TSH), which is made by the anterior pituitary gland.  TSH also influences the size of the thyroid gland.  While TSH stimulates the production of thyroid hormones, these same thyroid hormones will inhibit the production of TSH.  So it’s a negative feedback mechanism, as if the thyroid hormone levels get too high then the TSH will stop signaling the thyroid gland to produce thyroid hormone, and if the thyroid hormone levels get too low the TSH will increase in an effort to tell the thyroid gland to produce more thyroid hormone.

TSH during hypothyroidism.  High TSH levels typically are associated with an underactive thyroid gland.  In other words, if someone has depressed or less than optimal thyroid hormone levels then the TSH will typically increase.  As mentioned above, what happens is that when the thyroid hormone levels become too low the pituitary gland will produce more TSH in order to stimulate the thyroid gland to produce more thyroid hormones.  Sometimes the TSH will be quite elevated, where it is obvious to any doctor that the person has a thyroid problem (or possibly a pituitary issue).  But what happens more frequently is that the TSH is within the lab reference range, but outside of the “optimal” reference range.  Unfortunately many medical doctors don’t look at the “optimal” reference range, but will only pay attention to a marker if it is out of range.

TSH during hyperthyroidism.  On the other hand, someone with an overactive thyroid (hyperthyroidism) will usually have a low or depressed TSH.  The reason for this is because when someone has elevated thyroid hormone levels this will cause the pituitary gland to produce less TSH so that the thyroid gland will stop or slow down thyroid hormone production.  It’s important to understand that in most cases of hyperthyroidism where someone is taking antithyroid medication (i.e. methimazole) or antithyroid herbs (i.e. bugleweed) the thyroid hormone levels will start decreasing before the TSH starts increasing.  In fact, it’s very common to see someone take antithyroid medication or bugleweed who has normal thyroid hormone levels, but their TSH is still depressed.  In most cases the TSH will eventually increase and normalize.

Reference ranges:

Labcorp: 0.450-4.50 uIU/ml

Quest: 0.40-4.50 uIU/ml

Optimal reference range: 1.0 to 2.0 uIU/ml

TOTAL THYROXINE (TOTAL T4)

Thyroxine, also known as T4, is a type of thyroid hormone.  Approximately 85% of thyroid hormone released by the thyroid gland is T4, with approximately 15% being T3.  When looking at total T4, you need to keep in mind that most of the T4 is protein-bound.  In other words, most of the T4 produced by the thyroid gland (as well as T3) binds to a protein, which is then transported around the bloodstream.  I’ll discuss this in greater detail when I talk about thyroid-binding globulin below.

Total T4 during hypothyroidism.  Hypothyroidism is characterized by low thyroid hormone levels, including total T4.  It’s important to mention that many people with Hashimoto’s thyroiditis have subclinical hypothyroidism, which is characterized by an elevated TSH and normal thyroid hormone levels.  Many times in those with Hashimoto’s the total T4 will be within the lab reference range, but below the optimal reference range.

Total T4 during hyperthyroidism.  Those with overt hyperthyroidism will usually have elevated total T4 levels, although there are times when I see the free T4 elevated and the total T4 on the high side, but within the lab reference range.

Labcorp: 4.5−12.0 mcg/dL

Quest: 5.1-11.9 mcg/dL

Optimal reference range: 6.0 to 11.0 pg/ml

FREE THYROXINE (FREE T4)

Free T4 represents the free form of thyroxine in the blood.  When discussing total T4 I mentioned that most of the T4 is bound to a protein, with a very small percentage being free.  So just to clarify the difference between total T4 and free T4, the total T4 looks at the BOTH the T4 that’s bound to a protein and the free T4 in circulation, whereas when testing the free T4 by itself this obviously is only looking at the free form of the hormone.

Free T4 during hypothyroidism.  Hypothyroidism is characterized by low thyroid hormone levels, including free T4.  As is the case with the total T4, if someone has subclinical hypothyroidism then they will have an elevated TSH and free T4 levels that fall within the lab reference range, although they might be less than the optimal reference range.

Free T4 during hyperthyroidism.  Those with overt hyperthyroidism will have elevated free T4 levels.  If someone has subclinical hyperthyroidism they will have a depressed TSH and free T4 levels that fall within the lab reference range, although sometimes they will be on the high end of the range.   If someone with hyperthyroidism is receiving treatment with antithyroid medication (or antithyroid herbs), free T4 is the test of choice to determine whether the treatment is working since the TSH may remain low for weeks to months.  So as I mentioned earlier, for those with a depressed TSH and elevated thyroid hormone levels who are taking antithyroid medication, it’s common to see the TSH remain depressed for quite awhile, even when the thyroid hormone levels are decreasing in response to the antithyroid medication.

Labcorp: 0.82-1.77 ng/dL

Quest: 0.8-1.8 ng/dL

Optimal reference range: 1.1 to 1.5 ng/dL

TOTAL TRIIODOTHYRONINE (TOTAL T3)

Total T3 consists of both the bound form of T3 and the free T3 in circulation.  So just as is the case with total T4, with total T3 you’ll have most of the T3 bound to a protein, and a small percentage of the hormone is free, and can therefore bind to the thyroid hormone receptors.  When you think about it this makes sense, as you wouldn’t want all of your thyroid hormones to bind to thyroid receptors simultaneously, and so most of them are attached to proteins, and when needed they are released and become the free form, which will bind to the thyroid hormone receptors and have physiological effects.

Total T3 during hypothyroidism.  If someone has overt hypothyroidism then they will see total T3 levels below the reference range, but in subclinical hypothyroidism the total T3 will be within the lab reference range, although it might be below the optimal reference range listed below.

Total T3 during hyperthyroidism.  Those with overt hyperthyroidism will usually have elevated total T3 levels.

Labcorp: 71−180 ng/dL

Quest: 76-181 ng/dL

Optimal reference range: 100-160 ng/dL

FREE TRIIODOTHYRONINE (FREE T3)

Triiodothyronine is the active form of thyroid hormone, and the free form of the hormone (free T3) is what binds to the thyroid hormone receptors.

Free T3 during hypothyroidism.  If someone has overt hypothyroidism then they will have a free T3 below the lab reference range.  If someone has subclinical hypothyroidism then they will have an elevated TSH and free T3 levels that fall within the lab reference range, although they might be less than the optimal reference range.  It’s also important to know that many people have problems converting T4 to T3, which will show up on a lab as a normal free T4 with a low or depressed free T3, and I’ll discuss some of the common causes of conversion problems when discussing reverse T3.

Free T3 during hyperthyroidism.  Those with overt hyperthyroidism will have elevated free T3 levels.  If someone has subclinical hyperthyroidism they will have a depressed TSH and free T3 levels that fall within the lab reference range, although sometimes they will be on the high end of the range.   It’s also worth mentioning that some patients with hyperthyroidism have “T3 toxicosis” where the T4 is normal but there is an elevation of T3 (1).

Labcorp: 2.0-4.4 pg/ml

Quest: 2.3-4.2 pg/ml

Optimal reference range: 3.0 to 3.7 pg/ml

REVERSE T3

The number “4” in T4 means that it has 4 iodine molecules, and if it loses one of them it will yield either T3 or reverse T3, depending on which iodine molecule it loses.  So reverse T3 is manufactured from T4, and the role of reverse T3 is to block the action of T3.  When testing the reverse T3 the main concern is having elevated levels.

Reverse T3 during hypothyroidism.  One of the most common problems I see with patients is a problem converting T4 to T3.  There can be numerous causes of this, but regardless of the cause, when this occurs it’s common to see an elevated reverse T3.  Since most of the conversion of T4 to T3 takes place in the liver, having a liver problem can affect the conversion of T4 to T3, and thus cause an elevated reverse T3.  Some of this conversion also takes place in the gut, and thus an unhealthy gut microbiome can be a factor in an elevated reverse T3.  Elevated cortisol levels can also affect the conversion of T4 to T3, and even inflammation can be a factor.  Anything that results in a decrease of T4 to T3 conversion can cause an elevated reverse T3.

Reverse T3 during hyperthyroidism.  Most people with hyperthyroidism and Graves’ disease will have an elevated reverse T3.  The reason is because with hyperthyroidism there is an excessive amount of T4, and while a lot of this will convert to T3, a good amount of reverse T3 will also be manufactured from the high levels of T4.

Labcorp: 9.2-24.1 ng/dL

Quest: 8-25 ng/dL

Optimal reference range: 10-18 ng/dL

FREE THYROXINE INDEX (FTI)

Most doctors order the free T4 instead of the free thyroxine index (FTI), although every now and then I’ll still see this on a report.  The FTI is determined by the following calculation: Thyroxine (T4)/Thyroid Binding Capacity.

Hyperthyroidism usually causes increased FTI and hypothyroidism causes decreased values.  The FTI isn’t something I specifically recommend for my patients to order, although some thyroid panels will include this marker.

Labcorp: 1.2-4.9 mg/dL

Quest: 1.4-3.8 mg/dL

Optimal reference range: 1.5-3.7 mg/dL

T3 UPTAKE

The T3 uptake measures the amount of receptor sites available on thyroxine-binding globulin (TBG).  So essentially it is an indirect measurement of TBG binding capacity.  The more binding sites that are available on TBG, the lower the T3 uptake will be.  So for example, if someone has hyperthyroidism and has a high total T4, they will have less available binding sites since there is an excessive amount of thyroid hormone bound to those proteins, and this will usually result in a high T3 uptake.  On the other hand, if someone has low total T4 levels, they will have more binding sites available on TBG, and this will have a lower T3 uptake.

Labcorp: 24-39%

Quest: 22-35%

Optimal reference range: 25-33%

THYROXINE-BINDING GLOBULIN (TBG)

Thyroxine-binding globulin (TBG) is manufactured by the liver, and is one of the proteins responsible for transporting thyroid hormones from blood to tissues.  So both T4 and T3 bind to TBG and are transported to the target tissues.  As a result, an increase or decrease of TBG can alter the total concentrations of T4 and T3 in the blood.  For example, estrogen therapy (or taking oral contraceptives) can increase TBG, which means that TBG will bind to more thyroid hormones, which will decrease the free hormone available in the blood.  So in this case we commonly would see a high total T4 and a low free T4.

On the other hand, corticosteroids will lower TBG levels, and so TBG will bind to less thyroid hormone levels.  This will result in low total and free thyroid hormones.  I know this might be a little confusing to some reading this, but the truth is that TBG is a marker that most people don’t need to test for.

Labcorp: 13−39 mcg/mL

Quest: males (12.7-25.1 mcg/mL); females (13.5-30.9 mcg/mL)

Optimal reference range: 18-27 mcg/mL

THYROID PEROXIDASE (TPO) ANTIBODIES

Thyroid peroxidase (TPO) is an enzyme involved in the synthesis of T3 and T4, as it converts iodide to iodine, and the iodine combines with tyrosine on thyroglobulin.  This in turn forms T4 and T3.  Anti-TPO antibodies are the most common type of thyroid autoantibody, as it is present in most people with Hashimoto’s thyroiditis, and many people with Graves’ disease also have elevated anti-TPO antibodies.  Since TPO is involved in the synthesis of T3 and T4, having elevated anti-TPO antibodies can lead to the decreased enzymatic production of thyroid hormone.  Anti-TPO antibodies are also frequently seen in the general population and are 5-fold more common in women than in men.

Labcorp: 0-34 IU/ml

Quest: <9 IU/ml

Optimal reference range: <9 IU/ml

THYROGLOBULIN

Thyroglobulin is a glycoprotein that is produced by thyroid follicular cells. T4 and T3 are synthesized on thyroglobulin within the lumen of thyroid follicles.  Conventional medical doctors use thyroglobulin as a tumor marker, although research shows that elevated levels can also indicate an iodine deficiency (2) (3).  Because thyroglobulin is only produced by thyroid follicular cells, if someone has a total thyroidectomy they should have an undetectable thyroglobulin level, and the same is true for many people who receive radioactive iodine treatment.

Labcorp: 1.4-29.2 ng/mL

Quest: unable to find reference range

Other Lab: 1.7-56.0 ng/mL

Optimal reference range: 2.0-29.2 ng/mL

THYROGLOBULIN ANTIBODIES

I just discussed what thyroglobulin is, and so when someone has elevated anti-thyroglobulin antibodies, this means that the immune system is damaging thyroglobulin, which over time can lead to hypothyroidism.  These anti-thyroglobulin antibodies are associated with Hashimoto’s thyroiditis.  When looking at the lab reference ranges from Labcorp and Quest Diagnostics you’ll see that both ranges suggest that there should be almost no anti-thyroglobulin antibodies, whereas some labs will have much higher ranges, even though they are using the same units.

Labcorp: 0.0-0.9 IU/ml

Quest: <1 or = 1 IU/ml

Other Lab: <20 IU/ml

Optimal reference range: <1 IU/ml

TSH RECEPTOR ANTIBODIES (TRAB)

There are two types of TSH receptor antibodies. Thyroid stimulating antibodies (TSAb), also known as thyroid stimulating immunoglobulins (TSI), are the main antibodies associated with Graves’ Disease.  These antibodies bind to the TSH receptor, which causes thyroid growth, increases the vascularity of the thyroid gland, and causes an excessive production of thyroid hormone.

There are also blocking TRABs, also known as thyrotropin-binding inhibiting immunoglobulins, which can be found in approximately 15% of patients with thyroid autoimmunity (4).

Regarding the reference ranges, I’m going to specifically list the ranges for the thyroid stimulating immunoglobulins below, since this is the most common antibody associated with Graves’ disease.  However, it’s important to know that recently some of the labs (including Labcorp) changed the units associated with this marker.  As a result, when retesting this marker it would be a good idea to use the same lab for comparison purposes.

Labcorp: 0.00-0.55 IU/L

Quest: <140% Baseline

Optimal reference range: <0.55 IU/L or <80%

CALCITONIN

Calcitonin is usually measured if someone is suspected to have medullary thyroid cancer, which is a rare form of thyroid cancer that usually causes an increase in calcitonin.  As a result, it’s not something I commonly test for in my practice.

Labcorp: Male: 0.0−8.4 pg/mL; female: 0.0−5.0 pg/mL

Quest: unable to find reference range

Two Other Thyroid-Specific Diagnostic Tests Worth Mentioning:

THYROID ULTRASOUND

An ultrasound uses sound waves to develop images, and many endocrinologists will recommend a thyroid ultrasound to their patients with Graves’ disease and Hashimoto’s.  There are a few benefits of thyroid ultrasounds, as they are non-invasive, they don’t use ionizing radiation, and they’re not as costly as other imaging techniques (i.e. CT scan, MRI).  But does this mean that everyone with a thyroid or autoimmune thyroid condition should receive a thyroid ultrasound?

I discussed this in detail in a past blog post I wrote entitled “Should You Get a Thyroid Ultrasound?”  In the post I discussed the indications of a thyroid ultrasound according to the American Association of Clinical Endocrinologists.  If you haven’t had a thyroid ultrasound done and are wondering if you need one I would recommend to check out this blog post.

RADIOACTIVE IODINE UPTAKE TEST

This test involves either swallowing or injecting a small amount of radioactive iodine, which allows practitioners to see how active the thyroid tissue is.  The way this test works is that the thyroid gland absorbs the small dosage of radioactive iodine, and is evaluated after six hours and 24 hours.  Graves’ disease is typically characterized by a high uptake of radioactive iodine.

While many endocrinologists will recommend the radioactive iodine uptake test to confirm or rule out Graves’ disease, most of the time this test is unnecessary.  In fact, if someone has hyperthyroidism in the presence of elevated TSH receptor antibodies then this confirms Graves’ disease.  While some doctors will recommend the radioactive iodine uptake test to see if someone has “hot” or “cold” nodules, you can’t confirm or rule out a malignant thyroid nodule with the radioactive iodine uptake test alone.

Which Of These Markers Have You Tested For?

I’d love to hear which of these markers you have tested for. I assume most reading this have had some of the basic thyroid markers (TSH, free T3, free T4), and many have also had the thyroid antibodies tested. If there are any other blood test markers and/or other thyroid-specific tests you think I should have included in this blog post please let me know!

When I was dealing with Graves’ disease, one of the most prominent symptoms I experienced was heart palpitations.  The same is true with many of my patients with hyperthyroidism and Graves’ disease, although occasionally I’ll also have people with hypothyroidism and Hashimoto’s tell me that they’re experiencing palpitations.  While thyroid hormone imbalances can cause heart palpitations, there can be numerous other causes.  In this blog post I’ll discuss many of these causes, when you should be concerned about heart palpitations, and towards the end I’ll discuss some natural treatment solutions.

It makes sense to begin by discussing what palpitations are.  Here are some common descriptions of heart palpitations (1):

• An abnormally rapid or irregular beating of the heart
• A skipped beat and/or rapid fluttering in the chest
• A pounding sensation in the chest or neck
• A flip-flopping sensation in the chest

The good news is that the cause of palpitations is usually benign, although sometimes they can be a sign of a life-threatening condition.  Many people get diagnosed with hyperthyroidism because of the heart palpitations they’re experiencing.  In other words, prior to getting diagnosed with hyperthyroidism, many people will decide to get checked by a medical doctor mainly because they’re experiencing heart palpitations, and will then find out that they have hyperthyroidism.

My situation was different, as prior to being diagnosed with hyperthyroidism I was losing a lot of weight and had an increased appetite, but it was an elevated resting heart rate that led me to schedule an appointment with a medical doctor who ended up diagnosing me with hyperthyroidism (and referred me to the endocrinologist who diagnosed me with Graves’ disease).  In the opening paragraph I mentioned how my heart palpitations were prominent, but I really didn’t start noticing them until after I was diagnosed.

What Can Cause Heart Palpitations?

Let’s take a look at some of the different factors that can cause heart palpitations.  You’ll notice that some of these are actual conditions (i.e. hyperthyroidism), but I’ve listed other factors as well, such as consuming too much caffeine.  It’s worth mentioning that these aren’t listed based on the frequency of occurrence.  For example, hyperthyroidism is listed first not because it’s the most common cause of heart palpitations, but because I work with a lot of people with hyperthyroidism.

• Hyperthyroidism.  This is what caused my heart palpitations in the past, and it is the most common cause of palpitations in my practice.
• Hypothyroidism. When someone with hypothyroidism experiences heart palpitations it usually isn’t due to the low thyroid hormone levels, but other factors, such as sex hormone imbalances and/or high cortisol levels.
• Taking too much thyroid hormone replacement.  I could have discussed this under “hyperthyroidism”, but I figured that some people with hypothyroidism and Hashimoto’s who are overdosing would miss it if I didn’t list it separately.  Although overdosing with thyroid hormone replacement isn’t something I commonly see in my practice, it does happen from time to time.  Some practitioners prefer to see the TSH of their hypothyroid patients who are taking thyroid hormone replacement on the low side, but if the person’s thyroid hormone levels are on the high side and/or the person is experiencing heart palpitations and other hyperthyroid symptoms, then the dosage should be reduced.
• Weaning off of beta blockers.  Sometimes weaning off of beta blockers such as Propanolol and Atenolol can cause heart palpitations.  This is especially true when they are abruptly stopped.
• Stress and anxiety.  We all know that stress can cause a lot of symptoms, and heart palpitations are one of these symptoms.  Anxiety can also cause palpitations, and it’s quite common for my patients to experience anxiety, especially those with hyperthyroidism and Graves’ disease.
• Excess caffeine.  Coffee of course is the most common culprit, although other sources of caffeine can also cause heart palpitations, including black tea, green tea, and chocolate.
• Anemia.  This can be confirmed through a complete blood count (CBC) with differential.  Many people associate anemia with an iron deficiency, although it’s important to remember that there can be other causes.
• Hypoglycemia.  This is yet another potential cause of heart palpitations, and sometimes it can be difficult to diagnose.  Having low fasting blood glucose and insulin levels is a sign of hypoglycemia, along with symptoms such as shakiness and/or irritability when skipping meals, dizziness, and fatigue that is relieved by eating.
• Electrolyte imbalances.  Low calcium, high or low potassium, and/or low magnesium levels can cause palpitations.  A comprehensive metabolic panel (CMP) measures the electrolytes, and is something I recommend for everyone to get.
• Certain medications.  I mentioned that too much thyroid hormone replacement can cause heart palpitations, but other medications that can cause them include amphetamines, anticholinergic drugs, and vasodilators.
• Sex hormone fluctuations.  Due to fluctuations in estrogen and progesterone, heart palpitations can occur in women of all ages, including cycling women (i.e.  the luteal phase of the menstrual cycle), during pregnancy, and the perimenopausal period.
• Structural abnormalities.  Examples include cardiomegaly associated with congenital heart disease, aortic aneurysm, and acute left ventricular failure.

When Are Palpitations a Concern?

I mentioned earlier how most heart palpitations are benign.  Many of my patients with hyperthyroidism and Graves’ disease experience heart palpitations, and while I can’t say that there isn’t a concern in these situations, correcting the hyperthyroidism will almost always resolve the heart palpitations.  It’s also worth mentioning that anxiety is very common in people with hyperthyroidism, and so this can also be a factor.  There are times when heart palpitations are related to an underlying cardiac condition, including an arrhythmia.  One should especially be concerned when someone has symptoms such as perspiration, fainting, alternating headaches, and vertigo or chest pain, as these can be indications of weak or irregular heart function which must be seriously examined (2).

Regarding my patients with hyperthyroidism and Graves’ disease, I’m more concerned with the elevated resting heart rate.  After all, it’s the elevated heart rate that is a risk factor for the development of an arrhythmia/atrial fibrillation.  Fortunately, upon decreasing the thyroid hormone levels there usually is a reduction of both the resting heart rate and palpitations.

Evaluation of Heart Palpitations

As I mentioned earlier, I commonly encounter patients with heart palpitations, which isn’t surprising since many of my patients have hyperthyroidism and Graves’ disease.  If someone didn’t experience heart palpitations until they developed hyperthyroidism, then one can usually assume that the heart palpitations were related to the elevated thyroid hormone levels.  However, it still is important to conduct a comprehensive health history and physical examination to rule out other causes or contributing factors.

For example, I mentioned how anemia and electrolyte imbalances can cause heart palpitations.  As a result, in addition to getting a thyroid panel, it is wise for everyone with any health condition to get a complete blood count (with differential) and comprehensive metabolic panel.  It’s also important to find out what medications the person is taking, if they consume caffeine on a regular basis, find out if they’re consuming alcohol, etc.  Adrenal testing can determine if they have elevated cortisol levels that are causing or contributing to the heart palpitations.

There of course are times when further evaluation of the heart is required.  For example, if someone is considered to be a high risk for an arrhythmia then an ambulatory EKG monitoring device might be indicated, such as a Holter monitor.  This is a 24-hour monitoring device worn by the patient.  Echocardiograms are commonly recommended for patients in whom structural heart disease is a concern.

Conventional Treatments for Heart Palpitations

Conventional treatments for heart palpitations depend on the cause.  For example, if someone has hyperthyroidism then the person will usually be told to take antithyroid medication and/or beta blockers, although many endocrinologists will recommend for their hyperthyroid patients to permanently ablate the thyroid gland through radioactive iodine.  If the heart palpitations are caused by something other than hyperthyroidism then this may be addressed by the medical doctor.

Natural Treatment Solutions for Heart Palpitations

While conventional treatment methods are sometimes necessary, of course the goal of a natural treatment approach is to address the underlying cause of the problem.  However, while doing this the person might need to take medication and/or herbs to help manage the symptoms.  For example, when I was dealing with Graves’ disease I took the herb bugleweed to help lower the thyroid hormone levels, and because I still experienced heart palpitations I ended up adding motherwort.  Both of these herbs don’t do anything to address the underlying cause of the condition, but instead manage the symptoms.

What I’d like to do is first list some things you can do to address the cause of heart palpitations, and then I’ll discuss some specific herbs which can help with the symptoms while one is addressing the cause.

• Lower the thyroid hormone levels.  If someone has heart palpitations due to hyperthyroidism, then it makes sense that lowering the thyroid hormone levels will usually help to resolve the heart palpitations.
• Be aware of medications that cause heart palpitations.  I already mentioned some of the medications that can cause heart palpitations, including amphetamines, anticholinergic drugs, and vasodilators.
• Decrease stress and anxiety.  Although I group these two together because there is some overlap, sometimes stress and anxiety need to be dealt with separately.  For example, someone might have a lot of chronic stress in their life which leads to anxiety, and in this situation addressing the stress should help with the anxiety.  Hyperthyroidism itself can cause anxiety, and in this situation, normalizing the thyroid hormone levels should resolve the anxiety.
• Reduce consumption of stimulants.  If you’re consuming caffeine on a regular basis then it makes sense to reduce your consumption, or better yet, take a break from the coffee, chocolate, etc.
• Address anemia.  Many people with anemia don’t take it seriously, but being anemic can lead to numerous health consequences.  In fact, when I see someone with anemia who has heart palpitations, the palpitations are frequently the least of my concerns.
• Balance blood sugar levels.  If someone has hypoglycemia this needs to be addressed.  Sometimes changing one’s diet and eating regularly can make a big difference, although some cases of hypoglycemia can be complex.
• Correct electrolyte imbalances.  If someone has low levels of calcium, potassium, and/or magnesium, then it makes sense to correct these imbalances.

Herbs That Can Help With Heart Palpitations

I just want to let you know that the list of herbs below isn’t all inclusive, as there can be other herbs, as well as nutrients that can potentially help to reduce heart palpitations.

• Hawthorn (Crataegus oxyacantha).  Many healthcare practitioners recommend hawthorn for overall cardiovascular support.  Not only can hawthorn help with heart palpitations, but it exerts a wide range of cardiovascular pharmacological properties, including antioxidant activity, anti-inflammatory effect, anticardiac remodeling effect, antiplatelet aggregation effect, vasodilating effect, endothelial protective effect, reduction of smooth muscle cell migration and proliferation, protective effect against ischemia/reperfusion injury, antiarrhythmic effect, lipid-lowering effect and decrease of arterial blood pressure effect (3).
• Motherwort (Leonurus cardiaca).  As I mentioned earlier, I took motherwort to help with my heart palpitations when I was dealing with Graves’ disease, and I’ve had many others with hyperthyroidism take this herb over the years.  Pharmacological studies have confirmed its effects on the heart and circulatory system, but motherwort also has antibacterial, antioxidant, anti-inflammatory and analgesic activity (4).
• Bugleweed.  This herb doesn’t specifically support the cardiovascular system, but by lowering thyroid hormone levels in those with hyperthyroidism it can help with heart palpitations.  In my situation taking bugleweed alone didn’t completely eliminate my palpitations, as I mentioned a few times in this post that I ended up adding motherwort.  However, some people do fine with bugleweed alone and don’t need to add motherwort.
• Lemon Balm (Melissa officinalis).  This herb has a calming effect and can help with heart palpitations, but also can benefit people with menstrual problems, hypertension, migraines, vertigo, depression, asthma, eczema, and advanced studies have demonstrated neuroprotective, anxiolytic, antispasmodic, antihyperlipidemic, and hepatoprotective effects (5).
• Valerian (Valeriana officinalis).  Since anxiety is a potential cause of heart palpitations, it makes sense that certain herbs that can help to reduce anxiety can also reduce heart palpitation.  These include valerian root (6), St. John’s Wort (7), and passionflower (8).  Just keep in mind that if hyperthyroidism is the cause of the person’s anxiety then the primary goal should be to reduce the thyroid hormone levels.
• Cortisol-lowering herbs.  High cortisol can also cause heart palpitations.  While taking herbs isn’t a substitute for lowering stress levels and improving stress management skills, certain herbs can aid in lowering cortisol levels by helping us to better adapt to the stress.  This includes herbs such as ashwagandha (which is a member of the nightshade family), rhodiola, and relora.

What’s Your Experience With Heart Palpitations?

If you have dealt with heart palpitations (or currently deal with them) please share your experience in the comments section below.  Were your palpitations caused by hyperthyroidism, hypothyroidism, or something else?  What helped to reduce your heart palpitations?  Thank you for sharing your experience!