I’ve written about thyroid nodules in the past, as many people with thyroid and autoimmune thyroid conditions have nodules.  I’ve also written about insulin resistance, as this is also commonly seen in people with thyroid imbalances.  This is especially true for those people with hypothyroidism and Hashimoto’s thyroiditis, although it can also affect those with hyperthyroidism and Graves’ disease.  But there is also evidence that insulin resistance can be a factor in the development of thyroid nodules, which of course will be the focus of this blog post.

I’m frequently asked how to shrink thyroid nodules by patients and non patients.  The truth is that there is no specific natural treatment approach for all thyroid nodules.  The obvious goal should be to find and address the cause of the thyroid nodules, which isn’t always easy to do.

Other Causes of Thyroid Nodule Formation                                                  

Although the focus of this blog post will be to discuss the relationship between insulin resistance and thyroid nodules, there can be other causes.  Two of the more common ones are an iodine deficiency and problems with estrogen metabolism.  As a result, it makes sense to determine if someone has these imbalances.

There is no perfect method of determining whether someone has an iodine deficiency, although urinary testing is preferred by many healthcare practitioners, including myself.  For example, when I was diagnosed with Graves’ disease I ordered an iodine loading test.  The downside of this test is that it requires ingesting a 50mg tablet of potassium iodide, and not everyone does well when taking this.  Another option that doesn’t involve consuming iodine is an iodine spot test, which is a one-sample urinary iodine test.  Although some people test for iodine in the blood, normal serum iodine levels doesn’t rule out an iodine deficiency.

As for determining whether or not you have problems with estrogen metabolism, blood testing of course is one method that can be used to measure the estradiol levels.  Saliva and urine testing is also an option, and without question are superior options for cycling women.  The reason for this is because a cycling hormone panel allows cycling women to collect multiple saliva or urine samples throughout their cycle.  This is more accurate than collecting a single sample in the second half of the cycle, although it also is more expensive.

However, measuring the estradiol levels won’t always indicate whether someone has estrogen metabolism issues.  For example, the enzyme catechol-o-methyltransferase (COMT) is involved in estrogen metabolism.  As a result, if someone has a genetic polymorphism of the COMT gene then this can affect estrogen metabolism.  Having elevated levels of an enzyme called beta-glucuronidase can also prevent the excretion of estrogen.

What Is Insulin Resistance?

Although I would recommend to read other articles I’ve written on insulin resistance for more detailed information, I’ll briefly explain what this is here.  Insulin is a hormone that is produced by the beta cells of the pancreas.  As the name implies, insulin resistance is when the cells are no longer sensitive to insulin.  So this is actually a high insulin state, which is why this is associated with pre-diabetes and type 2 diabetes.  Although some doctors rely on a fasting glucose test to determine if someone has insulin resistance, other testing is recommended to make a diagnosis, including a fasting insulin and a hemoglobin A1C.  Sometimes a glucose tolerance test will also be used.  Elevated triglycerides on a lipid panel are frequently a sign of insulin resistance.

As for how insulin resistance develops, there is no question that eating a diet consisting of high amounts of refined carbohydrates and sugars is a factor.  A high intake of fructose can especially be problematic, as this can lead to an increase in fat deposition in the liver and skeletal muscle, thus increasing the risk of insulin resistance and type 2 diabetes (1).  And when I say that high amounts of fructose can be a factor in the development of insulin resistance, this is especially true when fructose is used as a sweetener in processed foods and beverages.  This doesn’t mean that you can’t overdo it with fruit, but eating a few servings of fruit per day isn’t going to cause insulin resistance in most people.

While one’s diet can play a big role in the development of insulin resistance, there can be other factors.  Inflammation is a big factor, and there are many different causes of inflammation.  Since the mitochondria play a role in glucose homeostasis, mitochondrial dysfunction can also be a factor.  There is even evidence that intestinal dysbiosis can cause insulin resistance (2), which is yet another reason to do everything you can to improve the health of your gut.

What Does The Research Show?                          

One study examined the prevalence of insulin resistance in a case-control study of patients with benign thyroid nodules (3).  These patients lived in an iodine-sufficient area, and as a result, an iodine deficiency was unlikely to be the culprit, although in my opinion it still would have been worth testing to determine if they had an iodine deficiency.  In any case, the study showed that there is an association between insulin resistance and benign thyroid nodules.  Another study looked at the association between insulin resistance and the vascularization of thyroid nodules (4).  The authors of the study concluded that there is a vital role of insulin resistance in the distribution, construction, and density of thyroid nodular vascularization, and that this in turn might contribute to the growth and the progression of thyroid nodules.

Yet another study looked at the relationship between insulin resistance in those with euthyroid nodular goiter (5).  For those who are unfamiliar with the term “euthyroid”, this refers to someone who has normal thyroid hormone levels.  In any case, the results showed that insulin resistance may cause an increase in thyroid cell proliferation and nodule volume, as well as nodule formation.  I’ll mention one more study that looked to see if there was a correlation between insulin resistance and thyroid nodules in those with type 2 diabetes (6).  The results of the study demonstrated that insulin resistance was a risk factor for thyroid nodule formation in patients with type 2 diabetes.

3 Steps You Should Take If You Have Thyroid Nodules

Based on the information presented in this article, if a thyroid ultrasound reveals that you have one or more thyroid nodules then you should take the following steps:

Step #1: Modify diet and lifestyle factors.  Regardless of what imbalances you have, it will benefit your overall health if you eat a healthy diet.  This is especially true if you have insulin resistance, although it can help with other health issues as well.  And of course it won’t hurt to address other lifestyle factors, which includes improving your stress handling skills and getting sufficient sleep.

Step #2: Do the appropriate testing.  In this blog post I discussed three factors that can lead to the formation of thyroid nodules, including an iodine deficiency, problems with estrogen metabolism, and insulin resistance.  I also discussed how to test for these imbalances.

Step #3: Correct any imbalances found through the testing.  You of course would want to correct any imbalances that show up on the testing.  Sometimes this is easier said than done.  For example, if you have an iodine deficiency, then you might need to improve other aspects of your heath before correcting this deficiency.  I’ve spoken about this in an article I wrote entitled “An Update on Iodine and Thyroid Health”.  As for how to correct a problem with estrogen metabolism, I would recommend reading an article I wrote entitled “7 Ways To Positively Influence Estrogen Metabolism”.

But of course the focus of this blog post is on insulin resistance as being a factor in the development of thyroid nodules.  And while many times following the first step will help with this, other times this won’t be sufficient.  Earlier I mentioned some of the other factors that can play a role in the development and perpetuation of insulin resistance, including inflammation, mitochondrial dysfunction, and intestinal dysbiosis.  I’ve discussed all of these factors in different articles and blog posts.

Will following these three steps result in the shrinking of your thyroid nodules?  Perhaps, although you need to keep a few things in mind.  First of all, it’s not always easy to find and correct these imbalances.  You need to find the imbalances that are responsible for the formation of thyroid nodules, which can be challenging at times.  And then even if you find the imbalances, correcting them can also be a challenge.  For example, I briefly mentioned the challenges of correcting an iodine deficiency earlier.

I also mentioned that there can be numerous causes of insulin resistance.  So even if you have confirmed that you have insulin resistance through testing, it isn’t always easy to find what specifically is causing the insulin resistance.  This doesn’t mean that you shouldn’t attempt to find out the cause, but just remember that doing so can be challenging at times.

So hopefully you have a better understanding of the relationship between insulin resistance and thyroid nodules.  Some of the common causes and contributing factors of insulin resistance include poor diet, inflammation, mitochondrial dysfunction, and intestinal dysbiosis.  Two other common causes of thyroid nodules include an iodine deficiency and problems with estrogen metabolism.  As a result, it makes sense to do the appropriate testing to find out what imbalances might be causing or contributing to your thyroid nodules, and then correct any imbalances that are found.

The oral cavity is home to billions of microorganisms (that’s right…billions!), including an estimated 750 different species of bacteria (1).  Problems with oral health can lead to numerous health issues, including cardiovascular disease, and even diabetes mellitus (2).  But while there is no question as to whether oral health is important to one’s overall state of health, some still question the claims that oil pulling can improve oral health.  I’m a big proponent of oil pulling, which is why I decided to put together this blog post.

I’d like to start out by discussing what oil pulling involves.  Essentially oil pulling involves taking a small amount of oil (i.e. coconut oil, sesame oil) and swishing it around your mouth for 10 to 20 minutes.  By swishing the oil in your mouth it is “pulled” between your teeth.  After you’re done you want to spit it out in a trash can or paper towel.  Don’t spit the oil in your sink…unless if you want to clog it!  Some sources also suggest to swish some warm water in your mouth a few times after oil pulling, and you can then brush your teeth afterwards.

When Should Oil Pulling Be Done?                                                

Some suggest that oil pulling should be performed in the morning, before your first meal, and prior to brushing your teeth.  This is when I usually will do it, as I will swish 1 tablespoon of coconut oil in my oil in my mouth while preparing green tea and making my smoothie.  I’ve had some patients tell me that they do oil pulling in the shower while getting ready for work.  I suppose you can even do oil pulling while you drive to work, and bring along some type of container to spit the oil in after you’re done.

Although some suggest that oil pulling should be performed before meals, I wonder if doing it after certain meals would be more beneficial.  For example, it might be beneficial to do oil pulling after eating fermented foods.  The reason for this is because fermented foods such as sauerkraut have Lactobacilli.  Lactobacilli are gram-positive, lactic acid bacteria, and they are very important for the health of the gut, along with the urinary system and vaginal tract.  However, some Lactobacillus species can cause dental cavities (3), as the lactic acid they produce can corrode the teeth.  Because of this, an argument can be made to incorporate oil pulling after eating fermented foods.

How Frequently Should You Do Oil Pulling?

Some sources suggest to do oil pulling daily, and perhaps even multiple times per day.  I can’t say that I do oil pulling on a daily basis, as I do it 3 or 4 times per week.

Which Oils Should You Use?

The truth is that you can use any type of oil for oil pulling, but of course it makes sense to use healthier types of oils, along with oils that have been shown in the research to have antimicrobial properties.  I’m going to discuss three specific oils:

Coconut oil.  Coconut oil contains lauric acid, which has antimicrobial and anti-inflammatory properties.  In vitro studies have shown coconut oil to be effective against Streptococcus mutans and Candida albicans (4).  The monolaurin in coconut oil has been shown to be effective against microorganisms such as Staphlococcus aureus, Candida, Helicobacter pylori, and Enterobacter spp (5).

Olive oil. The constituents of olive oil have antimicrobial, immunomodulatory, and antioxidative effects (5).

Sesame oil.  Sesame oil contains sesamin, sesamolin and sesaminol and has detoxification, antioxidant, and antibiotic actions (5).

Health Conditions That Can Benefit From Oil Pulling

While I’m sure you can understand how oil pulling can improve conditions directly related to oral health, it might also benefit other health conditions.  Here are some of the different health conditions that can benefit from oil pulling (6):

• Dental caries
• Plaque-induced gingivitis
• Halitosis (bad breath)
• Oral thrush
• Headaches and migraines
• Asthma
• Diabetes mellitus
• Eczema
• Thrombosis

What The Research Shows         

Let’s take a look at a few research studies which show the benefits of oil pulling.  You’ll notice that most of these studies focus on oral health benefits.

General antimicrobial effects.  One small study compared oil pulling using sesame oil with chlorhexidine mouthwash, and the results showed a statistically significant reduction in the Streptococcus mutans (S. mutans) count in the oil pulling group (7).  It’s important to mention that the chlorhexidine mouthwash group had a greater reduction in S. mutans, but of course we also need to consider the chemicals in the mouthwash.

Another study looked to assess the reduction in S. mutans and Lactobacillus species count in the saliva after ten minutes of oil gum massage therapy for three weeks with sesame oil, olive oil, and coconut oil (8).  The results of the study showed a significant reduction in mean S. mutans count, Lactobacillus count, plaque scores, and gingival scores.

Halitosis (bad breath).  One study evaluated the effect of oil pulling on halitosis and the microorganisms that could be responsible for it (9).  Sesame oil was used, and it was compared to chlorhexidine mouthwash.  The study showed that oil therapy is equally effective as chlorhexidine on halitosis and reducing the microorganisms associated with halitosis.

Another study compared the efficacy of oil pulling and chlorhexidine in reducing oral malodor and microbes (10).  The results showed that oil pulling with sesame oil is as effective as chlorhexidine in reducing oral malodor and microbes causing it.

Plaque-induced gingivitis.  One study evaluated the effect of oil pulling with sesame oil on plaque-induced gingivitis (11).  The study showed that oil pulling resulted in a reduction in the plaque index, modified gingival scores, and the total colony count of aerobic microorganisms.

Another study evaluated the effect of coconut oil pulling on plaque formation and plaque induced gingivitis (12).  There was a statistically significant decrease in the plaque and gingival indices, and thus the authors concluded that oil pulling using coconut oil could be an effective adjuvant procedure in decreasing plaque formation and plaque induced gingivitis.

Can Oil Pulling Benefit Those With Graves’ Disease and Hashimoto’s?

Not surprisingly, there are no studies demonstrating that oil pulling can directly benefit thyroid health, as well as autoimmune thyroid conditions such as Graves’ disease and Hashimoto’s thyroiditis.  So I can’t say that oil pulling is an essential component of restoring your health back to normal.  On the other hand, having good oral health is important for overall optimal health.

In addition, the research shows that proinflammatory cytokines are found in diseased periodontal tissues (13), and some of these same proinflammatory cytokines are a factor in autoimmunity.  There is also an increase in Th17 cells in periodontitis (14), and these are also present in autoimmune conditions.  And as I mentioned earlier, problems with oral health can have systemic effects.  So for example, if someone has an elevated C-reactive protein (CRP) marker, there is always the possibility that their oral health is responsible for this elevation, and if this is the case, then oil pulling may help, depending on the cause.  Keep in mind that there are many other factors that can cause an elevated CRP as well.

Doing Oil Pulling With Essential Oils

Although using the oils I mentioned earlier can benefit your oral health, some healthcare practitioners suggest that mixing in essential oils can be of further benefit.  Although I couldn’t find any studies showing this, it makes sense when you think about it, as certain essential oils also have antimicrobial properties.  So for example, you can mix one drop of tea tree oil with coconut oil.  Dr. Eric Zielinski is an expert when it comes to essential oils, and in an article he wrote he suggested adding one drop each of clove, orange, lemon, and peppermint with 1 to 2 tablespoons of coconut oil.  In the past I wrote an article on the benefits of Frankincense and myrrh oil, and Dr. Zielinski also mentioned how these can be mixed with essential oils.

Are There Any Risks of Doing Oil Pulling?

If you read the research it seems that oil pulling is very safe, and that there are no risks involved.  The only concern I have is whether it possibly can also affect some of the good bacteria in the mouth.  In other words, is it possible to overdo it with oil pulling?  I’m not sure what the answer is, as it might be fine to do oil pulling once or twice per day, but as I mentioned earlier, I do it 3 or 4 times per week.  And perhaps this also is overdoing it, but I’ll add that there is no evidence I’m aware of demonstrating that doing oil pulling on a daily basis can cause any type of oral dysbiosis.  I’m sure there is a greater risk of this happening with chemical mouthwashes.

It’s also important to mention that after you oil pull, you don’t want to swallow the oil.  The reason for this is because you want to spit out any bacteria or toxins that are in the oil.  Of course swallowing the oil isn’t going to kill you, but it’s best to spit it out.

Final Thoughts:

I started doing oil pulling a few years ago, and while I haven’t had any cavities since, because I brush and floss regularly it’s hard to say if the oil pulling has been the primary factor.  But based on some of the research I presented it does seem to help reduce some of the harmful microorganisms in the mouth.  In addition, oil pulling is easy to do and is inexpensive, and so I do recommend trying to get into the routine of doing this.  And of course if anyone has a positive (or negative) experience to share regarding oil pulling please feel free to post a comment below.

Most people reading this probably have heard of a leaky gut.  But many people don’t truly understand what causes a leaky gut, how to determine if they have it, and how to heal their gut.  Many people just assume they have a leaky gut, and then will attempt to repair their gut by drinking bone broth and/or taking gut repair supplements.  In the past I have written numerous articles and blog posts on leaky gut syndrome, but since a leaky gut is something that impacts those with Graves’ disease and Hashimoto’s I’ve decided to put together an updated blog post that focuses on five things you should know about a leaky gut.

1. According to the triad of autoimmunity, everyone with Graves’ disease and Hashimoto’s has a leaky gut.  The triad of autoimmunity involves a genetic predisposition, an environmental trigger, and an increase in intestinal permeability, which is also known as a leaky gut.  It’s common to work with an autoimmune thyroid patient who wonders if they have a leaky gut, although according to this theory, EVERYONE with any type of autoimmune condition has a leaky gut, at least initially.  In other words, according to this theory a leaky gut is one of the three factors necessary for autoimmunity to develop, but this doesn’t mean that a leaky gut can’t be healed.  In fact, in order to reverse the autoimmune component it is necessary to find and remove the environmental trigger and heal the gut.

2. Gluten causes a leaky gut in everyone.  Speaking of environmental triggers, recent evidence shows that gluten causes a leaky gut in everyone.  This is a very good argument for everyone with Graves’ disease and Hashimoto’s to avoid gluten while restoring their health, and to also try to your best to avoid it after you have achieved a state of remission.  I was diagnosed with Graves’ disease in the fall of 2008, and I achieved a state of remission in 2009.  And while I avoid gluten most of the time, I can’t say that I’ve been 100% gluten free since restoring my health.  So if gluten causes a leaky gut in everyone, why haven’t I relapsed?

There are a few potential reasons for this.  First of all, I do minimize my exposure to gluten.  Second, I’m pretty sure that I don’t have Celiac disease or a non-gluten sensitivity.  So while gluten causes a leaky gut in everyone, in my case it wasn’t the direct trigger of my Graves’ disease condition.  A third reason is luck, as if I were to overindulge in foods with gluten for a prolonged period of time, and at  the same time I was exposed to a certain environmental trigger, then there is a very good chance I would relapse.  So every time I’m exposed to gluten I’m playing with fire.  And to be honest, there is a risk even with a single exposure to gluten.  So in no way am I encouraging anyone to consume gluten after getting into remission.

By the way, I think another reason why I haven’t relapsed is because I do a lot of other things to maintain a healthy state.  Even though I’m not perfect with the diet, I eat well most of the time.  And just like most people, I deal with a lot of stressors, but I’m confident that I do a good job of dealing with them, as I block out time for stress management each day, and I also make sure to get sufficient sleep each night.  In addition, I’m always doing things to reduce my toxic load, including doing a 21-day liver detox a few times per year, as well as infrared sauna therapy a few days per week.  Don’t get me wrong, as there is always room for improvement, but it’s also important to understand that perfection isn’t necessary to maintain a state of wellness after achieving a state of remission.  If this were the case then everyone would eventually relapse.

3. Leaky gut testing is available.  Some people aren’t aware that there is testing available to find out if you have a leaky gut.  One option is the lactulose-mannitol test, which is a urine test that requires someone to swallow a sugary solution of lactulose-mannitol.  Lactulose is a larger molecule, and therefore it’s poorly absorbed in someone who has a healthy gut.  As a result, if someone who does this test has high levels of lactulose in the urine then this usually indicates that they have an increase in intestinal permeability.

Cyrex Labs also has a leaky gut test.  The name of the test is the Intestinal Antigenic Permeability Screen, also known as their Array #2.  This tests for a few different antigens associated with a leaky gut, including actomyosin, occludin/zonulin, and lipopolysaccharides.

I used to recommend leaky gut testing frequently, most commonly the Array #2 from Cyrex Labs.  And there are times when I still recommend this test to my patients, but in most cases I assume that the person has a leaky gut.  And there are a few reasons why I take this approach.  First of all, according to the triad of autoimmunity, everyone with Graves’ disease and Hashimoto’s has a leaky gut.  Second, when I used to recommend the Array #2 more frequently I found that most people did test positive.  And when someone tested negative I would wonder if the results were accurate since everyone with an autoimmune condition has a leaky gut, at least according to the triad of autoimmunity I mentioned earlier.

Of course there is always the possibility that someone initially had a leaky gut but then took the necessary steps to heal it.  So for example, in some people gluten is the sole leaky gut trigger, and if someone has eliminated gluten from their diet, yet hasn’t found and removed the “direct” autoimmune trigger, then conceivably this can cause someone to have a normal leaky gut test, even in the presence of positive autoantibodies.  Stated differently, it’s possible to remove the “leaky gut” trigger and heal the gut, yet still have elevated thyroid antibodies if the “direct” environmental trigger hasn’t been removed.

4. A leaky gut can lead to multiple food sensitivities.  I’m not a big fan of food sensitivity testing, but there are times when I have had patients order a food sensitivity panel.  And it’s common for those who have a leaky gut to have many different food sensitivities.  The good news is that healing the gut usually will help to resolve most, if not all of the food sensitivities.

5. In order to heal your gut you need to follow the 5-R protocol.  The five components of the 5-R protocol include 1) remove, 2) replace, 3) reinoculate, 4) repair, and 5) rebalance.  It is imperative to remove the leaky gut trigger, and while this may sound like common sense, I commonly see people focusing on replacing, reinoculating, and repairing before they find and remove the factor that caused the leaky gut.  Admittedly it can be challenging at times to find the leaky gut trigger, and while you can incorporate the different “Rs” of the protocol simultaneously, you won’t heal a leaky gut if you don’t remove the factor that is causing it.

So how can you find the leaky gut trigger?  I talk about this in great detail in my book Hashimoto’s Triggers, and the same process of finding and removing triggers also applies to those with Graves’ disease.  While many times testing is necessary to find your leaky gut trigger, this isn’t always the case.  For example, if gluten is someone’s sole leaky gut trigger, then simply eliminating gluten can allow someone’s gut to heal.  If taking a course of antibiotics were the leaky gut trigger, then of course you removed the trigger as soon as you stopped taking the antibiotics.

Sometimes it’s not so simple, and testing may be necessary to find your leaky gut trigger.  And even if testing isn’t necessary to detect your “leaky gut trigger”, it very well might be necessary to find your “direct trigger”.  If this is confusing to you then I’d recommend reading my blog post on the triad of autoimmunity.  It’s also important to keep in mind that someone can have multiple leaky gut triggers.  So for example, if someone is eating gluten and has a gut infection, both of these can cause a leaky gut, and thus both of these “leaky gut triggers” would need to be removed in order for the gut to heal.

So let’s summarize this blog post.  According to the triad of autoimmunity, everyone with an autoimmune condition has a leaky gut, which of course would include those with Graves’ disease and Hashimoto’s.  Although gluten isn’t a “direct” environmental trigger in everyone, it does cause a leaky gut in everyone.  A leaky gut can also cause multiple food sensitivities, and while leaky gut testing is available, it’s not something that I commonly recommend to my patients.  Finally, in order to heal your gut you need to remove the leaky gut trigger, which is the first “R” of the 5-R protocol.

Methimazole (brand name Tapazole), is commonly prescribed to those who have hyperthyroidism and Graves’ disease.  In most cases it is effective in reducing thyroid hormone levels, and while it’s not doing anything for the cause of the problem, it can help to prevent someone from receiving radioactive iodine (RAI) or thyroid surgery while the underlying cause of the condition is being addressed.  However, not everyone is able to tolerate Methimazole, and if someone has a negative reaction to Methimazole, there is a good chance the endocrinologist will recommend RAI or thyroid surgery.

Methimazole, along with other thionamide-derived antithyroid drugs, have been used for over half a century.  A common starting dosage is 20 mg per day, although if someone has a more severe case of hyperthyroidism then larger doses might be prescribed (i.e. 40 mg/day).  Most endocrinologists will recommend Methimazole for 12 to 18 months, assuming the person isn’t experiencing any severe side effects, or other problems, including elevation of the liver enzymes.

As for how Methimazole works, it inhibits an enzyme called thyroperoxidase, which is important in the synthesis of thyroid hormone.  It specifically inhibits the metabolism of iodide and the iodination of tyrosine residues, which in turn prevents the synthesis of both T4 and T3 (1).

Potential Side Effects of Methimazole

Here are some of the side effects people can experience when taking Methimazole (2) (3):

• Changes in taste
• Dizziness
• Hair loss
• Headaches
• Hives
• Itching
• Joint pain and swelling
• Nausea
• Rashes
• Vomiting

More serious side effects include the following (3):

• Blood in your urine or stools
• Clay-colored stools
• Dark urine
• Fever
• Jaundice (yellowing of the skin or eyes)
• Loss of appetite
• Severe blistering, peeling, and red skin rash

Two Additional Complications Associated With Methimazole

Agranulocytosis.  This is a term used to describe a severe reduction in the production of white blood cells. This is more likely to affect those who take high doses of Methimazole.  Some patients with agranulocytosis will present with signs and symptoms of an infection, including a high fever and a sore throat (4).

Elevated liver enzymes.  This is more commonly associated with Propylthiouracil (PTU), but over the years I’ve had numerous patients with hyperthyroidism whose liver enzymes were elevated when taking Methimazole or Carbimazole.  You might want to check out an article I wrote entitled “How To Decrease Elevated Liver Enzymes In Hyperthyroidism and Graves’ Disease“.  In the article I discuss when you should be concerned about elevated liver enzymes, and some strategies to decrease them.

What Alternatives Are There To Methimazole?

As I mentioned in the opening paragraph, if someone is unable to take Methimazole, it’s common for their endocrinologist to recommend radioactive iodine or thyroid surgery.  However, there are three treatment options you should consider before getting your thyroid gland ablated or surgically removed:

Option #1: Try to get a prescription for Propylthiouracil (PTU).  The downside of PTU is that it can be harsher on the liver than Methimazole, and approximately 50% of those who are unable to tolerate Methimazole will also be unable to tolerate PTU.  That being said, it still might be worth giving PTU a try, as while it might produce similar side effects as Methimazole, there is also a chance that you might be fine taking it, and at the very least it can buy you some time while you are trying to address the underlying cause of your condition.

Option #2: Consider natural antithyroid agents.  Many reading this know that when I was diagnosed with Graves’ disease I didn’t take antithyroid medication.  Instead, I took an antithyroid herb called bugleweed to manage my hyperthyroid symptoms.  Although bugleweed isn’t always potent enough to lower the thyroid hormone levels, it’s definitely worth a try before resorting to extreme treatment methods such as RAI and thyroid surgery.  It’s also important to mention that the quality of the herb is important, and you should consider taking a stronger extract ratio.  For more information on bugleweed and other herbs that can help manage the hyperthyroid symptoms, I would read a blog post entitled “Which Are The Best Herbs For Managing The Symptoms Of Hyperthyroidism & Graves’ Disease?”.

Option #3: Low dose naltrexone (LDN).  This option should be considered for those people with Graves’ disease, and not other types of hyperthyroid conditions (i.e. toxic multinodular goiter, subacute thyroiditis, etc.).  Naltrexone is an FDA-approved medication, and it was discovered that low dose naltrexone (LDN) has immune-modulating effects that can benefit many people with autoimmune conditions.  While there are no studies I’m aware of that specifically show that LDN can help people with Graves’ Disease, over the years I have had some people with Graves’ disease successfully use LDN to manage their symptoms while addressing the underlying cause of their condition.

If LDN can modulate the immune system and effectively manage the hyperthyroid symptoms, then why don’t I recommend it more frequently to my patients with Graves’ disease?  There are a few reasons for this.  The main reason is because while it’s not harsh on the body like Methimazole, it’s also not as effective in managing the hyperthyroid symptoms.  I also find bugleweed to be more effective than LDN.  And if someone has an elevated resting heart rate due to high thyroid hormone levels, then it’s important to get the thyroid hormone levels down as soon as possible.

Another reason why I don’t commonly recommend LDN to my patients is because it can be challenging to get a prescription.  Unfortunately most endocrinologists aren’t open to prescribing LDN, and many aren’t even aware of the benefits regarding its immune-modulating effects.  However, recently I’ve had a few patients get a prescription remotely by working with a medical doctor online at www.ldndoctor.com.  The way this works is that you schedule a consultation with a medical doctor, and they will write a 6-month prescription for LDN.  I must warn you that I don’t personally know any of the LDN-prescribing doctors, although so far the feedback from my patients have been positive.

Another website to check out is www.ldnscience.org, where you can find a local doctor who prescribes LDN.  The upside is that you not only can search for a doctor who prescribes LDN in the United States, but in other countries too.  The downside is that there are some locations that don’t have an LDN-prescribing doctor.  For example, I live right outside of Charlotte NC, but as of writing this blog post, the closest doctor who prescribes LDN practices approximately 2 hours away.  However, if I was facing either radioactive iodine or thyroid surgery I would gladly drive a few hours to get a prescription for LDN, although I also would consider scheduling a consultation with someone through www.ldndoctor.com.

Which Option Should YOU Choose?

If you had a negative reaction to Methimazole and are currently facing a situation where your endocrinologist is pressuring you to receive radioactive iodine or thyroid surgery, you might be wondering which of these three alternatives to consider.  It’s not an easy decision to make, as while I listed PTU first, this doesn’t mean that you can’t try a natural approach such as bugleweed.  And even though I gave a few reasons why I don’t initially recommend LDN to my patients with Graves’ disease, you might decide to start with this option.

One of the benefits of LDN is that unlike antithyroid medication and herbs, LDN actually modulates the immune system.  However, even if LDN effectively modulates your immune system, keep in mind that it’s not addressing the underlying cause of the problem.  Of course neither is antithyroid medication or bugleweed, and so regardless of which of these three options you choose, you would still want to address the cause of your condition.  If someone has a non-autoimmune hyperthyroid condition, such as toxic multinodular goiter, then they will want to consider the first two options I mentioned.

In summary, many people with hyperthyroid conditions take Methimazole to manage the hyperthyroid symptoms.  However, not everyone with hyperthyroidism can take Methimazole, as some people experience side effects.  When this is the case you might want to look into other options, including PTU, bugleweed, and low dose naltrexone.

The last month or two I have been talking a lot about my new book “Hashimoto’s Triggers”, which was released a few days ago.  During this time I’ve had a few people with Graves’ disease ask about “Graves’ Disease Triggers”.  The truth is that while managing the symptoms of Graves’ disease is dramatically different when compared to Hashimoto’s, the process of finding and detecting the autoimmune triggers is the same with both conditions.  And many of the same triggers that are found in Hashimoto’s are also found in Graves’ disease, although some triggers are more common in Graves’ disease, and vice versa.

For example, although I discuss H. Pylori in my book as a potential trigger of Hashimoto’s, this is a more common trigger in those with Graves’ disease.  Similarly, the research shows a higher correlation between stress and the development of Graves’ disease.  On the other hand, the parasite Blastocystis hominis seems to be a more common trigger in those with Hashimoto’s.

Some people with Graves’ disease have asked if they should read my Hashimoto’s Triggers book, or if it’s best to read the book I wrote on hyperthyroidism and Graves’ disease?  The honest answer is “both”, and here is the reason.  The book on hyperthyroidism and Graves’ disease focuses on hyperthyroid conditions, and so it of course makes sense for anyone with Graves’ disease or a non-autoimmune hyperthyroid condition to read this book.  However, there is a lot of updated information in my Hashimoto’s Triggers book that isn’t in my other book.  And while some of the information is specific to Hashimoto’s thyroiditis, a lot of the information will be useful for those with Graves’ disease, as well as those with other autoimmune conditions.

For those wondering when I plan on releasing a new book on Graves’ disease, all I can say is that this is something that will happen in the near future.  It almost definitely won’t be this year since I haven’t started writing it, but I wouldn’t rule out a new Graves’ disease book in 2019.  Of course originally I was hoping to release my book on Hashimoto’s a few years ago, and so I’m sure you can understand that I can’t put a firm date on the book at this point.  But in the meantime I would not only check out my book on hyperthyroidism and Graves’ disease, but I would also seriously consider reading my new book on Hashimoto’s Triggers…especially since the electronic version is steeply discounted and I’m also offering 3 special bonus gifts.  You can check out this special offer by clicking here.