When I consult with someone who has Graves’ Disease or Hashimoto’s Thyroiditis, it’s common for the person to have a family history of thyroid disease.  However, I also work with a lot of patients with an autoimmune thyroid condition who don’t have a family history of thyroid autoimmunity, or any other autoimmune conditions for that matter.  The National Institutes of Health estimates that up to 23.5 million Americans suffer from autoimmune disease, and that the prevalence is rising, while the American Autoimmune Related Diseases Association (AARDA) claim that the number is closer to 50 million (1).  And of course there are tens of millions of people in other countries who suffer from Graves’ Disease, Hashimoto’s Thyroiditis, and other autoimmune conditions.  But why is there an increased prevalence of autoimmunity?

Before discussing some of the different reasons for the increased prevalence of autoimmune thyroid conditions, as well as other autoimmune conditions, it’s important to point out that there is a genetic component behind most, if not all of these conditions.  And the reason why this is important to mention is because in all likelihood the genetic predisposition hasn’t changed over the last 50+ years, but there is no question that over the last few decades our environment has changed for the worse.  And if we don’t modify these environmental factors, not only will you not improve your health and therefore will remain more susceptible to developing other autoimmune conditions, but if you have children then there is an increased likelihood that they will develop an autoimmune condition.

So let’s go ahead and discuss some of the main reasons why thyroid autoimmunity is on the rise:

1. Increased C-sections and bottle feeding.  Having a Cesarean section changes the gut microbiota, as does bottle feeding.  And so being born via a C-section and/or being bottle-fed can make you more susceptible to developing an autoimmune condition in the future.  Children born via a C-section lack the benefit of protective vaginal bacteria, which may make them more susceptible to viruses, allergies, and asthma later in life, as well as type one diabetes (2) (3).  Another study showed that being born via a C-section increases the risk of developing Celiac disease (4). As for the importance of breast milk, human milk differs from formula not only with regards to nutrients, but it also has growth factors, cytokines, immunoglobulins, and digestive enzymes that are lacking in infant formula (5).  Yet another study showed that formula-feeding is associated with a shift towards Th1 cytokines, which may have an influence on the development of autoimmune disease (6).  It’s worth noting that Hashimoto’s Thyroiditis is usually a Th1-dominant condition.

Of course I realize that sometimes C-sections are necessary, and the same is true with bottle feeding.  But many C-sections are unnecessary, and some mothers don’t breastfeed their babies because they find it more convenient to bottle feed.  Another factor is that many women aren’t aware of the health benefits of breastfeeding, although I realize that most women reading this are probably aware that breastfeeding is a healthier option.  Of course I understand that some women do want to breastfeed their babies but are unable to, but the point I’m trying to make is that thousands of women are able to breastfeed their babies but choose not to do so, and most of these women don’t realize the negative impact this can have on the future health of their baby.

2. Western diet.  A “Western diet” typically includes foods that are high in sugar, unhealthy fats and oils, are frequently processed, etc.  And the reason why eating poorly can increase the risk of developing an autoimmune condition is because such diets promote inflammation.  Obesity is one factor, as this leads to the excessive accumulation of white adipose tissue and systemic inflammation (7).  In addition, processed foods and fast foods usually contain high amounts of salt, which in turn can increase Th17 cells (8) (9), which is a factor in autoimmune conditions.  In addition, Western diets will result in significantly different microbiota compositions, and one reason is because these diets are typically low in the fiber necessary to feed the good bacteria (10).  One study mentioned that a Western diet creates a specific inflammatory environment in the gut (11), and as many people reading this know, in order to have a healthy immune system you need to have a healthy gut.  A Western diet usually involves the excess consumption of omega 6 fatty acids, which also will promote inflammation.  And let’s not forget the negative impact that gluten can have on the gut.

3. Environmental toxins.  Over the past few decades there have been tens of thousands of chemicals manufactured.  One of the most well known ones is bisphenol a (BPA), which not only is an endocrine disruptor, but may play a role in the development of autoimmune conditions (12) (13) (14).  Phthalates are added to plastics to make them more flexible and harder to break, and they are found in adhesives, cosmetics, fragrances, vinyl flooring, polyvinyl chloride pipes, and certain toys and medical supplies (15).  And there is evidence that phthalates can trigger autoimmunity (15) (16).  Vaccines are also a possible factor (17) (18), and while this remains controversial, one thing that’s not debatable is that infants and children today receive many more vaccines than they did a few decades ago.  And of course there are many other environmental toxins we are exposed to, and to be honest, it would be shocking if there wasn’t an increase in autoimmunity with the stress put on our immune system by all of these chemicals.

4. Chronic Stress.  Both physical and psychological stress has been implicated in the development of autoimmune disease (19).  Of course humans have always dealt with stress, but the stressors of today are different than the stressors of the past.  In the past humans dealt more with acute stress situations, but these days we commonly deal with chronic stress.  As for how this can lead to autoimmunity, stress activates the hypothalamic-pituitary-adrenal (HPA) axis, which in turn releases cortisol, and this in turn suppresses the immune system (20) (21).  However, it is thought that the stress-triggered neuroendocrine hormones cause dysregulation of the immune system, which alters cytokine production, and this in turn leads to autoimmunity (22).  Keep in mind that this is just a theory, as the mechanism isn’t completely understood, but there does seem to be a connection.  And of course having an autoimmune condition such as Graves’ Disease or Hashimoto’s Thyroiditis can be very stressful, and so even if someone has an autoimmune thyroid condition that wasn’t triggered by stress, having the condition itself can be stressful, and this chronic stress can perpetuate the autoimmune response.

5. Antibiotics, hand sanitizer, and the hygiene hypothesis.  The hygiene hypothesis suggests that exposure to bacteria, viruses, and other “germs” can help improve your immunity.  For example, when I was a child my friends and I frequently would play outside in the dirt.  In fact, it was unusual for me to come back into the house clean.  These days I rarely see this, as it’s more common to see children and teenagers on their electronic devices.  In addition to not interacting with the environment, hand sanitizer is frequently used, and this also minimizes our exposure to these “germs”.  As a result of being too hygienic this can actually weaken our immune system, and can make us more susceptible to developing chronic inflammatory conditions, including autoimmune conditions.

What can you do about this?  Well, I would definitely minimize the use of hand sanitizer and antibacterial soaps.  I spoke about this in greater detail in an article I wrote entitled “Triclosan and Thyroid Health“.  Of course trying to avoid taking antibiotics is also important, and while there is a time and place for taking these, in many cases these are unnecessary.  And if you have children please let them play in the dirt…and feel free to go ahead and get dirty with them!

So hopefully you have a better understanding as to why the incidence of thyroid autoimmunity is increasing, along with other autoimmune conditions.  While genetics is no question a factor in the development of autoimmune thyroid conditions, lifestyle and environmental factors are primarily responsible for the increased prevalence.  Some of the main reasons for the rise in thyroid autoimmunity include increased number of C-sections, formula feeding, eating a poor diet, greater exposure to environmental toxins, chronic stress, and the hygiene hypothesis.

In the previous blog post I briefly spoke about the mechanism of action of vitamin D, and I explained the difference between vitamin D2 and vitamin D3.  I also discussed some of the more common health conditions that are affected by a vitamin D deficiency.  In this post I’m going to talk about why many people are deficient in vitamin D, and I’ll also discuss how to test for a vitamin D deficiency.  I’ll conclude the post by mentioning three ways to increase vitamin D levels.

So why are many people deficient in vitamin D?  Well, here are some of the different reasons:

1. Most people don’t get enough sunlight.  Many people work indoors and don’t get enough sunlight.  This definitely describes me, as while I’d like to say that I take a 30-minute walk in the sun during my lunch break every day, this usually isn’t the case.  And keep in mind that the amount of skin that is exposed to the sun plays a big factor.  For example, if someone takes a walk in the sun fully clothed then they will produce much less vitamin D when compared to someone who is sunbathing.  So I’ll consult with people who take a daily walk outside, or perhaps they work in their garden every day, but because they have a lot of clothing on they aren’t getting enough skin exposure.

2. Latitude.  Those who live in northern latitudes have a decreased exposure to sunlight during the winter, and thus are more likely to be deficient in vitamin D.

3. VDR polymorphism.  Vitamin D binds to the vitamin D receptor (VDR), which in turn is encoded by the VDR gene.  Many people have genetic polymorphisms of the VDR gene, which can increase one’s risk of developing a vitamin D deficiency.  And the research shows an association between VDR polymorphisms and thyroid autoimmunity (1) (2).

4. Skin pigmentation.  Those with dark colored skin absorb more UVB in the melanin of their skin, and as a result, they require more sun exposure to produce the same amount of vitamin D (3) (4).

5. Air pollution.  Air pollution can block the absorption of ultra-violet B (UBV) light.  This of course is a factor wherever you live, but if you live in a larger city then chances are you are dealing with a greater amount of air pollution.

6. Age.  Aging affects vitamin D metabolism, as the older you get, the less vitamin D is produced by the skin.

7. Frequent use of sunscreen.  Many people apply sunscreen whenever they go out in the sun, and since sunscreen blocks the absorption of vitamin D, using it frequently can lead to a vitamin D deficiency.  This isn’t meant to suggest that you should never use sunscreen, as I can understand using it if you are planning to be in the sun for many hours, but I would try to get at least 20 to 30 minutes of sun exposure daily without the use of sunscreen.

8. Deficiency in one of the cofactors.  Vitamin D works together with numerous cofactors, including magnesium, vitamin K2, zinc, boron, and vitamin A.  The vitamin D Council website has an excellent article which discusses the role that each of these cofactors has with regards to vitamin D.

What Are The Symptoms of a Vitamin D Deficiency?

Many people who are deficient in vitamin D don’t experience any noticeable symptoms.  If the vitamin D deficiency is severe then they might experience symptoms such as muscle pain or weakness.  But other factors can cause such symptoms, and not everyone with depressed vitamin D levels will experience muscle pain or weakness.  As a result, the best way to determine if you have a vitamin D deficiency is through testing.

Testing The Vitamin D Levels

25-OH vitamin D is the marker that should be tested through the blood.  Some healthcare professionals will test 1,25-dihydroxyvitamin D, and when you consider that this is the active form of vitamin D this might make sense.  However, it’s important to understand that 1,25-dihydroxyvitamin D is regulated by parathyroid hormone, and when someone has a vitamin D deficiency this results in a compensatory increase in the parathyroid hormone levels, and this in turn will increase 1,25-dihydroxyvitamin D.  And so 1,25-dihydroxyvitamin D is usually normal or elevated, even in the presence of a vitamin D deficiency.

3 Ways To Increase Vitamin D Levels

1) Sunlight.  Ideally this is the best way to increase vitamin D levels, as one hundred years ago people didn’t take vitamin D3 supplements as they do today.  However, we of course live in a different world, as many people don’t have the opportunity to go outside when it’s sunny, and most who do get regular sun exposure are fully clothed.  In addition, air pollution is a big issue, as I mentioned earlier how this affects the absorption of vitamin D.

2) Supplementation.  I personally take 5,000 IU/day of vitamin D3 on a wellness basis, and this keeps my levels at a healthy level, which I confirm through annual testing.  Does this mean that everyone should take a vitamin D3 supplement on a wellness basis?  Not necessarily, as some people do need to supplement with vitamin D3 to correct a deficiency, but are then able to maintain healthy levels through regular sun exposure.  Others need to supplement with vitamin D3 but don’t need to take as high of a dosage.

3) Indoor tanning.  Using indoor tanning beds can also be an option.  This is controversial, as indoor tanning can potentially increase the risk of skin cancer (5) (6).  However, the vitamin D Council considers tanning to be a good option if you take the following two precautions (7).  First, get half the amount of exposure that it takes for your skin to turn pink.  And second, use low-pressure tanning beds that have a good amount of UVB light, instead of the high intensity UVA light.

Can Vitamin D Be Obtained Through Diet?

Vitamin D is very low in the food supply, as it is not found in plant materials (i.e. vegetables, fruits, or grains) and it is present in small amounts in meats and other animal food sources, except in rare cases such as fish liver oils (8).  Dairy products are of course commonly fortified with vitamin D, and canned salmon, sardines, and tuna can be good sources of vitamin D (9).  But overall it is very difficult to get enough vitamin D from the diet, and it is almost impossible to correct a vitamin D deficiency through diet alone.

In summary, many people with thyroid and autoimmune thyroid conditions are deficient in vitamin D, and while a big reason for this is due to insufficient exposure to sunlight, other reasons include living in a northern latitude, having a VDR polymorphism, having dark colored skin, air pollution, frequently using sunscreen, and being deficient in one or more of the cofactors of vitamin D.  When testing for vitamin D in the blood you want to test for 25-hydroxy vitamin D, as this is more accurate than 1,25-dihyroxyvitamin D.  Sunlight and supplementing with vitamin D3 are the two main ways to increase vitamin D levels, although indoor tanning is also an option.

 

Many people are aware of the importance of healthy vitamin D levels with regards to bone health.  But vitamin D has many other important functions.  In fact, just about every tissue and cell in your body has vitamin D receptors.  Unfortunately, many people are deficient in vitamin D.  Others fall within the recommended lab reference range, but while most of the research still suggests that optimal levels should be above 30 ng/mL, some sources, including the vitamin D Council, suggest for these levels to be greater than 50 ng/mL.

I’d like to start out by discussing the mechanism of action of vitamin D.  This can get pretty complex, and so I’m just going to cover the basics.  Although vitamin D is referred to as a vitamin, the active form is actually a prohormone, and this is produced in the skin through the ultraviolet irradiation of 7-dehydrocholesterol, which is a cholesterol precursor.  So 7-dehydrocholesterol is converted into vitamin D3 (also known as cholecalciferol) in the skin.  However, vitamin D3 is biologically inert, and it needs to be metabolized to 25-hydroxy vitamin D3 in the liver, and then it gets metabolized to 1, 25 hydroxy vitamin D3 (also known as calcitriol) in the kidneys by the enzyme CYP27B1, although other tissues have this enzyme as well.

More Facts About Vitamin D

Vitamin D and its metabolites are carried in the blood mostly bound to vitamin D binding protein (DBP) (1).  So what happens is that after cholecalciferol (vitamin D3) is manufactured or taken as a supplement, it binds to DBP, and after it gets converted into calcitriol, this also is carried through the blood by DBP before binding to the vitamin D receptor.

Vitamin D increases the intestinal absorption of calcium and phosphorus, which in turn promotes bone mineralization and remodeling, and it is also involved in regulating serum calcium and phosphorus levels.  This is the main reason why most medical doctors test for Vitamin D, as they are concerned about low levels affecting bone mineral density.  However, vitamin D has numerous other functions, as it also plays a role in neuromuscular function and influences cellular growth and differentiation.  It also plays a big role in immunity, which of course is important for those with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  I’ll talk more about this later.

What’s The Difference Between Vitamin D2 and D3?

Supplemental vitamin D comes in two primary forms.  When someone purchases vitamin D in a health food store they are usually getting cholecalciferol, which is also known as vitamin D3.  On the other hand, when a medical doctor writes a prescription it is for ergocalciferol, which is known as vitamin D2.  Even though some sources claim that these two are equivalent, vitamin D3 has been proven to be the more potent form of vitamin D in all primate species, including humans (2).  In addition to vitamin D3 being more effective than vitamin D3, there is diminished binding of vitamin D2 metabolites to vitamin D binding protein in the plasma, a nonphysiologic metabolism, and a shorter shelf life of vitamin D2 (2).

Vitamin D and The Research                           

What I’d like to do now is discuss some of the research involving vitamin D, including numerous conditions which are affected by a vitamin D deficiency.

Vitamin D in dementia and cognition.  A few studies show that a vitamin D deficiency can increase one’s risk of dementia, and even Alzheimer’s disease (3) (4) (5).  Vitamin D receptors are abundant in the tissues of the brain, and the active form of vitamin D has neuroprotective effects which include the clearance of amyloid plaques, which is a hallmark of Alzheimer’s disease (6).

Inflammation/autoimmunity.  There are also numerous studies which show that vitamin D plays an important role in modulating the immune system and inflammation (7) (8) (9).  It appears to do this by decreasing pro-inflammatory cytokines, and is also associated with higher regulatory T cells (10) (11), which help to suppress autoimmunity.  However, some sources question whether a vitamin D deficiency is a cause of inflammation, or if it is a consequence of the inflammatory process (12) (13).

High Blood Pressure/Cardiovascular disease.  Numerous studies show that vitamin D might have antihypertensive effects in those people with essential hypertension, which in turn can help to prevent the development of a stroke (14) (15).  There is also evidence that a vitamin D deficiency can be a risk for the development of peripheral arterial disease (16) (17).  Although there is some evidence linking a vitamin D deficiency to atherosclerosis (18), other studies suggest that more research is needed in this area (19).

Osteoporosis.  One of the main functions of the active form of vitamin D is to enhance the intestinal absorption of calcium.  And this is why healthy vitamin D levels are important for healthy bone mineral density (20) (21).

Gut microbiota/Intestinal mucosal barrier.  There is evidence that vitamin D may play an important role in gut homeostasis and in the signaling between the microbiota and the host (22).  In addition, the vitamin D receptor appears to play a critical role in homeostasis of the intestinal mucosal barrier by preserving the integrity of the junction complexes (23).

Cancer.  Since vitamin D is important for optimal immune system health then it shouldn’t be surprising that some studies show that intake or synthesis of vitamin D leads to the reduced incidence and death rates of colon, breast, prostate, and ovarian cancers (24) (25) (26) (27).

Thyroid Health.  Numerous studies show a correlation between vitamin D deficiency and autoimmune thyroid disease.  A few studies have shown that low levels of vitamin D is associated with the presence of antithyroid antibodies and abnormal thyroid function (28) (29).  Both people with Hashimoto’s Thyroiditis and Graves’ Disease commonly have low levels of vitamin D (30) (31) (32).  This doesn’t mean that a vitamin D deficiency is the cause of these conditions, although having such a deficiency might make someone more susceptible to developing thyroid autoimmunity.

Autism.  There is evidence that healthy levels of vitamin D might reduce the risk of autism (33).  In addition, supplementation of vitamin D (in those who are deficient) may significantly improve the outcome of some children with Autism Spectrum Disorder through its anti-inflammatory actions, antiautoimmune effects, increasing regulatory T cells, protecting the mitochondria, and upregulating glutathione (33) (34) (35).

Infections.  Since healthy vitamin D levels are necessary for a healthy immune system, it makes sense that a vitamin D deficiency can increase one’s risk of developing infections.  There is some evidence that it can reduce the incidence of influenza (the flu), and one study suggests keeping the levels around 50 ng/mL to prevent infection (36) (37) (38).

In the next blog post I will start out by talking about why many people are deficient in vitamin D.  I will also talk about how to test the vitamin D levels, as while most healthcare professionals test for 25-OH vitamin D, since 1,25-OH vitamin D is the active form, I’m sure that some people reading this are wondering if this should be tested.  I will also discuss three ways to increase vitamin D levels.

Hashimoto’s Thyroiditis is an autoimmune thyroid condition that is characterized by elevated thyroid autoantibodies.  An encephalopathy is general term for a disease of the brain.  Hashimoto’s encephalopathy is an autoimmune condition that not only involves elevated thyroid antibodies, but it also is characterized by brain dysfunction.  In fact, the encephalopathy symptoms are usually more prominent than the thyroid symptoms.  While Hashimoto’s Thyroiditis is common, Hashimoto’s encephalopathy is a rare condition.

Because there are thyroid autoantibodies present in Hashimoto’s encephalopathy, not surprisingly one can have thyroid hormone imbalances.  This can lead to the classic hypothyroid symptoms such as fatigue, weight gain, cold hands and feet, etc.  However, many times the person with Hashimoto’s encephalopathy is in a subclinical hypothyroid state, and so while they might have elevated thyroid antibodies, they frequently will present with a normal thyroid panel and minimal hypothyroid symptoms.  As I’ll discuss below, other autoantibodies are present as well, which can lead to psychiatric manifestations, seizures and focal neurologic deficits (1).

The Autoantibodies Associated With Hashimoto’s Encephalopathy

Hashimoto’s encephalopathy involves numerous autoantibodies.  These can include elevated thyroglobulin antibodies, thyroid peroxidase antibodies, or both.  These thyroid antibodies are of course commonly seen in Hashimoto’s Thyroiditis.  But with Hashimoto’s encephalopathy, in addition to one or both thyroid autoantibodies being present, there are also autoantibodies against alpha-enolase (2) (3) (4).

Alpha-enolase, also known as Enolase 1, is a glycolytic enzyme.  These autoantibodies are found in other autoimmune conditions as well, such as Behçet’s disease (5).  Enolase exists in three different forms: α, β and γ (4). Isozyme α is found in most tissues, isozyme β in muscle, and isozyme γ is present mainly in nervous tissue (5) (6). It appears that the antibodies in Hashimoto’s Encephalopathy only involve α-enolase (4).

What’s important to understand here is that autoimmunity involves the body attacking its own cells and tissues.  What differentiates one autoimmune condition from another is that different parts of the body are attacked.  So with Hashimoto’s the immune system will attack either thyroglobulin, or the thyroid peroxidase enzymes, which is why you will see one or both of these antibodies elevated.  With Hashimoto’s encephalopathy you will not only see an increase in one or both of these thyroid antibodies, but since the immune system is attacking alpha-enolase, you will see elevated levels of these autoantibodies as well.  As for why one person will develop Hashimoto’s Thyroiditis, while another person will develop Hashimoto’s encephalopathy, it comes down to a combination of genetics, lifestyle factors, and environmental triggers.

What Is The Conventional Treatment Approach?

Corticosteroids are commonly recommended as the first line of treatment in those people with Hashimoto’s encephalopathy (7) (8).  And while many people respond very well to corticosteroids, several adverse outcomes, relapses and temporary or permanent spontaneous remissions have also been reported (8).  This doesn’t mean that I’m opposed to people using corticosteroids, as while I’m not a big fan of them, I realize that in some cases they might be necessary to take.  There have also been a few case studies where intravenous immunoglobulins were beneficial (9) (10), as they help by modulating the immune system.

Can A Natural Treatment Approach Help?            

Although conventional medical treatments might be necessary at times to help manage the symptoms, and possibly to help put the person into a state of remission, what we of course need to keep in mind is that treatments such as corticosteroids and intravenous immunoglobulins are not addressing the cause of the problem.  As a result, even if the person is put into a state of remission through modulation of the immune system, relapses are common.  This was highlighted in a case report I came across that involved a 43-year old woman with Hashimoto’s encephalopathy who experienced three relapses around the time of her menstrual cycle (11).

After the third relapse she was given thyroid hormone medication for her hypothyroidism, and she was also given estrogen and progesterone to help regulate her menstrual cycle.  After this she didn’t experience any further relapses.  If she were my patient I might have tried to address her problem without giving estrogen and progesterone, but the point I want to get across is that the apparent trigger was addressed in this situation.  Unfortunately, addressing the cause of the problem isn’t always this straightforward, but either way, one does want to ideally detect and address the cause of the problem.  So if someone has a hormone imbalance, infection, food sensitivity, toxic exposure, or another factor that is triggering the autoimmune response then of course this needs to be addressed.

You might wonder if natural agents can be used instead of corticosteroids and intravenous immunoglobulins.  In some people nutritional supplements and herbs can be used to help suppress the autoimmune response, although the cause of the problem still needs to be addressed.  But taking things that can reduce proinflammatory cytokines and increase regulatory T cells can help, including fish oils, vitamin D, curcumin, and resveratrol.  I’ve discussed this in greater detail in other articles and blog posts, and keep in mind that high doses might be necessary to help suppress the autoimmune component.

In summary, Hashimoto’s encephalopathy is an autoimmune condition that not only involves elevated thyroid antibodies, but it also is characterized by having autoantibodies against alpha-enolase.  This in turn can lead to symptoms of brain dysfunction, including psychiatric manifestations, seizures, and focal neurologic deficits.  Corticosteroids and intravenous immunoglobulins are two types of conventional treatments, with corticosteroids usually the first option.  Natural treatments might also help to put the person into remission, but whether you use natural or conventional methods to control the symptoms, the ultimate goal should be to address and remove the autoimmune trigger.

When I was dealing with Graves’ Disease I chose not to take any medication.  I decided not to take the beta blocker that was prescribed by the primary care physician who told me I had hyperthyroidism, and then I refused to take the Methimazole that was recommended by the endocrinologist who diagnosed me with Graves’ Disease.  It was approximately two months between these two doctor visits, and I didn’t begin taking bugleweed (and eventually motherwort) until after my appointment with the endocrinologist.  While everything turned out okay, I was taking a big risk by not managing my hyperthyroid symptoms for so long, and I decided to put this blog post together because unmanaged hyperthyroidism has numerous risks, and I’m going to discuss three of the main ones here.

Getting back to my situation, if the bugleweed and motherwort didn’t do a good job of managing my symptoms then I’m pretty sure I would have taken the antithyroid medication while trying to restore my health.  While it might sound hypocritical telling people with hyperthyroidism the risks of not managing their symptoms when this is exactly what I did for a couple of months, keep in mind that at the time I wasn’t working with other people who had hyperthyroidism and Graves’ Disease.  If I knew then what I know now about hyperthyroidism and Graves’ Disease I wouldn’t have gone so long without managing my symptoms.

With that being said, let’s go ahead and take a look at three of the main risks of unmanaged hyperthyroidism:

Risk #1: Decrease in bone density.  Thyroid hormones are required for skeletal development and establishment of peak bone mass (1).  In adults, T3 regulates bone turnover and bone mineral density, and normal levels of thyroid hormone are essential to maintain optimal bone strength (1).  Overt hyperthyroidism can cause accelerated bone remodeling, reduced bone density, osteoporosis, and an increase in fracture rate (2) (3).  Although this decrease in bone density is reversible (3) (4), it can take years to reverse osteopenia and osteoporosis.

In order to avoid a decrease in bone density it is important to address elevated thyroid hormone levels.  This can be accomplished through antithyroid medication such as Methimazole or PTU, or in many cases by taking an antithyroid herb such as bugleweed.  Just keep in mind that not everyone is able to lower their thyroid hormone levels by taking bugleweed, and when this is the case then it might be necessary to take antithyroid medication.  In addition to lowering the thyroid hormone levels, eating a healthy diet and engaging in some weight-bearing exercises at least a few days per week can also help to increase the bone density.

Risk #2: Thyroid storm.  A thyroid storm is a rare complication of hyperthyroidism, and is frequently caused by a secondary event such as an infection or myocardial infarction (5).  In addition to the person presenting with elevated thyroid hormone levels, they usually will have an extremely high heart rate (i.e. greater than 140 beats per minute), and a fever greater than 102 degrees Fahrenheit (>39 degrees Celsius) is almost universal (5).  Other symptoms can include persistent sweating, shaking, diarrhea, nausea, vomiting, and disorientation. The overall mortality of a thyroid storm is between 10-20% (5) (6), and this assumes that there is no delay in treatment.  This is considered to be a medical emergency, and so if you are experiencing some of the symptoms I just described then you need to take this seriously, and it probably would be wise to visit the nearest urgent care or hospital emergency center.

3) Atrial fibrillation.  An atrial fibrillation is the most common type of heart arrhythmia, and this involves an abnormal heart rate and/or heart rhythm.  Atrial fibrillation is the most common cardiac complication of hyperthyroidism, and it can increase the risk of blood clot formation inside the heart (7).  The best way for someone with hyperthyroidism to prevent atrial fibrillation from occurring is to make sure their resting heart rate isn’t too high.  I discussed this condition in greater detail in an article I wrote entitled “Hyperthyroidism and Atrial Fibrillation“.

Should You Take Medication or Herbs To Manage The Hyperthyroid Symptoms?

Some people have a difficult time deciding whether they should take antithyroid medication to manage their symptoms, or if they should choose to do this naturally through herbs such as bugleweed and motherwort.  Although I personally chose not to take the medication, some people aren’t able to effectively manage their symptoms through herbs alone.  And if this is the case, then taking medication on a temporary basis is probably a good idea.  After all, while it’s great if you can manage your symptoms naturally, even if you do need to take antithyroid medication you can still follow a natural treatment protocol.  In fact, it’s quite common for patients with hyperthyroidism to already be on antithyroid medication prior to working with me.  If you’re still not sure what to do, I would check out the following blog post I wrote entitled ” Choosing Between Prescription Drugs and Natural Supplements In Managing The Hyperthyroid Symptoms“.

In summary, while many people with hyperthyroidism and Graves’ Disease can benefit from following a natural treatment protocol, it is important to manage the symptoms while taking this approach.  There are risks of unmanaged hyperthyroidism, and three of the main risks include a decrease in bone density, thyroid storm, and atrial fibrillation.  The incidence of these three conditions can be greatly reduced by decreasing the thyroid hormone levels through the use of antithyroid medication such as Methimazole, or herbs like bugleweed.  And if you have an elevated resting heart rate then of course you also want to take action to help lower this.  Frequently the antithyroid medication or herbs will help to accomplish this, although sometimes taking an agent that specifically focuses on the cardiac symptoms is necessary, and is why some people will take a beta blocker or an herb such as motherwort.