6 min|Dr. Maya Kuczma
Autoimmune Disease 101: Treatment of Graves' DiseaseImmune Health
Conventional treatments, such as medications, radiation, and surgery, aim to treat the thyroid gland, without addressing the immune system. Medications such as propylthiouracil (PTU) and methimazole (also known as Tapazole) are antithyroid drugs that interfere with the production of thyroid hormones. These medications can lead to a decrease in thyroid hormone production; this decrease can lead to hypothyroidism. Additionally, they both have lengthy lists of additional potential side effects.(1,2)
Radioactive iodine can be used to permanently destroy cells of thyroid, resulting in little or no production of thyroid hormones. After this procedure, you may have to use thyroid hormone replacing medication for the rest of your life.(3) Surgical intervention, in the form of partial removal of the thyroid (known as a partial thyroidectomy) may be completed when antithyroid medications or radiation cannot be used.
Diet and Lifestyle
Graves disease is an autoimmune condition. For this reason, Naturopathic Doctors opt for treatment to directly treat the thyroid gland, as well as regulate the immune system. There are specific foods that may induce inflammation, a factor that contributes greatly to the development of autoimmune conditions.(4). Grain consumption has been linked to increased gut permeability (also known as ‘leaky gut’), which can lead to increased inflammation, and has been linked to autoimmune conditions.(5) High sugar and refined carbohydrate intake has been shown to worsen autoimmunity, due to increased inflammation.(6,7) Lectins, a component found in all plants but at particularly high levels in grains, beans, and legumes, have been shown to alter immune-signaling on thyroid cells, a change that may set the stage for the development of autoimmunity.(8) Additionally, food sensitivities can lead to inflammation and increased intestinal permeability, contributing factors to autoimmune conditions.
As we have learned, the thyroid hormonal cascade requires many different nutrients, without which it cannot function optimally. Regulation of the immune system can also be influenced by specific nutrients. For example, vitamin D deficiency has been associated many autoimmune conditions, including Graves’ disease.(9) Omega-3 fatty acids, such as those found in fish and fish oil supplementation, can decrease inflammation throughout the body.(10)
When treating Graves’ disease, we guide patients towards a diet that emphasizes the nutrients required by the thyroid and immune system while eliminating potentially problematic foods, such as grains, legumes, and sugar. The result is a diet that predominantly relies on animal protein, fruits, and vegetables, such as a Paleo, Autoimmune Paleo (AIP), or Whole30 plan.
Stress plays a large role in the development of autoimmune conditions. Graves’ disease may be influenced by stress via direct stimulation of the immune system by stress hormones.(11) As a result, it is vital to manage your stress. Stress management is different for everyone. Depending on your symptoms, you may find stimulating activity, such as running or weight lifting, helpful in alleviate stress; alternatively, you may gain more relief from relaxing habits, such as drawing, Epsom salt baths, or light walking.
At times, a healthy diet and lifestyle can result in significant symptom relief and a decline in antibody levels. For others, there may be additional factors that need to be considered, such as improving gut health. Specific gastrointestinal infections, such as small intestinal bacterial overgrowth (SIBO), yeast overgrowth, and parasitic infections can interfere with nutrient absorption and contribute to gut inflammation and increased intestinal permeability (‘leaky gut’), a known contributor to the development of autoimmune conditions. A Naturopathic Doctor can help guide you through specific gastrointestinal diagnostic testing, identification of infections and food sensitivities, and a specific gut healing protocol, if necessary.
Many toxins, such as bisphenol-A,(12) mercury,(13) and glyphosate,(14) a key ingredient in the pesticide RoundUp, may play a role in the development of autoimmunity. The safety of many of these toxins is tested individually; throughout our life, we are exposed to many toxins simultaneously. Research into the complex effects of combined toxic exposure is in its infancy, and is likely influenced by genetic mutations known as polymorphisms. A trained practitioner can help guide you through tests for toxic load and genetic polymorphisms, and provide suggestions on how to eliminate further toxic exposure and encourage detoxification.
Many infections have been linked to the development of autoimmunity, as well as the initiation of Graves’ disease, including the Epstein Barr virus,(15) herpes viruses,(16) and Yersinia enterocolitica.(17) These infections can be tests for, and treated, if needed.
Naltrexone is a prescription drug used as a treatment for opiod addiction, due to its ability to bind and block opiod receptors; however, at a low dose (typically 1.5-4.5mg before bed), naltrexone can modulate the immune system and decrease inflammation.(18) Research indicates the immune-modulating effects of low dose naltrexone (LDN) may improve immune-mediated conditions, such as fibromyalgia,(19) and inflammatory bowel disease.(20) The most common side effect of LDN is sleep disturbance.(21) Due to the safety profile and immune0modulating effects of LDN, it may be utilized within a treatment plan for Graves’ disease.
Monitoring and Thriving
Your Doctor will likely test your TSH, thyroid hormones, and antibodies frequently, especially in the early days of treatment, in order to monitor your progression. Antibody levels can be helpful in monitoring if our treatment plan is leading to a decrease in thyroid destruction. In cases of Graves’ disease, it is important for us to monitor both your labs, and how you feel.
Pregnancy, menopause, stressful life events, toxic exposure, infections, and changes in diet can all affect the complex thyroid cascade; as a result, your labs, how you feel day-to-day, and treatment plan, may change as well. Due to the effect of thyroid hormones on the heart, Graves’ disease can become a medical emergency if it is not adequately treated. A skilled practitioner will help guide you through signs and symptoms to be aware of, while also monitoring objective markers like the size of your thyroid and lab results.
Do you have many of the symptoms of hyperthyroidism?
Have you been diagnosed with hyperthyroidism, but your antibody levels weren’t tested?
Or, are you receiving treatment for hyperthyroidism and wondering if there’s more you could be doing to support you body?
At Integrative, we’re here to help. Contact our reception - (604) 738-1012 - or [email protected] to take a step towards better health and vitality.
- Falgarone, Géraldine, et al. “MECHANISMS IN ENDOCRINOLOGY: Role of Emotional Stress in the Pathophysiology of Graves' Disease.” European Journal of Endocrinology, vol. 168, no. 1, 2013, doi:10.1530/eje-12-0539.