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Hyperthyroidism
 

Hyperthyroidism Introduction

Hyperthyroidism, also known as thyrotoxicosis, is a condition characterized by both the increased metabolism, and elevated serum levels of thyroid hormones. The condition can be caused by several different disease states, all with the same result. Of the diseases that can cause hyperthyroidism; Grave’s disease, which is also known as a diffuse toxic goiter, is the most common. Other diseases that can cause hyperthyroidism are pituitary tumors that secretes excess TSH (the hormone that tells thyroid to produce and secrete more hormones), toxic multinodular goiter, thyroiditis (inflammation of thyroid), excessive iodine ingestion, and congenital hyperthyroidism. [1]

Grave’s disease is an autoimmune cause of hyperthyroidism. It accounts for nearly 85% of all diagnosed cases of hyperthyroidism in the US. It is more common in women than men. The average age of incidence is between 20 and 40 years old. Stress is thought to be a precipitating factor in the development of Grave’s disease. [2]

Hyperthyroidism Signs and Symptoms

The clinical signs and symptoms of hyperthyroidism can vary from patient to patient. Common complaints are often the result from an increase in metabolism brought on by the elevated serum thyroid hormones, as well as an increase in adrenergic (adrenalin) response. Symptoms of hyperthyroidism can include;

  • warmth
  • increased sweating
  • moist skin
  • increased heart rate
  • nervousness
  • increased energy and activity
  • loose bowel movements
  • weight loss
  • increased appetite
  • tremor
  • eye signs, which may include lid lag, lid retraction, stare, and redness of the conjunctiva

Persons with Graves’ disease will also have characteristic eye signs as a result of the auto-immune interaction with the eye, including orbital pain, increased tearing, irritation, photophobia, and protrusion of the eyes. Pre-tibial myxedema can also occur in persons with Grave’s disease.

Clinical signs that are commonly observed by physician for diagnosis of hyperthyroidism, include;

  • goiter (enlargement of the thyroid)
  • exophthalmos (protrusion of the eyes)
  • pre-tibial myxedema
  • changes in the blood pressure. [3]

Hyperthyroidism Treatment

Conventional treatment of hyperthyroidism depends on the cause. Iodine in high doses can be used if the cause is thyroid storm or pre-surgical suppression. Anti-thyroid drugs, such as propylthiouracil and methimazole, impair production of hormones by the thyroid gland and are commonly used in cases of Grave’s disease, congenital hyperthyroidism, and pituitary tumor. Radioactive ablation is a treatment option that uses radioactive iodine and destroys the thyroid. Radioactive ablation is the most recommended choice of treatment in the US. The last option for treatment is surgical removal. [4]

Alternative treatments of hyperthyroidism are also aimed at decreasing the serum levels of thyroid hormones, either by interrupting the synthesis, or by decreasing the overall activity of the hormones. Treatment also focuses on repairing and supporting the body during the hyperthyroid condition. Hyperthyroidism typically causes an overall increase in metabolism, and with that, an increased use of nutrients. It is also well understood that the generation of free radicals is increased in hyperthyroidism. Therefore, it is essential to support the health of the body in a variety ways, while also dealing with the root of the disease.

Supplements helpful for Hyperthyroidism

Iodine Supplementation with iodine in high doses can suppress the production of thyroid hormones. Although, it has been effective at relieving the symptoms of hyperthyroidism and has been shown to block the conversion of T4 to T3, the active form of the hormone. Iodine therapy is one that should only be used short term. After time, it can actually increase the amount of hormones being produced. In a clinical trial, a saturated solution of potassium iodide (SSKI) given for 10 days blocked conversion of T4 to T3 and reduced serum levels of thyroid hormones. [5]

Melatonin Melatonin is a substance secreted by the pineal gland in the brain. It plays a role in sleep patterns and the circadian rhythms of the body. Melatonin is also a potent antioxidant and an effective free radical scavenger in hyperthyroidism. It has been shown to suppress T4 production by the thyroid gland. [6] Supplementation with melatonin is also beneficial for insomnia, which is a common symptom of hyperthyroidism.

L-carnitine Carnitine is an amino acid that plays a pivotal role in the production of energy inside the cell. It is also thought to be an antagonist of the thyroid hormone action in the body, and may actually inhibit thyroid hormone entry into the liver, brain, and fibroblast cells. In one study, supplementation with L-carnitine for 6 months was shown to reverse and prevent symptoms of hyperthyroidism. Carnitine also had beneficial effects on bone metabolism. [7]

Niacin Niacin (Vitamin B3, nicotinic acid) was shown in a clinical trial to decrease the concentration of serum thyroid hormones in individuals who were euthyroid (persons exhibiting normal levels). [8] Because no adverse effects of supplementation were observed, niacin may be an adjunctive therapy for hyperthyroidism. Niacin does, however, cause flushing of the skin at high doses. It may be wise to use niacinamide, another form of niacin, because it does not cause flushing.

Vitamin A Vitamin A and beta-carotene levels in the blood of patients with hyperthyroidism are often decreased and supplementing with large amounts of this particular vitamin actually inhibits thyroid function. The supplementation of Vitamin A also ameliorates the symptoms of Grave’s disease. [9] Vitamin A is a potent antioxidant, which thwarts the oxidative stress that is increased in those with hyperthyroidism. [10, 11]

Vitamin C Vitamin C is a potent anti-oxidant. It has been shown in experimental studies to be decreased in individuals with excess thyroid hormone activity. Anti-thyroid drugs also cause a decrease in serum Vitamin C. [12] Hyperthyroidism causes an increase in oxidative stress and higher levels of anti-oxidants like Vitamin C are needed. Vitamin C does not directly treat the disease, but may be used to treat the accompanying symptoms. In certain clinical trials, the oxidative stress markers significantly declined in patients with hyperthyroidism after Vitamin C treatments were used over a month’s time. Conversely, the participant’s serum anti-oxidant markers increased.[ 13]

Vitamin E Vitamin E is an anti-oxidant. It also functions to stabilize cell membranes. It can act as a free radical quencher and decrease the damage caused by oxidative stressors in hyperthyroid patients. [14]

Botanical therapies Lycopus ssp, Lithospermum officinale, and Melissa officinalis have all been proven to treat hyperthyroidism. The mechanism of action in these botanicals, is the blocking of TSH receptors on the thyroid cells. This blockage interferes with the internal signal needed to produce more thyroid hormone Lycopus also blocks conversion of T4 to T3 in the peripheral tissues. These three herbs have had repeated success in treating Grave’s disease as well, because of interruption of the Grave’s specific thyroid stimulating immunoglobulin (the autoimmune component). In fact, one study found that freeze dried extracts of the three herbs inhibited binding of TSH to thyroid receptors by weakly binding themselves. The study also showed the decreased activity of the thyroid stimulating immunoglobulin that is responsible for the increase in thyroid hormone production in Graves’ disease patients. [15]

References

[1] Beers M and Berkow R. Hyperthyroidism. The Merck Manual 17th Ed.: 86-93.

[2] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002 Churchill Livingstone. Pages 242-249.

[3] Beers M and Berkow R. Hyperthyroidism. The Merck Manual 17th Ed.: 86-93.

[4] Beers M and Berkow R. Hyperthyroidism. The Merck Manual 17th Ed.: 86-93.

[5] Robuschi G et al. J Endocrinol Invest. 1986 Aug; 9(4): 287-291.

[6] Karbownik M and Lewinski A. The role of oxidative stress in physiological and pathological processes in the thyroid gland: possible involvement in the pineal-thyroid interaction. Neuro Endocrinol Lett. 2003 Oct; 24(5): 293-303.

[7] Benvenga S et al. The usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double blind, placebo controlled clinical trial. J Clin Endocrinol Metab. 2001 Aug; 86(8): 3579-3594.

[8] Shakir K et al. Nicotinic acid decreases serum thyroid hormone levels while maintaining a euthyroid state. Mayo Clin Proc. 1995 June; 70(6): 556-558.

[9] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002 Churchill Livingstone. Pages 242-249.

[10] Goswami UC and Choudhury S. The status of retinoids in women suffering from hyper and hypothyroidism: interrelationship between vitamin A, beta-carotene and thyroid hormones. Int J Vitam Nutr Res. 1999 Mar; 69(2): 132-135.

[11] Bianchi G et al. Oxidative stress and anti-oxidant metabolites in patients with hyperthyroidism; effect of treatment. Horm Metab Res. 1999 Nov; 31(11): 620-624.

[12] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002 Churchill Livingstone. Pages 242-249.

[13] Seven A et al. Biochemical evaluation of oxidative stress in propylthiouracil treated hyperthyroid patients. Effects of vitamin C supplementation. Clin Chem Lab Med. 1998 Oct; 36(10): 767-770.

[14] Pizzorno J, Murray M, Joiner-Bey H. The Clinicians Handbook of Natural Medicine. 2002 Churchill Livingstone. Pages 242-249.

[15] Auf’mkolk M et al. Extracts and auto-oxidized constituents of certain plants inhibit the receptor binding and the biological activity of Grave’s immunoglobulin. Endocrinology. 1985 May; 116(5): 1687-1693.