Graves Disease

 

Under construction
Graves’ disease, also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid.[1] It frequently results in and is the most common cause of hyperthyroidism.[4] It also often results in an enlarged thyroid.[1] Signs and symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea, and unintentional weight loss.[1] Other symptoms may include thickening of the skin on the shins, known as pretibial myxedema, and eye bulging, a condition caused by Graves’ ophthalmopathy.[1] About 25 to 80% of people with the condition develop eye problems.[1][3]

The exact cause is unclear; however, it is believed to involve a combination of genetic and environmental factors.[2] A person is more likely to be affected if they have a family member with the disease.[1] If one twin is affected, a 30% chance exists that the other twin will also have the disease.[5] The onset of disease may be triggered by stress, infection, or giving birth.[3] Those with other autoimmune diseases such as type 1 diabetes and rheumatoid arthritis are more likely to be affected.[1] Smoking increases the risk of disease and may worsen eye problems.[1] The disorder results from an antibody, called thyroid-stimulating immunoglobulin (TSI), that has a similar effect to thyroid stimulating hormone (TSH).[1] These TSI antibodies cause the thyroid gland to produce excess thyroid hormone.[1] The diagnosis may be suspected based on symptoms and confirmed with blood tests and radioiodine uptake.[1][3] Typically, blood tests show a raised T3 and T4, low TSH, increased radioiodine uptake in all areas of the thyroid, and TSI antibodies.[3]
The three treatment options are radioiodine therapy, medications, and thyroid surgery.[1] Radioiodine therapy involves taking iodine-131 by mouth, which is then concentrated in the thyroid and destroys it over weeks to months.[1] The resulting hypothyroidism is treated with synthetic thyroid hormone.[1] Medications such as beta blockers may control some of the symptoms, and antithyroid medications such as methimazole may temporarily help people while other treatments are having effect.[1] Surgery to remove the thyroid is another option.[1] Eye problems may require additional treatments.[1]
Graves’ disease will develop in about 0.5% of males and 3% of females.[4] It occurs about 7.5 times more often in women than in men.[1] Often, it starts between the ages of 40 and 60, but can begin at any age.[5] It is the most common cause of hyperthyroidism in the United States (about 50 to 80% of cases).[1][3] The condition is named after Robert Graves, who described it in 1835.[5] A number of prior descriptions also exist.[5]

 

Hholistic Approach

 
1. Methylfolate
This is an interesting one. People with Grave’s disease actually have a greater need for folate, but also have a greater sensitivity to folic acid. Most folks can get away with the folic acid we get from processed foods and other parts of our diet, but for those with Grave’s disease it can actually be harmful.
Methylfolate can be found in more progressive multivitamins that we might be able to find and can help us deal with our increased sensitivity to folic acids.

2. Magnesium
Your body needs more and your body loses more when you have Grave’s disease. So many people are actually already deficient in magnesium, so if you did not already have enough now you are really in trouble.
The other wrinkle is that Grave’s side effects actually mimic the side effects of a magnesium deficiency. Even a couple hundred milligrams of magnesium can be a game-changer for your body, in giving it what it needs.
3. EPA
This is one of the omega-3 fats that we can benefit from having in our bodies. We get this from fish oil, and it can help protect and reverse damage that we have to the brain.
One of the problems with Grave’s disease is that it can cause faster wear and tear on the brain cells. EPA can actually help to reverse that, and it can also be cardioprotective for the heart, at the same time.
4. Vitamin D
Having enough, but not too much, vitamin D is an important step in the process of Grave’s reversal.

5. Molybdenum
Grave’s disease affects all parts of your body, and that’s because that is what the thyroid does – it plays such an important role in your entire body, it touches almost every aspect of it. Molybdenum is actually critical for liver function, which is important when you are in the Grave’s state.
6. Vitamin E
When we think of vitamin E, we want it to be mixed natural tocopherols. This is how they are found in existing healthy foods. The benefit of vitamin E is that it helps to break down the free radical damage that hurts the nerves and hurts the heart with Grave’s disease.
7. Calcium
Calcium is super important, both for calming nerve conduction and preventing bone thinning and bone loss.
8. DHA
Docosahexaenoic acid (DHA) is the cousin of EPA, and is another good omega-3 fat that we could use more of when we are in the Grave’s state. This one is especially powerful for building the cell membranes of the brain cells, helping to calm the effects of anxiety and keeping brain cognition sharp.
9. Chamomile
This is a herb that I love and one that can easily be found in teas. There has been a lot of data showing that chamomile can go a long way in reducing stress, anxiety and generally calming the nervous system. It can also do so safely, without causing sedation and clouding your thinking.
10. Melissa (or lemon balm)
There are three really interesting things about lemon balm, as it relates to Grave’s disease: it can actually help slow and calm an overactive thyroid, it can act as a gentle sedative and it can help to clarify mental function. That’s a great combination of factors and is exactly why a little bit of lemon balm can really help your body.

Try some of these herbs and supplements today, and get to feeling your best while you are going through treatment for Grave’s disease. After you have fully reversed the disease, you might even have found a few new favorite supplement to take with you on your way.

 

 

 

 
Stop Suffering
Graves disease is reversible for most and we can help.

 

 

 

 

 

 

We have established there are two options (natural and pharmaceutical) for managing the hyperthyroidism aspect of Graves’ in the short term. Why not just try to cover up the symptoms and hope it goes away? The relapse rate for patients who are treated with thyroid suppressing drugs can approach 68%. This means there may be roughly a 70% chance you need to have your thyroid removed or destroyed. This gives weight to how important it is to do everything possible to treat this at the cause (18).

Functional Medicine Treatment – Secondary Treatment; Treating the Underlying Cause
Why do I have Grave’s disease? This is the most important question to ask and answer. This van diagram illustrates the

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factors associated with thyroid autoimmunity, remember Graves’ disease is a form of thyroid autoimmunity. Please note not all of these factors are ones that can be treated. From this list the most important and treatable factors are:

•Selenium deficiencies

•Infections

•Stress

•Gluten

•Vitamin Deficiencies

◦Vitamin D, omega 3, folate

•Gut Microflora

•Leaky gut

Infections
Several different bacteria and viruses have been associated with autoimmunity. Some of the most well studied are:

•Bacteria:

◦Yersinia enterocolitis

◦Helicobacter pylori

•Viruses:

◦Epstein Barr

◦Cytomegalovirus

◦Herpes Simplex Virus

This has caused researchers to identify these infections as one of the contributors to developing autoimmunity (19, 20, 21, 22, 23, 24, 25, 26). Some studies have even shown as infection activity increases, so does the severity of the autoimmune process (25).

A meta analysis examining the association of H. Pylori infections and thyroid autoimmunity concluded, “Overall, H. pylori infection was associated with autoimmune thyroid disease; the association was significant for Graves’ disease… These findings suggest that H. pylori infection potentially plays a part in the development of ATDs.” (19ATD means autoimmune thyroid disease (Hashimoto’s and Graves’ being the most common forms).

Three case studies were published showing that all three women with Graves’ had concurrent Epstein Barr virus reactivation. Note severe Epstein Barr is also known as mononucleosis.

“Although the etiology of Graves’ disease is still not clear, it is generally suggested that environmental factors such as infections contribute to the development of Graves’ disease. We report here three cases of Graves’ disease which presented simultaneously with infectious mononucleosis due to primary EBV infection(27).” 

Some researchers are theorizing the reason why Epstein Barr virus might cause autoimmunity is essentially because the virus actually gets inside the thyroid gland thus stimulating your immune cells to attack the gland and cause autoimmunity (28).

While we have great studies showing the correlation between infections and autoimmunity; and there is a suggested causal

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relationship, we are still lacking some data. Published studies showing a decrease of autoimmune activity after treating infections are sparse but impressive.

A study was conducted in Italy that illustrated how powerful treatment of infections can be in halting the autoimmune process. Ten patients who had Hashimoto’s autoimmune thyroid disease and also had an H. Pylori infection were selected. Five underwent treatment and five did not. Here is a breakdown of the findings (please note adequate data was only available for three patients from each group) (29).

Again the patients all had thyroid disease and a H. Pylori bacterial infection. The three in green (on top) were treated for the infection. The three in red (on bottom) were not treated. The numbers you see are the patients’ levels of TPO antibodies. TPO antibodies tell us how severe the autoimmune process is; the higher the number the higher the damage, under about 35 is ideal. As you see here ALL of the patients’ levels were elevated to start. But, those who underwent treatment for bacteria had a significant drop in their antibody levels while the patients who were not treated did not. So treating an infection helped to dampen or stop the autoimmune process that damages the thyroid.

How important are the anti-body levels?
A large study, known as meta-analyses, showed that high antibodies levels are predictive of Graves’ relapse; so whatever we can do to lower these antibodies will be a good idea (30).

While there may not yet be any large scale randomized control trials looking at this, there are many clinicians in the field, myself included, who report that screening for and treating these infections seems to contribute greatly to halting the autoimmune process. It’s a simple inference to draw that removing a pathogenic bacteria overgrowth like Helicobacter Pylori, could be beneficial. Remember Hashimoto’s and Graves’ are immune disorders, infections cause activation of the immune system, clearance of an infection allows the immune system to calm down.

The H. Pylori bacterium has been shown to cause stomach burning, ulcers and inflammation. Fortunately, H. Pylori and many of these other infections can be safely eradicated with a course of antibiotic herbs. So there is good reason to screen for and treat these infections especially when we know for certain they have a strong relationship to autoimmunity. Additionally, most every infection will cause fatigue and treating an infection will almost always help with patients energy levels.

Leaky Gut
The subject of infections ties in with that of gut health. Why is this? Well, many of these infections can live in your gut, so this means they act not only as an infection which stimulated the already over stimulated immune systems but also damages your gut. H. Pylori and Yersinia are two examples of this.

Why is gut health linked to my thyroid? Well again the connection is via the immune system. Some researchers have said that it is not even possible to develop autoimmunity unless the gut is first damaged (31).

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(Click slide to enlarge)

But why exactly is this? While we don’t know for sure just yet, there are some highly plausible hypotheses. In this picture you see a sample of intestinal tissue. The blue and green cells are immune cells. As you can see there is a tremendous concentration of immune cells in the gut, about 70% of our immune system is contained in gut (32).

This is because the gut is the barrier between you and the outside world. Remember ‘stuff’ from the outside world gains entry to your blood stream via the gut so we need to have plenty of border patrol aka immune cells. When you have ‘leaky gut’ the boarder or gut barrier is compromised and too much ‘stuff’ is allowed in. This stuff may be bacteria, viruses, fungus, food particles, chemicals, etc… Well who then comes to the rescue once too much ‘stuff’ gets into your blood? You guessed it, your immune cells. So if you have an underlying predisposition to autoimmunity (see “Gene Factors” in van diagram above) and then you develop leaky gut, the stage may be set for you to develop autoimmunity, or specifically Graves’. I will go into much more detail about this in the book.

Gut Microflora
Here is a very simplified overview of a very exciting and complex topic. Good bacteria and fungus live in your intestines, more so in your colon. They are needed to help crowd out the bad bacteria, fungus and other infections. They are also needed to prevent leaky gut. Additionally they help breakdown nutrients and increase nutrient absorption. As if this isn’t enough, the good microflora has also been shown to have a direct impact on certain types of autoimmunity.

In a 2012 review published in the International Journal of Immunopathology and Pharmacology the authors commented, “Alterations in both the structure and function of intestinal microbiota could be one of the common causative triggers of autoimmune and/or autoinflammatory disorders (33).”

Dr. David Brady, ND, DC recorded a very well referenced lecture going into great detail on the gut microflora-autoimmune connection (34). Brady does a great job covering how the medical literature shows a strong association between gut flora and autoimmunity. Unfortunately, this is seldom mentioned in medical practice.

Stress
Stress in known to provocate almost any health condition. The effects of stress are far reaching, but specifically stress can effect Graves’ via two main mechanisms. Firstly, stress can weaken your immune system, which can make you more susceptible to acquiring an infection or can cause an infection you already have to become even more problematic. Secondly, we also know that stress modulates what is known as the Th1/Th2 balance in the immune system. One of the predominant theories of autoimmunity suggests that a shift in this balance is a predisposing factor to developing autoimmunity.

Gluten
Gluten intolerance may be connected to autoimmune thyroid, and specifically Graves’ disease by way of a gene or genes. A gene known as the CLTA-4 gene is known to be associated with Graves’.

A study published in 2012 showed that 60% of those with AIT (autoimmune thyroid) disease had this gene, while only 25% of healthy controls had this gene (35).

How does this link to gluten intolerance? In 2013 a meta-analysis was published showing a link between the CTLA-4 gene and celiac disease, celiac disease being the highest level of gluten intolerance one can have (36). These finding have been confirmed in other reviews as well (37).

Other studies, in Hashimoto’s patients, have shown that a gluten free diet can decrease one’s need for medication and dampen the autoimmune attack (38).

Irrespective of the exact gene or genes involvement, observational data is fairly clear that those with celiac disease have a high incidence of autoimmune thyroid disease (Graves’ and Hashimoto’s).

Now it’s important to mention that there is a growing subset of our population that does not have full blown celiac disease but does have what’s known as ‘gluten intolerance’ (39).

Recent medical studies support the idea that those with ‘gluten intolerance’ may also derive health benefit from a gluten free diet (40).

Vitamin Deficiencies
Vitamin D

It is becoming progressively more agreed upon that vitamin D helps fight autoimmunity to a greater or lesser extent. Lets look at a few details.

A 2012 study published in the journal Endocrine showed that patients who relapse after Graves’ treatment have lower vitamin D levels, while those who do not relapse have higher levels of vitamin D (41).

Interestingly other studies are suggesting that autoimmunity may be due to defects in the vitamin D receptor thus making the vitamin D in your body less effective. A 2013 study performed in Turkey showed that a certain defect in the vitamin D receptor left patients at higher risk for Hashimoto’s thyroid autoimmunity (42). Along these same lines, certain viral infections may actually block the vitamin D receptor and this may be another mechanism through which chronic infections lead to autoimmunity (43).

Omega 3s

Omega 3 fatty acids have become an important dietary and supplemental considerations because they have become deficient in the diet in industrialized nations. Omega 3s serve numerous functions, regarding autoimmunity the most important function they confer is likely their effect on inflammation.

Every cell of your body has a coating around it know as a cell membrane. The cell membrane is comprised of fatty acids. If the cell membrane is composed of too much omega 6 and not enough omega 3 fats, then the cell is more prone in inflammation. Increasing consumption of omega 3s will help restore balance to your cell membranes and make you less prone to inflammation and autoimmunity. But how does inflammation tie in with autoimmunity? Remember one of the hallmarks of autoimmunity is on overzealous immune response. Your body mounts an immune response by sending out white blood cells that essentially shoot inflammation at ‘bad guys’ to destroy them. This is good when it is controlled, but in those with autoimmunity the process rages out of control. Restoring proper levels of omega 3s is like taking bullets out of your immune systems guns thus preventing your immune system from getting out of control. Please remember its all about balance and over consumption of omega 3s may cause problems just like a deficient intake.

There is a wealth of data available on the health benefits of omega 3s. Just to quote one study regarding omega 3s effect on autoimmunity, the available evidence show that increased daily intake of dietary n-3 FA decreases the severity of autoimmune disorders…(44)”

Folate/MTHFR

Some patients have a gene mutation known as the MTHFR mutation. Essentially this mutation decreases one’s ability to break down folic acid. Folic acid is a synthetic form of the naturally occurring vitamin called folate. Because food processing damages folate, the synthetic form (folic acid), is added back to our food. Patients with this gene mutation cannot absorb folic acid and they become deficient in this vitamin.

Data on this topic is sparse and I question if treating this gene mutation will have any significant impact on thyroid autoimmunity. Some studies show an association with this mutation and autoimmune thyroid; one study showed that 30% of autoimmune thyroid patients had the MTHFR gene mutation (45).

However other studies show no correlation with this specific gene mutation and thyroid autoimmunity (46). Fortunately treating this gene polymorphism is inexpensive and safe as the preferred treatment is via diet and vitamin therapy. While this may not be the first item to address, it may be worthwhile to discuss this with your doctor if your doctor is up to date on this topic.

In Summary
We have reviewed information discussing conventional and natural treatment options. The first and most important action you can take is to undergo “Initial Treatment” for the symptoms of Graves’, the hyperthyroidism. This can be done with natural or pharmaceutical treatments. Once this is achieved you have bought yourself some time to decide on your next step of treatment.

The next step is to decide on “Secondary Treatment”; whether conventional or natural treatment will be your choice for addressing the thyroid itself. Likely the most important decision in this whole scenario regards the secondary treatment. Because conventional secondary treatment means permanent loss of your thyroid gland and subsequent need for thyroid medication for the rest of your life (in most cases) many would prefer this as a last resort.

Undergoing the functional medicine secondary treatment has the potential to save ones thyroid gland. The main criticism of this approach will be it is less well studied then the conventional approach. This is true, however it has more to do with funding. Natural treatments do not have the large research funding that drug and surgical procedures do. That being said we have covered a fair amount of research supporting the functional medicine approach. The functional medicine approach is natural and has the potential to allow one to avoid permanent loss of their thyroid, so it appears this is a highly logical first choice. You can always have the surgery/radiation later, but once it’s done there is no going back. Hopefully this review of Graves’ disease will enable you to make an informed decision that you feel

 

 
1 ^ Jump up to: 
a b c d e f g h i j k l m n o p q r s t u v w x y z “Graves’ Disease”. www.niddk.nih.gov. August 10, 2012. Archived from the original on April 2, 2015. Retrieved 2015-04-02.
2 ^ Jump up to: 
a b c Menconi F, Marcocci C, Marinò M (2014). “Diagnosis and classification of Graves’ disease”. Autoimmunity Reviews. 13 (4-5): 398–402. doi:10.1016/j.autrev.2014.01.013. PMID 24424182.
3 ^ Jump up to: 
a b c d e f g h Brent GA (June 2008). “Clinical practice. Graves’ disease”. The New England Journal of Medicine. 358 (24): 2594–605. doi:10.1056/NEJMcp0801880. PMID 18550875.
4 ^ Jump up to: 
a b c Burch HB, Cooper DS (December 2015). “Management of Graves Disease: A Review”. JAMA. 314 (23): 2544–54. doi:10.1001/jama.2015.16535. PMID 26670972.
5 ^ Jump up to: 
a b c d e Nikiforov YE, Biddinger PW, Nikiforova LD, Biddinger PW (2012). Diagnostic pathology and molecular genetics of the thyroid (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 69. ISBN 9781451114553. Archived from the original on 2017-09-08.
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