Graves’ (Thyrotoxicosis): Hyperthyroidism
Graves’ is an autoimmune condition named after the Irish doctor Robert James Graves, who first discovered it in 1835. In this condition, as the immune system attacks the thyroid gland, it becomes enlarged and produces excessive amounts of the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
It is estimated that this condition affects roughly 2.5 million people in the U.S., and as with most autoimmune conditions, Graves’ is more common in women, usually between the ages of 20 and 40.1 Although Graves’ is the number one cause of hyperthyroid symptoms, not all people with Graves’ have symptoms, and not all people with hyperthyroid symptoms have Graves’. Sometime symptoms can be caused by a goiter, which we will address later.
Graves’ has been recognized as being directly related to trauma and stress.2 In fact, many people report the onset of their symptoms being precipitated by a traumatic event or acute infection.
How is Graves’ Diagnosed?
Graves’ may be difficult to diagnose because many of the symptoms come on gradually and mimic other conditions. It’s not uncommon for a person to visit her doctor five to six times before the thyroid is suspected.
What You Need to Know: Autoimmune thyroid conditions rarely exist alone. There are typically combinations of several conditions presenting at the same time.
When the thyroid makes too much thyroid hormone, a person can begin to experience a variety of uncomfortable symptoms:
• Sensation of feeling too warm, sweating, sweaty hands—heat intolerance
• Feeling hungry all the time and losing weight despite eating more
• Feeling of fullness in the neck, goiter, enlarged thyroid
• A fast or irregular heart rate
• Inner trembling, tremors
• High blood pressure
• Shortness of breath—feeling like you can’t catch your breath
• Nausea, frequent bowel movements or diarrhea
• Feeling “wired but tired,” exhaustion, fatigue
• Bulging eyes, painful dry eyes, puffy eyes
• Muscle and joint pain or fatigue
• Hair loss or brittle, dry hair
• Bleeding gums and gum infections
• Chronic urinary tract infections (UTI’s)
• Chronic yeast infections of the GI and urogenital tract
• Chronic sinusitis—fungal
• Libido changes—increases for women; decreases for men
• Infertility/pregnancy complications/light or ceased menses
• Skin conditions, vitiligo, rashes, hives, itching, rash on ankles and shins (Graves’ dermopathy/pretibial myxedema)
• Swollen lymph glands
• Nail changes—separation of nail bed from skin
• Manic feelings/racing thoughts
• Sleep disorders—difficultly falling and staying asleep
• Mood swings
• Anxiety and panic attacks
• Quick temper, uncontrollable anger or rage
• Memory problems
• Difficult concentration
• Trouble making decisions
• Feeling like there is not enough time
• Feelings of being left out
That is a long list of symptoms, and since most doctors have less than ten minutes with each patient, you can see how easy it might be to misdiagnose this condition. The most common symptom is anxiety and irritability; so many people are given prescriptions for depression and anxiety before the thyroid is even suspected.
Once your doctor suspects that your thyroid is the cause of the symptoms, she will usually order a series of blood tests to determine levels of thyroid-stimulating hormone (TSH) and thyroxine (T4).
If the test comes back with a suppressed TSH and a high level of thyroxine (T4), she will most likely refer you to an endocrinologist. This is because most general practitioners, OB/GYNs and nurse practitioners don’t feel as comfortable treating hyperthyroid patients as they do hypothyroid patients. This is probably a good thing because hyperthyroid conditions can be dangerous, and it’s important that the practitioner has experience in the diagnosis and treatment of acute hyperthyroidism.
The endocrinologist or thyroid specialist will typically do a physical examination and run a full thyroid panel to determine whether your symptoms are due to an autoimmune process such as Graves’ or Hashimoto’s, a “hot” nodule (also called toxic nodular goiter), or thyroiditis.
Note: There are other reasons your thyroid could be making excessive amount of thyroid hormone. In this article, we are only going to focus on the autoimmune condition, Graves’.
With Graves’ the thyroid becomes swollen and starts to produce too much thyroid hormone. When thyroid hormone levels go up, the pituitary gets the signal and stops producing TSH.
People diagnosed with Graves’ may have high levels of antithyroid peroxidase antibodies (anti-TPO); Thyroid-Stimulating Immunoglobulins (TSI)—also called TSH receptor antibodies (TRAb); and antinuclear antibodies (ANA).
If you have symptoms of hyperthyroidism and you test positive for anti-TPO and TSI/TRAb, a diagnosis of Graves’ is made. But it’s important to note that not all people with Graves’ have these antibodies, which makes it a complicated condition to diagnose.
Other Diagnostic Tests
The body needs iodine to make thyroid hormones. One way to assess thyroid hormone function is by a radioactive iodine uptake test. For this test, you will be asked to take a small dose of radioactive iodine or radioiodine (iodine 123), and then you are checked with an X-ray a few hours later to see how fast your thyroid absorbs it. With Graves’, the entire thyroid become “hot” or overactive, and will take up a higher amount of iodine than a normal thyroid. This causes an elevated RAU-I result.
This test is also used to find out if thyroid nodules are hot or cold. Hot nodules overproduce thyroid hormones, and will show up that way on the X-ray.
If your symptoms of hyperthyroidism are due to a pituitary tumor or you are taking too much thyroid hormone, the results of the uptake will be normal.
Sometimes, your doctor might order a fine needle aspiration of the thyroid, which will show the activity of macrophages and T-cells.
What is the Conventional Treatment of Graves’?
Conventional doctors don’t typically question why a person’s thyroid is under attack by the immune system. Their main concern is to stop the production of excess thyroid hormones at all costs—even if that means the total removal of the gland itself!
If you’ve been diagnosed with Graves’, there’s no doubt that you have been presented with one or all of the following options. These options do not address the cause of the autoimmune condition. Instead, they remove or suppress the target organ and the condition continues in the body resulting in further autoimmune activity down the road.
Antithyroid Drugs (ADT)
Your doctor might initially prescribe antithyroid drugs such as methimazole (Tapazole) or propylthiouracil to block the formation of T4 and T3. While roughly 30 percent of people treated with long-term antithyroid medication will go into “remission” with this treatment, it’s important to remember that it’s not a cure. Sometimes, beta blockers, including propranolol (Inderal), atenolol (Tenormin) and metoprolol (Lopressor), are prescribed to relieve the symptoms of rapid heart rate and nervousness, but these drugs can potentially cause side effects and do nothing to address the cause of the autoimmune process.
If your hyperthyroid symptoms are severe, the short-term use of antithyroid medications may be indicated, but you and your doctor must search for the underlying cause of your autoimmune condition and treat that immediately in order to heal completely.
RAI (I-131): Radioactive Iodine Treatment
When antithyroid drugs fail to alleviate the symptoms of hyperthyroidism, the next course of treatment is to permanently shrink the thyroid gland with radioactive iodine (I-131). The thyroid needs iodine to make its hormones, so it absorbs the radioactive iodine and the radiation destroys some of the thyroid cells. The treatment is taken orally, either in liquid or pill form in a single dose, and takes three to six months to shrink the gland.
The amount of damage that that this treatment does cannot be controlled, so most people wind up becoming hypothyroid after this treatment and then need to take thyroid replacement hormones for life.
Since you have radiation in your body during treatment, you will be advised to avoid close contact with other people and pregnant women for two weeks after treatment. This includes sleeping in the same bed with your partner! The radiation is also absorbed by other tissues such as the breasts, the ovaries and testes, the pancreas and GI tract and may lead to DNA damage and increased cancer risks down the road.
This treatment does not address the cause of the autoimmune process, and the condition will likely persist somewhere else in the body. It also sets the stage for other conditions that may be caused by radiation exposure.
The most drastic form of treatment is a thyroidectomy, where all or part of the thyroid is surgically removed. As with radioactive iodine treatment, most people become hypothyroid and have to take thyroid replacement hormones for life. The complications of surgery can include paralysis of the vocal cords and damage to the parathyroid glands, which are the tiny glands behind the thyroid gland that control calcium absorption in the body.
What to do first if you’ve been diagnosed with Graves’
If you have been diagnosed as hyperthyroid due to Graves’ or are in a hyperthyroid stage of Hashimoto’s, your next step will depend on the severity of your symptoms. I have found that working with hyperthyroid clients can be difficult due to the high anxiety and increased emotionality they experience. If you are very anxious and emotional and have severe symptoms, your doctor may recommend a beta blocker, an antithyroid medication, or an anti-anxiety medication. This is perfectly acceptable, and may be necessary to help you to feel better right away.
If your symptoms are mild, you may decide to try some calming botanical preparations, such as bugleweed, valerian root, and lemon balm. Some of my clients have also found relief from eating a lot of the foods known to suppress thyroid activity, such as broccoli, kale, and Brussels sprouts, etc. You can read more about these foods in Chapter 14 of The Thyroid Cure: Optimize Your Nutrition.
Please keep in mind that taking medication and herbal treatments to reduce your symptoms will not reverse your condition. In order to heal, you will still need to find out why you have antibodies to your thyroid or other tissues in the first place.
Once you and your doctor have decided how to manage your hyperthyroid symptoms, your next step is to begin the Sensitivity Discovery Program, and then address any splinters you may have uncovered.
Graves’ and the Stress Connection
I have found that reducing stress is a big factor in recovery from Graves’ and the related symptoms. I’m not being trite; I realize that what you are going through is very difficult, and the symptoms can be awful. The hyperthyroid symptoms that accompany Graves’ and sometimes Hashimoto’s can make you feel like you are running from a pack of saber-toothed tigers! The last thing you probably want to hear is that you “should reduce your stress.” But what I have found is that in order to feel better, you must take your health into your own hands, and that includes your emotional health. You will benefit greatly from reading Chapter 15 and beginning a stress reduction program while you work on positive lifestyle changes.
Things You Can Do to Start Feeling Better Fast!
Healing involves restoring balance to the core systems of the body. While you work to get the proper thyroid tests to balance your thyroid hormones, you can begin to support your healing process by strengthening your body with good nutrition, supplementing deficiencies, and reducing your stress. I discuss just how to do that in The Thyroid Cure and on this website . If you need more help, please sign up for a tele series immersion program or make an appointment with me.
Remember, the body knows how to be healthy and will naturally move toward vibrant health if given what it needs: positive thoughts; sufficient rest; stress relief; vibrant food and proper nutrients; healthy GI and eliminatory systems; good detoxification pathways; and healthy environments!
If you have been diagnosed with Hashimoto’s or Graves’ you don’t have to suffer with this condition for the rest of your life. You can cure yourself! I wrote The Thyroid Cure so that you learn about how can uncover the roots of your condition and heal!
Buy The Book
The Thyroid Cure is the most comprehensive and well-researched book on the topic of autoimmunity, what triggers it and how to heal naturally.
It’s not just about autoimmune thyroid disease. It’s about all autoimmune conditions.
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In The Thyroid Cure, I outline the exact steps that anyone can take to reverse ANY kind of chronic, inflammatory autoimmune condition. I show you how to become empowered, navigate the broken medical system and get the right care, so that you can undercover the roots of your illness and heal for good.
My book has already helped thousands of people finally solve the mystery of autoimmunity and take the path to healing.
What you get with The Thyroid Cure
The Thyroid Cure comes with the following online companions:
· 14-Day Detox Program
· 30-Day Meal Plan
· Test Request for your doctor
· Mind-Body Assessments to help you uncover the roots of your condition
The Thyroid Cure is the roadmap you need for your path to healing!
1. Georgetown University Medical School. Thyroid Disease. http://medicine.georgetown.edu/divisions/endocrinology/knowledge/thyroid-disease
2. Weetman A. Review Article: Graves’ Disease. N Engl J Med Online. Oct. 2000 http://isites.harvard.edu/fs/docs/icb.topic442065.files/Endocrine_Readings/Graves_Disease.pdf
Michelle Corey, C.N.W.C., FMC, is a Wellness Recovery Specialist, Certified Nutrition and Wellness Consultant, researcher and author. Michelle studied holistic nutrition at Clayton College of Natural Health and completed a comprehensive 2-year practical program at Academy of Functional Medicine and Genomics. Since reversing her autoimmune condition, Michelle has helped hundreds of people reverse autoimmune and other chronic conditions. She is currently an advisor to the Academy of Functional Medicine and Genomics and the Functional Medical University. She is a member of the Institute of Functional Medicine and the National Association of Healthcare Advocacy Consultants. Michelle and offers Functional Mind-Body healing retreats, workshops and online courses.
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