Hyperthyroidism

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

The Need for a Patient Approach as Well as a Patient-Centered Approach

The prevalence of hyperthyroid imbalance in the population is still a controversial subject, since a real differential definition of clinical hyperthyroidism, and subclinical disease or biochemical imbalance, has not been clarified. The treatment strategy for hyperthyroidism has not reflected the changes in scientific information gathered in the last 20 years, and the need to treat the subclinical or developing disorder holistically. Most patients with a hyperthyroid imbalance remain undiagnosed until symptoms and signs of a threatening nature become evident. Of those patients now diagnosed with an abnormal TSH level, but not yet with threatening signs and symptoms, the treatment strategy is basically the same as those patients with a clinical disease in standard medicine. Studies have indicated that an average of nearly 3 years occurs in Graves' disease, and other endocrinological diseases, between the report of intial symptoms and the diagnosis of a clinical disease. The progression of the hyperthyroid imbalance may have occurred for years even before this report of first symptoms, which often involve inexplicable anxiety, nervousness, rapid heart rate episodes, and hyperactivity and short-term memory changes. Studies have indicated that anxiety and panic disorders precede a diagnosis of Graves' disease and hyperthyroidism in a significant percentage of cases by 4 to 5 years. It is time for both patients and physicians to adopt a better strategy for addressing the slow and insidious progression of hyperthyroid imbalance and the associated health disorders, iodine deficiencies, and related environmental factors. The adoption of integrated medicine, and the utilization of Complementary Medicine to help correct these often slowly developing health problems with hyperthyroidism, needs to be seriously considered, by both the patients and the thyroid specialists.

Physicians and patients need to recognize the signs of a potentially developing clinical hyperthyroid disorder early in the course of this most often slowly developing endocrine imbalance. By addressing the underlying health issues in the years in which the hyperthyroidism is developing into a more threatening disease, overt hyperthyroidism may be averted, and the need for drug dependency, surgery, or radioactive destruction of thyroid tissues eliminated.

Numerous large population studies have been conducted since the landmark 1995 study entitled The Colorado Thyroid Disease Prevalence Study, confirming a very high percentage of the populations with abnormal TSH levels. There has been little agreement worldwide on the implications, or even the definitions of differentiated thyroid disorders based on normal and abnormal TSH levels. The range of normal TSH is still controversial, and although studies show differences in the asymptomatic TSH levels with aging, the range of normal TSH has not been adjusted. A 2004 large study of the population in France (Valeix P et al: Annals of Endocrinology (Paris) 2004 Dec;65(6):477-86) found that among a representative population of 11,256 men and women, with patients previously diagnosed with thyroid disease excluded, that TSH levels of less than 0.4, indicating a subclinical hyperthyroid imbalance, were found in 7 percent of men, 5.3 percent of women aged 35-44, and 4.4 percent of women aged 45-60. The prevalence of subclinical hypothyroid imbalance as noted by TSH 4-9.9 were 11.1 percent of women aged 45-60, 7.2 percent of women aged 35-44, and 4 percent of men, with an additional nearly 1 percent of the population with a TSH greater than 10 mU/I, among the general population not diagnosed with a thyroid disease or imbalance. These studies conclude that it is still unclear whether this high percentage of the undiagnosed public is experiencing a biochemical imbalance or dysfunction, or a traditional thyroid disease. The French study concluded that a significant percentage of patients with abnormal TSH were affected by iodine deficiencies or other environmental factors (see study links below). When an abnormal TSH level is found in your testing, it is time to take a comprehensive and holistic approach to correcting a slowly developing hyperthyroid imbalance, integrating Complementary Medicine, and gaining a real understanding of this confusing health problem.

While diagnosis of hyperthyroidism, especially Graves' disease, which almost always indicates an autoimmune disorder that is often indeterminate and sometimes complex, is often made when clinical signs indicate a threat to health, the actual course of development of most hyperthyroid disorders is slow and insidious. The term insidious indicates that the disease has progressed silently, with subtle signs and little or no overt symptoms. It is important for physicians to recognize the early dysfunctions leading to clinical hyperthyroidism and treat this disorder by restoring health before a clinical course is evident. Hyperthyroidism of a subclinical nature, or with mild to moderate symptoms, is often a slowly developing health problem that should be addressed with restoration of health and hormonal balance whenever possible. A review of treatment strategies in hyperthyroidism by the esteemed Cleveland Clinic, authored by Kevin M. Pantalone M.D. and Christian Nasr M.D. of the Endocrinology and Metabolism Institute, stressed in 2010 that current approaches to the treatment of many cases of hyperthyroidism should avoid immediate use of pharmaceutical medications, surgery, radioactive iodine, etc. that have been the hallmark of treatment of more serious clinical hyperthyroid presentations in the past. The report, entitled Approach to a low TSH level: Patience is a virtue, outlines how many cases in which a patient is found to have a low TSH (thyroid stimulating hormone of the hypothalamus/pituitary) are promptly treated with a variety of standard treatments which may not be necessary, and often have long-term deleterious consequences.

Often, today, a low TSH value is not properly assessed by endocrinologists and followed up with appropriate testing to determine the differential diagnosis. These tests should include measurement of the thyroid hormones in circulation, thyroxine (T4) and triiodothyronine (T3), especially the unbound, or free T3 and T4, as well as the array of antibodies associated with an autoimmune reaction. Thyroid peroxidase antibody (TPO) greater than 2 IU/ml may indicate either Hashimoto's or Grave's, Anti-microsomal antibodies greater than 35 units/ml may indicate an autoimmune reaction as well, Anti-thyroglobulin antibodies may also indicate Hashimoto's or cancer, and TSH receptor antibodies may indicate Grave's, although the diagnosis is not confirmed by antibodies alone, and often more than one may express. A percentage of euthyroid patients are also positive for antibodies, and some studies indicate that 13 percent of the population may test positive for both TPO and anti-thyroglobulin antibodies, perhaps associated with environmental toxins and mild autoimmune reactions against the thyroid tissues where these accumulate. To properly assess hyperthyroidism, a step-by-step diagnostic approach is recommended, as a number of causes could underly the finding of a low TSH level, and appropriate treatment should be applied to the correct underlying pathology, not a one-size-fits-all approach. While the temptation of the "magic pill", or antithyroid medication, is a simple solution, the long-term outcome may not be in the best interest of the patient. These experts at the Cleveland Clinic joined a growing chorus of thyroid experts who are alarmed at the standard treatment protocol today, as most cases of hyperthyroidism are slowly developing and pose no immediate threat to the health, hence the need for patience in assessment and treatment. One implication of this sensible approach is the possibility of trying more conservative therapies in Complementary Medicine when diagnosed with hyperthyroidism, unless the severity of the disease warrants a more immediate and radical approach, which is infrequent.

The diagnosis of hyperthyroidism most often means that the patient has a non-threatening and slowly developing dysfunction that may develop, in a small percentage of cases, into a threatening overt hyperthyroidism. Experts today recommend that the patient and treating physicians adopt a patient attitude as well as a patient-centered attitude, improving the underlying health to see if the endocrine dysfunction can be corrected without harsh medications, radioactive iodine, or surgical removal of the thyroids, all of which may insure a lifelong dependency on drugs, and a long-term outcome that is undesirable concerning quality of life. Today, Complementary Medicine may play a significant role in helping the patient to improve their health and correct the various underlying health problems that may cause a mild to moderate hyperthyroidism, or even the other pathologies that may cause the finding of a low TSH, which is not a thyroid hormone, but a hypothalamic/pituitary hormone called thyroid stimulating hormone. A thorough differential diagnosis is necessary in this disease, and patients often need to insist that it is performed properly.

Understanding the implications of a low TSH level

Not all findings of a low TSH indicate the same disease. For instance, overt hyperthyroidism is usually associated with a frankly suppressed TSH of less than 0.1. Even this low level could be a temporary abberation, caused by a number of health and environmental factors, including adverse effects of various medications. As the experts cited above state: "Low TSH has many causes", and a TSH less than 0.4 microIU per milliLiter (μIU/mL = μU/mL = mIU/L = mU/L) "can result from a variety of conditions that must be included in the differential diagnosis - not just overt or subclinical hyperthyroidism. In diagnosing the correct cause, patience is a virtue." These experts were compelled to publish this paper due to the alarming standard protocol seen today in the treatment of low TSH and the diagnosis of hyperthyroidism. When patients are aware of these facts, the treating medical doctors often do what the experts at the Cleveland Clinic recommend, hold off on prescribing harsh therapies and medications, and approach the complex differential diagnosis slowly, and in a step-by-step process, monitoring the TSH and other thyroid markers every 3 to 6 months to insure that the patient is not rapidly developing a more threatening scenario. This approach leaves open the possibility that, with the help of Complementary Medicine, especially the knowledgeable Licensed Acupuncturist and herbalist, that the hyperthyroid disease can be reversed. And as the differential diagnosis elucidates the correct underlying causes of the low TSH, this correct differential diagnosis should guide the therapy.

A 2004 article in the European Journal of Endocrinology, by Bernadette Biondi et al, states that "the pituitary (/hypothalamus) gland is sensitive to minor changes in serum thyroid hormone levels, and serum TSH reponds with logarithmically amplified variations to such changes. Therefore, the distinction between subclinical and overt hyperthyroidism, which is based on population-based reference range for thyroid hormone levels, is somewhat arbitrary and diagnosis depends on the position of the (individual) patient's setpoint for thyroid hormones within the laboratory range." What this means is that a particular patient may have many health factors affecting the actual thyroid production of active hormones, and small changes in these levels may be amplified dramatically, or logarithmically (by the square root; e.g. a simple change could be magnified times ten), in terms of serum TSH changes. These experts contended that even for nearly undetectable TSH levels, the diagnosis of overt hyperthyroidism must be supported by relevant changes in several cardiovascular measures, in bone density changes, and relevant signs and symptoms. We see that the range of TSH and free thyroid hormones in circulation may vary dramatically in the normal population. With patients experiencing an adrenal stress syndrome, other hormonal imbalances, aging, or even side effects of various medications, as well as environmental stressors, a simple change in thryoid hormones in circulation, often transitory, could result in dramatic changes in TSH. This is reflected even in treatment strategies in standard medicine. Today, many thyroid experts may utilize an adrenergic blocker, such as a selective beta-blocker, to reduce early signs and symptoms in subclinical hyperthyroidism, especially when atrial fibrillation is noted. This, in effect, acknowledges that adrenal dysfunction of a subclinical nature is integral to the pathology. Both the cardiovascular and osteoporotic problems are related to a broader endocrine dysfunction, namely the homeostatic regulation of the calcium metabolism.

An array of health problems could cause a low TSH. These include a central hypothyroidism (deficient function of the hypothalamus and/or pituitary), subclinical hyperthyroidism either with thyroid nodules or not, thyroid dysfunction (euthyroid sick syndrome), elevated human chorionic gonadotropin (hCG), medication side effects, thyroid toxicosis (thyroid nodule or lesion producing a toxic effect), autoimmune disease (Hashimoto's or Graves autoimmune disease), early Graves disease, Graves disease, thyroiditis (inflammatory disorder), iodine-induced hyperthyroidism, the rare ovarian struma, or cancer (functioning thyroid cancer metatastases are also rare). The diagnosis is often puzzling. The Rheumatologist or Endocrinologist must spend time to properly solve the diagnostic puzzle, and an array of tests and exams must be performed. Often, today, the patient must insist on this process, as the insurance companies and health corporations are loathe to provide it when a one-size-fits-all approach is cheaper. Pregnancy, or long-term use of synthetic hormonal contraceptives may be associated with the devlopment of the thyroid dysfunction. Various dietary mistakes may contribute as well.

In many cases of subclinical hyperthyroidism, meaning that the overt effects of the disease or dysfunction is not evident from clinical symptoms, other markers of the disease, such as the free T4 and T3 thyroid hormones (fT4, fT3), will be normal in circulation. If this is the case, subclinical hyperthyroidism, resolving hyperthyroidism, nonthyroid illness, medication-induced hyperthyroidism or hypothalamic dysfunction, or a pregnancy-related hyperthyroidism may be suspected. If the fT4 is normal, but the fT3 is elevated, thyroid toxicosis is suspected. If the fT4 is high, then thyroglobulin (the protein precursor to thyroid hormones), and thyroglobulin autoantibodies must be tested, and if these are increased, thyroiditis, excessive iodide exposure, or extraglandular production may be suspected. Measurement of the thyroid uptake will help differentiate Graves disease, toxic multinodular goiter, or toxic adenoma. Of course, a physical exam and ultrasound will help to find the presence of small nodules as well. Not only low TSH, but high TSH might also cause hyperthyroidism, but this is seen more rarely, and if fT4 is high as well, secondary hyperthyroidism or pituitary lesion or tumor is suspect. The presence of small pituitary and hypothalamic lesions that alter hormonal secretion is much more prevalent the was suspected just a few years ago. More extensive dissections after death have revealed that perhaps a majority of older patients will have small lesions or microtumors in or on the pituitary or hypothalamus. These tissue abnormalities could produce the alterations in TSH or HcG (Human Chorionic Gonadotropin, which may cause a subsequent change in the TSH).

The list of pharmaceutical drugs that may suppress TSH includes glucocorticoids (prednisone, fludrocortisone, dexamethasone, betamethasone, and beclometosone inhaler), some of the statin drugs that lower cholesterol, dopamine, dobutamine, and amiodarone (types of anti-arrhythmic medication). Interferon drugs, commonly used to treat hepatitis C, are also highly associated with hyperthyroidism, with some studies showing that interferon-induced hyperthyroidism may occur as a clinical pathology in 10 percent of treated patients, with an alarming 30 percent experiencing a subclinical thyroid disorder. Hormones fed to feed lot animals may accumulate and affect the TSH, and large doses of iodine or improperly prescribed thyroid medications, including natural thyroid extracts, could also alter the TSH levels. The combination of prolonged high-dose lithium, a treatment for bipolar depressive disorder, coupled with the use of iodide potassium supplment, has been associated with increased risk of hyperthyroidism. All of these considerations should be assessed by the treating physician. (This information is derived from Jeri R Reid MD Univ of Louisville School of Medicine, in an article published in the American Family Physician in 2005).

The prevalence of subclinical hyperthyroidism

While the incidence of overt hyperthyroidism in the United States is low, the incidence of subclinical hyperthryoidism may be much higher than anyone realized in recent decades. Experts from Johns Hopkins Medical University and the University Frederico II Medical School in Naples, Italy, David S. Cooper, Bernadette Biondi MD, et al, have published research in recent years that has elucidated the potentially high incidence of subclinical hyperthyroidism, and the reasons why most of the cases may go undiagnosed. These experts stated: "To date, there is no definitive information about the incidence of subclinical hyperthyroidism in the general population. Its prevalence ranges from 0.6 to 16 percent depending on the diagnostic criteria, the sensitivity of the methods used to measure serum TSH concentrations, and iodine intake. In any event, subclinical hyperthyroidism appears to be a frequent disorder." Like many disorders that do not present overt and threatening symptoms, or have a reliable pharmaceutical remedy that is without significant side effects, subclinical hyperthyroidism has been ignored by standard medicine, despite the negative consequences of this disorder for the quality of life and general health of the patient.

Most cases of subclinical hyperthyroidism are diagnosed because of blood tests that look at the TSH (thyroid stimulating hormone) levels, and find that the TSH level is less than optimal. Overt hyperthyroidism is suspected if the TSH is less than 0.1, and this may indicate that the thyroid glands are producing an excess of hormone due to abnormal growths, or nodules. In this case, the free T4 and T3 in circulation will be high, which creates the negative feedback that results in very low production of thyroid stimulating hormone, or TSH. If the TSH level is less than 0.5 though, and the free T4 and T3 are not elevated in circulation, this indicates a subclinical syndrome of mildly suppressed hypothalamic-pituitary secretion. As stated above by experts, the methods used to measure TSH concentrations in blood serum also have variable sensitivities, so this low TSH finding could also indicate that a problem exists with the laboratory services. The experts cited above state: "It is important to recognize that subnormal levels of serum TSH do not always reflect the presence of subclinical hyperthyroidism. Subnormal serum TSH may occur in patients with pituitary or hypothalamic insufficiency, or non-thyroid pathological conditions, or consequent to administration of the glucocorticoids (prednisone et al), dopamine or amiodarone (anti-arrhythmic medication). In additioin, TSH concentration may be below the normal range in some elderly patients as a result of decreased age-related thyroid hormone clearance." Without a great effort to individually explore the underlying reasons for TSH levels between 0.1 and 0.5, the actual incidence of subclinical hyperthyroidism may never be adequately assessed.

Signs and symptoms of a developing subclinical hyperthyroid disorder

Since there are many potential causes of a developing subclinical hyperthyroidism, the identification of early signs, and the course of treatment to prevent development of the clinical hyperthyroid state must be individualized. In integrative Complementary Medicine the patient may utilize a comprehensive approach to correct these problems at an early stage with treatment that is safe, promotes general health, and may prevent the need for future drug therapies, as well as improve the quality of life. Experts agree that while subclinical hyperthyroidism may not be life threatening, is does reduce the 'quality of life',affecting a number of systems in the body, including the central nervous system, the endocrine system, and the cardiovascular system, and may accelerate such conditions as osteoporosis. Cardiovascular signs, such as an altered heart rate, resulting in arrhythmia, tachycardia, or a decreased tolerance to hard exercise, or contributing to a sense of episodic anxiety, or sleep disorders, may be seen. The most common early signs of subclinical hyperthyroidism include difficulty falling asleep, nervousness, restlessness, abnormal warmth, shortness of breath, or an episodic fast heart rate (tachycardia). Often, these signs and symptoms are considered mild and overlooked. As the hyperthyroid syndrome slowly progresses to an overt, or clinical presentation, such signs and symptoms as mild tremor of the upper extremities with stress and exertion, hair loss, and inexplicable weight loss may be seen. Of course, all of these signs and symptoms may be attributable to other health problems, which stresses the need for a careful and intelligent evaluation.

Early signs and symptoms of thyrotoxicosis, or a clinical hypermetabolic syndrome due to elevated serum T3 or T4, with accelerated thyroid hormone synthesis and secretion, include anxiety, palpitations, rapid pulse, fatigue, muscle weakness, tremor, weight loss, diarrhea, heat intolerance, warm skin, excessive perspiration, menstrual changes, and tremor of the hand with use. Late symptoms of thyrotoxicosis include cardiac pathology (palpitations, congestive heart failure, cardiomegaly, fatty change), as well as fatty changes of skeletal or liver tissues, osteoporosis from bone resorption, generalized lymphadenopathy, and in a small percentage of cases ocular changes, with a wide staring gaze and lid lag, caused by sympathetic nervous system overstimulation of the levator palpebrae superioris muscles. While Graves's disease is thought to account for over 80 percent of these cases, assessment in recent years has shown that pituitary lesions and adenomas are much more prevalent than we had thought, with autopsy studies indicating that perhaps 10 percent of the aging population has a benign pituitary adenoma, usually oncocytic (abnormal excess of mitochondria in the affected cells), and often stimulating excesses of various pituitary hormones, such as growth hormone (GH), human chorionic gonadotropin (HcG), adrenal corticotrophic hormone (ACTH), or prolactin, that could lead to hyperthyroidism. The incidence of benign hypothalamic and pituitary lesions other than adenomas is also higher than expected, and could produce the subclinical hyperthyroid condition.

Assessment of Thyroid Nodules in Diagnosis and Differentiation

To assess whether the thyroid dysfunction is resulting from a thyroid gland abnormality, either a growth or nodule, or an inflammatory disorder, the thyroid specialist should perform a physical exam, palpating the thyroids for signs of growth, an ultrasound, and if nodules are suspected, a biopsy. The thyroid glands are usually not felt with palpation against the trachea, but with a rolling of the fingers agains the harder trachea, sometimes aided by the patient swallowing, small nontender lumps many be felt, or a larger soft goiter. If tender enlargement is felt, a more inflammatory type of hyperthyroiditis, such as subacute DeQuervain's is suspected. Cancerous growths are rarely felt, but may be hard and attached. The fine needle aspiration biopsy of the thyroid glands is an initial step in the management of thyroid nodules, useful in distinguishing benign from neoplastic, or malignant tumors, and to diagnose papillary carcinoma. This fine needle aspiration should be considered a screening test, not a definitive diagnostic test. If the specimen is adequate, sensitivity and specificity with fine needle aspiration are greater than 90 percent, but considering the small size of the thyroid glands, assuring adequate tissue samples is problematic. High false-negative rates exist for detecting thyroid malignancy (Am J Surg;195;396). For this reason, a repeat fine needle aspiration may be ordered. The test should collect 5 groups of 10 cells each of well preserved follicular epithelium. Differentiation with fine needle aspiration between follicular or Hurthle cell adenomas, and carcinomas may require an additional biopsy with excision. The fine needle aspiration cannot definitively diagnose follicular variants of papillary carcinoma, and further diagnostic testing may be required to confirm this finding. False positives in fine needle aspiration of 10 percent are noted in studies, and false negatives of 25 percent (Cancer 2008;114:27). Nevertheless, this test is an essential component of the diagnosis of thyroid nodules. All of the information from labs and physical testing should be gathered and assessed thoughtfully, as the possibilities in differential diagnosis of hyperthyroidism are varied and complex.

Environmental Causes of Hyperthryroidism

A number of environmental causes are being studied to identify the causes if increased incidence of subclinical and clinical hyperthryoid disease. Water contamination and radiation exposure levels are the areas of most concern. In 2006, the U.S. Centers for Disease Control and Prevention (CDC) reported that women may develop thyroid disorders after consuming trace amounts of perchlorate, a chemical used in the production of rocket fuel, road flares, pyrotechnics, and automobile devices, in the drinking water. Of course, this finding was immediately criticized, despite the findings of increased incidence of thyroid disorders in areas surrounding the aerospace industry. Perchlorate is known to inhibit the thyroid gland uptake of iodine, an essential nutrient mineral that is now found to be deficient in a high percentage of women in the United States. Iodine deficiency is due to a number of factors, including the depletion of the topsoils by industrial farming methods and erosion, the increased use of competing halogens in industry (bromide, fluorine, et al), as well as the increased use of synthetic hormones in contraception and post-menopausal hormone replacement. Excessive intake of cigarette smoke and alcohol is also associated with iodine deficiency, as well as excessive intake of calcium supplements, and poor dietary habits. Iodine is a key component of production of thyroid hormones, as well as regulation of thyroid hormones, acting as the key chemical in the release of the stored hormones and the activation of the hormones at the receptors, and is an important antioxidant and detoxifying chemical in the thyroid. As the body struggles with iodine deficiency, the stress upon the thyroid and endocrine feedback regulation may create various stresses for the thyroid function and tissue health. Perchlorate pollution may a be an important factor leading to this increased incidence of thyroid disorders in the last few decades.

Often, there is more than one factor leading to the gradual development of a hyperthyroid dysfunction. Excess exposure of environmental radiation over time is also associated with iodine deficiency. Since iodine is a highly regulated essential mineral in the body that comprises the backbone of thyroid hormones and regulates their activation, both the deficiency of iodine and the inhibition of uptake of iodine by the thyroid glands is an area of much concern in the epidemiology of thyroid disesases, both hypothyroid and hyperthyroid. Perchlorate is a known inhibitor of iodine uptake, evidenced by its use in medicine to treat hyperthyroidism for 50 years as a potent inhibitor of iodine uptake to achieve an antithyroid effect. Today, due to the adverse effects and risks associated with perchlorate treatment of acute hyperthyroidism, the use of potassium perchlorate as a medicine in most countries has been discontinued. In the 1960s, perchlorate medications in high dosage were found to induce aplastic anemia, a serious type of anemia that sometimes results in death, and involves the failure of the bone marrow to produce enough new blood cells. The type of perchlorate toxicity we find in the general population, that may be associated with thyroid dysfunction, is not the high dosage used to decrease the thyroid function acutely in overt hyperthyroidism, but a small constant dosage accumulating in the gland from environmental pollution. When coupled with the stress of increased accumulation of radiation, this low level of perchlorate toxicity may become a more prominent threat, especially in patients that have a history of heavy cigarette smoking or alcohol use, poor dietary habits, or even the long-term use of hormonal contraceptives. When these factors are combined, the risk of thyroid dysfunction is increased.

What is perchlorate and how can it be eliminated from the environment? Perchlorates are salts derived from perchloric acid that are widely used in various industries. Not only the manufacture of solid rocket fuel, but numerous applications in the automotive industry, such as oxidizers in airbags, seat belt pre-tensioners, tire pressure monitor systems, valve sensors, and batteries in keyless ignition systems utilize perchlorates, as well as safety flares and fireworks. Factories that produce these perchlorates for these industries also contribute to environmental contamination. While perchlorates exist naturally in the environment, most perchlorate salts are soluble in water, but these perchlorates commonly used in industry do not easily break down in the environment. The Environmental Protection Agency (EPA) released a report in 2004 that found perchlorate in ground water and drinking water in 26 states, as well as cow's milk. Obviously, these industrial perchlorates do not break down easily. The level of perchlorate concentration in water supplies exceeded the common limit of 2 micrograms per liter in many cases, with findings as high a 5 micrograms per liter in Massachusetts, and the level in samples of cow's milk averaged 1.3 micrograms per liter. In February of 2011, after many years of procrastination, the EPA finally declared perchlorates a contaminant in drinking water that needed to be regulated. The level of contamination by this date was extreme, though, with a CDC study in 2009 finding that 15 common brands of infant formula now show significant contamination with perchlorates. The injury to the health with this low level of exposure may only be seen years later. Methods to control perchlorate contamination could easily be implemented. Numerous alternatives to perchlorate have been developed; perchlorate wastes could be properly treated by the industries; methods to speed the breakdown of perchlorates could be devised and implemented; and new methods to treat drinking and waste water could be devised. The solutions apparently will not be implemented until the public demands it, and/or the government finally regulates the industry. Since the implementation of increased government regulation is sometimes a burden to industry, the best solution would be public awareness, speaking out, and voluntary changes by the industries. If the human beings that work in these industries don't change their attitudes, and the public doesn't speak out, then there is nothing left but increased government regulation of the perchlorate industry to protect us.

While perchlorate toxicity and inhibition of iodine uptake is most associated with hypothyroidism, especially subclinical hypothyroidism, the effect of altered thyroid homeostasis may lead to thyroid nodules and goiter, which are significant causes of hyperthyroidism as well. The National Research Council (NRC) of the National Academies of Health, in 2005, also determined that perchlorates could theoretically produce several types of adverse immunological reactions, with direct effects on cells, or modulation of thyroid hormone-immune homeostasis. Since autoimmune hyperthyroid conditions are very prevalent, such as Hashimoto's and autoimmune Grave's disease, this makes perchlorates a double threat in the area of environmental causes of hyperthyroidism. The fact that high dosage of perchlorates were used to inhibit thyroid production to treat acute clinical hyperthyroidism does not rule out the potential of low levels of perchlorates adversely affecting human thyroid function, as well as the endocrine axis. When considering the adverse effects of low levels of perchlorate toxicity on the immune system, and the high incidence of autoimmune hyperthyroidism, the most common type, we must also consider the cofactors environmentally associated with autoimmune disorders. Heavy metal toxins in the environment and altered food proteins, such as glutens, are the areas of much concern. The relationship between celiac disease and Hashimoto's autoimmune thyroiditis is alarming to health experts, and much research is presently being conducted to discover the puzzling relationship between the two. The most obvious connection would be the increased immune stress that occurs when our bodies are exposed to excessive levels of high-gluten flours and genetically altered food proteins.

Excess radiation exposure is an area of increasing concern in the unclear etiology of hyperthyroidism as well, both as an inhibitor of iodine metabolism, and as a direct cause of abnormal thyroid growths, or nodules. Accumulative radiation may also contribute to abnormal tissue growths in the hypothalamus and pituitary tissues, as well as CNS dysfunction. While the human organism is exposed to natural radiation, which is most often accumulative, since radioactive isotopes do not break down easily in many cases, and often have half-lives that exceed the normal human life span, humans have evolved ways to protect against natural levels of radiation in the body. Excess radiation, or the exceeding of the natural accumulative radiation levels, is a product of the modern industrial society. Today, even though the 2009 President's Council on Cancer elucidated the growing threat of radiation as a cause of cancer, and recommended that the medical industry curtails the use of radiation in imagery and treatment, the standard medical industry has instead increased the use of highly radioactive CT scans, as well as radiation therapies. The result, coupled with such uses of radiation as airport scanners, is that there is an excess accumulative level of radiation in a growing segment of the population. The effects of ionizing radiation on the thyroid have been studied for several decades, with meltdowns of nuclear power plants being the principle source of information on this subject. The results of decades of study is that there is a clear association of both hypothyroidism and hyperthyroidism with radiation exposure, as well as thyroid nodules and immune dysfunction, and the radiation exposure is most often accumulative and not a result of a single large exposure.

Other areas of concern with hyperthyroidism and environmental toxicity include the heavy accumulation of polybrominated biphenols (PBB), polychlorinated biphenols (PCB), polyaromatic hydrocarbons (PHC), and various problematic chemicals found in pesticides. Slowly, the public awareness of these toxic chemicals is forcing the industry to adopt changes, but the damage may have already been done to many people. The adverse effects of these various environmental factors occurs over time, and the addition of the various causative factors increases the risks. In addition, organic mercury and lead toxicities are also highly associated with hyperthyroidism, and an enormous amount of these heavy metal pollutants are being spewed into the air with outdated coal-fired energy technologies, as well as metal smelting and other industrial practices. The perverse persistence of our industries to continue with these dramatically harmful technologies that harm our health and contribute to an enormous heavy metal toxic accumulation in our environment, depositing in our waters, soils, foods, and the human tissues, all for the sake of added profit to an already highly profitable industry, is ethically and morally unbelievable. Fortunately, after decades of delay, the Obama administration has finally put us onto the path of requiring up-to-date technology to clean the smokestack emissions of these industries, and the first dozen of the new clean coal scrubbers have gone on line in 2012, saving many tens of thousands of lives yearly, and preventing hundreds of thousands of serious illnesses. Further information on this important subject is found in another article on this website entitled Lead, Mercury et al, neurodegenerative disease, immune and endocrine dysfunction, and organ damage from heavy metal toxins.

Standard treatment with hyperthyroid disorders

Today, the great majority of cases diagnosed as hyperthyroid are of a subclinical nature, and the most prevalent treatment is to start the patient on a 12 month course of antithyroid medication. This tactic has been questioned, though. In 1998, experts at the Mount Sinai School of Medicine in New York (Dr. Terry F. Davies et al) wrote that: "Over 50 percent of patients with hyperthyroid Graves disease relapse after a 12-month course of antithyroid drugs, the actual percentage varying among populations and with their iodine intake. The measurement of TSH receptor antibodies (TSHR-Abs) by competitive radioreceptor assay or by thyroid cell bioassay in patients with Graves disease can be a useful predictor of relapse and remission." At this time, standard medicine assumed that about 99 percent of cases of clinical hyperthyroidism (exhibiting signs and symptoms in the clinic) were a result of a primary hyperthyroidism related to Graves disease, which could mean either an autoimmune Graves disease or a Graves disease related to nodules or inflammation. The statement of efficacy from these experts is very revealing, though. If over 50 percent of patients with clinical hyperthyroidism relapse after a 12 month course of antithryoid medications, how many of the patients with subclinical hyperthyroidism treated with these drugs will relapse as well, leaving them no better off in the future, and many with a dependency on synthetic thyroid medication as well. The statement also reveals that standard medicine often does not fully assess the patients for an autoimmune disorder, and test for the array of antibodies that are seen in hyperthyroidism.

Most treatment guidelines today reserve this anthyroid drug therapy for clinical hyperthyroidism with elevated T3. For clinical hyperthyroidism with elevated T4, beta blockers may be used to calm symptoms of cardiac arrhythmia, palpitations, and fast heart rate (tachycardia), thionamide-type drugs may be prescribed to block new hormone synthesis, iodine may be prescribed to block release of T4/T3, and radioactive iodine may be used to destroy thyroid tissue. The variance in treatment strategies among thyroid specialists is great, though, reflecting opinion rather than a sound basis built on evidence of outcomes, which may vary between patients. This is thought to be attributed to the difficult puzzle of differential diagnosis, as well as the variation in responses to therapy. As stated, more and more experts are stating that a patient and patient-centered approach be adopted for subclinical hyperthyroidism, and greater diagnostic efforts by used before starting drug, radiation, or surgical treatments.

An alternative to standard treatment in subclinical hyperthyroidism would be the integration of Complementary Medicine into the treatment protocol, continuing to monitor and assess the disease and dysfunction, but since the disease is not threatening the patient or having a dramatic effect on the health in many cases, utilizing acupuncture, herbal and nutrient medicine, as well as dietary changes and improvement in overall health to try to reverse this endocrine abnormality. Many patients who try this protocol, when administered by a Complementary Medicine physician who is experienced and knowldgeable, and who pays attention to current research, will testify to the positive results. Restoring health, rather than inhibiting functions with drug therapy, will obviously result in a healthier life in the future. In cases where the medical doctor recommends radioactive iodine or surgery to stop thyroid function, and then a life-long dependency on synthetic thyroid hormone, trying a course of medicine in Complementary Medicine, with acupuncture, herbal and nutrient medicine, and dietary changes, could lead to the avoidance of this radical therapy, and if the doctor in charge continues to adequately monitor, test and assess the patient, there is little risk in trying this type of remedy.

Standard treatment of overt or clinical hyperthyroidism still involves the choice of radioactive iodine, surgical excision of nodules, partial thyroidectomy, or complete thyroidectomy, with radioactive iodine still the treatment of choice in the United States. The choice, though, is usually the choice of the specialist MD, not the patient, and is still somewhat arbitrary, with some groups of thyroid specialists advocating destruction of the thyroid cells with radioactive iodine, and other groups advocating various surgical procedures, which have been refined in recent years with improved imaging of nodules. Since the size of the thyroid glands are small (normal size is no more than 4 by 1.5 cm, and only 2-3 mm in depth), the excision of abnormal tissue or nodules is a delicate surgery. Since the parathyroid glands sit on the thyroids and are even smaller, and are sometimes even embedded into thyroid gland tissue, the chance of damaging or removing the parathyroids in surgery is also great. Of course, if the size of the thyroid glands exceeds normal, this is likely due to nodular growth or goiter, and analysis of the size of the glands is important in the diagnosis, as well as the surgical considerations. If the size is much larger than "normal", it is likely due to multinodular growth, or thyroid toxic growth (thyrotoxicosis), while a single nodular growth has a small chance of being diagnosed as cancer. Of course, if a single nodule is suspected, a biopsy is needed to identify the cells (cytology) and rule out thyroid cancer. The trouble with these procedures is that often the ultrasound and physical exam does not clearly identify whether a small nodule exists or not. The course then requires monitoring to see if the gland or nodule grows, as cancerous nodules will usually grow. Repeated ultrasounds and growth monitoring is often sensible as well, when the disease is not threatening, as a "normal" size of the thyroid glands could vary in an individual outside of the supposed range of normal. Repeat ultrasound monitoring achieves a clearer assessment of the actual size and type of thyroid problem.

Key diagnostic considerations are gathered from repeat ultrasound and physical exam, and even if conservative treatment is chosen before resorting to the various surgeries, radioactive iodine destruction, or antithryoid medication, an exam and ultrasound every 3-6 months is sensible, and choosing a good endocrinologist, or thyroid specialist, is important. The size of the glands is important both in choosing the type of surgery, if needed, and in the often puzzling diagnostic choices. Decreased gland size usually indicates either a single toxic adenoma nodule (benign tumor), a factitial thyroid (drug induced changes), or the very rare metastatic ovarian cancer spreading to the thyroid. Markedly increased gland size usually indicates either a toxic multinodular pathology, Graves autoimmune disease, subacute thyroiditis, iodine-induced growth, or a pituitary tumor driving excess growth. Moderately increased gland size usually indicates either lymphocytic thyroiditis, medication-induced thyroiditis, or a postpartum thyroiditis. The abscence of nodules on the ultrasound usually indicates that the patient has either subacute thyroiditis, lymphocytic thyroiditis, Graves disease, factitial thyroid (drug-induced changes), medication-induced thyroiditis, a pituitary adenoma, or the rare metastatic ovarian struma (cancer). This expert physical exam, and repeat ultrasound studies are combined with a differential diagnosis based on the THS level and abnormalities of the fT4 and fT3, as well as evidence of various antibodies. A thoughtful patient will understand that the diagnostic considerations are not simple, and that a quick and incomplete assessment means that the medical doctor in charge is merely guessing. A real assessment considers the potential causes of the low TSH and an individualized analysis of the patient history, age and environmental exposures, the severity of symptoms and degree of alarm, the size of the thyroid glands, best determined by repeat ultrasounds and physical exams, and comorbid conditions. The best type of thyroid specialist will admit that the diagnosis is often unclear, and the treatment choices should ultimately be made by the informed patient.

Understanding the thyroid pathologies

Some basic understanding of the thyroid pathologies is helpful to the patient when these diagnostic and treatment considerations are being made. The main difference between the nodular thyroid pathology and the inflammatory thyroiditis is that the nodules are abnormal growths that may alter the autonomous hormone production, either decreasing or increasing the production of thyroid hormone, while the inflammatory thyroiditis will involve leakage of stored thyroid hormone from the gland. Graves disease and central hypothyroid or hyperthyroid conditions (hypothamalic and pituitary dysfunctions) involve increased thyroid stimulation as well, and excessive iodine exposure or drug-induced thyroid pathologies also will involve increased stimulation of the thyroid gland, which may remain normal in function despite excess release of thyroid hormones into circulation. These thyroid hormones are called T4 (thyroxine), and T3 (triiodothyronine, or 3 iodines attached to the thyronine). T4 and T3 may be bound to carrier proteins in circulation and thus relatively inactive. Unbound T4 and T3, called free T4 and T3 (fT4 and fT3), are able to activate hormone receptors, but fT3 is far more active. fT4 is converted to fT3 by removing an iodine molecule (deiodinase driven). fT3 is further processed to produce T1a and T0a, which are very active at thyroid hormone receptors, again by the removal of another iodine molecule. We see the importance of iodine in thyroid function.

Different types of thyroid disease or dysfunction will require different overall treatment strategies to restore health. While inhibiting thyroid function, destroying thyroid cells and tissues, or removing the thyroid itself are proven to stop the serious consequences of an overt or clinical hyperthyroidism when the symptoms threaten the patient, these standard therapies do not restore the thyroid and endocrine axis itself, and in most cases will end up with the patient dependent on synthetic thyroid hormone replacement, possibly for the rest of their lives. This treatment outcome is not acceptable for many intelligent patients, who increasingly are opting to try more conservative and holistic therapies when possible.

Thyroiditis, or inflammatory thyroid disease, is most commonly seen as Hashimoto's thyroiditis, an autoimmune disorder. The onset of disease may be acute, or in the form of chronic lymphocytic thyroiditis. Most cases of acute autoimmune Hashimoto's thyroiditis quickly turn into a hypothyroid state, as the autoimmune reaction affects the thyroid peroxidase enzyme or thyroid receptors, and with continued inflammation, thyroid function and utilization of iodine in the gland is reduced. Today, Hashimoto's thyroiditis is the most common cause of hypothyroidism. Thyroid antibodies are present in about 95 percent of patients with Hashimoto's thyroiditis, and a variety of antibody reactions may be related. These antibodies may also be seen in Graves's autoimmune thyroiditis. Thorough assessment and testing are necessary to arrive at the correct diagnosis. Without a reliable assessment, unnecessary or wrong therapy may be prescribed. There are at least 15 potential causes for a finding of low TSH, and the intelligent diagnosis takes time, testing and thought.

While the most common cause of a reduced TSH in a non-hospitalized patient is thyroid hormone excess, the free and bound thyroid hormones must be tested to properly assess this diagnosis. Even this reduced TSH with thyroid hormone excess may be commonly caused by either endogenous hyperthyroidism, or intake of excess exogenous thyroid hormone, or even intake of other hormones that affect the thyroid or hypothalamic control and feedback regulation. This intake of excess thyroid hormone may be in the form of a synthetic thyroid hormone in treatment of hypothyroidism, in the form of natural dessicated thyroid extract, or even in rare cases from the intake of growth hormones used in the stimulation of meat growth in commercial production of meat (heaven forbid). Further assessment is necessary in the prescence of excess fT4 or fT3 (unbound thyroid hormones in circulation), and the time must be taken to consider various explanations tied to drug use. Human chorionic gonadotropin (HCG) may alter TSH levels by stimulating the thyroid, and this can be seen in the first trimester of pregnancy. HCG is now commonly used in artificial reproductive technology as well, to enhance fertility treatment. Corticosteroids, such as prednisone, are increasingly used today, and may alter the TSH levels and affect the thyroid function, not only during use, but after discontinuing. Dopamine medications suppresses TSH release, by as much as 50 percent in normal patients in studies. While dopamine in the form of L-Dopa is common only to Parkinsons treatment, various psychological illnesses and treatments may alter dopamine enough to suppress TSH, and today, dopamine medications are commonly used to treat ADHD (attention deficit and hyperactivity disorder). In addition, dopamine hydrochloride is now prescribed for various cardiovascular pathologies, especially after hemodynamic shock with heart attacks, after open heart surgery, chronic cardiac decompensation in congestive heart failure, with trauma, septicemia, or renal failure. Finally, studies in animals have suggested that pharmacological amounts of retinoids (related to Vitamin A) may decrease serum TSH concentration, and these pharmaceuticals are used to treat a variety of skin disorders, including dark pigmentation, inflammatory disorders, psoriasis, acne, and cancer.

If the excess of thyroid hormone is chronic, this may cause "atrophy" of the hypothalamus-pituitary function, reducing thyroid releasing hormone (TRH). If thyrotoxicosis occurred, it may take months to re-establish a normal TSH secretion. Thyrotoxicosis may occur and resolve without significant immediate threat to the health, from a variety of reasons. If the symptoms are not threatening, TSH and hypothalamic function may be restored without harsh therapies, but again, patience is needed. Chronically high thyroid levels and suppressed TSH, or elevated TSH stimulating high thyroid hormone release, may also occur with depression or psychosis, and patients receiving a high dose lithium for treatment of bipolar depression may have elevated TSH that results in excess circulating thyroid hormones, eventually creating a chronically lowered TSH. What the patient needs to understand is that the diagnosis of hyperthyroidism is complex, and a proper assessment and thorough testing are indicated, utilizing a specialist in thyroid disorders. Once this assessment is made, and an assured diagnosis is arrived at, most cases do not present immediate health threats, and these findings may be presented to an integrative Complementary Medicine physician, such as a knowledgeable Licensed Acupuncturist and herbalist, to help with health restoration and resolution of the thyroid dysfunction.

Treatment Strategies for Hyperthyroidism in Integrative Complementary Medicine

Treatment for hyperthyroidism with integrated Complementary Medicine may include a number of areas of focus to provide the thorough holistic help the body may need to regain thyroid and endocrine homeostasis, as well as address the specific underlying causes of the hyperthyroid state. Since the hyperthyroid disease or dysfunction may involve the hypothalamus-pituitary, the thyroid glands, the adrenal responses, and/or immune dysfunction in the form of an unwanted autoimmune response, the therapy should be individually tailored and act to bring these various systems back to a harmony of function and feedback. The chemical makeup of the thyroid hormones and even the receptors may also be problematic, especially if there is a nutritional deficiency, and restoration of this nutritional balance may be important to the outcome. The choices in the treatment protocol may be more complicated than what we would desire, but without an intelligent comprehensive protocol, success may be difficult.

Complementary Medicine may focus on both the relief of symptoms related to hyperthyroidism (anxiety, insomnia, tremors etc.) as well as the disease or dysfunction itself and the underlying causes. The choices in the protocol would depend on the individual case. If the symptoms were a problem with daily function, these may need to be addressed first, if possible. Of course, complete symptom relief would not be expected until the thyroid function and hormonal balance is normalized in many cases. As stated above, studies have demonstrated that with chronic excess of thyroid hormone, the hypothalamus-pituitary function is "atrophied", and a period of restoration of function and balance is needed after the thyroid function is restored. The diagnosis would determine the strategy in Complementary Medicine to treat the actual thyroid disease or dysfunction. In many cases, especially subclinical hyperthyroid cases, the course of the disease is not immediately threatening, giving the patient and physicians time to gradually correct or restore dysfunction. The thyroid dysfunction itself may not respond well to direct treatment at first unless underlying causes are corrected, unless anti-thyroid medication is used. If anti-thyroid medication is used, the initial course often involves 6 months to a year of medication, and then seeing if the medication may be discontinued with restoration of the thyroid function and endocrine balance. To facilitate this outcome, Complementary Medicine should be integrated to improve the chances of success. If the underlying causes and general hormonal and immune health are addressed properly, this relatively short course of medication should produce a good outcome, or euthyroid state.

A number of food chemicals exert antithyroid effects. Indole-3-carbonol (I3C) in brassica, or cruciferous, vegetables, is the most well known, and high amounts of I3C are found in cabbages, brussel sprouts, broccoli leaf (rapini or broccolini), collard greens, turnip greens and mustard greens. The nutrient medicine DIM provides the active ingredient of I3C. Cabbage leaf contains goitrin, able to help relieve thyroid goiter. Rutin, a chemical found in onion, shallot, garlic, celery, asparagus, parsley, cilantro, lemon peel, and chamomile, as well as the herbs yarrow, horse chestnut flower, artemesia absinthia, St. John's wort, and Hu zhang (resveratrol source), is another will known antithryoid food chemical. Some of these foods and herbs contain more than one antithyroid chemical, with apigenin found in celery, chamomile, parsley, and cilantro. Apigenin is also found in Gingko, European olive leaf, milk thistle, perilla seed, yarrow, flax seed, many beans, whole wheat, basil, thyme, and carrot. Caffeic acid is found in turmeric, pear, basil, thyme, tarragon, oregano, burdock, sunflower seed, and granny smith apples. Ellagic acid is found in evening primrose oil, black walnut extract, guava and grapes. Rosmaric acid is found in rosemary, peppermint, basil, oregano, marjoram, and thyme. PABA (p-aminobenzoic acid), a food chemical now used in standard therapy, is found in sesame seed, and unprocessed sesame oil, as well as brown rice and pineapple. Vitexin is found in buckwheat, green tea, oregano and passionflower extract. Bon appetite. L-carnitine may be useful in the early stages to block T3 and T4 uptake into the cell nucleus to reduce symptoms.

Dietary protocol may also involve the avoidance of potentially harmful foods in hyperthyroid disease. For example, many companies grind the neck glands, including the thyroids and parathyroids, into hamburger, sausage and lunchmeats, and many commercially processed foods containing meat may also have these chemicals included. Of course, the companies are not supposed to use parts of the animals that contain hormonal glands, but we all must realize by now that these prohibitions are routinely ignored. Making sure that ground meats and sausages come from a reliable local producer may be important. Seafoods that are potentially rich in iodine should be avoided in excess, as excess dietary iodine or even iodine toxicity or reaction could be a factor in the disease. Testing for iodine levels is now a simple process, utilizing urine on small blotters, and is recommended to achieve a normal range of iodine in the body. Both excess and deficient iodine often plays a significant role in the disease. Avoidance of the artificial sweetener aspartame, which affects glutamate receptors in the central nervous system, along with MSG and other glutamate additives found in commercial foods, is important, as aspartame and these glutamate additives, now common in commercial food products, is implicated in numerous studies as a potential cause or contributor to hyperthyroid disease. Diet soft drinks usually use these chemicals, and in fact, to be safe, avoidance of most commercially processed foods is sensible. These glutamate additives increase the desire for the food and are now numerous in type. Since autoimmune hyperthyroidism is common, and gluten intolerance is associated, avoidance of both wheat and dairy are now common among hyperthyroid patients, decreasing the possibility that a food allergy, hypersensitivity, or celiac disease has contributed.

Mineral balance may be very important in the treatment protocol, as minerals such as iodine and various calcium compounds are integral to thyroid and hypothalamic functions. Magnesium deficiencies are also implicated. Since the body strives to achieve mineral balance to function, a variety of mineral imbalances can be implicated in hyperthyroid disorders. The essential minerals studied in relation to hyperthyroid disease include iron, copper, selenium, potassium, sodium, lithium, zinc, and mineral toxicities associated with aluminum, zince, and cadmium have been implicated. Both restoration of essential minerals and balance, and potentially, chelation of unwanted tissue accumulations of metal or mineral toxins may be helpful in the overall protocol. Nutrient medicines that may be utilized to aid correction of mineral imbalances include biotin, pantothenic acid, PABA, Vitamin B3 inositol hexacotinate, Vitamin B1 and B2 complex, and essential mineral formulas. As always, professional products are highly recommended, as commercial products are not regulated and are often not what they claim to be. The science of nutritional chemicals in medicine, or naturopathy, is also complicated, and relying on simplistic advice is often problematic. Professional prescription and guidance by a knowledgeable Complementary Medicine physician, such as a Licensed Acupuncturist and herbalist, would help insure that this protocol is intelligent and of assured quality. While use of a higher dose iodine in the early stages of hyperthyroidism may overstimulate the glands and worsen symptoms, in sub-acute and chronic disease, iodine therapy is often used with success, but only after insuring that selenium levels are sufficient. Mineral deficiencies may be assessed with urine samples (blotter tests are now available from ZRT), as well as hair and blood samples (Doctor's Data in Chicago). Selenium also is used as a cofactor for the glutathione peroxidase metabolism in the thyroid, and the thyroid usually has higher levels of selenium than even the liver.

Ultimately, a patient with hyperthyroidism should become as educated to the disease as possible, but utilize professional Complementary Medicine to treat effectively. Using the wrong herbal formulas could be counterproductive, and with the complexity of the disease and variants in underlying health problems and dysfunctions, what works for one patient may not work for another. Complex health problems require more knowledge and more work performed in assessment and thoughtful treatment strategies.

Maintaining Thyroid and Hormonal Health

Of course, the best option for patients is either to prevent the hyperthyroid disease or dysfunction, or to treat and restore this hormonal system. In either case, maintenance of the thyroid health is important, and this maintenance should extend beyond the thyroids to encompass the endocrine axis that regulates thyroid health in a complex hormonal feedback system, as well as the healthy function of the immune system. Balance should be the main focus, as a healthy homeostasis depends upon the balance of paired hormones, as well as the balance of groups of inflammatory mediators, or cytokines, especially the T-helper cells type 1 and 2. In Traditional Chinese Medicine we call this the balance of Yin and Yang. One key to hormonal health may be found in the fast development of the science of natural bio-identical hormones. Synthetic hormone replacement in menopausal health and use of synthetic hormones in control of inflammatory processes and asthma, auto-immune disorders, and other problems has garnered much bad press because of the proven risk, harm and side effects involved. Only now, after decades of use has some of the long range consequences become apparent. Two large studies by the Women's Heatlh Initiative has led to an NIH (National Institutes of Health) conclusion that synthetic hormone replacement dramatically increases risk of breast cancer, cardiovascular disease, deep vein thromboses and other serious threats to your health.

In 2010, standard medicine once again attempted to bring back some semblance of respect for their long history of prescribing dangerous and problematic synthetic hormones despite much evidence of potential harm, especially with risk of cancers and cardiovascular disease, and dramatic signs and symptom complaints from patients, by stating that evidence does show that unopposed estrogen does appear to reduce the risk of breast cancer to some degree. Once again, confusing public statements about a subject too complicated for most patients to fully understand, were widely printed in the hope of restoring some public trust to medical doctors that recklessly overprescribed synthetic hormones for decades, with evidence that this medical practice was directly linked to a large increase in the incidence of breast cancer, uterine cancer, ovarian cancer and cardiovascular disease. Unopposed synthetic estrogen, or estradiol sulfate, was originally prescribed in these hormone therapies, quickly creating alarming incidence of serious health problems, and then always coupled with synthetic progesterone, or progestins, to reduce risks and harm. Today, though, we now see that balancing hormones to a physiologicall normal state, with simple testing and use of bioidentical plant hormones in topical creams, combined with herbal and nutrient medicine, and acupuncture, will achieve this reduction of risk of breast cancer without harm, and with very little risk of side effects.

The use of bioidentical estriol creams to stimulate increased estrogen production, balanced with progesterone stimulating bioidentical creams, with testing to analyze the actual restoration of hormonal levels to a physiological normal level that is individualized and adjusted for menstruating, premenopausal, perimenopausal, menopausal, and post-menopausal states, is a very effective approach, especially when combined with a protocol that features selenium supplementation, restoration of iodine levels in tissues, correction of subclinical hypothyroid states, periodic supplementation with DIM and potent lignans, and herbs that are proven in clinical trials to reduce risk of breast cancers. This type of therapy is available to patients that take advantage of a knowledgeable Complementary Medicine physician, such as a Licensed Acupuncturist and herbalist, as well as active hormone metabolite testing and analysis with simple saliva and veinous blood stick samples. The public is beginning to understand that the dire warnings against biodidential phytohormonal therapies that we were given by standard medicine, without sound scientific evidence of harm, was merely a ploy to protect the profits generated from the overprescription of synthetic hormones.

In fact, today, modern medicine, or standard medicine, is finally embracing these herbal extracts to provide a bio-identical hormone therapy as well, and combining this with a holistic approach with other supporting herbs and nutrient supplements. The public is applauding these progressive MDs that have acknowledged and embraced this modern integrative approach, combining safe and effective evidence-based Complementary Medicine with standard pharmaceutical practice. A combination of bio-identical hormones, herbal formulas, nutrient supplements and acupuncture utilizes the latest research with the proven effects of centuries of Traditional Chinese Medicine. An integrative approach may utilize both the progressive M.D. and the TCM physician, or Licensed Acupuncturist, and careful monitoring of your active hormone levels with laboratory analysis may be accomplished at either office. Considering the lack of medical school training in these herbal and nutrient therapies for medical doctors, and their long history of stubborn persistence of overprescription of synthetic hormones, though, many intelligent patients are insisting on integrating a real Complementary Medicine physician, or Licensed Acupuncturist or Naturopathic Doctor into their treatment team.

In recent years, much research has also linked the hormone called Vitamin D to a wide variety of health problems as well. Vitamin D was among the first chemicals in the body that was called a vitamin, or a naturally produced or essential dietary chemical that was important to maintain vitality. We have long ago learned, though, that Vitamin D is not really a vitamin, but a hormone, and that the daily metabolism of a sequence of chemicals is what is vital to our health. While some metabolites of these hormones may act as vitamins in the body, the actual chemicals of importance are tightly regulated, stored, and converted to provide a necessary hormonal regulation that is now recognized as important for almost all cells in the body. The sequence of lipid-based hormonal chemicals in D3 production are cholesterol, cholecalciferol, calcidiol, and calcitriol, and a healthy visceral function of the liver and kidney/adrenal organs is also vital to this hormone metabolism. The time to quit calling these chemicals vitamins is now, and attention to this important hormonal, or endocrine, balance in the body should be recognized by the public, especially the aging public. By continuing to call these chemicals vitamins, the public is encouraged to purchase and consume so-called vitamin D without adhering to the actual body's needs, creating a new potential for adverse effects that may be as bad as deficiency of the production of the chemicals. Professional guidance and testing to restore this essential hormonal metabolism has very much potential for increased health, quality of life, and reduced risk of the most serious consequences of aging and disease. Once again, the Complementary Medicine physician, such as the knowledgeable Licensed Acupuncturist and herbalist, or the Naturopathic Doctor, can help achieve this hormonal restoration in the best possible manner.

To learn more about these subjects, a number of informative articles are also available on this website, fully exploring the true story of so-called Vitamin D, clinical and subclinical Hypothyroidism and Hyperparathyroidism, hormone replacement and contraception, hormonal pathologies, calcium supplementation and its risks and potential harm, autoimmune disorders, and diabetes/metabolic syndrome. The informed and pro-active patient takes seriously their role in the modern integrated team of physicians and guides the therapies. A physician is defined in Stedman's medical dictionary with various meanings, including "a person who has been educated, trained, and licensed to practice the art and science of medicine", such as a Licensed Acupuncturist, and "a practitioner of medicine, as contrasted to a surgeon". The most important "physician" in the team is potentially the patient. A patient-centered approach to medicine works best when the patient becomes educated to their health problems and assumes a role in treatment guidance. The only person that is able to treat 24/7 is the patient.

Patient Knowledge is the Key to a Pro-Active Approach

The hormonal system, or endocrine system, is a complex feedback mechanism responsible for regulation and coordination in the body. The proper function of this system is extremely important for the health of both the man and the woman.

The endocrine system is composed of the adrenals, thyroids, parathyroids, pancreas, gonads/ovaries, thymus, hypothalamus, pituitary, pineal, and other tissues of the nervous system, muscles, vessels, bone and fat. Key hormones regulate the menstrual cycle, fertility, blood sugar, mineral circulation, bone density, sexual function, inflammatory processes, mood, blood pressure, and much of our chemical metabolism and excretion. When hormone production becomes deficient or excessive, and circulating levels are abnormal, many systems in the body may become dysfunctional because of the feedback mechanisms of the endocrine system. Not only menopausal symptoms, but diabetes, prostrate problems, autoimmune disorders, thyroid problems, breast cancer, osteoporosis, and other common health problems result. Infertility, a growing problem in industrialized societies, is also now recognized a having an underlying cause related to hormonal imbalance in a large percentage of cases. Endometriosis, ovarian cysts, and uterine fibrods also are related to hormonal imbalance, and even neurological disorders, especially neurodegenerative disorders, are now known to have hormonal imbalance as a key aspect of the complex underlying pathophysiology. Cardiovascular risk is increased dramatically by hormonal imbalance as well, and strokes, heart attacks and veinous thromboses are the most prevalent cause of death in the aging population. Even arthritic joint degeneration is now linked to hormonal imbalance, as the normal repair and growth of cartilage is dependant on a hormone Vitamin D3 isomer. By maintaining a healthy endocrine system the risks of cardiovascular disease and cancer are dramatically decreased and overall quality of life is greatly improved.

Hormones act by stimulating target cells and the hormonal effects are determined almost entirely by the target cells, not the hormones themselves. For this reason, many hormones are very similar, and in fact, many hormones easily become other hormones when the body needs them. We now know that hormonal receptors are numerous on cells, with some targeted cells having more than 300 hormonal recptors on a single cell, and that often these receptors are also triggered by neurotransmitters and immune cytokines. In fact, many chemical in the body act as both neurotransmitters and hormones, depending on the type of cell receptors, and the surrounding mix of chemistry in local tissues. Adrenaline, or norepinephrine, is the prime example of this type of simple chemical that plays complex roles in the body, and adrenal health is now recognized as a very important part of our overall healthy hormonal and endocrine function. The endocrine system, or excretion of hormones from glands, is in fact guided by neurological stimulation in the adrenal-pituitary axis, with the intimate pituitary sister organ, the hypothalamus, provides this neurological control of the axis. Complete hormonal balance is thus necessary to achieve optimum hormonal health, as well as healthy neurological, immune, and cardiovascular health.

Why are natural bioidentical hormones, mostly produced from plant sources, better in many ways than synthetic hormone pharmaceuticals? Synthetic hormones that are similar to your natural hormones trigger key hormonal responses the same as natural hormones, but confuse the body in regards to overall response. They do not easily transform into other hormones when needed, and they do produce a false feedback response that signals the endocrine system to act as if certain hormonal levels are high, when actual production of natural hormone is low, thus triggering a cessation of natural hormone production in the body. While synthetic hormonal medicines do produce dramatic results, and have their important role in hormonal therapy when needed, their use in general has many drawbacks that are not seen with bioidentical hormone therapy, which is now proven to produce effective and immediate results itself. Coupled with less direct hormonal therapies, such as acupuncture, which stimulates normal physiological processes in the brain, as well as the hormonal organs, and herbal nutrient medicine in general, which research has shown also may play key roles in maintaing hormonal health in less direct, but no less effective ways, the holistic package of care provides the patient and team of integrated physicians with tools to restore physiological hormonal levels and functions. On the other hand, chronic dependance on synthetic hormones discourages normal hormonal production, which is guided by a complex feedback mechanism in the body.

Bioavailability of hormones in the body depends on the health of the whole system. There are two types of hormones, lipid based and amino acid based. Healthy cholesterols are the backbone of the lipid based, or steroid hormones, such as the estrogens. Insuring that the cholesterol metabolism, based in the liver function, is optimal, is one key to hormonal health. Amino acid metabolism is also a function of the liver, which is a second reason that optimal health of the liver is important in hormonal health. Intelligent use of herbal formulas, acupuncture, and amino acid supplements with key vitamins may be very important to optimum liver function and lipid balance and targeted hormonal therapy. Natural restorers of lipid metabolism and balance, such as Red Rice Yeast extracts, bitter melon extract, Syntriol palm and citrus extracts, pomegranate extract, niacin metabolites (B3 as inositol hexacotinate), Gugulipid, Gamma Oryzanol, and Beta Sitosterol, are very effective, as well as Chinese formulas, to include in the treatment protocol. While taking a variety of medicines is not desirable to the patient, the consideration of these therapies should include the fact that, unlike pharmaceuticals, these herbal and nutrient medicines do not need to be taken forever, and actually achieve restoration of the natural physiological processes in the body.

"The person that works to achieve hormonal health holistically now, rather than waits until serious problems develop, is able to live a much healthier and productive life and decrease the fear of cancer, stroke, alzheimers, arthritis, and other serious health problems."

Males and females both produce the same hormones, although menstruating females produce many hormones with a great degree of variance due to the feedback demands of the menstrual cycle. Because of the huge spikes in estrogen and progesterone associated with the monthly menstrual cycle and pregnancy, the female physiology becomes much less reliant on the production of these hormones in the adrenals, kidneys, liver, and other localized cells of the brain, blood vessels and fat cells, until ovulation ceases at menopause, with a hysterectomy, or with anovulatory disorders. When these events occur, the body often needs to be stimulated to achieve proper production of hormones from these other tissue sources. Synthetic hormones used in hormone replacement therapy are not identical to the natural hormones in your body. Synthetic hormones may alleviate some symptoms, but actually work to decrease the ability of the body to naturally produce hormones by replacing rather than stimulating. This is counter to a healthy life.

Plants have a physiology that is similar to animals, and so they too produce hormones in a system for regulation and coordination of physiological function. These plant hormones are often surprisingly similar to the human hormones. Many herbs and a few animal medicinals contain hormones useful to the treatment of the human. The wild yam of Mexico was one of the first plants to be highly publicized as a source of hormone replacement. Simply ingesting the herb had little effect, but use of the extract as a topical cream had dramatic effects, leading doctors to believe that this herb contained estrogen. Since then we know that it actually has an effect on the progesterone levels, primarily. It is often referred to as a progesterone cream.

The truth is that wild yam does not contain human progesterone or estrogen. The plant hormones it does contain stimulate increased progesterone production in the adrenals in a manner that is believed to be associated with affecting hormone receptors. The use of this herbal cream does not directly affect the progesterone level, only the production of progesterone within a feedback system. When it is used in an intelligent manner there are absolutely no ill effects. When used in the wrong dose or at the wrong time of the cycle, it can cause abnormal menstrual bleeding. This has frightened many women and practitioners. When used properly, especially when coordinated with other herbal formulas and acupuncture, and when hormonal levels are monitored with active hormone tests, it becomes a very safe and effective stimulation of proper hormone production. Increased estrogen production will result from increased progesterone production eventually, as will increased testosterone production, until proper levels are achieved, in a feedback system.

To facilitate a faster and smoother return to normal hormone production we also may make use of a topical cream with plant estriol. Estriol is in the estrogen family and use will stimulate increased production of the other, more active estrogens, estradiol and estrone. Estriol is proven to not stimulate significant tissue growth in the breast and uterus, and thus does not promote cancerous growth directly. Estrogen triggered cancerous tumors are believed to be a result of imbalance of the key estrogens, coupled with genetic triggers, and thus use of synthetic estradiols in birth control and hormone replacement therapy are believed to be significant causes of many breast and uterine cancers. Estriol is now compounded with a plant estrone for more specific effects. These topical bio-identical hormones are used in very low dosage and always combined with topical progesterone cream to insure a safe balance as your hormonal levels change.

Prior to the availability of these topical creams, the herbalist was limited to only a few estrogenic herbs, and a few androgenic herbs that indirectly stimulated progesterone production over a longer period of time. Now we are accumulating a number of options for effective treatment. Of course, treatment of hormonal levels may involve some fluctuation in hormones, and thus some temporary changes in symptoms during the course of the therapy. Any woman that experiences PMS understands that hormonal fluctuation can have dramatic results. These symptomatic changes are temporary and benign, and the end result is optimal hormonal health. Goal orientation is the key, as well as adherence to a consistent course of therapy.

What is the safety level of these herbs and cures?

To date, there has been no claims of health injury of consequence from the proper prescription of these natural cures, and acupuncture stimulation remains the safest treatment in human history, with virtually no complaints of injury in the United States other than a few cases of minor bruising or skin reaction. The malpractice cost to a practitioner of TCM is approximately one thousand dollars a year, reflecting the fact that there are no lawsuits. The TCM physician completes a graduate degree from a specialized medical school that requires much knowledge of medicine, modern and traditional, and usually includes extensive study in herbal medicine.

As progress is made in the research and clinical use of herbal medicines and acupuncture to regulate the body, many more specific uses of herbs will be uncovered. The body of knowledge grows every day. What is important is that you take products with reliable quality and the proper dose. This is accomplished by choosing a TCM physician with the knowledge and clinical experience to utilize quality herbal products and supplements and perform and coordinate care in a professional manner. The quality of products varies considerably and dosage claims are often false in a business that has no government regulation. It pays to utilize a professional to guide your care rather than to rely on self medication.

In my practice I have helped many women with menopausal problems, infertility, premenstrual symptoms and infrequent menstruation. The benefits from this treatment extend far beyond the immediate cure because improvement in the hormonal health is the foundation for improvement in many areas. Increased vitality, mental ability, less pain, lowered cholesterol and blood sugar, reduced blood pressure, prevention of cancer, osteoporosis and stroke, a healthier sex life, improved skin health, and many other benefits are part of the package in holistic care. Instead of harmful side effects we give you healthy side effects. If you need more information, call and schedule a free short consultation. You won't regret it.

Information Resources and Additional Information with Links to Scientific Studies

  • A broad study of the general population in France in 2004 found that among patients not already diagnosed with thyroid disease that the prevalence of abnormal TSH was very high, indicating an alarming percentage of the population in industrialized society now experiencing a subclinical thyroid imbalance, with a significant percentage associated with deficient iodine levels and other environmental factors. Undiagnosed subclinical hyperthyroidism in the general population was 7 percent for men, 5.3 percent for women age 35-44, and 4.4 percent of women aged 45-60. Abnormal TSH levels have been correlated with lipid imbalances, and a variety of metabolic disorders and disease. http://www.ncbi.nlm.nih.gov/pubmed/15731735
  • Research in 2011 at the Universidade Federal do Rio Grande do Sul, in Porto Alegre, Brazil, stated that decades of research make clear that ionizing radiation is a potential cause of both hypothyroidism and hyperthyroidism, as well as thyroid nodules: http://www.ncbi.nlm.nih.gov/pubmed/22011852
  • A 2011 report issued by the National Cancer Institute, NIH, of the U.S. Institutes of Health in Bethesda, Maryland, states that the threat of excess accumulative radiation from CT scans, which accounted for 47 percent of collective effective radiation from diagnostic procedures in 2008, and is growing yearly, is directly associated with rising rates of thyroid cancer incidence. This finding directly reflects on the potential of excess radiation from multiple CT scans in the lifetime to cause hyperthyroidism: http://www.ncbi.nlm.nih.gov/pubmed/21296564
  • A 2016 large cohort study by experts at the Leiden University School of Medicine, in The Netherlands, found that there was an increased risk of breast cancer for women with hyperthyroidism:http://www.ncbi.nlm.nih.gov/pubmed/26863886
  • A 2015 report by the British Thyroid Association, with input from the University of Birmingham, Cardiff University, the University of Dundee, the Imperial College London, and the Institute of Metabolic Science in Cambridge, UK, shows that a high percentage of total clinical cases of hypothyroidism are caused by aggressive treatment for hyperthyroidism. Such reports are being issued to support the integration of more benign holistic therapy in most cases of hyperthyroidism: http://www.ncbi.nlm.nih.gov/pubmed/26010808
  • A 2015 large cohort study of patients with thyrotoxicosis in France found that patients with a subclinical hyperthyroid disorder often have signs of mild thyrotoxicosis, with symptoms of palpitations, disturbed sleep, heat-related signs and weakness, and that thyrotoxicosis is seen more frequently in younger patients, while older patients with hyperthyroid disorder more frequently showed cardiovascular complications. Such information is very useful in designing the right individualized holistic treatment protocol: http://www.ncbi.nlm.nih.gov/pubmed/25959282
  • A large 2007 study at China Medical University, in Shenyang, China showed that excessive iodine intake with food and supplements did not increase the incidence of hyperthyroidism. This study followed 3761 randomly selected subjects from 3 areas of China that traditionally experienced iodine deficiency and thus utilized iodine supplements. These individuals were thoroughly tested and followed for over 5 years, and individuals that showed iodine excess dd not experience higher rates of hyperthyroid disease: http://www.ncbi.nlm.nih.gov/pubmed/17389453
  • A 2014 study by experts at the David Geffen School of Medicine at the University of California Los Angeles (UCLA) showed that excessive iodine intake via food and supplements is not associated with hyperthyroidism, but does increase the risk of both hyperthyroid and hypothyroid disease in a small set of vulnerable patients, such as those individuals with prior thyroid disease, the frail and elderly, fetuses, and neonates. The utilization of iodine is heavily regulated in the body and so supplementation poses little risk for almost all individuals. Iodine studies have been conducted for a century to insure that iodine introduced into the salt, food and water did not pose hazards in the United States, and indeed it has not. This study provides limited evidence that in patients with thyroid disease, especially with goiter and Graves disease with chronic iodine deficiency, a high sudden increase in iodine may induce hyperthryoidism, which in most cases would be transient and be resolved with a decrease in iodine intake: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976240/
  • A 2006 study at Henan College of TCM in Zhengzhou City, China, found that the active diterpenoid chemical in the Chinese herb Trypterygium wilfordii (Lei gong teng) could inhibit interferon-gamma-induced activation of retro-ocular fibroblasts, induced by a variety of autoimmune cytokines, and inhibit human leucocyte antigen-DR, intercellular adhesion molecule-1, and CD40, markers of this autoimmune imbalance, when the sufficient dosage of the herb is used: http://www.ncbi.nlm.nih.gov/pubmed/16671908
  • A 2011 randomized controlled study at Chongqing Medical University, in Chongqing, China, found that the commonly used Chinese herbal medicine Astragalus root could significantly relieve clinical signs of hyperthyroid disorder, such as sweating and palpitation, and regulate the immune function of patients with Graves disease, with levels of IL-beta and TNF-alpha reduced more than the control group, who received an anti-thyroid medication:http://www.ncbi.nlm.nih.gov/pubmed/22303710
  • A 2010 study at Chang Gung University College of Medicine, in Niao-Sung Hsiang, Taiwan, found that standard formulas prescribed as adjunct care for patients with Graves disease, a more severe form of hyperthyroidism, was effective, and even could be an alternative for these patients who were allergic to the standard thioamides. The formulas used in the study involved Jiao Wei Xiao Yao San, with Xia ku cao, Bei mu, and Mu li added, which are very common herbs used in TCM, with many formula names and variations in use in the United States: http://www.ncbi.nlm.nih.gov/pubmed/21058888
  • A 2007 meta-review of all scientific studies of Chinese Herbal Medicine in the treatment of hyperthyroidism, published on the esteemed Cochrane Database, shows that evidence supports TCM and Chinese Herbal Medicine as adjunct care in treatment protocol. No single treatment could be recommended due to lack of large high quality studies, and individualized treatment by an experienced TCM physician and herbalist should be utilized: http://www.ncbi.nlm.nih.gov/pubmed/17443591
  • A large 2015 study in Pakistan found that the Chinese herb turmeric, often now standardized as curcumin, was safe and effective in reducing prevalence of goiter in subclinical hyperthyroidism, a common occurrence in Pakistan with many populations affected by chronic iodine deficiency. Turmeric is also widely used as a food spice: http://www.ncbi.nlm.nih.gov/pubmed/25932388
  • A large randomized controlled 2015 study of iodine intake in patients with Graves disease, a more severe form of hyperthyroidism, at the Sungkyunkwan University School of Medicine, in Seoul, South Korea, found that excessive iodine intake did not present a risk of recurrence of Graves disease after finishing treatment with anti-thyroid drugs: http://www.ncbi.nlm.nih.gov/pubmed/17443591