EPISODE 76
5 Myths of Hyperthyroidism and Graves’ Disease
“Your options for treating hyperthyroidism are medication, radioactive iodine, or surgery.”
That’s just one of the many myths patients with hyperthyroidism and Graves’ disease hear from endocrinologists daily. Medication and surgery have their place, but there’s much more to consider before leaping down that path.
Today I’m sharing the top five myths patients with hyperthyroidism and Graves’ disease encounter, and I’m arming you with the truth as you continue on your thyroid healing journey. I encourage you to keep an open mind and not to believe everything you’ve been told about this condition. If you have Graves’ disease, toxic multinodular goiter, or another hyperthyroid condition, then you won’t want to miss this episode.
During this episode, you’ll learn about:
- Myth #1: The only treatment options for hyperthyroidism are medication, radioactive iodine, and surgery
- Radioactive iodine and thyroid surgery should be the last resort
- Alternative treatment options can play a significant role in many cases
- Myth #2: Radioactive iodine is a cure for Graves’ disease
- While radioactive iodine can get rid of hyperthyroidism, it does nothing for the autoimmune component of Graves’ disease
- It’s essential to address the cause of the problem, not just the symptoms
- Myth #3: Improving your diet doesn’t help with hyperthyroidism
- Most endocrinologists don’t advocate for dietary changes
- Diet is a crucial piece of the puzzle when it comes to healing your thyroid
- Myth #4: You can’t take methimazole for longer than two years
- The problem with how many endocrinologists define remission
- Research shows that it can be safe to take low doses of methimazole over a longer term
- Myth #5: Your thyroid will eventually burn out
- The two situations where hyperthyroid patients may become hypothyroid over time
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Here is the transcript for this episode:
Myth #1 is that the only three treatment options for hyperthyroidism are medication, radioactive iodine, and surgery. Of course, this describes what just about every endocrinologist recommends. Either they will recommend antithyroid medication or a beta blocker or both. Or they very well might rush into radioactive iodine or thyroid surgery.
Without question, there is a place for at least two of these three options. I am not a big fan of radioactive iodine, but there is a time and place for antithyroid medication. I do have a lot of patients who take methimazole or PTU, or carbimazole if they are living elsewhere, such as the United Kingdom.
There is a time and place for thyroid surgery. Sometimes, surgery is necessary. In most cases, radioactive iodine and thyroid surgery should be last resorts, not first resorts. Once again, there are endocrinologists who will rush the patient and pressure the patient into receiving these harsh treatment methods.
Of course, you know that my goal is to try to help people address the underlying cause of the problem. Like I said, while doing that, they may need to take antithyroid medication. Sometimes, they may even need to take beta blockers like propranolol or atenolol. I think it’s crazy that just about every endocrinologist won’t be open to alternative treatments, and the only treatment options are medication, radioactive iodine, or thyroid surgery.
Myth #2 is related to Graves’ Disease. That myth is that radioactive iodine is a cure for Graves’. We can make the argument that radioactive iodine might be a cure for hyperthyroidism. Even that is not true all the time. Some people will need multiple doses of radioactive iodine. I hate using the word “cure” because radioactive iodine can get rid of the hyperthyroidism just as can thyroid surgery. If someone gets a complete thyroidectomy, they will no longer be hyperthyroid. It’s not really a cure for Graves’ disease. It is doing something to manage the hyperthyroid symptoms.
When it comes to Graves’, of course, Graves’ is an autoimmune condition. Radioactive iodine does absolutely nothing for the autoimmune component. Same thing with surgery. There is a time and place for surgery, but even if someone were to get surgery, or if someone were to get radioactive iodine, in my opinion, they should still do things to address the immune system since we are dealing with an autoimmune condition here.
I’ll add that even if someone has a different type of hyperthyroid condition, such as toxic multinodular goiter, and they were to receive radioactive iodine or thyroid surgery, they would still want to do things to address the cause of the problem.
Myth #3 is improving your diet doesn’t help with hyperthyroidism. I don’t know how many times I’ve heard this from patients who told me that their endocrinologist said, “Don’t bother with the diet.” Maybe they don’t say that specifically, but they might say, “You could try eating well, but it’s not going to help at all.” Most endocrinologists are negative towards the diet.
Any doctor should be open to the fact that eating whole, healthy foods will improve one’s overall health. Maybe I could understand them not thinking that eating healthy will reverse hyperthyroidism just because that’s not what their training includes when they go to medical school and go on to get their specialty in endocrinology.
But to completely dismiss diet and to tell people don’t bother following a healthy diet, which again, not every endocrinologist will do but some will. At the very least, they should have the perspective, “I don’t think diet will help, but it won’t hurt to eat a diet consisting of whole, healthy foods, and avoiding inflammatory foods and unhealthy oils. Go ahead and follow it while taking the antithyroid medication, for example.” No, they almost always will talk negative and will talk down to the patient. That’s definitely a big myth.
I have mentioned in the past that diet alone usually isn’t going to reverse one’s hyperthyroid condition, but it is an important piece of the puzzle. If someone eats a diet consisting of inflammatory foods, they will probably not achieve optimal results.
Myth #4 is that you can’t take methimazole for longer than two years. My goal is not to encourage people to be on antithyroid medication for a long period of time. In fact, you might know that when I dealt with Graves’, I did not take antithyroid medication. I took the herb bugleweed, and I also took the herb motherwort for symptom management. Some people do need to take antithyroid medication just because the herbs don’t work with everybody.
Many endocrinologists will tell their patients that they can only take methimazole, or another type of antithyroid medication, but we will stick with methimazole since it is the most commonly prescribed antithyroid medication. Many endocrinologists say you can only be on antithyroid medication for 18 months to two years. After two years, if the person is not in remission, they will need to get radioactive iodine or thyroid surgery.
There are a few problems with this. First of all, their definition of remission is they are on the medication for let’s say two years, and then after two years, everything looks normal. Usually, it’s just the thyroid panel. They are not usually focusing on the thyroid stimulating immunoglobulins, the thyroid antibodies associated with Graves’. Just because someone has normal thyroid hormone levels and doesn’t need methimazole after 18 months or two years does not mean that they are in remission. In fact, many of these people will eventually relapse just because the cause of the condition was never addressed.
The second problem is that people can take antithyroid medication for longer than two years, especially in lower doses. Once again, this isn’t the ideal situation. When someone works with me, I really don’t want them to be on antithyroid medication for that long. That’s not the goal. The goal is to address the cause of the problem, so they won’t need antithyroid medication. I don’t take them off it; that’s the goal of their prescribing doctor. If everything starts looking good when we try addressing the triggers of the underlying imbalances, then the numbers will shift into more hypothyroid condition. Over time, the person will get their dosage reduced by their endocrinologist.
If there is a situation where someone needs to be on methimazole for longer than two years, there is research that shows it is safe, especially in lower doses, like 5mg or 10mg per day. 20mg or greater, I don’t know if I’d want to be on that high of a dose for that long.
Honestly, if I was faced with a situation of receiving radioactive iodine or thyroid surgery or staying on the methimazole, if I was on a higher dose, I’d think about it. If it was 5mg or 10mg, to me, it would be a nobrainer to stay on the medication and save my thyroid. Once again, not the ideal situation. That’s not my goal when I work with someone.
But I think it’s wrong for endocrinologists to put the timetable and the pressure on the person, where after two years, they need to stop taking the antithyroid medication and choose between radioactive iodine or thyroid surgery.
Myth #5 is that your thyroid will eventually burn out. I hear this a lot from endocrinologists telling people with hyperthyroidism, “Eventually, your thyroid will burn out, so you might as well receive the radioactive iodine or thyroid surgery.” The thyroid doesn’t burn out. There are a few situations where someone with hyperthyroidism can become hypothyroid, but it’s not related to the thyroid burning out.
One situation is subacute thyroiditis, which is a temporary hypothyroid condition caused typically by a virus. What happens is you get damage to the thyroid follicular cells. The person eventually, within a few months usually, will switch from hyperthyroid to hypothyroid. In most cases, they will eventually become euthyroid again, which means they will have normal thyroid hormone levels. They won’t become hyper or hypo. In some cases, they will become permanently hypothyroid. This is one situation where someone may be hyper and become hypo.
Another situation is if someone has hyperthyroidism, but they also have antibodies for Hashimoto’s. Thyroid peroxidase antibodies, TPO, are very common in Graves’, but they are more commonly associated with Hashimoto’s. They are associated with damage to the thyroid gland. So are TSI antibodies. If someone with Graves’ has an addition to the thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody, and/or TPOs, over time, that could cause damage to the thyroid gland, which could result in hypothyroidism.
When I am working with someone with Graves’ and other auto antibodies, we are addressing the immune system overall. We are trying to find triggers, underlying imbalances that will help with all the antibodies and the immune system overall. If someone with Graves’ just goes to an endocrinologist and takes antithyroid medication for 18 months to two years, for example, and they are not doing anything to improve their immune system health, then over time, there is a decent chance they can become hypothyroid. It could take many years for this to happen. It could take 5, 10, 15 years. There is no guarantee it will happen.
There is a good chance if someone has those auto antibodies that over time they will eventually become hypothyroid if they don’t address the underlying cause of the problem. That is a myth: Your thyroid will not eventually burn out. Those are two situations when someone with hyperthyroidism may eventually become hypothyroid.
I’d like to go ahead and summarize these five myths. Myth #1 is the only three treatment options are radioactive iodine, thyroid surgery, and medication. Definitely not true. I’ve been proving it for well over 10 years…since 2009. I proved it on myself when I was able to reverse my hyperthyroid condition being diagnosed with Graves’ in 2008.
Myth #2: radioactive iodine is a cure for Graves’. Again, completely false. Radioactive iodine may help with the hyperthyroid component. Usually, it does. Sometimes they will need multiple rounds. But radioactive iodine does help with hyperthyroidism. Graves’ is an autoimmune condition, which radioactive iodine doesn’t do anything for.
Myth #3: Improving your diet doesn’t help with hyperthyroidism. Once again, diet is an important piece of the puzzle. Changing one’s diet alone may not reverse hyperthyroidism, and it usually won’t in most cases. I think it’s ignorant of most endocrinologists to dismiss diet completely as being an important factor.
Myth #4: You can’t take methimazole for longer than two years. As I mentioned, it’s not an ideal situation to take methimazole longer than two years when people work with me because I want to address the cause of the problem. When someone is seeing an endocrinologist, and they are not addressing the underlying cause of the problem, many times, they are told that within 18 months to two years, if they are not in so-called remission, they need to get radioactive iodine or thyroid surgery. The research doesn’t support this. There are a number of studies out there that show taking lower doses of methimazole longer-term is a safe option.
I should add that everybody is different. There are a lot of people who don’t do well with methimazole. If someone is taking methimazole and has elevated liver enzymes or depressed white blood cell count, obviously they don’t want to be on it for even 18 months let alone longer than two years. They will probably be taken off of it relatively quickly and can try taking another type of antithyroid medication like PTU.
If someone is tolerating the antithyroid medication fine, and two years goes by, it’s kind of crazy to say, “It’s been two years, so you need to receive radioactive iodine or thyroid surgery. You need to make that choice now.” If it were up to me, if I were taking antithyroid medication, and two years went by, if I wasn’t doing anything naturally, and I still wasn’t in so-called remission, I would rather take the antithyroid medication than to go through surgery or radioactive iodine. But that’s just me.
Myth #5: Your thyroid will eventually burn out. Once again, that’s false. I mentioned how there were two situations where someone might switch from hyperthyroidism to hypothyroidism. One of those is subacute thyroiditis. A second situation is if someone with Graves’ also has the antibodies for Hashimoto’s, specifically the anti-thyroglobulin antibodies as well as the thyroid peroxidase antibodies, and you are not doing anything to address the autoimmune component, over time, there is adecent chance you will become hypothyroid.
These are five myths associated with hyperthyroidism. I hope you learned a lot, and I look forward to catching you in the next episode.