Episode - Natural Hyperthyroid Symptom Management Tips


Natural Symptom Management for Hyperthyroidism/Graves’ Disease

While many of my patients take antithyroid medication, when I was diagnosed with Graves’ disease in 2008, I chose to take a natural approach to manage my symptoms.  I took the herbs bugleweed and motherwort, and they did a wonderful job of managing my symptoms while I worked on addressing the underlying cause of my condition.  And while not everyone can successfully manage their symptoms through the use of herbs, many are able to do this, but they don’t know anything about the different options.  That’s why I created this episode.

During this episode you’ll learn:

  • The different types of herbs used to manage hyperthyroidism, including general dosing guidelines
  • Other natural agents that can be used to manage the hyperthyroid symptoms
  • The benefits and risks of using potassium iodide for symptom management
  • Can you take medication (i.e. methimazole) and natural agents (i.e. bugleweed) at the same time?

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Here is the transcript for this episode:

Welcome to the Save My Thyroid podcast. In the last episode, I discussed conventional symptom management options for hyperthyroidism, such as antithyroid medication, beta blockers, low-dose naltrexone, and cholestyramine. In this episode, I will discuss natural symptom management options, including bugleweed, motherwort, L-carnitine, lithium, and other natural agents.

We will discuss my very favorite herb for managing the symptoms of hyperthyroidism, which is bugleweed. Bugleweed is an herb that has antithyroid properties as it reduces the thyroid hormone levels. Lycopus virginicus and lycopus europaeus are the two main species. Most of the research studies involving bugleweed that I have come across have involved lycopus europaeus. These studies show that bugleweed is effective in mild forms of hyperthyroidism although in my clinical experience, I have had patients with moderate to severe forms respond.

On the other hand, for some people, this isn’t potent enough. In these cases, taking antithyroid medication may be necessary. Again, you can’t always go by the severity of hyperthyroidism, but there are some people who may take bugleweed who have a mild case of hyperthyroidism, and for some reason it doesn’t work. Yet there are people with moderate to severe cases of hyperthyroidism where bugleweed does work.

According to master herbalist Kerry Bone, 2-6ml of a 1:2 liquid extract should be used. I have used higher doses than this on some patients. 6-18 ml of a 1:5 tincture is recommended by Kerry Bone.

Let’s talk about motherwort. This is more specific for the cardiac symptoms. Bugleweed is actually helping with the thyroid hormone levels. Think of motherwort as a natural beta blocker, so it can help to reduce heart palpitations, decrease the heart rate, and also it has antiarrhythmic activity. Motherwort can be beneficial for other conditions, such as digestive disorders, bronchial asthma, amenorrhea, and even externally in wounds and skin inflammation. Pharmacological studies have confirmed its antibacterial, antioxidant, anti-inflammatory, and analgesic activity.

According to Kerry Bone, 2-4ml of 1:2 liquid extract should be used although I have used higher doses than this in some patients. If you are using a 1:5 tincture, then 6-12 ml should be used by most people.

Let’s talk about hawthorn. I usually recommend hawthorn to manage cardiac symptoms associated with hyperthyroidism, but there are times I will recommend hawthorn. Those people with cardiac arrhythmias can take this. Hawthorn also has gastroprotective, free radical scavenging, and antimicrobial activity.

With regards to its antimicrobial activity, it seems to be most effective against gram positive bacteria. It doesn’t have any effect against Candida albicans, at least in the research I have seen.

Regarding dosing, according to Kerry Bone, he recommends 3-7 ml of a 1:2 liquid extract. If someone is taking a 1:5 ratio, then 9-20 ml should be used.

How about lemon balm? Lemon balm has mild antithyroid activity, as it may block the binding of TSH to its receptor by acting both on the hormone and the receptor itself. It also may inhibit the TSH receptor antibodies binding to the TSH receptors, which is pretty cool. Lemon balm also has been used as a mild sedative, spasmolytic, and antibacterial agent. It might even have anti-tumor activities. I also came across a few studies that show that lemon balm has inhibitory activities on the herpes simplex virus. Another study shows that lemon balm can decrease elevated liver enzymes due to its strong antioxidant properties and phenol compounds. Another study conducted on mice show that lemon balm has antidiabetic effects.

As far as dosing, Kerry Bone has not given dosing for lemon balm. In this case, I will usually give what the bottle recommends, so the dosing on the label. With bugleweed, I will be more specific. I will look at the patient’s thyroid hormone levels and presentation. With motherwort, it depends on the person. With lemon balm, I am not as specific with the dosing. In most cases, I will have people take that in the evening. I use it more for its calming effects. I find bugleweed does a much better job when it comes to its antithyroid properties.

Speaking of antithyroid properties, there is also L-carnitine. Carnitine is a nitrogen-containing compound that is necessary for the transport of long-chain fatty acids into the mitochondria for oxidation. L-carnitine is the mirror image of carnitine, and it is the form typically taken in supplements. L-carnitine can help to lower thyroid hormone levels, but it has to be taken in higher doses. Studies show that 2,000-4,000mg a day or 2-4g a day of L-carnitine has antithyroid properties, so that is typically what I will recommend.

Some people will bring up acetyl l-carnitine. The research doesn’t show that acetyl L-carnitine, which is when you have an acetyl group attached to L-carnitine, will help. It won’t hurt to take it.  I will usually give acetyl-l-carnitine to someone who has a fatty acid oxidation problem or it can help in some cases of brain fog. For the purpose of lowering thyroid hormone levels, I can’t say I usually give it. Some people take a few different types of carnitine. They will take both regular L-carnitine and acetyl L-carnitine, and that seems to work better for them. Of course you could experiment if you’d like.

I must add that when I was dealing with Graves’ Disease, I did not take L-carnitine. I took bugleweed and motherwort. I started with bugleweed. That did help a lot, but I was still experiencing some heart palpitations after a few weeks, so then I added motherwort. But I did not take L-carnitine or lemon balm.

Let’s talk about lithium next, which I also did not take. Lithium can affect the production of thyroid hormone in multiple ways. First of all, lithium inhibits iodine uptake. Iodine is important for the formation of thyroid hormone. It also inhibits iodotyrosine coupling, which alters thyroglobulin structure and inhibits thyroid hormone secretion. Lithium also can decrease the conversion of T4 to T3.

Lithium carbonate vs. lithium orotate. Lithium carbonate is typically given by prescription, and not for hyperthyroidism. It’s been given in the past, and perhaps still currently for cases of depression. They found that it commonly causes hypothyroidism. From a natural standpoint, most practitioners who recommend lithium will recommend lithium orotate to their hyperthyroid patients.

There is potassium iodide, which is controversial when it comes to iodine. Some people will wonder, “Why in the heck would someone with hyperthyroidism take iodine?” And I am not recommending potassium iodide. Keep that in mind I am not saying any of these people should take it; I am just giving different options.

There is some research that backs up that potassium iodide can help with hyperthyroidism even though iodine is important for the formation of thyroid hormone. High doses of potassium iodide may inhibit thyroid hormone production. There was a study that involved potassium iodide combined with antithyroid medication, which showed at least in combination, they did a better job than antithyroid medication alone in lowering thyroid hormone levels. In the past, iodine, potassium iodide, Lugol’s solution was commonly used as a symptom management option in the past. However, not everyone does well with iodine, including potassium iodide.

When it comes to risk versus benefits, I’d be very cautious. This is coming from someone who actually took potassium iodide in the past. I have taken different types of iodine, and I had positive benefits in the past. But I have seen people who didn’t have positive experiences, and in some cases, make their condition worse. You want to be cautious if you decide to do this.

I am just bringing this up as an option because it could potentially induce hyperthyroidism. So sometimes it can cause hyperthyroidism or exacerbate hyperthyroidism if someone is currently experiencing hyperthyroidism. Also, there is some risk of it triggering autoimmunity or perhaps just exacerbating the autoimmune response. I have had a few nonpatients who mentioned they took iodine, and it made their thyroid eye disease worse.

Thyroid eye disease will be discussed in future podcast episodes. Like Graves’, it is an immune system condition where the immune system attacks the tissue of the eyes. Definitely be cautious with any of these iodine supplements, but especially potassium iodide.

Also, I should mention there is a practitioner who used Lugol’s iodine combined with lithium. The practitioner mentioned how using this got the people in remission. Keep in mind that it’s not addressing the triggers and underlying causes, just like a lot of people who are on methimazole will be told they are in remission. But the state of remission is usually temporary because the cause of the condition wasn’t addressed.

Even though this episode is focusing on natural agents, now that I have covered both the conventional symptom management options (in episode 3) and the natural symptom management options, I want to bring up and discuss when you should consider taking medication. Some people might say, “These natural agents are for me, and I am going to stop taking medication.” I am definitely not suggesting that you do that. Everything comes down to risks versus benefits.

I will say that I have a lot of patients who take antithyroid medication. Even though I personally did not take antithyroid medication, I would have taken antithyroid medication if the bugleweed didn’t work. You need to keep in mind that sometimes the natural agents don’t work well. If someone is taking antithyroid medication and they are not experiencing side effects, in that case, you might just want to stick with the antithyroid medication. Ultimately, it’s up to you. But don’t feel bad if you are taking antithyroid medication. Bugleweed and these other natural agents are not addressing the cause of the problem. They are just managing symptoms in a more natural way.

If someone has overt hyperthyroidism, you definitely want to do something to manage the symptoms. If you have elevated thyroid hormone levels, it’s important to take antithyroid medication or an herb such as bugleweed or L-carnitine (in larger doses). On the other hand, if someone has subclinical hyperthyroidism, where their TSH is depressed but their thyroid hormone levels are looking okay, they might not need antithyroid medication. They also may not need bugleweed. It depends on the situation.

Keep in mind that when some people take antithyroid medication or even bugleweed, after a little bit, their TSH might still be depressed, but their thyroid hormone levels look okay. That’s the subclinical state. But I am talking about people who have subclinical hyperthyroidism before taking anything, so they haven’t taken antithyroid medication or natural agents, and their TSH is depressed, and their thyroid hormone levels are looking okay. In these cases, they may not need to take medication or natural agents.

Then you might wonder, “If I am leaning toward medication, should I take antithyroid medication or a beta blocker or both?” Just remember, even though some beta blockers help inhibit that T4 to T3 conversion, they still aren’t as effective as antithyroid medication when it’s lowering thyroid hormone levels. Elevated thyroid hormone levels can also affect bone density. If someone is not having side effects, then antithyroid medication is not necessarily a bad thing. If someone is experiencing side effects with methimazole, PTU, or carbimazole, that is when they might want to look into beta blockers or natural agents.

As far as the dosage you should take with medications, that is up to the prescribing doctor. If someone has a severe case of hyperthyroidism, then the endocrinologist is more likely to prescribe higher doses of methimazole, PTU, or carbimazole. If the person becomes hypo, then typically the dosage will be reduced. That is also why you want to make sure to retest when you are on anything. You don’t want to wait 3-6 months before retesting. I would say 1-2 months, depending on the situation.

As far as how to wean off the medication, I can’t tell someone to stop taking medication. Let’s say if someone is taking antithyroid medication such as methimazole, and they are interested in weaning off of that and taking bugleweed (again, I am not advising anyone to do this), but what some people do is take the bugleweed at the same time as the antithyroid medication. Maybe not at the exact same time. They may take methimazole first thing in the morning and wait an hour to take the bugleweed. Then the goal is for the bugleweed to push them more towards the hypothyroid side. You can confirm this with a follow-up blood test. The prescribing doctor will then reduce the dosage of the medication, so ultimately you will eventually be just on the bugleweed. Then eventually you will wean off the bugleweed.

So once again, I was diagnosed with Graves’ in 2008. I took bugleweed and motherwort into 2009, but I have not taken bugleweed or motherwort since 2009. So bugleweed is not permanent either, which is a good thing. You shouldn’t want to take bugleweed, motherwort, L-carnitine, or anything else I mentioned here on a permanent basis.

As far as the dosing with herbs and other natural agents I mentioned, I gave some suggestions earlier, but the dose does depend on the person as well as the thyroid panel results. I only give specific dosing recommendations to my patients because I work with them one-on-one and look at their blood tests and keep their symptoms in mind as well.

I will say that when I was dealing with Graves’ Disease, I took a 1:2 extract of bugleweed as well as a 1:2 extract of motherwort. The dose I took in my situation was 5ml, 2 times per day of each. 5ml is the same as one teaspoon.

Keep in mind that not everyone takes the same dosage. So you don’t want to go out and get the same bugleweed and take the same dosage. Of course, there are people who are going to self-treat. What I see people do is they will get bugleweed and take what’s recommended on the bottle. Many of those people do okay. I am not saying most of those people will experience serious side effects. But there is a risk with herbs, too. There is a risk with medication, but herbs aren’t completely safe as well, which is why I always recommend working with a natural health care practitioner. But of course I am going to be biased because I am a natural healthcare practitioner.

Hopefully this episode provided you with some options if you are thinking about not taking the medication or if you are currently taking it and want to switch off the medication.  Once again, I’m not advising anyone to switch, but if you are thinking about natural agents such as bugleweed, motherwort, L-carnitine, lemon balm, I am really hoping that this episode gave you some insight on how these could be effective. They are not effective in everyone. But in a good amount of people, these can be effective. Whether or not you are taking conventional medication such as antithyroid medication, beta blockers, or natural agents such as bugleweed, motherwort, or L-carnitine, you still want to address the cause of the problem. You want to find triggers and address underlying imbalances. I will be discussing this in future podcast episodes.

I’d like to give a brief summary of what I discussed. Bugleweed is an herb that has antithyroid properties. Motherwort and hawthorn don’t lower thyroid hormone levels but can help with the cardiac symptoms associated with hyperthyroidism. Lemon balm is also an herb with mild antithyroid properties and other therapeutic effects. L-carnitine, when taken in higher doses, has antithyroid properties. According to the research, 2,000-4,000mg per day. Lithium and potassium iodide can also affect thyroid hormone production.

You might still be wondering if you should be taking medication, or should you go with a natural agent? This of course is ultimately up to you. Just remember that everything comes down to risk versus benefits. You want to do what is necessary to safely manage your symptoms.

With that being said, I’d like to thank you for tuning in, and I look forward to catching you in the next episode.