It took me two bouts of Graves Disease five years apart to really understand what this autoimmune hyperthyroidism is all about. I say this in all humility because my intention in submitting this paper is to generate interest in bona fide research from the perspective of naturopathic medicine. I believe this will verify the positive effect of a holistic approach, demonstrate that our medicine can do much to alleviate suffering from this poorly understood disease and in fact must be engaged to help reverse the normal allopathic practice of “slash or burn” that continues to be the norm in 2014.

The literature cites Graves Disease as a consequence of a faulty immune system; antibodies treat thyroid tissue as foreign and attack. No different than any autoimmune disease except this one strikes the thyroid, generating increased thyroid hormone that produces serious results. 

Yet the thyroid gland is no wilting violet in its healthy state. It is the master regulator of the body, the Queen Bee so to speak. Every cell and organ in the body takes direction from it, both physical and mental. It affects not only protein and carbohydrate metabolism, body weight, heart rate, blood pressure, sleep, sexual response but also influences mental wellbeing particularly cognitive ability and mood stability.

After my own diagnosis, I wanted to know what factors lurk that might cause a thyroid to succumb to a spinning of hormone that in its most severe complications, without treatment, could lead to disfigurement, even death. What were the roots of this inflammatory process? I had to know. Was there a link to food, minerals, environmental toxicity, exhausted adrenal glands and/or unfettered emotion, as is the cause of much of what we treat?

“Thyroid gland function is one of the most misunderstood systems by conventional medical doctors,” write Erin Lommen, ND and Jay Mead, MD in Slim, Sane and Sexy. “Regaining full thyroid function requires a willingness to strive for optimal hormone levels rather than normal levels.” 

A willingness to strive for optimal health, I translated. By necessity a whole person approach, the kind that takes all aspects of health into account to manifest a positive outcome. How could I do this with a diagnosis of Graves Disease?

The bottom line of the physical manifestation of autoimmune hyperthyroidism is clear. The Queen Bee, in its hyper state, means an acceleration of the metabolic rate and subsequent pounding of the heart.

This disease process comes on suddenly (or appears to) but usually starts slowly with mild symptoms like the inability to relax, irritability, an intolerance to heat, difficulty sleeping, a fast pulse. These warning signs can expand to include an even faster resting pulse (mine was 100), severe weight loss, increased perspiration and bowel movements, hand tremors, low libido, dry and brittle hair, changes in menstrual flow, tinnitus, a goiter, and eventually brittle bones. Five percent will have Graves’ dermopathy/ pretibial myxedema, a thick, orange peel like appearance skin on the shins, top of feet, possibly elsewhere. In thirty percent exophthalmos will occur. This is the dreaded Graves ophthalmology/Thyroid-associated orbitopathy (TAO) caused by carbohydrate metabolism dysfunction. (Antibodies attack and inflame the soft tissue behind the eyeball, pushing it forward.) 

Further complications may include heart rhythm disorders, changes in structure and function of the heart muscles and coronary heart failure, and blindness. In pregnancy there is the threat of miscarriage, pre-eclampsia, fetal thyroid dysfunction and poor fetal growth. 

The rare but life threatening possibility is thyrotoxicosis, also known as thyroid storm. This event requires immediate emergency care. Symptoms of fever, profuse sweating, vomiting, diarrhea, severe weakness, seizures, a markedly irregular heartbeat, yellow skin and eyes and severe low blood pressure that can lead to coma make this event out of range of naturopathic physicians. 

Too nervous to read on, cringing that naturopathic medicine should even be considered to treat this serious disease? Let me explain further.

In my first bout of Graves Disease I trembled not just from the “hyperness” of a fast pulse but from the fear of how I could save my thyroid while avoiding the allopathic standard of radioactive iodine therapy or thyroidectomy, especially after calling the medical director at my alma mater and learning naturopathic medicine continued to stay away from treating hyperthyroidism.

I was undeterred; I had to get to the bottom of this disease in order to heal myself. How did I rein in the attacking antibodies forcing my thyroid cells to overproduce? They couldn’t be magically acting on their own, I thought. The thyroid, like any other organ, does not work alone. To compartmentalize it, to isolate it, seemed absurd. The phrase, “it takes a village,” came to mind. 

I was grateful to NATO scholar, Dr Ryan Drum, PhD (who used to take my patients on herb walks): “Please stop blaming the thyroid gland for thyroid dysfunction. …Rather a person’s behavior contributes significantly…Please engage the thyroid gland as an obligate ally rather than a mass of misbehaving errant tissue, which must be disciplined with medications, radiation ablation or surgical removal. The thyroid gland is probably usually doing its best to respond to events and demands.”

Ah, events and demands. 

Before delving into that hornet’s nest, I reviewed the feedback loop from the hypothalamus (TRH, thyroid releasing hormone), to the pituitary gland (TSH, thyroid stimulating hormone) and finally, the thyroid (T3, T4). I remembered the hypothalamus responds to stress, strong emotion. Ditto the pituitary. 

After twenty-five years of not needing to, I re-read the risk factors. I was female but no longer under forty, not pregnant, had no family history, didn’t have another autoimmune disease, didn’t smoke (something that also increases the risk of Graves’ ophthalmology) and no physical stress. I had emotional stress from grief but I was handling that. Wasn’t I?

While I calmed myself in a variety of ways—meditation, slow walks, homeopathy, Chinese herbs, acupuncture, massage along with Tapazole, (the trade name for Methimazole)—I looked deeper into my situation. I was determined to put my finger on what I needed to understand to heal a disease I was taught not to treat. 

Thankfully history re-framed my predicament. Leaning into the past I learned the constellation of symptoms that would become known as Graves Disease, was first described in 1786 by Dr Caleb Parry in England, twenty-five years earlier than Dr Robert Graves in Ireland. It was as if these medical men were standing in my home, offering their insights on the core expression of what they had observed, clapping that someone was paying attention. 
Dr Graves, published in the London Medical Journal in 1853, noted the cause “…a bereavement following the death of a loved one, a marital breakup, major financial concerns…an overwhelming grief, an upset.” He spoke of a sense of doom, something I more and related to over time as denial of my emotional state waned. 

Although I am not keen on diseases being named after men, I feel deeply indebted to these doctors for their observations, a discussion that never entered the room with any of my medical doctors. If these 19th Century men hadn’t written down their conclusions two hundred years earlier, my thyroid, like thousands of others, would have gone the way of the knife, or been shrunk in size through radiation, leaving me, in either case, if nothing else, dependent on thyroid medication the rest of my life. And nothing for what else was going on.

Although I don’t want to make any assumptions each person I have come across diagnosed with Graves Disease confirmed the historical literature of a sudden grief. A child or sibling murdered, a mother dying, financial woes... or shock from a fall, an accident, something physical. 

Our practices are filled with people with unresolved psychological trauma, whether we delve in and treat at that level or not. This is the crux of the body-mind connection or psychoneuroimmunology—physical symptoms that stem from emotion. This was the concept that, along with my love of plants, had pole-vaulted me toward naturopathic medical school almost three decades earlier. 

The more I knew about Graves Disease the more I felt shocked that not one medical doctor mentioned stress to me. No one even suggested I see someone for anxiety. Just part of the symptom package that would be healed through one caustic method or another.

This malady of omission is, of course, rampant, even though medical professionals have stepped forward in the last century to voice the role of emotions and stress as a cause of ill health. It’s only lately that I learned that Hans Selye, in my hometown of Montreal in the 1950s, came to the conclusion that seven distinct conditions including Graves Disease had an underlying cause as stress. So why does it continue to be ignored? 

I was in the first class at Bastyr that offered counseling. I gobbled it up but it was the Vancouver Diocese that really concentrated my awareness in the mental/emotional root of physical symptoms. As I began treating survivors of sexual abuse with PTSD, post-traumatic stress disorder, it was relatively easy to link physical complaints such as migraine, digestive disorders, dysmenorrhea, painful intercourse, endometriosis, fibromyalgia and more to a story of abuse. Once this connection was made, and patients were able to track the cause through active listening, visualization, simple witnessing and/or creative expression, symptoms would disappear. It didn’t matter what the presentation, something would change, dramatically. This is true holism…to explore the whole picture, the whole person. 

The trauma in Graves may be more sudden, more apparent as the body goes into overdrive to deal with the shock of a profound upset but I believe our knowledge of, and our commitment to, Tolle Causam and Vix Medicatrix Naturae, is exactly what people suffering autoimmune hyperthyroidism need. 
This is not to say pharmaceuticals aren’t necessary, especially at the beginning. It depends on the severity of the disease. And it doesn’t mean you have to be directly involved in emotional therapy. Just be aware of this possible central core and refer out. 

The opposite is true of course: the physical affects the psychological. Graves Disease has been described historically as “…a heightened sensitivity of receptors to sympathetic nervous system activity possibly mediated by increased alpha-adrenergic receptors in some tissues.” This acknowledges the adrenal glands, the body’s bell ringers that call together the “village” of the thyroid including the pancreas, liver, and kidneys, for a concerted response to a shock or grief. Undoubtedly, there is much our medicine—scientific knowledge coupled with natural modalities—can do, without nailing a psychological event. 

For instance, how much do endocrine disrupters affect the thyroid? What is the outcome when essential minerals are displaced in our metabolic processes? How do allergies, environmental and food, or Vitamin D, B12 and other micronutrients play a role in hyperthyroidism? What about viruses or bacteria? One theory has Yersinia, the cause of bubonic plague as a possibility.

We know the liver converts 60% of thyroid hormone, making transport proteins like thyroid binding globulin that carry T4 and T3 to tissues, and is a factor in estrogen dominance, a condition that can increase free T4. The need for a healthy liver is obvious. Ditto all the other organs. Including carbohydrate metabolism. I have often wondered at my “luck” at escaping protruding eyes. Was it that I have eaten an anti-inflammatory diet since a teenager? 

There is no question that as the pioneers of integrated medicine we excel at optimizing metabolic pathways to effect optimal health. Without restoring gut function, detoxifying the liver, managing cortisol levels, regulating blood sugar there can be no regular pulse, no optimal lab values for the thyroid. Not to mention a bright and relaxed facial expression. 

It’s best to find an open-minded endocrinologist if your symptoms are severe but get started right away on a naturopathic or integrated medicine protocol, one that is truly holistic. Here are some facts to get started.

Botanicals, Lycopus (bugleweed) and Leonuris (motherwort), work like prescription anti-thyroid medication. They disable thyroid hormone production by inhibiting iodine binding to tyrosine. The grain, millet, does this too. Synthetic drugs include either propylthiouracil (PPO) or methimazole (Tapazole). Methimazole is not to be taken by pregnant women in their first trimester because of the risk of birth defects; both can generate a skin rash, joint pain as well as liver failure and a decrease in white blood cells. 

A little scary, these anti-thyroid medications are usually necessary at the acute stage, prescription tablets that can be slowly shaved down to nothing as the anxiety and heart racing is calmed. Have it prescribed through a medical doctor with the notion that is for the short term. (Note: Neither the botanicals or the prescription drugs are immediate in action…they don’t act on already stored thyroid hormone and will take three to six weeks to work.) 

The other prescription drug at the onset of treatment are beta-blockers, whether propanolol (Inderal), atenolol (Tenormin), nadolol (Corgard), metoprolol (Lopressor, Toprol-XL). They do not inhibit thyroid hormone but rather block pathways affected, giving fairly rapid relief of fast and irregular heartbeat, tremors, anxiety, irritability, heat intolerance and sweating. Unfortunately these may trigger an asthma attack in people susceptible and may also cause complications in diabetes. I appreciated these as I worked to increase my parasympathetic nerves with my longtime favorite, meditation.

On the other hand, I am vehemently opposed to the other two standards. Surgery means either a complete thyroidectomy or subtotal thyroidectomy; either procedure risks damaging vocal cords and parathyroid glands. Radioactive Iodine Therapy, measuring the uptake of radioactive iodine, will determine the rate the gland is taking up iodine. Destroying thyroid cells over time, the gland shrinks and hyperthyroid symptoms gradually decrease to the point of lifelong mandatory hormone replacement. 

Make sure to have TPO and TSI measured as well as TSH and free T3, reverse T3 and free T4. Eat an anti-inflammatory diet. Listen to my radio play, DR GRAVES, WE HEALED YOUR DISEASE. 

I believe that once the underlying forces are evident, psychologically and physically, Graves Disease is no longer scary. A holistic treatment plan can utilize the full spectrum of the modality arc, from meditation to anti-thyroid medication, making this “incurable” disease on its way to being understood and healed.