A Functional Medicine Protocol for Hyperthyroidism

The thyroid is a small, butterfly-shaped gland located in the front of your neck that produces hormones to help regulate the way your body uses energy. When too much thyroid hormone is produced it results in hyperthyroidism.

These extra thyroid hormones cause many bodily functions to speed up and/or become dysregulated. Thyroid hormones have wide-reaching effects throughout the body, so signs and symptoms of hyperthyroidism can impact the whole body including weight loss, fast or irregular heart rhythms, fatigue, heat sensitivity, sleep disturbances, anxiety, and changes in bowel functions and menstruation.

In the United States, 1-3% of people experience hyperthyroidism. The prevalence of hyperthyroidism increases with age and is more frequent in women.

Hyperthyroidism can result from various causes. The most common cause of hyperthyroidism is the autoimmune condition Graves’ disease followed by toxic multinodular goiter. A functional medicine approach to hyperthyroidism uncovers and addresses contributing causes while working to balance thyroid function to control symptoms.

[signup]

What is Hyperthyroidism

The thyroid gland is a small butterfly-shaped gland located in the front of your neck. It produces thyroid hormones that impact how the body uses energy and regulate many important bodily functions. Thyroid hormones travel throughout the bloodstream and influence heart rate, energy production, body temperature, and growth.

Hyperthyroidism results when the thyroid gland becomes overactive and produces and releases too much thyroid hormone. Thyroid function is normally regulated to stay within a range that allows metabolism and other functions to remain balanced. This balance is orchestrated by a complex interplay of signals coordinated by the brain and interacting with several nutrients and other hormones.

The hypothalamus in the brain is responsible for managing hormones, hunger, thirst, sleep, and body temperature and monitors the level of thyroid hormone present in the blood. When it detects the need for increasing metabolism and energy, it releases thyroid releasing hormone (TRH) to signal the pituitary gland at the base of your brain to release thyroid stimulating hormone (TSH) also known as thyrotropin.

TSH acts directly on the thyroid, stimulating it to produce and release thyroid hormones including

• T4, a storage form of thyroid hormone that circulates throughout the blood and is stored in tissues for when it is needed
• T3, the active form of thyroid hormone

In hyperthyroidism, elevated levels of these thyroid hormones can affect many important functions throughout the body.

Hyperthyroid Symptoms

The extra thyroid hormones in hyperthyroidism can cause many bodily functions to speed up and/or become dysregulated. When too high levels of thyroid hormones are released into the blood, your metabolism speeds up, causing the body to burn through energy and nutrients too quickly. This can result in malnutrition and a wide range of problems. Additional signs and symptoms of hyperthyroidism can impact the whole body since thyroid hormones have wide-reaching effects.

Common signs and symptoms of hyperthyroidism include:

• weight loss
• increased appetite and hunger
• fast or irregular heart rhythms
• anxiety and irritability
• sleep disturbances and insomnia
• tremors or small trembling
• fatigue
• muscle weakness
• heat sensitivity, hot flashes, and sweating
• thinning skin
• fine, brittle hair
• changes in bowel habits like frequent stools, loose stool, or diarrhea
• changes in the menstrual cycle
• reduced bone density and osteoporosis
• swelling and enlargement of the thyroid gland in the neck (goiter)
• bulging of the eyes (with Graves’ disease)

Thyroid storm (accelerated hyperthyroidism or thyrotoxic crisis) is a rare but serious complication that may occur with hyperthyroidism. In this condition, a sudden and drastic increase in thyroid hormones causes an increase in metabolism resulting in

• fever
• sweating
• vomiting
• diarrhea
• delirium
• severe weakness
• seizures
• irregular heartbeat
• yellow skin and eyes (jaundice)
• severe low blood pressure
• coma without appropriate care

What Causes Hyperthyroidism

Several different conditions can cause hyperthyroidism.

Graves’ Disease

Graves’ disease is the leading cause of hyperthyroidism in iodine-sufficient regions like the United States, causing four out of five cases. This autoimmune disorder causes the immune system to attack the thyroid gland which causes the thyroid to grow and release too much thyroid hormone.

Toxic Multinodular Goiter

Toxic multinodular goiter or toxic adenomas involves overactive thyroid nodules that cause hyperthyroidism. In this condition, noncancerous lumps (adenomas) of thyroid tissue form and produce thyroid hormones autonomously, regardless of TSH. These nodules can also make the thyroid bigger than usual. When these adenomas produce too much thyroid hormone, hyperthyroidism results. Adenomas are more common in developing countries where iodine intake is insufficient.

Thyroiditis

Thyroiditis involves an inflamed thyroid gland that can cause extra thyroid hormones to leak into the bloodstream and cause symptoms of hyperthyroidism. The thyroid can become inflamed due to an autoimmune process, after delivering a baby (postpartum thyroiditis), or for unclear reasons.

Excess Iodine

Iodine is a mineral that the thyroid needs to create hormones. Too much iodine consumed through your diet or via medications like amiodarone or intravenous iodinated contrast (iodine “dye”) can cause the thyroid to produce more hormones and result in hyperthyroidism.

Genetics & Environment

Genetic predisposition and environmental factors influence the risk of developing hyperthyroidism. Several thyroid- and immune-related genes increase susceptibility to hyperthyroidism.

Environmental or epigenetic factors interact with this genetic susceptibility to influence whether someone develops this condition. For example, some of the main factors that contribute to autoimmunity underlying the development of Graves’ disease and some forms of thyroiditis include genetics, imbalances in gut health, nutrition, infections, and environmental exposures.

5 Functional Medicine Labs to Assist Root Cause Treatment for Hyperthyroidism

Testing can diagnose hyperthyroidism and help to identify the underlying contributing factors. This includes assessing the functioning of the thyroid, measuring autoantibodies, visualizing radioactive iodine uptake or thyroid nodules, and evaluating factors that play a role in immune system function to uncover the causes of the autoimmunity leading to Graves’ disease or thyroiditis.

Thyroid Function And Autoantibodies

To assess the state of thyroid function, a Complete Thyroid Panel including thyroid-stimulating hormone (TSH), T3 (free and total), T4 (free and total), and reverse T3 should be assessed using functional medicine ranges. Hyperthyroidism is characterized by a low TSH level and elevated T4 and T3.

• TSH measures how the pituitary gland in the brain is communicating with the thyroid and is indicative of hyperthyroidism when decreased
• Free T4 measures the bioavailable or unbound thyroid hormone and is a marker of increased thyroid function when elevated
• In the peripheral tissues, T4 is converted to T3. An elevated level of T3 can indicate increased thyroid function
• In addition, thyroid antibody testing for thyrotropin receptor antibody (TRAb) can help diagnose Graves’ disease
• Some patients with Graves’ will also develop Thyroid Peroxidase (TPO) antibodies or antithyroglobulin antibodies, although typically these antibodies are more commonly associated with Hashimoto’s hypothyroidism

Micronutrient Testing

A Cellular Micronutrient Assay can measure nutrients that support thyroid health including iodine, Vitamin D, iron, zinc, and selenium.

Measuring urine iodine can help assess excess iodine supplementation as a potential cause of Graves’ disease.

Gut Health

Since dysbiosis and leaky gut are key factors in overall inflammation that can impact the thyroid and the development of the autoimmunity which occurs in Graves’ disease and some forms of thyroiditis, assessing gut health can help provide targeted interventions. A Comprehensive Stool Test measures amounts of healthy and unbalanced gut bacteria (dysbiosis), inflammatory markers, leaky gut, parasites, and yeast to assess the state of the gut and guide treatment aimed at restoring balance.

Additional testing for gluten sensitivity or celiac disease with Genova Diagnostics Celiac and Gluten Sensitivity and evaluation of the leaky gut marker zonulin can also help to guide treatment.

Food sensitivities can contribute to increased intestinal permeability, inflammation, and autoimmunity. Foods to which an individual is sensitive to can be identified with ELISA testing.

Radioactive Iodine Uptake (RAIU)

RAIU uses a small dose of radioactive iodine (I-131) to look at how much iodine the thyroid takes up and in what pattern. A high iodine uptake is indicative of hyperthyroidism.

Ultrasound (US)

US of the thyroid can help with evaluating the cause of an overactive thyroid. This type of imaging uses high-frequency sound waves to see if the thyroid is enlarged and to look for nodules or adenomas on the thyroid which occur in toxic multinodular goiter and may produce excess thyroid hormones.

Hyperthyroidism Treatment

Depending on the factors contributing to hyperthyroidism, a combination of conventional and integrative medical approaches can address the impacts of too many thyroid hormones. While conventional approaches may sometimes be needed, such as in an acute hyperthyroid crisis, they do not address the underlying factors contributing to the condition. A functional medicine approach can help to investigate and address contributing underlying causes of hyperthyroidism to help bring the body back into balance

Conventional Treatment for Hyperthyroidism

Conventional treatment approaches to hyperthyroidism include

• suppressing thyroid function with medications
• using radiation to destroy part of the thyroid gland
• surgically removing the thyroid tissue (thyroidectomy)

Antithyroid drugs like propylthiouracil (PTU) and methimazole (MMI) interfere with the production of thyroid hormones by blocking the thyroid’s use of iodine to produce hormones. They require careful monitoring for side effects and to avoid overcorrection and hypothyroidism.

Large doses of radioactive iodine (I-131) are sometimes used in hyperthyroidism to permanently destroy thyroid gland cells. After the thyroid gland is destroyed, synthetic thyroid medication is used to replace normal hormone levels.

In some cases, partial thyroidectomy or surgical removal of part of the thyroid gland is used. After the surgery, treatment is generally needed to supply the body with normal amounts of thyroid hormones.

The specific treatment approach depends on the underlying cause of hyperthyroidism. All three of these therapeutic options can be effective in treating Graves’ disease, whereas patients with toxic multinodular goiter are usually conventionally treated with radioactive iodine therapy or surgery since they are less likely to go into remission.

Integrative Medicine Treatment for Hyperthyroidism

An individualized gluten-free, anti-inflammatory diet that balances micronutrients alongside supplements and herbs is commonly prescribed.

Nutrition

Gut dysbiosis, chronic inflammation, and nutrient deficiencies can all contribute to hyperthyroidism so an individualized gluten-free, anti-inflammatory diet is an important step in regaining hormonal balance. A nutrient-rich, anti-inflammatory organic diet that is tailored to an individual’s sensitivities and needs can help balance inflammation and tame autoimmunity. Eliminating individual trigger foods, such as gluten and other grains, dairy, soy, processed sugars, and inflammatory fats can help reduce inflammation and balance autoimmunity that can contribute to hyperthyroidism.

Rebalance the Gut Microbiome

The gut microbiome has a significant impact on inflammation, the immune system, and dysbiosis in the gut, factors that can contribute to the risk of hyperthyroidism. Therefore, restoring equilibrium in the gut microbiota by eating a variety of real whole foods and incorporating probiotic-rich foods like kimchi and sauerkraut that contain naturally-occurring probiotics and prebiotic-rich foods like artichokes and garlic that nourish healthy bacteria is critical for repairing the mucosal barrier and halting excess inflammation and autoimmunity that can harm thyroid function. Specific probiotics containing Bifidobacterium longum bacteria have been shown to improve thyroid function and rebalance the gut-thyroid axis.

Mineral and Nutrient Balance

Sufficient micronutrients are needed to support healthy thyroid function. Balancing the intake of micronutrients can help to balance inflammation and thyroid function. These include

• iodine
• vitamin C
• vitamin E
• selenium
• zinc
• vitamin D
• omega-3 fatty acids

While iodine is crucial for making thyroid hormones, too much iodine intake from eating refined iodized salt in processed foods or excessive consumption of seaweeds can negatively affect thyroid functioning.

Antioxidants like vitamin E and vitamin C are essential for reducing the excess oxidative stress which occurs in Graves’ disease and thyroiditis. Foods such as red bell peppers, broccoli, citrus fruits, and kiwi are rich in vitamin C. While avocados, nuts, olives, and seeds are rich in vitamin E.

Selenium is required for the activation and deactivation of thyroid hormones and is a cofactor for glutathione peroxidase, an enzyme that helps to protect the thyroid gland from oxidative damage. Brazil nuts are one of the richest food sources of selenium, which is also found in eggs, sunflower seeds, chicken, mushrooms, and sardines.

Keeping zinc, vitamin D, iron, and omega-3 fatty acid intake and levels balanced is also important for immune balance and a healthy thyroid healthy.

Herbs & Supplements

L-carnitine is an amino acid analog that blocks the effects of thyroid hormones in many peripheral tissues so that it is not able to act. While L-carnitine does not directly impact thyroid hormone levels, it is effective in reversing and preventing many of the symptoms of hyperthyroidism like an elevated heart rate, nervousness, and insomnia.

Resveratrol, curcumin, omega-3 fatty acids, and glutathione are antioxidants that may help counteract the excess oxidative stress associated with hyperthyroidism.  

Lifestyle changes

Caffeine and alcohol can aggravate symptoms of hyperthyroidism like anxiety and rapid heart rate so should be avoided.  

High levels of chronic stress contribute to inflammation and autoimmunity that underlie many cases of hyperthyroidism. Finding balance via lifestyle practices like adequate quality sleep, stress management practices, and balanced movement can improve thyroid and overall health.

Summary

The thyroid is an important gland located in the neck that produces hormones that regulate processes throughout the body. Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone causing symptoms like weight loss, increased appetite, anxiety, difficulty sleeping, rapid heart rate, fatigue, hair and skin changes, and more.

The most common cause of hyperthyroidism in iodine-sufficient regions like the United States is the autoimmune condition Graves’ disease where an immune attack results in an increased release of thyroid hormones. In iodine-deficient regions, toxic adenoma or toxic multinodular goiter are common causes of hyperthyroidism. Other causes of hyperthyroidism include inflammation of the gland in thyroiditis and excess iodine.

Blood tests can measure levels of thyroid hormones and look for signs of the underlying cause of hyperthyroidism such as the presence of antibodies in Graves’ disease. A low TSH indicates that the thyroid is producing too much hormone. Iodine scans and ultrasound imaging can look at the function and structure of the gland.

A functional medicine approach to hyperthyroidism aims to bring hormones back into balance and prevent complications. Functional laboratory testing can help uncover contributing factors like dysbiosis of gut bacteria or iodine imbalances. Dietary and lifestyle interventions can then target causes of autoimmunity and excess inflammation to rebalance the gut, manage chronic stress, and bring the body back into balance.