Resources abound for hypothyroidism online. After all, it is one of the leading hormonal imbalances affecting women, and rates are rising faster than ever. But for those dealing with a different condition—or really, quite the opposite condition—of hyperthyroidism, it can feel lonely and isolating when nobody is talking about, or offering help for you.
Well, you’re in the right place.
Doctors use the term hyperthyroidism to refer to a condition in which the thyroid gland is producing too much thyroid hormone, increasing metabolic rate to debilitating and sometimes dangerous levels. There are classically two main autoimmune conditions that can cause this: Graves’ Disease and Hashimoto’s Disease. While both Graves’ Disease and Hashimoto’s Disease are autoimmune conditions affecting the thyroid, they are different from each other. They are diagnosed differently, treated differently, and have different long-term health implications.
Let’s start by explaining autoimmunity.
Autoimmunity refers to the abnormal immunological process of producing antibodies against a person’s own self. Antibodies are like little soldiers made by the immune system for the purpose of fighting off foreign invaders like germs. If the body starts mobilizing soldiers against itself, that leads to problems ranging from inflammation to organ damage and even death. Graves’ Disease and Hashimoto’s Disease both involve the abnormal production of antibodies targeting the thyroid gland, but they produce hyperthyroidism in different ways.
What Is Hashimoto’s Disease?
Hashimoto’s Disease is the most common autoimmune diseases affecting the thyroid. Classically, however, it is thought of as causing hypothyroidism, and that’s because most cases do eventually result in a hypothyroid state. However, in the early stages, it can cause hyperthyroidism, or an overactive thyroid, too.
In Hashimoto’s Disease, the body makes antibodies (anti-thyroglobulin and anti-thyroperoxidase antibodies) that destroy elements of the thyroid gland. This causes swelling and inflammation of the thyroid gland. The inflammation itself is what can cause periods of thyroid overactivity because the provocation from the antibodies and resultant inflammatory processes may trigger the thyroid gland to produce even more hormone.
However, over time, as enough damage is wrought on the thyroid resulting from this autoimmune-driven inflammation, the thyroid may stop functioning as well as it should, or perhaps even may stop functioning altogether. As a result, hypothyroidism develops and while it can sometimes be improved through functional medicine, Hashimoto’s Disease that is diagnosed too late may lead to permanent hypothyroidism.
What Is Graves’ Disease?
Graves’ Disease is very different. Whereas Hashimoto’s Thyroiditis is the most common cause of hypothyroidism (ultimately), Graves’ Disease is the autoimmune disorder that is the most prevalent cause of hyperthyroidism. It occurs when the immune system produces antibodies that bind to the thyroid-stimulating hormone receptor (TSHR), leading to excessive thyroid hormone production. Under normal circumstances, the brain makes TSH (thyroid-stimulating hormone) for the purpose of binding to these receptors and stimulating the thyroid to produce thyroid hormone. In Graves’ Disease, thyroid-stimulating immunoglobulins (antibodies) bind to these receptors. In other words, the immune system mimics the brain and triggers the thyroid to make antibodies.
How Does Graves’ Disease Cause Health Problems?
Overproduction of thyroid hormone in Graves’ Disease accelerates metabolism and can result in symptoms such as weight loss, rapid heartbeat, anxiety, tremors, and eye problems like bulging eyes (Graves’ orbitopathy). Additionally, Graves’ Disease poses risks for people who are trying to get pregnant (or stay pregnant,) who struggle with anxiety, or who have cardiac conditions. It also may be challenging to function with Graves’ Disease because it often also brings other symptoms that affect quality of life, like body aches, sleep problems, and panic attacks. The immune side of Graves’ Disease is also problematic, as it can bring on episodes of full-body hives. If you’ve ever experienced this, you know just how overwhelming it can be.
How Is Graves’ Disease Diagnosed?
Diagnosis typically involves:
- Blood Tests: Measuring levels of thyroid hormones (T3 and T4), thyroid-stimulating hormone (TSH), thyroid-stimulating immunoglobulin (TSI) and thyroid-stimulating hormone receptor antibodies (TRAb) is an essential piece of diagnosing Graves’ Disease.
- Ultrasound: Assessing the size and texture of the thyroid gland. Thyroid nodules can also produce thyroid hormone, so it’s important to understand the root cause of hyperthyroidism and not simply assume that the root cause is Graves’ Disease.
- Radioactive Iodine Uptake Test: Determining how much iodine the thyroid absorbs, which is often elevated in Graves’ disease.
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The Role of Gut Health in Graves’ Disease
Emerging research indicates a significant connection between gut microbiota and Graves’ disease. Studies have shown that individuals with Graves’ disease exhibit reduced gut microbiota diversity compared to healthy controls. Specifically, there is a decrease in the abundance of Firmicutes and an increase in Bacteroidetes, suggesting an imbalance in gut bacteria that may influence autoimmune responses.
Furthermore, certain gut bacteria have been found to share structural similarities with thyroid proteins, potentially triggering immune responses that lead to autoimmune thyroid diseases like Graves’ disease. The functional medicine perspective recognizes that gut health, and balancing the gut microbiome, is essential for managing Graves disease.
Functional Medicine Strategies for Managing Graves’ Disease
Functional medicine emphasizes a holistic approach to managing Graves’ disease, focusing on diet, supplementation, and lifestyle modifications to support thyroid health and overall well-being.
1. Functional Medicine Testing
- Gut Health: Gut health plays a crucial role in regulating the immune system, as a large portion of immune activity occurs in the gastrointestinal tract. An imbalanced gut microbiome or increased intestinal permeability (“leaky gut”) triggers immune dysregulation, contributing to autoimmune reactions like Graves’ disease by allowing toxins or antigens to enter the bloodstream and provoke an inappropriate immune response. Functional medicine offers testing methods for identifying the status of the microbiome including specific strains of microbes that are or are not present, allowing tangible, specific tests for treatment and rebalancing.
- Food Sensitivities: Food sensitivities overstimulate the immune system by triggering chronic, low-grade inflammation each time reactive foods are consumed. In individuals with autoimmune conditions like Graves’ disease, this constant immune activation may exacerbate symptoms or contribute to flare-ups by increasing the overall inflammatory burden. Identifying and eliminating trigger foods can help reduce immune system stress and support more balanced immune function. Functional medicine offers testing methods for IgG and IgA-mediated food sensitivies as well as Ig-E mediated food allergies.
- Histamine:Histamine intolerance occurs when the body cannot properly break down histamine, leading to an overload that triggers inflammation and immune system activation. This heightened immune response worsens symptoms in autoimmune conditions like Graves’ disease by increasing systemic inflammation and aggravating thyroid dysfunction, especially symptoms like heart palpitations, hives and anxiety. Histamine is a routine part of functional medicine testing, as well as other pathways of the body involved in histamine production and detoxification.
2. Dietary Strategies
- Anti-inflammatory Diet: Incorporate whole foods rich in antioxidants, such as fruits, vegetables, and fatty fish, to reduce inflammation. Many patients also experience food sensitivities to eggs, gluten or dairy, so testing and elimination of these reactive foods is also important.
- Limit Iodine Intake: Excessive iodine can exacerbate hyperthyroidism; it’s important to limit high-iodine foods unless testing demonstrates that you’re deficient in iodine.
- Avoid Stimulants: Reduce or eliminate caffeine and high-sugar foods to prevent overstimulation of the thyroid.
- Regular Meals: Eating at consistent times helps stabilize blood sugar levels and support metabolic function. It also helps prevent exacerbation of Graves’ symptoms, like anxiety, racing heart, or feeling dizzy.
3. Herbal and Supplement Support
- 1. Bugleweed (Lycopus europaeus)
Action: Inhibits thyroid hormone synthesis and reduces TSH receptor activity.
Evidence: Shown to reduce thyroxine (T4) levels and may help manage mild hyperthyroidism.
2. Lemon Balm (Melissa officinalis)
Action: Competes with TSH for receptor binding and may help reduce symptoms like anxiety and palpitations.
Evidence: Traditionally used to reduce hyperthyroid symptoms; more robust human trials are limited.
3. L-Carnitine
Action: Acts as a peripheral antagonist of thyroid hormone activity and may relieve symptoms like muscle weakness and fatigue.
Evidence: Effective in reversing hyperthyroid symptoms in both overt and subclinical cases.
4. Selenium
Action: Antioxidant that protects thyroid tissue and modulates autoimmunity.
Evidence: Supplementation improves quality of life and reduces thyroid autoantibody levels in Graves’ disease.
5. Vitamin D
Action: Modulates immune function and lowers autoimmunity risk.
Evidence: Low vitamin D is associated with increased thyroid autoimmunity and more severe Graves’ disease.
6. Omega-3 Fatty Acids
Action: Anti-inflammatory effects and immune modulation.
Evidence: Helps regulate immune response and may reduce autoimmune thyroid inflammation.
7. Ahnjeonbaekho-tang (AJBHT)
Action: Traditional Korean herbal remedy shown to reduce thyroid hormone levels.
Evidence: Clinical trials demonstrate improvement in T3/T4 levels and TSH normalization.
4. Lifestyle Modifications
- Stress Management: Chronic stress can exacerbate autoimmune conditions; practices such as meditation, yoga, and adequate sleep can help manage stress levels.
- Regular Exercise: Engaging in regular physical activity can improve cardiovascular health and support metabolic function.
- Avoid Environmental Toxins: Limit exposure to environmental toxins that may trigger or worsen autoimmune responses. It’s also important to avoid using hormonal contraceptives, as in my experience, these are a common trigger for new onset of Graves disease.
Graves’ disease is a complex autoimmune disorder with significant implications for thyroid health. Understanding its pathophysiology, recognizing the role of gut health, and implementing functional medicine strategies can provide a comprehensive approach to managing the condition. Always consult with a healthcare provider before making significant changes to diet, supplementation, or lifestyle to ensure safety and efficacy.
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I’m Dr. Alexandra MacKillop, a functional medicine physician, food scientist and nutrition expert.
I specialize in women’s health & hormones, addressing concerns like fertility, PCOS, endometriosis, dysmenorrhea (painful periods), PMS symptoms like bloating and mood changes and more.
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References
- ZUFRY H, ZULFA PO, HARIYANTO TI. The gut microbiota and its role in Graves’ Disease: a systematic review and meta-analysis. Biosci Microbiota Food Health. 2024 Jun 7;43(4):300–308. doi: 10.12938/bmfh.2024-020. PMID: 39364132; PMCID: PMC11444861.
- Kiseleva EV, Kiseleva EV, Kiseleva EV. Gut Microbiota May Play a Significant Role in the Pathogenesis of Graves’ Disease. Front Endocrinol (Lausanne). 2020 May 5;11:301. doi: 10.3389/fendo.2020.00301. PMID: 32416683; PMCID: PMC7210420.
- Lee YJ, Lee YJ, Lee YJ. An alternative therapy for graves’ disease: clinical effects and mechanisms of an herbal remedy. J Ethnopharmacol. 2008 May 28;118(3):409-13. doi: 10.1016/j.jep.2008.04.014. PMID: 18479224.
- Komosinska-Vassev K, Olczyk K, Kucharz EJ, Marcisz C, Winsz-Szczotka K, Kotulska A. Free radical activity and antioxidant defense mechanisms in patients with hyperthyroidism due to Graves’ disease during therapy. Clin Chim Acta. 2000 May;300(1-2):107-17. doi: 10.1016/S0009-8981(00)00306-5. PMID: 10727685.
- Ross DS, Burch HB
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