Living Well With Graves' Disease and Hyperthyroidism

Last Editorial Review: 8/1/2005

WebMD Live Events Transcript

Are you one of the more than 3 million Americans suffering with Graves' disease or hyperthyroidism? If you have questions about the diagnosis or treatment of these thyroid problems and their effects on your weight, energy level, heart rate, and more, Mary J. Shomon joined us on July 21, 2005.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Welcome to WebMD Live, Mary. Thank you for joining us today. It seems as though the first hurdle that patients face is getting an accurate diagnosis. Why is that?

The problem is that for thyroid disease the symptoms can be vague and common to many other conditions. When you are looking at everything from fatigue to weight changes to hair loss to depression it's common for a doctor to say you are stressed, depressed or PMSing rather than run the actual tests needed to diagnose a thyroid condition. That's why it's extra important for women to understand their family history, know about the symptoms and to advocate for themselves with their doctor. Symptoms of a thyroid condition depend on what kind of condition that you have.

What are symptoms that would send you to the doctor for a thyroid check?

If you are hypothyroid or have an underactive thyroid the symptoms can include fatigue, weight gain, depression, hair loss, constipation, fertility problems, and dry skin, dry hair, body aches and pains, and numerous other problems that show the body slowing down.

If your problem is hyperthyroidism or overactive thyroid you may have anxiety and panic attacks, rapid heart rate, weight loss, difficulty sleeping and insomnia, extreme pain in the legs and arms, a complete lack of menstrual period, hair loss, depression, diarrhea, high blood pressure and other signs of an overactive metabolism.

"Unfortunately, even when we have our thyroid condition treated and we are taking thyroid medications like Levoxyl, we may still be battling the problem of additional weight."

What are the tests that the doctor will perform to check the thyroid?

Typically, the main test most doctors use as a first diagnostic effort is called TSH (thyroid stimulating hormone) test. TSH is considered the standard blood test by most physicians to evaluate the thyroid. A high THS level is evidence of underactive thyroid, and low THS is evidence of hyperthyroidism or overactive thyroid. This can be confusing because sometimes the doctor will tell you that you have a high thyroid, when you actually have a high TSH. Some people misunderstand the terminology so it's important your doctor explain what he or she means when they say your thyroid is high or low and you need to be clear on what your specific level is.

It's important to know that TSH number because in recent years, the lab standards for what is considered normal have changed. It used to be, in the past several years, a level of 0.5 to 5.0 was considered the normal range and now it's 0.3 to 3.0. This is a fairly dramatic difference that many doctors and labs are still not aware of. So, if your TSH is 0.3 or below, you may be hyperthyroid and if your TSH is 3.0 or above, you may be hypothyroid. That's only using the TSH test as the first test.

Other doctors may use an additional battery of tests, known as the thyroid panel, and that includes Free T4, Free T3, and thyroid antibodies to help make a formal diagnosis.

My doctor just gave me a result of 0.185 and said his norm is 0.5 to 1, but wants me to remain on my current medication of Levoxyl .125 and see me again in four months. Should I seek a second opinion? I feel fine. I am just having the weight issue, but have recently cut sugar out of my diet after reading your book. I have been on the new medication for 2.5 months.

While I'm not a doctor and can't give you specific medical advice, I can tell you that many practitioners have their own philosophy about where patients feel best and where patients are optimally treated as far as the TSH level is concerned.

Clearly, your doctor feels comfortable keeping you at a slightly lower TSH level and many doctors have this position because they seem to think their patients feel well -- as you have described that you do -- when their TSH level is somewhat depressed or lower. If you notice you're having symptoms that are indicating hyperthyroidism -- if your pulse rate is high, heart palpitations or you can't sleep -- then you definitely want to check with your doctor right away. But if your doctor is comfortable with this level and you are feeling well, I wouldn't think a second opinion is necessary unless you are having symptoms that are bothering you.

Unfortunately, even when we have our thyroid condition treated and we are taking thyroid medications like Levoxyl, we may still be battling the problem of additional weight. Changing the medicine dose and manipulating the TSH level may not have impact on the weight that you have already gained due to the thyroid condition. The best effort to focus on, as you mentioned, is changing your diet -- eliminating sugar, the anti-inflammatory food -- and boosting metabolism using various natural means.

My TSH is 4 and my doctor says this is normal. Where can I get something showing the new TSH levels to take to my doctor to convince him to try to lower the TSH level?

Good question. There are two places that you would want to check to get the information that would demonstrate to your doctor that a level of 4.0 should be considered evidence of borderline hypothyroidism.

  • The American Association of Clinical Endocrinologists (AACE) has sidelines regarding the new levels at their web site --
  • There is a detailed sideline from the clinical laboratory testing group that specifies these new ranges, and you can find a link to that information from my web site at

If the doctor is not willing to review materials that you bring from legitimate sources, such as AACE or the clinical laboratory guidelines, you may want to consider getting a new doctor. There's no reason to have to suffer with undiagnosed hypothyroidism, simply because your doctor has not stayed up on the latest developments.

Don't you have Hashi's? If so, how is it that you have come to be an expert in Graves' disease? By the way, I love your book Living Well With Hypothyroidism !

Thank you so much. Since writing Living Well with Hypothyroidism , I've tried to turn my own effort at research and information gathering into a patient advocacy campaign to help thyroid patients get the information they need to live well.

I do, in fact, have Hashimoto's Disease and in the course of eight years of writing my book along with running my web site and newsletters, I've corresponded with thousands of patients and hundreds of doctors all over the world who have every form of thyroid condition. I've felt that based on all of the information and research I was putting together from patients and doctors, that the type of empowered approach that I had used in the book for hypothyroidism, could be helpful for hyperthyroidism and Graves' disease.

My goal is to help patients step forward through the information gathering process and introduce them to all options, both conventional and alternative, to make informed decisions along with the practitioner.

"It's particularly important that doctors pay attention to symptoms, that patients not dismiss symptoms, and adequate treatment be provided the moment a diagnosis is made."

How serious is Graves' disease?

Graves' disease can be extremely serious, particularly if not detected fairly quickly by your practitioner. When left untreated, Graves' disease can cause episodes of extremely high blood pressure and pulse rates, and in rare cases, can even be potentially fatal if it progresses to a condition known as thyroid storm, where blood pressure and heart rate become uncontrolled.

It's particularly important that doctors pay attention to symptoms, that patients not dismiss symptoms, and adequate treatment be provided the moment a diagnosis is made. The challenge is that sometimes people will go into a doctor or an emergency room with a high heart rate and may have anxiety, and may be diagnosed with having a panic attack, or if someone is having rapid weight loss, there are many younger women who are told they are anorexic, and older women are menopausal, when the underlying facts are Graves' disease.

My doctor told me that radiation cures Graves' disease but I have read elsewhere that you can only hope for remission with antithyroid drugs. Is this true?

It depends on how you view the word "cure."

For conventional physicians, they consider getting rid of the hyperthyroidism as the cure. However, what you are doing when you receive radiation, also known as radioactive iodine or RAI treatment, is you are permanently disabling and deactivating your thyroid. So you do eventually eliminate the hyperthyroidism. However, you are trading one condition for another because the end result of RAI is almost always hypothyroidism and you will require lifelong therapy on thyroid replacement drugs.

Remission, which in this case means the absence of hyperthyroid conditions and return to normal TSH levels, is possible in about 25% of cases if patients are given a proper regimen of antithyroid drugs such as PTU, or methimazole or Tapazole. Also, adding in integrative, holistic or alternative approaches can often increase the chance that antithyroid drugs can help you achieve and sustain a remission from Graves' disease.

Are there any risks involved with radioactive iodine (RAI)?

The question of whether there are risks associated with RAI is one that is very controversial. Some doctors claim it is absolutely safe and has no side effects, no lasting problems or results and they consider it a completely safe treatment for Graves' disease and hyperthyroidism. Other practitioners believe that the end results of hypothyroidism is a significant and dangerous side effect of RAI and should be a consideration in a decision to give radiation treatment vs. thyroid drugs or a third option, which is used as treatment -- surgery. Some doctors believe that radiation should never be used in a woman of childbearing age or in children.


Where is the thyroid gland located? See Answer

In the United States, radiation treatment is the primary treatment for Graves' disease and hypothyroidism in the entire population. Outside the U.S., antithyroid drugs are the first choice of treatment followed by surgery or radiation, depending on the practitioner. However, outside the U.S. radiation is almost never done on children or women of childbearing age because of concerns of the long term effects of radiation on a child's development or on a woman's childbearing potential for future children.

With hyperthyroidism, what treatment do you recommend -- RAI, drugs or surgery?

I don't recommend any particular treatment. What I do recommend is that you -- as a patient -- be informed, knowledgeable and have a practitioner who is your partner in getting information and making the right decisions for you.

Some patients, depending on the severity of their condition, do well with an antithyroid drug to start, followed by more holistic measures to deal with the immune system and calm down the autoimmune problem. Other patients may be in such an acute state of hyperthyroidism that an immediate permanent treatment may be called for. Surgery, for example, is often the primary treatment recommended for a woman who is pregnant, in order to avoid radiation, which is never given when pregnant, or to avoid the potential dangers to the fetus of antithyroid drugs.

So ultimately, there is no one course of action that is the right answer for everyone. Rather, it depends on your condition, your willingness to incorporate holistic and nutritional elements into your overall health program, and having a practitioner who is open-minded, knowledgeable about these options and not biased in one direction or another while helping you make the best decision possible for you.

"Ultimately, one of the most important things a patient can do is to determine which combinations of options, both nutritional, conventional, alternative and even mind/body (I swear by deep breathing, Pilates and some meditation) will help you personally achieve your best possible outcome despite your thyroid condition."

Can you elaborate on the holistic measure you keep bringing up? I am truly interested in these! Also, are there holistic treatments for hypothyroidism?

Can you tell us more about "holistic measures to deal with the immune system and calm down the immune system"?

Holistic approaches to thyroid disease are varied and can incorporate everything from mind/body approaches, such as stress relief, breathing, and yoga, to dietary changes, to the use of herbs and supplements, traditional Chinese medicine and acupuncture.

When it comes to hypothyroidism or underactive thyroid, unfortunately, we do not have an herbal supplement for the missing thyroid hormone in the body. What you can do -- if you still have a thyroid -- is enhance the thyroid's ability to function using some of the essential nutrients that the thyroid needs in order to work at its optimal capacity. These include selenium, tyrosine, the B vitamins and essential fatty acids which all help the thyroid function at its best.

With hyperthyroidism, there are some herbs and nutrients that can help slow down the thyroid, making it less hyperactive. These include fluoride and soy foods.

There are many ways that we can work to help modulate the immune system which typically is dysfunction in both hypo and hyperthyroidism. These include a lower sugar or low-glycemic diet, making sure that we're getting enough omega-3 and omega-6 fatty acids to reduce inflammation, minimizing starches, white flour, sugars, ensuring sufficient protein, vegetables, and some fruits.

In my Living Well with Graves' Disease and Hyperthyroidism book is a detailed protocol from patient advocate John Johnson that describes a very complex combination of nutritional supplements that include copper, zinc, magnesium and other vitamins and minerals that may help some Graves' disease patient rebalance their immune system and achieve remission.

Ultimately, one of the most important things a patient can do is to determine which combinations of options, both nutritional, conventional, alternative and even mind/body (I swear by deep breathing, Pilates and some meditation) will help you personally achieve your best possible outcome despite your thyroid condition.

I have read that excess iodine is a trigger for autoantibodies associated with Graves' yet iodine-rich foods and supplements are often recommended for those with Hashi's. For those with both diseases, couldn't this exasperate the problem?

This is an excellent question, and it brings up several important issues.

First, you can have Hashimoto's disease and Graves' disease or hyperthyroidism at the same time. Sometimes that condition is known as Hashitoxicosis. In Hashitoxicosis, one can swing back and forth between hypo and hyperthyroid conditions. It is often one of the most difficult conditions to diagnose because if a doctor sees you during a hyperthyroid phase, you may be given antithyroid drugs or rushed into radiation treatment, which then deactivates the thyroid and worsens the existing Hashimoto's disease, whereas if you're seen during a hypothyroid phase, you may be given thyroid replacement drugs, which then make you more hyperthyroid. If you have symptoms that change frequently, have your doctor check all antibodies that test for hypo and hyper antibodies at the same time.

The second part of your question related to iodine. That is a very controversial subject for thyroid patients because both too much and too little can be a host for a variety of thyroid problems. If you have autoimmune thyroid tendencies, taking iodine or an iodine-containing supplement such as bladderwrack, may in fact aggravate your autoimmune condition and worsen both Hashimoto's and/or Graves' disease and can make you either more hypo or hyperthyroid. If you are iodine deficient, however, and only 20% of the American public is deficient in this essential nutrient, then you can develop what's known as a goiter or an enlarged thyroid, and the use of iodine or iodine supplements can actually help restore your thyroid to normal functions. Deficiency in iodine is a major problem in the developing world, and areas where salt in foods are not routinely iodized. However, the lack of iodine has not been a common problem in the U.S. since iodized salt. However, in people on low-salt diets and avoiding salty foods, we're seeing an increasing insurgence of iodine deficiency -- but again, it's the minority of the population.

Be careful about the use of iodine. Many holistic practitioners have an almost knee-jerk reaction, and suggest kelp or iodine as a treatment. Unfortunately, the reality is that whether or not you need iodine is a question unique to your own nutritional status, and given where you are located within the U.S. and the world, so be careful and discuss it with your practitioner before changing iodine intake to affect your thyroid condition.

"There is research, however it's considered controversial, that has shown overconsumption of soy may be a trigger to autoimmune thyroid disease in some people."

I have a few questions concerning a hypothyroid condition with a goiter. Is consumption of soy safe? I've read that amounts of isoflavones from soy can be bad for thyroid symptoms. Nutrition -- what kinds of food are beneficial and what kinds of food should I avoid? Treatment -- how to deal with a goiter? What medicine is helpful and are there any side effects?

Goiter refers to an enlargement of the thyroid; sometime it is enlarged enough to be visibly a thickening of the neck area.

There is research, however it's considered controversial, that has shown overconsumption of soy may be a trigger to autoimmune thyroid disease in some people. What we're talking about here is not eating some soy to be healthy. Rather, it's the "soy crazy, if some is good more is better" approach that some people tend to take. What you don't want to be doing are soy smoothies for breakfast, soy powders for snacks, soy nuts, burgers, creams all day long. If you are going to eat soy, eat it in moderation and use it in its natural form like the Asians. That means tempeh or tofu, not pills powders and shakes. Edamame are fine in reasonable quantities as well, for most people.

When it comes to goiter, certain foods eaten in large quantities can actually contribute to a worsening goiter. These are known as goitrogens. Goitrogens include large quantities of raw cabbage, brussel sprouts, many other greens and the aforementioned soy. Broccoli is also one of these. Cooking goitrogens, however, neutralizes most of the thyroid impact, and typically they are not a problem unless you are eating large quantities of them raw everyday.

The treatment for a goiter is typically the use of thyroid hormone drugs which can help shrink the goiter to a manageable size, but if the goiter is extremely large so that it is cosmetically unsightly, if it endangers breathing or swallowing, most doctors will typically recommend partial or complete removal of the thyroid, surgery known as thyroidectomy. However, most goiters don't require such dramatic measures and usually respond to drug treatment.

I am taking prenatal vitamins. Is this giving me a sufficient amount of the vitamins you recommended in your book or should I be taking additional supplements in addition to the prenatal?

Prenatal vitamins characteristically have somewhat higher levels of the B vitamins and calcium and iron than typically found in a regular multivitamin. Whether this is meeting your requirements is not something I can determine. You'd need to talk to your doctor or nutritionist, about whether this is suitable for your health situation.

I can tell you that even some of the best prenatal vitamins do not include, in sufficient quantities, some of the nutrients that you may want to be sure you're getting. Also, most do not include amino acids like Tyrosine that are helpful to thyroid conditions.

A warning: Prenatal vitamins are typically high in iron and may contain supplemental calcium. Those are essential to a pregnant woman or nursing mother. Calcium and iron have the ability to interfere with the thyroid hormone that you are taking. So you need to make sure you are allowing three to four hours time difference between taking a vitamin that includes calcium or iron, and your thyroid drug, or you may be deactivating your thyroid drug and allowing yourself to become hypothyroid. This is important for pregnant women because adequate thyroid replacement hormones are important during your baby's development, even in the earliest weeks of pregnancy. Many women begin taking prenatal vitamins when trying to conceive or as soon as they find out they are pregnant. So be sure to take these drugs at least three to four hours apart. This also applies to calcium-fortified orange juice, which many people like to take in the morning, with their vitamins and medication. Do not take that with your thyroid medication.

"Calcium and iron have the ability to interfere with the thyroid hormone that you are taking."


Hyperthyroidism: Symptoms, Treatment, Medication See Slideshow

Mary, we are almost out of time. Before we wrap things up for today, do you have any final comments for us?

I thank everyone for coming, and if you have questions that weren't answered, I'd be happy to find information for you if you write to me. You can write to me at [email protected] If you'd like to stay up on information, I welcome you to visit the web site and sign up for my free email letter. I hope you find this information helpful as you stay on the road to living well.

When will your new book be out?

This fall, late September. The new addition of Living Well with Hypothyroidism came out this spring with updated information for 2005.

Our thanks to Mary J. Shomon for joining us today. For more information, please read Mary Shomon's books including Living Well with Hypothyroidism , The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss , and her new one Living Well with Graves' Disease and Hyperthyroidism . You can also visit her on the web at For more discussion on this topic, be sure to visit the WebMD message boards to ask questions of our online health professionals and to share questions, comments, and support with other WebMD members.

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