Graves’ Disease: Searching for Whole-Body Approach to Thyroid Health
For Cova Najera, a diagnosis of Graves’ disease could have meant a lifetime of medication, but her doctor offered her a more whole-body alternative.
After her son was born, Cova Najera developed symptoms that would take 10 years for doctors to diagnose.
“I was experiencing a lot of weight fluctuations. My energy was up and down. I had episodes of depression for no reason,” she told Healthline.
It wasn’t until she was 43 that a doctor in Florida noticed during a routine examination that her thyroid gland was larger than it should be. Her previous symptoms had been subsiding, so Najera hadn’t mentioned them to her doctor.
The results of several tests, though, revealed that Najera had Graves’ disease, an autoimmune condition that affects the thyroid.
Because she didn’t have severe symptoms at the time, her doctor suggested they wait to see how things progressed.
In 2013, after moving to New York City, the symptoms returned in full force. A severe thyroid attack left her feeling anxious and confused.
Her new doctor prescribed drugs to treat her condition, but that did little to improve how she felt.
“They were giving me medication to suppress my thyroid, but I was feeling really, really horrible,” said Najera. “I couldn’t eat. I had all kinds of heart palpitations. I had zero energy. I was completely depressed.”
Other conventional treatments were available to her, but Najera’s recent flare-up would instead lead her down a nontraditional path toward healing.
What Is Graves’ Disease?
The thyroid gland is located in the front of the neck. It produces hormones that regulate how the body uses energy — sometimes called your metabolism.
Like lupus, rheumatoid arthritis, and several other conditions, Graves’ disease is an autoimmune disorder. These are marked by the immune system mistakenly attacking the body’s own cells.
With Graves’ disease, antibodies made by the immune system, which normally help fight disease and infection, instead target the thyroid.
But it’s more than just an attack.
The antibodies mimic the behavior of thyroid-stimulating hormone (TSH) made by the pituitary gland. The antibodies also overstimulate the thyroid cells, causing them to churn out too much thyroid hormone — what’s known as hyperthyroidism.
According to the American Thyroid Association, around 20 million Americans have some form of thyroid disease.
Graves’ disease makes up a small portion of that, but it still affects 2 to 3 percent of the population, according to the Graves' Disease & Thyroid Foundation. It is also five to 10 times more common in women than men.
Typical symptoms of Graves’ disease are related to the over-activity of the thyroid — enlarged thyroid, difficulty sleeping, unexpected weight loss, rapid heartbeat, muscle fatigue, and others.
Symptoms may come on slowly or appear suddenly. They may also be confused with other health problems. Or dismissed by patients.
Slow Road to Diagnosis
Before Kimberly Dorris, executive director and CEO of the Graves' Disease & Thyroid Foundation, was diagnosed with Graves’ disease in 2007, her symptoms were so minor that she didn’t think to mention them to her doctor.
“Looking back, I had had a lot of classic symptoms [of Graves’ disease], but I didn’t connect any of them with thyroid issues,” she said in an interview with Healthline.
But she got lucky.
Her doctor “did a screening test for thyroid function, and when that came back out of range, they did some more testing,” she said. “I eventually got the Graves’ disease diagnosis.”
This type of routine screening, however, is not currently recommended by the U.S. Preventive Services Task Force, except for pregnant women and people with symptoms.
Patients may ignore minor symptoms for years, especially when the symptoms come and go. Knowing your family medical history, though, may help your doctor connect mild symptoms with a thyroid problem.
“Family history is really important to understand,” said Dorris, “not just with thyroid dysfunction, but also with autoimmunity, because Graves’ disease is an autoimmune disease and those can cluster in families.”
Once the possibility of a thyroid problem is on a doctor’s radar, things progress much more smoothly.
“In most cases it’s pretty easy to make the diagnosis of hyperthyroidism, as long as you’re thinking about it,” endocrinologist Dr. Jason Wexler, a member of the Advocacy and Public Outreach Core Committee of the Endocrine Society, told Healthline.
“To determine the underlying cause of the hyperthyroidism can sometimes be a challenge,” he said, “but there are pretty straightforward tests that are usually quite helpful to be able to answer what the underlying cause is.”
After that, patients must work with their doctor to choose a treatment.
“Different people come to different conclusions about what’s the best way to treat their condition,” said Wexler. “There are three main choices. They are all choices because they all work. You just have to find what’s the best one for the patient.”
Treatment Options Work Well
The three main choices for treating Graves’ disease are antithyroid medications, radioactive iodine, and thyroid surgery.
Antithyroid medications — such as methimazole — slow the production of hormones by the thyroid. These may not cure the condition, but they can help control it.
Radioactive iodine cures the problem, although it usually destroys the thyroid tissue. Patients treated in this way will likely need to take thyroid hormone medication for the rest of their lives.
Surgical removal of the thyroid is also an effective cure. If the entire thyroid is removed — instead of just part of it — lifelong thyroid hormone pills are necessary.
Surgery may not be the first choice for many people, but it can be appropriate in certain cases. This includes people who experience bad side effects from antithyroid drugs or have a higher risk of complications due to the radioactive iodine.
“There are certain situations in which surgery might be the best choice and the first choice,” said Wexler, “even though that would not be the most common option overall for the management of the condition.”
Each treatment has its own pros and cons — even something as simple as taking a pill every day.
“I actually felt worse for a few weeks after I started taking the antithyroid medications,” said Dorris. “My general practitioner explained that my body had kind of gotten used to running on all cylinders and all of a sudden these medications were trying to slow things down.”
Her extreme fatigue decreased after that, even while she stayed on the medication. She was on methimazole for about seven years before going off it last year. However, she still works closely with her doctor to monitor her ongoing thyroid function.
However, not everyone fares that well on antithyroid medication.
Targeting the Autoimmune Disease
After having a bad experience with antithyroid medication, Najera searched the Internet for thyroid experts.
She found Dr. Ashita Gupta, an integrative endocrinologist at Mount Sinai West in New York.
Like Najera’s other doctor, Gupta reviewed Najera’s medical history and suggested that she start taking an antithyroid medication.
But that was not the end of the treatment.
As an expert in complementary medicine, Gupta takes a more whole-body approach to thyroid conditions.
“I might be a proponent of any of [the conventional treatments], depending on my discussions with the patient,” she said, “but I will also advise lifestyle modifications to target the autoimmune system, which is the underlying cause of the disease.”
Antithyroid medications, radioactive iodine, and thyroid surgery work well to slow or stop the release of hormones from the thyroid. But other approaches are needed to keep the immune system from attacking the body.
“Conventional treatments are effective, but they are targeting the vessel here. They are not targeting the underlying cause,” said Gupta. “That’s why I recommend lifestyle and diet changes, as well, because that’s what is targeting the underlying issue here, which is an overactive or hypersensitive immune system.”
At Gupta’s suggestion, Najera made major changes in her diet — avoiding gluten, sugar, and processed foods, and eating more fresh fruits and vegetables. She also started doing low-intensity physical activity such as walking and yoga. And she tried meditation.
Within two weeks she felt much better, with greater focus, more energy, and fewer weight fluctuations. These changes remain in place today.
“I feel completely different,” said Najera. “It’s not 100 percent. It’s 500 percent better. My life has completely changed.”
Eating better, of course, is good for overall health. But some experts caution that using food to treat autoimmune disorders, including Graves’ disease, has limited scientific evidence.
“I’m really not aware of a solid foundation of medical literature that supports changes to diet that are going have a positive impact on reducing the autoimmune disease, and thereby controlling their Graves’ disease,” said Wexler.
Dorris’ work with the Graves' Disease & Thyroid Foundation has given her similar concerns. Especially when people try to heal themselves without the guidance of a doctor.
“We’ve heard from patients who tried to go the natural route initially,” she said, “and then by the time they finally do decide to pursue conventional medicine, they’re much, much more ill.”
Without proper treatment, the health of people with Graves’ disease can quickly go downhill. And other problems may develop, such as eye problems, loss of bone density, and potentially deadly irregular heart rhythms.
Healthy Lifestyle Goes Beyond Thyroid
Scientists are just starting to explore the role of diet in autoimmune disorders, but the kind of lifestyle changes recommended by Gupta for her patients are potentially beneficial for everyone.
“Whatever approaches we recommend for targeting autoimmune disease are just a healthful way to live,” said Gupta.
This includes eating lots of fresh fruits and vegetables, whole grains, lean sources of protein, and healthy fats, such as from olive oil and avocado.
Regular exercise, yoga, and meditation are also good for stress-relief, no matter what your health condition.
But people with autoimmune disorders should be careful not to expect too much from natural treatments.
“Sometimes you can be doing all of these things right and you can be eating healthfully and meditating, and taking your supplements, and you could still have a flare-up of Graves’ disease or any other autoimmune condition,” said Gupta.
Najera had a flare-up like that earlier this year but was able to reduce her symptoms by getting back on track with healthy eating. More importantly, she also continues to monitor her thyroid health on her own and through regular doctor’s visits.
It took a long time for Najera to find more balance in her own health. But she hopes those experiences can benefit other people. She is currently studying integrative nutrition in graduate school.
“I definitely want to help people that went through the same process,” said Najera. “If I think of myself in my darkest days, I would love to get to people that are going through that.”