Hyperthyroidism – A Naturopathic Case Study

I had the pleasure of helping to manage hyperthy- roidism symptoms for a lovely lady named Jo (fake name) in the summer of 2020. Jo was a 31 years old female whose chief concerns included chronic headaches, chronic fatigue, heart palpitations, and nausea experienced on a daily basis. Her headaches were 10/10 on the pain scale and it felt like her head was about to explode behind her eyes. She popped Tylenol pills like candy multiple times a day. Her energy was so poor that she could barely keep her eyes open during the day. Falling asleep at night was also an issue. It would take her a couple hours to fall asleep in spite of having good sleep hygiene. She would wake up a couple times at night and would have diffi- culty falling back to sleep. Jo was diagnosed with Hyperthyroidism in 2013 when she was admitted to the emergency room for a thyroid storm with symptoms of shortness of breath, fever, severe headaches and heart palpitations. Afterwards her symptoms were managed with Tapazole.The dose had gradually decreased to 20 mg QD over the years.

Other issues that Jo experienced included night sweats and irregular menstrual cycle fluc- tuating between 21 to 45 days. Bowel movement occurred once a week. Appetite was poor yet she was gaining weight. Physical exam showed enlarged thyroid glands. She also mentioned constant throat irritation and pain. She brought in her lab reports ordered by her GP in July 2020. It showed TSH <0.01 (reference range 0.2 – 4mIU/L), fT3 6.4(3.5 – 6.5 pmol/L), fT4 22.3 (10 – 25 pmol/L), hsCRP 1.1 (0 – 8). Other labs such as CBC, ferritin, electrolytes, kidney function, B12, HbA1C, fasting glucose, lipid pan- el, urea and liver enzymes were within reference range. I ordered more labs and those were 25 hydroxy-Vitamin D 54.4 (80 – 200 nmol/L), 1,25 Vitamin D 176 (60 – 208 pmol/L), thyroglobulin 2.2 (0 – 50 ug/L), thyroglobulin antibodies 3938 (0 – 35 kIU/L), thyroid peroxidase antibody 259 (0 – 34 kIU/L). I also ordered an IgG food sensitivity test and it showed Jo had sensitivities to dairy, gluten, eggs, corn, pea, soy and other foods.

In summary, her thyroid was over-reactive and may have been caused by autoimmunity and inflammation. Her vitamin D level was low. Our long term goal was to calm down the autoimmunity and inflammation with a short term goal of symptom manage- ment to allow her to have a better quality of life.

We started working on a dairy-free, gluten-free, soy-free, corn- free diet according to the IgG4 food sensitivity Test results, as well as low carbohydrate diet. I also suggested other diet modi- fications including at least one fist size cooked (or a plateful of raw) colourful vegetables in every meal, 8 cups of water instead of coffee, and high sugar content drinks. I also recommended that she replace bad oils with healthy oils. I asked her to use EWG (En- vironmental Working Group) as a resource when selecting foods, skincare products and cleaning products. Of course, gentle physi- cal movements such as yoga or stretches were also suggested. 

This was the supplement list I suggested for her: 1.Acetyl-L-Carnitine: 1,600mg twice a day. L-carnitine has been shown to be a peripheral antagonist of thyroid hormone action in some tissues. L-carnitine is effective in both reversing and preventing symptoms of hyper-thyroidism and has a beneficial effect on bone mineralization.

2. Selenomethionine: 200mg twice a day.

Selenium has antioxidant and an- ti-inflammatory effects on thyroid gland as it protects thyrocytes against ROS in Grave’s disease. Studies have shown that selenium may improve mild Grave’s symp- toms such as Graves orbitopathy and prevent deterioration when compared with placebo.

3. Rhodiola, Cordyceps, Eleuthe- ro, Ashwagandha herbal extracts have immunomodulatory effects and anti-inflammatory effects. They help improve energy by supporting the adrenals/hypo- thalamus-pituitary- adrenal axis. Cordyceps has been shown to reduce antibody levels in Graves disease by restoring the balance between helper T and cytotoxic T cells. I asked Jo to take a product by Vita Aid that consisted of a combination of these herbs. Dos- ing: 2 capsules twice a day.

4. Buplerum has been shown to have comparable effects with PTU in L-thyroxine induced hyperthyroidism mice model, and has been shown to inhibit histopathological changes on the thyroid glands. I advised Jo to take Femalance (a traditional Chinese medicine formula, also known as Free and Easy Wan- derer) by Vita Aid, 2 capsules twice a day.

5. Magnesium threonate: 48mg in 1 capsule. 1 – 2 capsules as needed for headaches.

A number of double-blind randomized placebo-controlled trials have shown that magnesium is efficacious in relieving head- aches and have led to the recommendation of oral magnesium for headache relief in several national and international guidelines. 6. Vitamin D was recommended to be taken at 5,000IU a day, and Omega-3 was recom- mended to be taken at 1,500mg twice a day. A nationwide, randomized, double blind, placebo controlled trial showed taking vitamin D and Omega-3 reduces autoimmune disease risk.

I also asked her to come for Adrenal shots that had Methylcobalamin, Biotin, L-5-Methylfolate, B1, B6, AMP, Hydroxoco- balamin, Chromium, and Procaine. 1 ml was injected in the deltoid muscle. A total of 6 injections was performed on a biweekly basis. 6 months into the treatment, Jo had minimal headaches, more energy, better appetite and less pressure behind her eyes. Sleep and menstrual cycle was still an issue. Labs were ordered and showed higher TSH 0.03 (whereas it was undetectable previ- ously), lower fT3 4.6, lower fT4.Vitamin D levels were still below reference range. Antibodies shifted, however, the levels did not improve significantly.

Jo had a consultation with her endocri- nologist in the beginning of 2021 and the endocrinologist strongly believed that Jo needed radioactive treatment (I-31) after years of taking Tapazole; Jo was not comfortable with radioactive treatment. Her long term goal included a desire to stop Tapazole and potentially having children. Her endocrinologist responded by discharging her as a patient. I felt that I could benefit from further advice, and so I reached out to Dr. Martin Kwok ND Dr.TCM for guid- ance. Dr. Kwok practices in Richmond, BC and he is well-versed in treating thyroid disorders. Dr. Kwok suggested that since her hyperthyroidism symptoms were well- managed, we could work towards address- ing HPA-axis and balancing sex hormones. He recommended Jo to monitor resting heart rate upon waking as it should be below 80 bpm. I continued with Adrenal IM injections and also added 100,000IU vitamin D IM injections concurrently every other week for a total of 6 injection sessions. I encouraged Jo to include more fibre and 2 tablespoons of ground flaxseed everyday to promote regular bowel movements. Jo decided to taper down Tapazole herself. I referred her out for Low Dose Naltrexone (LDN) treatments.

In August 2021 after working with Jo for exactly a year, she came in for her last visit before moving to Europe. Her vitals were within normal range. Her heart rate used to be above 80 bpm, and now had come down to 75 bpm on average. Night sweats were resolved with a regular menstrual cycle of 26 – 28 days. She was able to have undisturbed sleep throughout the night.TSH was at 0.86, fT3 at 4 and fT4 at 16. Vitamin D was 125.Tapazole was decreased from 20 mg QD to 5mg once a week and LDN was adjusted to 3mg QD. I did not run thyroid antibodies at this time but I forwarded her case to her family doctor for future lab requisition when she settled down in Europe. I have not heard from Jo since.

This was my first hyperthyroid case managed using naturopathic medicine. It was humbling to see health improvements within a year.The outcome was favorable due to high compliance from the patient and her support system. I am especially thankful for the seasoned doctors in our profession who were kind and generous to share their clinical experience and expertise. In hindsight, I realized that I somehow forgot about addressing autoimmunity with ozone therapy; so oxidative therapies might have been a useful tool for this case.