7 Things Most Endocrinologists Don’t Know About Hyperthyroidism and Graves’ Disease
For those with hyperthyroidism and Graves’ disease who are working with an endocrinologist, it can be very frustrating being told that the only three treatment options are: 1) antithyroid medication, 2) radioactive iodine, and 3) thyroid surgery.
Without question, there is a time and place for conventional medical treatment. And while antithyroid medications such as methimazole and PTU commonly cause side effects, they usually do an excellent job of lowering thyroid hormone levels.
Obviously there are situations when more extreme treatment options, such as thyroid surgery, are necessary. But while conventional treatment methods are sometimes required, it’s sad how closed-minded most endocrinologists are.
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Finding an Open-Minded Endocrinologist Can Be Challenging
Why do most endocrinologists only give three treatment options to their hyperthyroid patients?
One obvious reason is the training they receive in medical school. But this isn’t the only reason, as these days there are many medical doctors who practice functional medicine, and most of these doctors received the same conventional medical training.
Perhaps two of the main characteristics that lead some medical doctors to practice functional medicine are: 1) having an open mind, and 2) being willing to deviate from the norm.
In other words, having a closed mind and/or being afraid to deviate from the norm are probably two of the main reasons why most endocrinologists refuse to practice functional medicine, and thus fail to do anything to address the cause of hyperthyroidism.
Obviously, I’m not suggesting that endocrinologists shouldn’t prescribe antithyroid medication or recommend surgery when necessary. What I am suggesting is that more endocrinologists should incorporate functional medicine principles while utilizing conventional treatment when appropriate.
In fact, even if an endocrinologist chose to recommend antithyroid medication to every patient with hyperthyroidism, but at the same time worked to address the cause of the condition, this would dramatically reduce the number of patients who ultimately received radioactive iodine or thyroid surgery.
So what I’d like to do now is discuss seven things most endocrinologists don’t know—or won’t admit—about hyperthyroidism and Graves’ disease.
1. The Autoimmune Component of Graves’ Disease Can Be Reversed
When I say the autoimmune component can be reversed, I mean that by removing autoimmune triggers, healing the gut, and correcting underlying imbalances (such as nutrient deficiencies), the autoimmune response can normalize.
This admittedly isn’t an easy process. Sometimes finding the triggers can be challenging, and many people struggle to make the necessary dietary and lifestyle changes.
But if someone is willing to take responsibility for their health, and their autoimmune triggers are identified and removed, it is very possible to achieve a state of remission and maintain good health thereafter.
In other words, the goal should be to achieve a state of permanent remission. Some might refer to this as a cure, but either way, the objective is to optimize immune health and do everything possible to keep it functioning well for years to come.
2. Eating Healthy Can Play an Important Role in Recovery
Over the years, I’ve had numerous patients bring up diet with their endocrinologists. In most cases, the endocrinologist tells them that diet isn’t a factor in the development of their hyperthyroid condition, and therefore eating healthier won’t improve their thyroid or immune health.
The truth is that certain foods can be triggers, although this doesn’t mean food is a trigger for everyone with hyperthyroidism and Graves’ disease.
And even when it is, people usually need to go beyond diet and lifestyle. I discuss this in my book The Hyperthyroid Healing Diet, where I explain why many people need to do more than simply eat healthier if they want to restore their health.
That said, it’s going to be very difficult to restore your health if you continue eating inflammatory foods on a regular basis.
3. There Are Natural Symptom Management Options
Every now and then someone tells me their endocrinologist is familiar with bugleweed, an herb with antithyroid properties. But many endocrinologists have never heard of it.
L-carnitine can also lower thyroid hormones in some people, yet most endocrinologists aren’t aware of this either, despite numerous research studies supporting its use in those with hyperthyroidism.
Earlier I mentioned that some people do need antithyroid medication. While many of my patients do well taking natural agents such as bugleweed, this approach isn’t effective for everyone.
When I dealt with Graves’ disease, I chose not to take antithyroid medication and instead took bugleweed and motherwort. But this doesn’t mean that’s the best decision for everyone.
If you’re taking antithyroid medication, aren’t experiencing side effects, and are concerned that bugleweed won’t adequately manage your symptoms, then by all means continue taking the medication.
On the other hand, if you’re experiencing side effects from antithyroid medication, you may want to consider bugleweed and/or L-carnitine as alternatives.
If you’ve been recently diagnosed and haven’t started medication yet, you might choose to begin with bugleweed as I did and see how your body responds. If it doesn’t work, you can always switch to medication.
4. Genetics Isn’t the Main Reason People Develop Graves’ Disease
Although some endocrinologists will admit they don’t know why someone developed Graves’ disease, others simply blame genetics. While genetics is certainly a factor, it isn’t the most important factor.
As I’ve discussed in previous newsletters, the triad of autoimmunity consists of:
1. A genetic predisposition
2. One or more environmental triggers
3. Increased intestinal permeability (leaky gut)
In other words, having the genes alone isn’t enough. You also need one or more triggers, and according to the triad of autoimmunity, a leaky gut is involved as well.
As a result, if you want to achieve remission, you need to remove triggers and heal the gut. The truth is that most people with the genetics for Graves’ disease never develop the condition.
In fact, it’s common for people to tell me they have no family history of Graves’ disease. If genetics were the primary factor, I would expect family history to be present far more often than it is.
As far as I know, nobody in my family has been diagnosed with Graves’ disease. Once again, genetics matters, but it’s not the main factor.
5. Chronic Stress and Adrenal Imbalances Can Be a Primary Trigger
While genetics isn’t the main factor, chronic stress and adrenal dysfunction appear to be major contributors in many people.
Admittedly, it can be difficult to prove this because correlation doesn’t always equal causation. Just because someone experienced significant stress before developing Graves’ disease doesn’t automatically mean stress caused it.
That said, I’m pretty confident stress was one of the main reasons why I developed Graves’ disease. And while I can’t say this is true for everyone I work with, it’s very common for people to tell me that stress was their primary trigger.
Keep in mind that I’m not just referring to emotional stress. Physical stress can be equally problematic.
For example, before I was diagnosed with Graves’ disease, I was overtraining. Over time, this can negatively affect adrenal function.
So in my case, I’m pretty confident it was a combination of emotional and physical stressors that wreaked havoc on my body and contributed to the development of Graves’ disease.
6. Antithyroid Medication Can Be Taken for Longer Than Two Years
While I’m not a big fan of antithyroid medication, it really frustrates me when endocrinologists tell patients they can’t take it for longer than two years. As a result, many people end up choosing radioactive iodine or thyroid surgery unnecessarily.
Multiple studies show that if someone is tolerating antithyroid medication well, it can be safely continued at a low dose beyond two years (1) (2).
For example, many people can take 5–10 mg of methimazole for 10–15 years—or even longer. This isn’t an ideal scenario, and it certainly isn’t my goal when working with someone one-on-one.
But if someone is tolerating a low dose of methimazole well, continuing the medication is often a better option than radioactive iodine or thyroid surgery.
Of course, the ideal situation is restoring health and no longer needing medication at all. But if that hasn’t happened after two years, it doesn’t automatically mean RAI or surgery should be the next step.
7. Radioactive Iodine Doesn’t “Cure” Graves’ Disease
I think it’s safe to say that many people with Graves’ disease reading this understand that radioactive iodine isn’t a cure. But that won’t stop many endocrinologists from referring to it as one.
While they can argue that radioactive iodine often provides a permanent solution for hyperthyroidism, remember that Graves’ disease is primarily an immune condition—not a thyroid condition.
Recently, I asked Google whether RAI cures Graves’ disease, and here was the AI-generated response:
“Yes, Radioactive Iodine (RAI) therapy cures Graves’ disease hyperthyroidism by permanently destroying the overactive thyroid tissue, though it typically results in an underactive thyroid (hypothyroidism) instead. Because RAI treats the thyroid gland rather than the underlying immune system malfunction, clinical experts view it as a permanent cure for the overproduction of hormones, but not a cure for the foundational autoimmune condition.”
In other words, radioactive iodine often permanently eliminates hyperthyroidism, but it does absolutely nothing to address the autoimmune component of Graves’ disease. The same concept applies to thyroid surgery.
This distinction is important because having one autoimmune condition increases the likelihood of developing another autoimmune condition in the future.
So if someone receives radioactive iodine but never addresses the autoimmune triggers or heals the gut, it’s difficult to argue that Graves’ disease has truly been cured—regardless of what Google or ChatGPT might say.
As for those with toxic multinodular goiter, I still wouldn’t consider radioactive iodine a cure, as it doesn’t address the underlying cause of the condition.
While there may not be the same autoimmune concerns as there are with Graves’ disease, there is still a reason the multinodular goiter developed in the first place. Ignoring that cause can contribute to future health issues.
Final Thoughts
While endocrinologists play an important role in helping people manage hyperthyroidism, most are trained to focus primarily on controlling thyroid hormone levels rather than addressing the underlying factors that contributed to the condition.
This doesn’t mean conventional treatment doesn’t have value. Antithyroid medication, thyroid surgery, and even radioactive iodine all have a time and place.
But if your goal is to achieve long-term remission and restore your health, then it’s important to look beyond symptom management. Diet, stress, gut health, environmental triggers, nutrient deficiencies, and immune system regulation all deserve consideration.
The good news is that more people are beginning to realize that Graves’ disease is much more than a thyroid condition. And the more we understand about the immune system and the root causes of autoimmunity, the better equipped we are to help people achieve lasting wellness.
Thank you for subscribing to Healing Graves’ Naturally! If you know anyone who has hyperthyroidism who is looking to save their thyroid, please share this with them right away.
Are You Ready to Heal Your Hyperthyroidism?
If you have Graves’ disease or a different type of hyperthyroidism and are looking to save your thyroid and regain your health, here are some other resources you might find helpful:
1. Save My Thyroid Podcast. While most of the guest interviews can benefit those with hyperthyroidism AND Hashimoto’s, there are many solo episodes that focus on hyperthyroidism.
Most of the podcasts are uploaded to my YouTube channel.
—> https://savemythyroid.com/podcast-2/
—> http://www.savemythyroid.com/YouTube
2. Hyperthyroid Books. I have three thyroid-related books, two of them which focus on hyperthyroidism. Natural Treatment Solutions for Hyperthyroidism and Graves’ disease is in it’s third edition, and my latest book is The Hyperthyroid Healing Diet.
—> https://savemythyroid.com/book
3. Healing Graves’ Naturally Skool Community. When you join you get access to my Graves’ Survival Roadmap Training, and there is also a free monthly Hyperthyroid Healing Diet Q & A call with one of my nutritional health coaches.
—> https://www.savemythyroid.com/healgravesdisease
4. Hyperthyroid Healing Program. If you’re ready to heal your hyperthyroidism then you might be interested in my Hyperthyroid Health Restoration and Optimal Health program, where you will work with me one-on-one to heal your hyperthyroidism. For more information click on the links below.
—> http://www.workwithdreric.com
—> https://savemythyroid.com/hyperwebinar
References
(1) https://journals.sagepub.com/doi/10.1089/thy.2019.0180
(2) https://link.springer.com/article/10.1186/s12902-020-00670-w