What is Grave’s Disease?

Graves’ disease is an autoimmune disorder that causes hyperthyroidism, which means an overactive thyroid.

The thyroid is a small, butterfly-shaped gland in the front of your neck that produce, store and secrete thyroid hormones.

It is these thyroid hormones that govern our metabolic rate and regulate the many cellular processes in the body.

Grave’s disease causes an elevation in your thyroid hormone levels. This elevation of thyroid hormone levels is called hyperthyroidism. Hyperthyroidism means your body is being pushed to operate at a faster rate. There is increased energy expenditure, which presents as the following signs and symptoms:

  1. Weight loss, in spite of an increase in appetite
  2. Rapid or irregular heartbeat
  3. Nervousness, irritability, trouble sleeping and fatigue
  4. Shaky hands and muscle weakness
  5. Sweating or trouble tolerating heat
  6. Frequent bowel movements
  7. A enlarged thyroid gland or thyroid nodules
graves hyperthyroidism

Enlarged Thyroid Gland?

Yes. There are two ways the thyroid factory can get larger as it is spurting out thyroid hormones at an increased rate. It can grow uniformly and so ‘bloat’ out into a Diffuse Goiter. Or the growth can be more bumpy and nodular, resulting in a Nodular Goiter.

In both cases, when the thyroid gland grows large enough, it can be felt as a lump in the front of the neck?

I have a lump on my neck. Is it an enlarged Thyroid Gland?

It can be helpful to try this in front of a mirror.

  1. Stand in front of a mirror.
  2. Tilt your head backwards a little.
  3. Swallow
  4. Observe if the lump is moving as your swallow.

If you see that the lump moves as you swallow, it is an enlarged Thyroid Gland.

What puts me at risk of Graves?

Graves disease is more common in females.

In fact, many of the women coming in with Graves do so within the first year of postpartum.

Because Graves is an autoimmune condition, other autoimmune conditions do predispose you to Graves, for example:

  1. Rheumatoid Arthritis (RA)
  2. Systemic Lupus Erythematosus (SLE)
  3. Diabetes Mellitus Type 1 (DM1)

Graves Disease Diagnosis?

If you are experiencing the signs and symptoms mentioned above, you may want to consult an endocrinologist who may suggest performing the following tests on you:

  1. Blood tests: Blood tests can help your doctor determine your levels of thyroid-stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3). People with Graves’ disease usually have lower levels of TSH and higher levels of thyroid hormones T3 and T4. Because Grave’s is an autoimmune condition, tests of TPOAb or TG may show up as elevated.
  2. Radioactive iodine uptake: Your body needs iodine to make thyroid hormones. This test measures the rate at which your thyroid gland takes up iodine. This helps to determine if Graves’ disease or another condition is the cause of the hyperthyroidism. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern.
  3. Ultrasound: Ultrasound imaging can show if the thyroid gland is enlarged. It’s most useful in people who can’t undergo radioactive iodine uptake, such as pregnant women.
  4. Other Imaging tests: If the diagnosis of Graves’ disease isn’t clear from a clinical assessment, your Endocrinologist may order other imaging tests, e.g. a CT or MRI.

What are some Complications of Graves Disease?

Sometimes, Graves Disease can lead to some serious complications such as:

  1. Heart-related problems
  2. Muscle problems and thinning bones (osteoporosis)
  3. Fertility problems
  4. Eye discomfort and changes in vision (Grave’s Ophthalmopathy aka Thyroid Eye Disease)

This is why it is always good to consult an endocrinologist the moment you think you may have Graves!

What are the most common ways to treat Grave’s hyperthyroidism?

The objective when treating Grave’s hyperthyroidism is to stop your thyroid gland from excessively producing thyroid hormones, and to block the effects of the thyroid hormones on your body. Common treatments include:

1) Antithyroid medicine

Anti-thyroid medications interfere with the thyroid’s use of iodine to produce hormones. These prescription medications include Propylthiouracil, Methimazole (Tapazole) and Carbimazole.

Propylthiouracil is the preferred anti-thyroid drug during the first trimester of pregnancy, as Methimazole has a slight risk of birth defects. Pregnant women will generally go back to taking Methimazole after the first trimester.

Carbimazole is also commonly used. Carbimazole converts to Methimazole in the body.

2) Beta Blockers

These medications don’t inhibit the production of thyroid hormones, but they do block the effect of hormones on the body. Beta blockers provide fairly rapid relief of irregular heartbeats, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea, and muscle weakness. Beta-blockers include Propranolol, Atenolol and Metoprolol.

Note: If you have asthma, you should not be using Beta Blockers as they may may trigger an asthma attack.

3) Radioiodine therapy

Oral radioactive iodine therapy helps to destroy the overactive thyroid cells, causing your thyroid gland to shrink, and symptoms to lessen gradually, usually over several weeks to several months.
This treatment is not recommended for pregnant women or women who are breast-feeding. It is also not for those with moderate to severe symptoms of Graves’ Ophthalmopathy aka Thyroid Eye Disease.

4) Thyroid surgery

Surgery to remove all or part of your thyroid. After the surgery, you will likely be taking thyroid medication for life as a form of hormone replacement.

Graves Disease TCM Treatment – How can Chinese Medicine help?

In general, we see patients who are already receiving treatment for Graves, but seek additional help.

It could be:

  1. Chinese Herbs are able to normalize your thyroid imbalance faster.
  2. Chinese Herbs are able to reduce the thyroid enlargement.
  3. Chinese Herbs are able to ameliorate symptoms that still persist despite a normalization in lab numbers.

We know we are able to help because of the training we have received on treating Graves. The usual approach is let the endocrinologist take the lead, while we support in ways that build on that.

Chinese herbs help to normalize your thyroid imbalance

According to Chinese Medicine, some level of Qi Stagnation is necessary for there to be a thyroid imbalance. While not always the case, it is often some stressful event or phase in your life that causes your body to tip over into imbalance.

In women, a common event is pregnancy and postpartum. It is during this time that thyroid imbalances commonly show up. For others, it may be emotional stress brought about by relational conflict and repressed emotion.

This is the nature of Qi Stagnation, that when the Qi is stuck, it may become entangled into masses, nodules and tumors.

The treatment for Qi Stagnation is herbs and formulations that help regulate the flow of Qi. For example,

  1. Bupleurum (Chai Hu) showed comparable results to propylthiouracil in reversing hyperthyroidism, according to a paper by SM Kim et al (2012).
  2. Peony Lactiflora (Bai Shao) contains more than 15 compounds which provide the therapeutic basis in the treatment of autoimmune diseases, as elucidated by DY He et al (2011).

As for herbal formulations, a case report published by Lin et al (2021) showed how 2 patients fared very well with modified Dan Zhi Xiao Yao San as the base formulation for treating an over-active thyroid. Dan Zhi Xiao Yao San has been used to treat various presentations of Qi Stagnation, including anxiety, depression, sleep disorder, compromised ovulation and PMDD. It is reasonable to say its use in the treatment hyperthyroid has alot of do with mitigating effects of stress on the body.

Chinese herbs to reduce an enlarged thyroid

Masses and nodules as they present in the thyroid are understood in Chinese medicine as manifestations of Phlegm.

Herbs that resolve Phlegm are often used to  shrink masses. These are the same herbs that are used to shrink fibroids or other growths in the body.

Below, we list some examples of such herbs used in shrinking thyroid lumps:

  • Citruses like Zhi Ke, Chen Pi reduce thyroid hormone levels, and this effect may be potentiated by other anti-thyroid drugs – Okon Akpan Uduak (2014). Citruses also contain high concentrations of phenols which have shown to possess antiproliferative and antitumor effects – John Manthey (2002).
  • Prunella (Xia Ku Cao) together with methidathion is able to reduce thyroid size more significantly than methidathion alone – Yang K (2007).
  • Fritillaria (Zhe Bei) contains imperialine, which has been widely recognized as an anti-inflammatory and anti-tumor agent that works by suppressing NF-kB activity – Qing Lin et al (2020).
  • Oyster Shell (Mu Li) contains biogenic calcium carbonate which are shown to be the major effective anti-cancer component and plays a critical role in suppressing proliferation – Ying Chen et al (2016).

Chinese herbs manage the symptoms of Graves

One area is that Chinese herbs help is by calming down the nervous system. A nervous system that is constantly upregulated is consider to be synonymous with Liver Fire Rising in Chinese Medicine.

There are Chinese herbs that help, for example,

  • Scutellaria (Huang Qin) can clear this excess Liver Fire by bringing down thyroid hormone levels in patients with hyperthyroidism – Mia Kim (2019).
  • Uncaria (Gou Teng) contains active ingredient that calm the central nervous system. This manages many symptoms of an over-active thyroid such as nervousness, irritability and trouble sleeping – Wen Yang et al (2020).

With help from herbs that downregulate the nervous system, you will see further improvement in many of your symptoms like rapid heartbeat, nervousness, irritability, shaky hands and aversion to heat.

One other common side effect of an overactive thyroid is that you are not just wired but also fried – this means a deep sense of malaise and fatigue.

According to Gang Zhang (2015) Chinese herbs like  Astragalus (Huang Qi) while Codonopsis (Dang Shen) combats fatigue by increasing energy resources, and decreasing detrimental metabolite accumulation – Qi Xie et al (2020).

To Wrap Up

We hope this article is enlightening and helps you understand how TCM and Chinese herbal medicine is able to support you if you are suffering from Graves, even if you are already seeing an endocrinology and  on prescriptive drugs.