What is Graves' Disease?
What is Graves' disease?
Graves' disease is a disorder that leads your immune system to attack your thyroid gland. This can cause your thyroid to overproduce thyroid hormones, a condition known as hyperthyroidism. Graves' disease is the leading cause of hyperthyroidism. While very treatable and rarely life-threatening, Graves' disease can cause significant complications if left untreated. Because hyperthyroidism puts significant strain on the heart, untreated Graves' disease can result in heart problems.
The thyroid gland, located in your neck, produces hormones that control your metabolism. Essentially, the thyroid controls how quickly you digest food. However, Graves' disease can lead the thyroid to accidentally produce more thyroid hormones than necessary, causing your metabolism to speed up to an unhealthy level.
Graves’ disease is also called Basedow’s disease, and is part of a broader family of diseases known as autoimmune disorders. An autoimmune disorder is any condition in which your own immune system attacks your body, and can lead to further complications including both hyper- and hypo- thyroidism.
Symptoms of Graves’ disease
Symptoms of Graves' disease include a range of conditions, from mild to serious. These can include the development of a goiter (an enlarged thyroid gland that protrudes or swells outward from the neck); weight loss; stress, anxiety and irritability; sexual difficulties or menstrual complications; and an increased sensitivity to heat.
Graves' disease can cause changes to the eyes. Some people with Graves' disease develop a condition called Graves' ophthalmopathy, which results in bulging eyes (known as exophthalmos). If left untreated, exophthalmos puts a great deal of pressure on the eyes, and can result in partial blindness or double vision. Graves' dermopathy, in which the skin on the shins or tops of the feet becomes thick and red, is also a common symptom.
A larger list of common Graves' disease symptoms includes:
Developing a goiter
Fatigue or exhaustion
Weight loss, despite a normal or increased appetite
Change or cessation of menstrual cycles in women or erectile dysfunction in men
Increased stress, anxiety and irritability
Tremors in the hands and fingers
Increased or irregular heart rate
High blood pressure
Heat sensitivity and sweats
Frequent bowel movements
Bulging eyes (exophthalmos)
Thick, red skin on the shins or feet
Causes of Graves' disease
Scientists have a clear picture of how Graves' disease occurs in the body. The level of thyroid hormones your thyroid produces is usually controlled by another hormone called TSH. TSH is released by the pituitary gland in the brain when your body needs your thyroid to get to work.
However, Graves’ disease can cause your immune system to mistakenly release chemical signals called antibodies that mimic TSH. Antibodies are meant to help your body identify invading bacteria, but these particular antibodies are interpreted by your thyroid gland as instructions to make additional thyroid hormones. This puts your metabolism into an unhealthy overdrive.
But what causes your immune system to malfunction and produce unhelpful antibodies? That is a matter of some debate. Researchers have suggested anything from genetics to a viral infection to diet and environmental factors. Most agree that there are likely a number of contributing elements.
Inflammation is perhaps the biggest factor. Inflammation occurs when tissue in the body is exposed to stressors, which can include anything from food allergies to toxic chemicals to infections to emotional trauma or difficult life circumstances. Food allergies are a particularly common cause, including allergies to gluten and dairy. An overgrowth of harmful bacteria and yeast in the gut is a frequent contributor as well. Overgrowth can often result from heavy use of antibiotics, which kills off healthy gut bacteria, giving harmful bacteria space to multiply.
Whatever the cause, inflamed tissue becomes swollen, reddened and often painful. Inflammation, particularly in the gut, is seen as an underlying cause of all autoimmune disorders, including Graves' disease. Treating inflammation in the body is key to removing the circumstances that lead to autoimmune disorders.
Hormones can also contribute to Graves’ disease. Stress hormones, released during times of mental, emotional or physical stress, can interfere with the normal functioning of your immune system at excessive levels. Estrogen is also linked to Graves’ disease, as the condition occurs more commonly in women than in men. High levels of estrogen are known to affect the thyroid.
Genetics are thought to play a role in the development of Graves' disease and hyperthyroidism, but many of the details are still unknown. Genes associated with the human leukocyte antigen (HLA) complex are believed to be involved, as the HLA complex helps the immune system identify viruses and bacteria. Other genes related to the immune system are thought to affect the development of Graves' disease as well. However, genetics are not considered to be the main causal factor.
While genetics, the immune system, and environmental factors such as exposure to toxins are all thought to play a role in the development of Graves’ disease (and autoimmune disorders in general), researchers estimate that at least 50 percent of cases are the result of uncertain causes. Stress and emotional upset likely play a huge role in those cases. Indeed, most people who develop an autoimmune disorder, including Graves’ disease, experience high levels of emotional stress before the onset of symptoms.
Stress of any kind puts tremendous strain on how well the body functions, and over time, can lead to physical as well as emotional health problems. It is believed that stress hormones interfere with the proper functioning of the immune system, which can lead to the immune system misfiring and attacking the thyroid gland.
Exposure to toxins like pesticides, heavy metals, household cleaners and other harsh chemicals can play a part in developing Graves’ disease or other autoimmune disorders. Environmental toxins are a major cause of inflammation, as they put significant stress on your body. Toxins chronically trigger your immune response, which over time can lead to your body being unable to distinguish healthy tissue from harmful foreign substances.
In addition, the thyroid gland is particularly at risk for exposure to toxins. The thyroid needs a chemical called iodine in order to properly function. However, iodine exists in the bloodstream only at very low levels, so the thyroid uses a special pump to pull iodine out of the bloodstream and concentrate it. This means that any toxins in the blood can get pulled into the thyroid along with the iodine. Toxins that resemble positive nutrients on a molecular level may mistakenly get pulled into the thyroid through a process called “molecular mimicry.”
Specific research shows that neuroendocrine disruptors—such as Bisphenol A (BPA) and phthalates, industrial chemicals used to make plastics and very common in our environment—are culprits that play a key role in thyroid dysfunction, and indeed health. It will be really worth your while to take the time to learn about the top endocrine disruptors and how to avoid them. See the Environmental Working Group’s Dirty Dozen Endocrine Disruptors list.
How to heal Graves' disease
Treating Graves’ disease holistically means dealing with the underlying causes in the body. This approach has been found to be effective in many cases.
If you are experiencing symptoms of Graves’ disease, a good place to start is finding a holistic physician who can help you assess what’s going on. Testing for food allergies and sensitivities, exposure to toxins, infections and other causal factors, as well as exploring the role of stress in your life, can help provide a clearer picture of what may be driving your symptoms. You and your doctor can then plan how to tackle them.
Since stress is such an important factor in Graves’ disease and autoimmune disorders, anything you can do to help de-stress and relax can be an important part in your treatment plan. As stress of any kind — physical, mental, emotional, spiritual, environmental, relational — puts a great deal of strain on the body’s ability to function well, stress reduction and emotional healing are always helpful when dealing with any sort of chronic disease.
Exercise is an effective way to deal with stress, and it also tends to reduce inflammation. Mind-body practices such as yoga and meditation can also be very useful, as they can help you relate to yourself and the world around you with greater ease. Working with a therapist to heal emotional trauma can also play a role, as can supportive relationships with others.
Working with nutrition is also a big part of treating the underlying causes of Graves’ disease. This can include both changes in your diet and adding supplements. A holistic physician or nutritionist can help you create a diet and supplement plan that works for you, but most will follow several basic rules of thumb.
Diet for Graves’ disease
A Graves' disease diet starts with removing foods that cause inflammation in your body, including dairy, gluten, some animal proteins, refined, omega-6 rich corn and soy oils, and almost all processed foods, which contain ingredients that cause inflammation, such as sugar, corn syrup and artificial sweeteners. While gluten-free grains are less harmful, many experts recommend limiting your intake of them as well.
Out with processed and in with fresh, anti-inflammatory foods such as wild fish, berries, sweet potatoes, nuts, and a heavy dose of those mega-healthy dark, leafy greens. Eat organic and avoid exposure to pesticides and fungicides, which can further strain your gut. Cook from scratch whenever you can, because this helps you avoid the extra, unhealthy ingredients that go into most processed and many restaurant foods.
Selenium and zinc are two key nutrients often deficient in the thyroid. Foods high in these include Brazil nuts, halibut, sardines, chicken and eggs, for selenium; and shellfish, pumpkin seeds, sesame seeds, chickpeas and garlic, for zinc. Seaweeds are a potential food source for iodine.
Avoiding nightshade vegetables—such as tomatoes, bell peppers, eggplants, and potatoes—is controversial, but worth mentioning, since some holistic practitioners feel strongly about the benefits of doing so for Graves’ patients. You might try an Elimination Diet and include nightshades as a category to see if this benefits you.
Functional medicine physician Shelly Sethi, DO, notes that the jury is still out on canola and safflower oils. “Data presented at Andrew Weil, MD’s Nutrition and Health Conference in 2018 suggests that we still need omega-6’s, and cold-pressed canola or safflower oil might be good sources. Corn and soy oils should definitely be avoided.
“Mediterranean cooks don’t stir fry or cook at high temperatures with olive oil,” Dr. Sethi continues. “They tend to slow cook or use olive oil to finish a dish, in a dressing or sauce. I do the same, and tend to use avocado, safflower, sunflower or coconut oils for cooking.”
Supplements for Graves’ disease
Supplements and herbs such as omega-3 rich fish oil, vitamin C, vitamin D, magnesium, selenium, zinc, probiotics (especially Saccharomyces boulardii), ginger, turmeric and rosemary have been found to be useful in treating Graves' disease and inflammation. They can help calm inflammation and reduce your overall stress levels. Meanwhile, common over the counter non-steroidal anti-inflammatory (NSAIDs) pain relievers should be avoided, as they can damage and inflame your gut.
“Many of my Graves’ patients aren't digesting food as well as they might,” explains Dr. Sethi. “For those needing digestive support, I typically prescribe digestive enzymes along with Betaine hydrochloride (HCl). I also recommend testing for iodine deficiency. People can be deficient or have an excess of iodine, and you don’t want to supplement before you know what you’re dealing with.
Also, many people use sea salt, which is not iodized. Even if you buy iodized salt, the iodine evaporates after exposure to air. It’s best to purchase in small quantities and store in a dark container. It’s the easiest way to supplement.”
Sufficient magnesium is especially important, since it helps with the conversion of the hormone T4 (thyroxine) to T3 (triiodothyronine). Only 25% of US adults are thought to be getting the recommended daily amount of magnesium—and the recommendation itself may be too low. “I prescribe magnesium for most of my patients,” says Dr. Sethi.
Holistic physicians, including functional medicine, integrative or naturopathic doctors, often have special expertise at treating the root causes of autoimmune disorders like Graves’ disease. A holistic physician can help you explore what could be causing your symptoms, as well as come up with a treatment plan. They can help you change your diet, detox toxins from your body safely, and heal underyling gut problems like leaky gut disorder that could be contributing to inflammation. This is a good place to start.
In addition, other healing modalities such as acupuncture, chiropractic, nutrition counseling, biofeedback, massage or talk therapy can help you deal with the stressors that are often at the root of Graves’ disease. Anything that helps you feel peaceful and relaxed in your body can support your healing.
If a cause-focused treatment plan doesn’t work, doctors can also use a number of more aggressive approaches to eliminate symptoms of Graves’ disease. These can include radioactive iodine, medication, and surgery. However, all have significant side effects.
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The following expert reviewed and contributed to this article:
Shelly Sethi, DO, Functional Medicine Physician
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Know Your Environment, Protect Your Health
Stress as a trigger of autoimmune disease
Stojanovich, Ljudmila, and Dragomir Marisavljevich.
Autoimmunity Reviews, 2008