A Functional Medicine Hyperthyroidism Protocol: Comprehensive Testing, Supplements, and Integrative Nutrition

A lot of attention is put on thyroid health - for a good reason. Twenty million Americans have some form of thyroid disease, and up to 60% are unaware of their condition. Women are at higher risk, with one in eight developing a thyroid disorder during their lifetime. While hyperthyroidism is less common than hypothyroidism, diagnosing and treating it is just as important. Hyperthyroidism affects one in 100 Americans over age 12 and can cause serious health complications when left untreated, such as infertility, osteoporosis, and heart failure. (10, 12)

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What Is Hyperthyroidism?

Hyperthyroidism is a condition characterized by an overactive thyroid gland. The thyroid is a butterfly-shaped endocrine gland in the front of the neck that is responsible for producing thyroid hormones. Thyroid hormones, thyroxine (T4) and triiodothyronine (T3), circulate through the body and bind to their receptors to regulate metabolic rate, growth, and development.

In normal conditions, the brain and thyroid work together to closely monitor and maintain a healthy amount of thyroid hormone in circulation. In certain scenarios, however, the thyroid gland produces too much thyroid hormone, causing hyperthyroidism. (7)

Hyperthyroid Signs & Symptoms

Excess thyroid hormone causes a hypermetabolic state throughout the body, causing systemic symptoms. The most common symptoms of hyperthyroidism include:

• Unintentional weight loss despite increased appetite
• Fast and irregular heartbeat
• A sensation of a pounding heart (palpitations)
• Nervousness, anxiety, and irritability
• Tremors
• Sweating and heat intolerance
• Fatigue
• Insomnia
• Irregular menstrual cycles
• Diarrhea
• Thyroid enlargement (goiter)
• Muscle weakness
• Thinning skin
• Hair loss and fine, brittle hair
• Bulging eyes

Root Causes of Hyperthyroidism

Hyperthyroidism can be caused by the following medical conditions that affect the thyroid gland:

Graves' Disease

Graves' disease is an autoimmune disease characterized by the production of antibodies called thyroid-stimulating immunoglobulin (TSI), which stimulate thyroid hormone synthesis. Graves' disease is the most common type of hyperthyroidism, causing four out of five hyperthyroid cases in the United States. The onset of Graves' disease can be influenced by genetics, pregnancy, iodine excess, infections, emotional stress, and smoking (20).

Tumors

Thyroid nodules called adenomas (noncancerous tumors) can overproduce thyroid hormone. This condition, called toxic multinodular goiter, causes 5% of hyperthyroidism cases in the United States. (22) 

Rarely, thyroid-stimulating hormone (TSH)-secreting or human chorionic gonadotrophin (hCG)-releasing tumors can overstimulate the thyroid gland, causing excessive thyroid hormone release (22).

Thyroiditis

Thyroiditis occurs when a trigger causes the thyroid gland to become inflamed and swollen, resulting in thyroid hormone leakage from the gland. Autoimmunity, infections, hormonal fluctuations during the postpartum period, and medications can induce thyroiditis.

Excess Iodine

Iodine is a trace element required for thyroid hormone synthesis; however, excessive exposure to iodine through iodinated contrast media, dietary supplements, and certain medications (like amiodarone) can cause the thyroid to overproduce thyroid hormones. This phenomenon is called Jod-Basedow Syndrome.

Medications

Factitious hyperthyroidism may occur in patients with hypothyroidism taking too much thyroid hormone medicine. To avoid this, working with a medical professional to monitor your thyroid levels and medication dosing is essential.

How to Diagnose Hyperthyroidism

Hyperthyroidism should be suspected in patients presenting with its associated signs and symptoms. Diagnosis is confirmed through laboratory testing. 

Step 1: Order Thyroid Panel

Initial testing in patients presenting with signs and symptoms suggestive of hyperthyroidism is thyroid function testing, which should include TSH, free T4, free T3, and TSI. Most cases of hyperthyroidism are characterized by low TSH and high free T4 and/or T3. Elevated TSI diagnoses Graves' disease. (22, 24) 

The following panels are recommended to diagnose hyperthyroidism:

• Thyroid Panel by Access Med Labs
• Thyroid Health Panel by Ayumetrix
• Thyroid-Stimulating Immunoglobulin by Access Med Labs

Step 2: Radioactive Iodine Uptake Scan

Doctors may recommend a radioactive iodine uptake scan to help differentiate the cause of hyperthyroidism if it is unclear from the clinical presentation and initial laboratory evaluation. This imaging technique measures the percentage of radioactive iodine uptake by the thyroid gland. Iodine uptake is usually elevated in patients with Graves' disease or with a toxic nodular goiter. Little or no uptake is typical in patients with thyroiditis, factitious hyperthyroidism, and Jod-Basedow Syndrome. (24) 

Step 3: Order Additional Testing to Uncover the Root Causes of Hyperthyroidism

Exposure to environmental toxins, emotional stress, and poor gut health can contribute to thyroid autoimmunity and inflammation, potentially exacerbating hyperthyroidism. A root cause approach to medicine seeks to identify and correct the underlying imbalances responsible for disease to enhance treatment outcomes. With this in mind, doctors may consider ordering the following specialty labs, especially if indicated by the patient's health history:

Environmental Toxin Panels

• Environmental Pollutants Profile (EPP) by US BioTek
• RTL Tox Complete by RealTime Laboratories

Gut Health Testing

• GI-MAP + Zonulin by Diagnostic Solutions
• GI360 by Doctor's Data
• SIBO - 3 Hour by Genova Diagnostics

Stress (Cortisol) Testing

• Adrenocortex Stress Profile by Genova Diagnostics
• Cortisol Awakening Response (CAR) by Doctor's Data
• Diurnal Cortisol by Ayumetrix

Step 4: Preventive Health Evaluation

Hyperthyroidism can cause secondary health complications (to be discussed in more detail below). Because of this, it can be helpful to order the following tests to screen patients for elevated white blood cells, anemia, elevated liver enzymes, hypercalcemia, and reduced bone density:

• CBC by Access Med Labs
• Comprehensive Metabolic Panel by Access Med Labs
• DEXA bone scan

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Treatment Plan for Hyperthyroidism

The main conventional treatment options for hyperthyroidism are antithyroid drugs, radioactive iodine, and surgery. The appropriate course of treatment will depend on the cause and severity of the disease, the patient's age, goiter size, and comorbid conditions. (22) This article will focus on a step-by-step treatment protocol that can be used as a first-line intervention strategy for those looking to avoid radioactive iodine and surgery.  

1. Pharmacotherapy

Here's Why This Is Important: 

Antithyroid medications act to normalize thyroid hormone levels and alleviate hyperthyroid-related symptoms quickly. 

How Do You Do This?

Antithyroid drugs interfere with thyroid hormone synthesis, thereby reducing their levels in circulation. 

• Methimazole is the drug of choice in nonpregnant patients due to its lower cost and reduced side effect profile. The starting dose is 15-30 mg daily. (22) 
• Propylthiouracil (PTU) is preferred for pregnant women because methimazole has been associated with congenital abnormalities. The starting dose is 100 mg three times daily. (22) 

Beta-blockers can be prescribed to manage tremors, palpitations, heat intolerance, and nervousness. Propranolol is most commonly prescribed at a starting dose of 10-20 mg every six hours. (22)

2. Dietary Modifications

Here's Why This Is Important:

Due to their increased metabolism, healthcare providers need to ensure that patients with hyperthyroidism are meeting their caloric and nutrient demands.

How Do You Do This?

Dietary interventions emphasizing nutrient-dense foods with increased caloric and protein intake are necessary. Diet can affect how the thyroid gland functions. Patients can be encouraged to eat the following: 

• Low-Iodine Foods: non-iodized salt, egg whites, vegetables, herbs and spices, and moderate portions of meat
• Cruciferous Vegetables: Brussels sprouts, cabbage, broccoli, collard greens, kale, bok choy
• Selenium-Rich Foods: Brazil nuts, seafood, meat, grains
• Foods Containing Calcium and Vitamin D: dairy, bone-in sardines, broccoli, cod liver oil, vitamin D-fortified foods

Eliminating trigger foods, which may include gluten and refined sugars, can reduce inflammation and autoimmunity. Elimination diets should be customized to the individual and overseen by a healthcare provider to ensure patients are still meeting their daily nutritional requirements.

3. Heal the Gut

Here's Why This Is Important:

The gut profoundly influences immune function, hormonal balance, systemic inflammatory load, and thyroid function. Thyroid disease may be a manifestation of gastrointestinal dysfunction and cannot be reversed until gut health is addressed.

How Do You Do This?

A 5-R Protocol intends to reduce intestinal permeability and inflammation, restore digestive function, and rebalance the gut microbiome to optimize the health of the gastrointestinal tract. 

• Remove or eliminate factors harming the gut, including triggering foods, alcohol, medications, toxins, and stressors.
• Replace essential nutrients and digestive enzymes that may be deficient or lacking in the diet. 
• Reinoculate the gut with beneficial bacteria. This can be achieved through the consumption of probiotic-rich foods like yogurt, kefir, sauerkraut, kimchi, and kombucha, as well as Lactobacillus and Bifidobacterium-containing probiotic supplements.
• Repair the gut lining by consuming foods and supplements that support intestinal integrity, such as bone broth, collagen, glutamine, zinc, vitamin A, and omega-3 fatty acids.
• Rebalance the body by adopting a balanced and sustainable lifestyle to maintain gut health and prevent future issues. This includes eating a nutrient-dense diet rich in whole foods, managing stress with techniques like meditation, yoga, and deep breathing exercises, getting regular physical activity, prioritizing sleep, and avoiding exposure to environmental toxins.

The Risks of Untreated Hyperthyroidism

Hyperthyroidism is correlated to a 20% increased risk of all-cause mortality. Without the proper treatment, hyperthyroidism can cause the following health complications and chronic diseases (11):  

• Heart disease, including atrial fibrillation and congestive heart failure
• High blood pressure
• Osteoporosis
• Graves' ophthalmopathy, which can lead to vision loss
• Brain damage
• Thyrotoxic crisis ("thyroid storm"): an emergent and life-threatening condition that presents with high fever, rapid heart rate, irritability, vomiting, dehydration, delirium, and loss of consciousness

Hyperthyroid Case Study

You can read a case study about hyperthyroidism here:

Taylor Suffered From Acid Reflux For Over 5 Years - Medications Didn't Help. Here's How She Found Relief

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Key Takeaways:

• Hyperthyroidism is characterized by an overactive thyroid gland, leading to a hypermetabolic state and potentially severe and life-threatening health complications when it is poorly managed. 
• While conventional treatments for hyperthyroidism offer effective symptom management, they often come with risks and side effects. Understandably, many individuals seek alternative treatment options that prioritize holistic approaches to address underlying imbalances contributing to thyroid dysfunction. 
• By collaborating with patients and incorporating dietary modifications, lifestyle changes, and targeted supplementation, healthcare providers can develop comprehensive treatment plans tailored to each individual's unique needs. These holistic approaches ultimately improve patient outcomes and facilitate a return to a euthyroid state.