Management of Graves’ Disease With Functional Herbal Therapy: A Case Study by Professor Kerry Bone
Graves’ disease is an autoimmune thyroid disorder, and the most common cause of hyperthyroidism in Western countries. It is up to 10 more common among women than men. The exact causes of Graves’ Disease are not completely understood, but it has a strong genetic component, with genes affecting T cell function most strongly implicated. Environmental factors also play a role; nutritional imbalances, stress, and toxin exposure have been identified as key triggers. Additionally, studies have found strong correlations between specific viral infections and the development of Graves’ disease.1
Initial Presentation
A female patient aged 42 years presented with Graves’ disease (thyrotoxicosis). Her main symptoms were palpitations, tachycardia, weight loss and nervous agitation; some exophthalmia was present. The onset of symptoms was precipitated by a bad bout of influenza the previous winter. Since then, she had had frequent colds, and had a history of genital herpes. She was also highly stressed. She was taking the highest recommended dose of the antithyroid drug carbimazole (60 mg/day). Test results showed that her Thyroid Stimulating Hormone (TSH) was low at 0.14 mIU/L (normal range 0.4-4 mIU/L) and thyroid hormones were high normal, with free thyroxine (T4) at 17.2 pmol/L (normal range 10-20 pmol/L). Thyroid antibodies were elevated, with thyroid peroxidase at 182 kU/L (normal range <12 kU/L).
Prescription
Successful treatment of any autoimmune condition involves identifying the key drivers in each case, and addressing these using Functional Herbal Therapy (FHT) principles. In this case, the primary FHT goals are:
- Support the hypothalamic-pituitary-adrenal (HPA) axis
- Eliminate chronic/persistent viruses
- Optimise and balance immune function
To address these treatments goals, she was prescribed the following:
- Basic dietary advice to follow a healthy wholefoods diet, and reduce her tea and
coffee intake
- Acute Immune Support Tablets: 3 tablets daily; containing Andrographis
(Andrographis paniculata) leaf 2 g, Holy Basil (Ocimum tenuiflorum) herb
500 mg and Echinacea (Echinacea purpurea and Echinacea angustifolia)
root 500 mg
- Herbal formula 105 mL: 5 mL three times daily; containing Echinacea blend 1:2
20 mL, Bugleweed (Lycopus europaeus) 1:2 20 mL, Rehamnnia (Rehmannia
glutinosa) 1:2 20 mL, and Siberian Ginseng (Eleutherococcus senticosus)
1:2 30 mL
Rationale for the treatment:
Andrographis, Holy Basil and Echinacea were included to boost and balance immunity, plus Holy Basil is beneficial for the thyroid. St John’s Wort was included for its antiviral effects and as a nervine tonic to support HPA function. Rehmannia is an effective anti-inflammatory which inhibits cytokines, and provides adrenal support. Bugleweed is specific as an antithyroid herb. Finally, Siberian Ginseng supports HPAS function as an adaptogen,and provides additional immune support.
Follow Up – 4 to 6 Months
Only minor improvement in the first three months, which her doctor attributed to the carbimazole. Herbal treatment was maintained. One month later, her thyroid function tests were nearly normal, so her doctor reduced her dose of carbimazole to 30 mg per day. One month later, her thyroid function tests were normal, and she had only very mild symptoms. After six months of herbal treatment, she was completely off carbimazole, her thyroid tests were normal, and she had no symptoms of hyperthyroidism.
Follow Up – Long Term
In the 18 years since, this patient has only one minor relapse of Graves’ disease. This was successfully managed by reintroducing a similar herbal protocol and no drug treatment.
Clinical Reflections
Autoimmunity is a complex mosaic disease, driven by rearranging common factors.2 The key to successful treatment is identifying which common factors are implicated in each disease, and in each individual case. In this case, underlying viral infections, immune dysfunction, and HPA axis activation were the primary common factors involved in the initiation of autoimmunity. Addressing these drivers provided long-term relief for this client.
References
1. Antonelli A, Ferrari SM, Ragusa F, Elia G, Paparo SR, Ruffilli I, et al. Graves' disease: Epidemiology, genetic and environmental risk factors and viruses. Best Pract Res Clin Endocrinol Metab. 2020 Jan;34(1):101387. https://doi.org/10.1016/j.beem.2020.101387
2. Shoenfeld Y, Ehrenfeld M, Perry O. The kaleidoscope of autoimmunity - From genes to microbiome. Clin Immunol. 2019 Feb;199:1-4. https://doi.org/10.1016/j.clim.2018.12.003
