This blog was created to help people understand autoimmunity, thyroid hormonal problems and Graves’ disease from a perspective of a fellow sufferer of Graves’ disease and a scientist. Blog by Jolanta Krywult.
How to choose a surgeon when considering thyroid surgery
Thyroid surgery is commonly performed in people with thyroid cancer and often in people with thyroid nodules. Surgery can also be recommended in the presence of large goitre which may obstruct the airways. The surgery is not as commonly performed for Graves’ disease. However some medical professionals believe that surgery is underused in the treatment of Graves’ disease as it provides immediate results and avoids the possible risks associated with the radioactive iodine. Surgery in case of Graves’ disease is often performed in children or adolescence with severe Graves’ disease. Other possible reasons include cases in which anti-thyroid medication is not working or is not tolerated, autoimmune thyroid eye disease and for people who refuse radioactive iodine opting for a surgical intervention. It can be an option for people for whom the radioactive treatment did not work or for women who are trying to become pregnant. Very rarely thyroid surgery may be performed in pregnant women.
Surgery is one option for Graves’ disease that a person may consider. Other options include anti-thyroid medications and radioactive iodine. There are also holistic approaches to Graves’ disease as well.
Surgery is an individual based decision and many factors need to be considered. However we have to remember that autoimmune thyroid disease is the problem of the immune system and not of the thyroid. Surgery for Graves’ disease reduces thyroid antibodies and the level of inflammation because it removes the tissue the immune system had been attacking.
Surgery is rarely performed in people with Hashimoto’s disease.
Sometimes thyroid surgery is necessary. The thyroid is not considered to be a self-regenerating organ as the cell turnover in thyroid is very slow. It is also important to aim for an optimal hormonal replacement after thyroid removal to live a good life.
The risks of thyroid surgery are generally low although there are some. I refer you to a website on the subject (1).
If you are planning a thyroid surgery, consider who will perform the operation. We choose a mechanic to fix our car, yet when it comes to a surgery, we often do not make a researched choice regarding a surgeon who will operate on us.
Here are some interesting statistics and tips to help you feel more confident when going under the knife.
The expertise of the surgeon can play a part in the rate of complications after a surgery. It is important that the surgery would be performed by a highly competent surgeon, who performs thyroid surgery routinely. Surgeons, who have performed around 500 thyroid surgeries are regarded as highly experienced. I refer you to an excellent website on the subject (2). General consensus for choosing an experienced thyroid surgeon is to ask about the number of operations the surgeon performs. Experienced thyroid surgeon performs one or more thyroid surgeries per week. Also, hospitals with an extensive experience in thyroidectomy have the lowest rates of complications. You should feel free to ask your surgeon questions regarding all of that.
I found a Canadian study (3) interesting and surprising. This study looked at 104 630 patients operated by 3314 surgeons, 774 female and 2540 male surgeons. This study talks about all types of surgeries, not just a thyroid ones. What is interesting that the study found that fewer patients treated by female surgeons died, were readmitted to hospital, or had complications within 30 days. Obviously, there seems to be more males than females in the field of operative medicine but it is still quite a surprising find. Go girl power!
Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparision of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ.2017 Oct 10; 359:j4366.
Hops is dried female flowers or seed cones of the hop vine (Humulus lupulus). It may help with hypothyroidism and many other health conditions.
Hops is traditionally used in beer making process and gives beer its unique aroma and slightly bitter flavor. It is used as flavoring component in some soft drinks.
It has been approved by the German Commission E for anxiety/mood disorders and restlessness.
Some scientific research (1) has shown that it helps thyroid hormones work better in the body. Xanthohumol, a flavonoid molecule in Hops, was found to modulate expression of genes involved in thyroid hormone distribution and metabolism in the liver. Xanthohumol affects expression of molecules which carry thyroid hormone in the body and regulates enzymes metabolizing hormones. It helps with the activity of iodothyronine deiodinase which converts thyroid T4 hormone into the active T3 hormone and it does so by decreasing inflammation, specifically NF-kappaB activation which is a key molecule to starting inflammation in the body (5, 12, 13). It lowers pro-inflammatory cytokines such as TNF-alpha and IL-6; less inflammation = better thyroid hormone action.
There are no studies as such on thyroid autoimmune disease and Hops but it might be very helpful for Hashimoto’s thyroiditis as it helps iodine to be up-taken by thyroid cells (2). It lowers inflammation as mentioned above, helps with sleep, anxiety, fibromyalgia and processing of hormones.
Hops has been used to help with rheumatic diseases and is present in some thyroid supporting supplements. It has anti-oxidant and anti-microbial activities. Preliminary studies (8) indicate that it may also improve cholesterol profile and lower markers of inflammation (such as C-reactive protein and complement C3 fraction) which is great news for the cardiovascular system and autoimmunity.
Hops helps to balance female hormones. It contains phytoestrogenic compounds (such as 8-prenylnaringenin, one of the most potent herbal phytoestrogens) which are similar to the hormone oestrogen. Oestrogens produced in the female body need to be balanced with another hormone called progesterone. However the production of progesterone is the first to go rapidly down during perimenopause and premenopause, often creating a state of ‘oestrogen dominance’. I refer you to a book by Dr John R. Lee “What your doctor may not tell you about premenopause.”
This oestrogen-progesterone imbalance can mimic hypothyroidism as strong oestrogens block thyroid hormone receptors so thyroid hormones cannot exert their actions properly.
This is how Hops can possibly help. I have my own theory and interpretation on how Hops may balance oestrogens in the body. The phytoestrogenic compounds in Hops can mildly replace excessive and strong oestrogens in binding sites of tissues and because phytoestrogenic compounds only have a mild oestrogenic activity, the oestrogen –progesterone imbalance is not felt as severely during the premenopausal transition. Also Hops helps to metabolize oestrogens in the liver. A study (15) has shown that Hops (Humulus lupulus) inhibits oxidative estrogen metabolism and estrogen-Induced malignant transformation in human mammary epithelial cells (MCF-10A), which means it may be protective against breast cancer.
Also, during menopause oestrogen production eventually goes down, Hops can provide some estrogenic activity, it may help with hot flushes and sweating. Hops may help to prevent osteoporosis. It is believed to have anti-cancer activity. However women who have hormone sensitive cancer or conditions should speak to their doctor regarding Hops as it is not known how Hops can impact these conditions.
My friend’s mum got advice from her doctor to have some Hops beer when she was going through a difficult menopause which had helped her. It makes me smile as I have a picture in my mind of menopausal women turning to beer for help during this bumpy time in their lives as everything else fails to help them feel better but I personally would recommend Hops tea or non-alcoholic Hops beer…
Hops is relaxing to the central nervous system. This effect has been documented in human studies. I have seen this first hand. I started to drink Hop’s tea few hours before sleep in recent weeks and I am surprised on how effectively it improved my sleep and my general well being. It is very relaxing for me. It is not surprising as Hops was shown to raise GABA, an inhibitory neurotransmitter acting in the central nervous system (CNS).
Hops is considered very safe to use but please as always consult your doctor before using hops, care needs to be taken in some medical conditions. This blog is for educational purposes only.
Radović B, Hussong R, Gerhäuser C, Meinl W, Frank N, Becker H, Köhrle. Xanthohumol, a prenylated chalcone from hops, modulates hepatic expression of genes involved in thyroid hormone distribution and metabolism. Mol Nutr Food Res. 2010 Jul;54 Suppl 2:S225-35.
Radovic B, Schmutzler C, Kohrle J. Xanthohumol stimulates iodine uptake in rat thyroid-derived FRTL-5 cells. Mol Nutr Food Res. 2005 Sep;49(9):832-6.
Vonderheid-Guth B, Todorova A, Brattström A, Dimpfel W. Pharmacodynamic effects of valerian and hops extract combination (Ze 91019) on the quantitative-topographical EEG in healthy volunteers. Eur J Med Res. 2000 Apr 19; 5(4):139-44.
Franco L, Sánchez C, Bravo R, Rodríguez AB, Barriga C, Romero E, Cubero J. The sedative effect of non-alcoholic beer in healthy female nurses. PLoS One. 2012;7(7):e37290
Colgate EC, Miranda CL, Stevens JF, Bray TM, Ho E. Xanthohumol, a prenylflavonoid derived from hops induces apoptosis and inhibits NF-kappaB activation in prostate epithelial cells. Cancer Lett. 2007 Feb 8; 246(1-2):201-9.
Salter, S. and Brownie, S. Treating primary insomnia – the efficacy of valerian and hops. Aust. Fam. Physician 2010;39(6):433-437)
Ross, S. M. Sleep disorders: a single dose administration of valerian/hops fluid extract (dormeasan) is found to be effective in improving sleep. Holist.Nurs Pract 2009;23(4):253-256)
Lopez-Jaen, A. B., Codoñer-Franch, P, Martínez-Álvarez, J. R., Villarino-Marín, A, and Valls-Bellés, V. Effect on health of non-alcohol beer and hop supplementation in a group of nuns in a closed order. Proceedings of the Nutrition Society 2010;69(OCE3).
Lukaczer D, Darland G, Tripp M, et al. A pilot trial evaluating Meta050, a proprietary combination of reduced iso-alpha acids, rosemary extract and oleanolic acid in patients with arthritis and fibromyalgia. Phytother Res 2005;19(10):864-9.
Erkkola, R., Vervarcke, S., Vansteelandt, S., Rompotti, P., De, Keukeleire D., Heyerick, A. A randomized, double-blind, placebo-controlled, cross-over pilot study on the use of a standardized hop extract to alleviate menopausal discomforts. Maturitas. 2006 May 20:54(2):164-75.
Heyerick, A., Vervarcke, S., Depypere, H., Bracke, M., and De Keukeleire, D. A first prospective, randomized, double-blind, placebo-controlled study on the use of a standardized hop extract to alleviate menopausal discomforts. Maturitas 5-20-2006;54(2):164-175.
Xiaohua Gao, Dorrah Deeb, Yongbo Liu, Scott A. Dulchavsky, and Subhash C. Gautam. Imunomodulatory activity of xanthohumol: inhibition of T cell proliferation, cell-mediated cytotoxicity and Th1 cytokine production through suppression of NF-κB. Immnunopharmacol.Immunotoxicol. 2009; 31(3):477-484.
Albini A, Dell’Eva R, Vene R, Ferrari N, Buhler DR, Noonan DM, Fassina G. Mechanisms of the antiangiogenic activity by the hop flavonoid xanthohumol: NF-kappaB and Akt as targets. FASEB J. 2006 Mar;20 (3):527-9.
Kyrou I, Christou A, Panagiotakos D, Stefanaki C, Skenderi K, Katsana K, Tsigos C. Effects of a hops (Humulus lupulus L.) dry extract supplement on self-reported depression, anxiety and stress levels in apparently healthy young adults: a randomized, placebo-controlled, double-blind, crossover pilot study. Hormones (Athens). 2017 Apr; 16(2):171-180.
Hemachandra LP, Madhubhani P, Chandrasena R, Esala P, Chen SN, Main M, Lankin DC, Scism RA, Dietz BM, Pauli GF, Thatcher GR, Bolton JL Hops (Humulus lupulus) inhibits Oxidative Estrogen Metabolism and Estrogen-Induced Malignant Transformation in Human Mammary Epithelial cells (MCF-10A). Cancer Prev Res (Phila). 2012 Jan;5(1):73-81
Malaria is a parasitic infection carried by mosquitoes in many tropical areas of the globe. Anti-malarial drugs are not only effective against malaria but they can also balance the immune system and reduce strong pro-inflammatory molecules involved in many autoimmune disorders.
Quinine was the first anti-malarial medication, isolated from cinchona bark. Since then many quinine related medications were synthesized. Quinine is also used in treatment of lupus, arthritis and the restless leg syndrome. Tonic water contains very small amounts of quinine.
Hydroxychloroquine is a quinine related compound originally used as an anti-malarial. It is also sold under the name Plaquenin, Axemal (in India), Dolquine and Quensyl.
Hydroxychloroquine is often given to people with autoimmune disorders such as lupus erythematosus and rheumatoid arthritis. Rheumatoid arthritis is the most common autoimmune disorder coexisting with thyroid autoimmunity, about 3-4% of people with GD and HT also have rheumatoid arthritis and hydroxychloroquine is often prescribed.
Sometimes, doctors prescribe Hydroxychloroquine (Plaquenil) for Hashimoto’s thyroiditis with positive results. It seems to be a slow acting medication. Trials are being undertaken to determine the exact effect of Hydroxychloroquine treatment in Hashimoto’s Thyroiditis.
This medication is not used to treat thyroid autoimmunity as such and there are no current studies that I could find in regards to Hydroxychloroquine and thyroid autoimmunity.
Halofuginone is a very promising agent for treatment for many autoimmune disorders. It is a plant alkaloid. Scientists are looking at its effects on autoimmunity and studies look very positive. It is currently used to treat malaria and scleroderma, an autoimmune disease of the connective tissue. It was isolated from a root of a plant called Dichroa febrifuga, ‘Chinese quinine’, (a blue evergreen hydrangea which grows in Tibet and Nepal) and had been used to treat malaria for thousands of years in China. This compound protects plant from stress and is more powerful than quinine. Halofuginone is also used in veterinary medicine to treat coccidiosis (protozoa parasites).
Researchers have discovered that halofuginone blocks the development of harmful immune cells called Th17 which are believed to be strongly involved in generation of autoimmunity. Halofuginone only affects these harmful immune cells and its action is to restrict amino acids proline incorporation into proteins (8). Proline deprivation blocks TH17 cells generation. TH17 immune cells are implicated in many autoimmune diseases such as inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, and psoriasis. Preliminary animal studies look very positive for Graves’ disease.
An animal study (3) has shown that Halofuginone decreased the incidence of autoimmune thyroid disease in mice in which Graves’ disease was induced.
As anti-malarial drugs have been prescribed to patients with autoimmunity, let’s look at the possible actions of these drugs on the immune system, although the way they work is not completely known.
Anti-malarial medications such as quinine are believed to be effective against Mycoplasma microorganism infections which have been implicated as possible causative agents of autoimmunity (including thyroid autoimmunity).
Patients with Graves’ disease were shown to have increased levels of Plasmacytoid Dendritic Cells (pDCs) in perithyroidal lymph nodes. These cells are the eyes of the immune system and they produce strong pro-inflammatory cytokines, such as IFNα and IFNβ. They are believed to be important in production of auto-antibodies. These cytokines can influence the central thymic tolerance to Thyroid Stimulating Hormone Receptor which may lead to Graves’ disease.
Hydroxychloroquine can reduce TLR (Toll like Receptor) signalling on pDCs. It impairs production of strong pro-inflammatory molecules such as INFα. It is therefore an immunosuppressant and that is why it is used in the treatment of some autoimmune disorders.
Anti-malarial medications which are alkaloids may alter pH within vesicles in immune cells called macrophages or other antigen-presenting cells which may influence the immune response to auto-antigens (6).
Hou X, Zhou J, Yang R, Liu S, Bi M, Liu T, Fan C, Guan H, Teng W, Shan Z, Li Y. Effect of Halofuginone on the Pathogenesis of Autoimmune Thyroid Disease in Different Mice Models. Endocr Metab Immune Disord Drug Targets. 2017;17(2):141-148
Jorge Cárdenas Roldán, Jenny Amaya-Amaya, Juan Castellanos-de la Hoz, Juliana Giraldo-Villamil, Gladys Montoya-Ortiz, Paola Cruz-Tapias, Adriana Rojas-Villarraga, Rubén D. Mantilla and Juan-Manuel Anaya. Autoimmune Thyroid Disease in Rheumatoid Arthritis: A Global Perspective. Arthritis. 2012; 2012: 864907.
Ben-Zvi I, Kivity S, Langevitz P, Shoenfeld Y. Hydroxychloroquine: from malaria to autoimmunity. Clin Rev Allergy Immunol. 2012 Apr;42(2):145-53
Fox R. Anti-malarial drugs: possible mechanisms of action in autoimmune disease and prospects for drug development. Lupus. 1996 Jun; 5 Suppl 1:S4-10.
Karim Sacre, Lindsey A. Criswell, and Joseph M. Hydroxychloroquine is associated with impaired interferon-alpha and tumor necrosis factor-alpha production by plasmacytoid dendritic cells in systemic lupus erythematosus. Arthritis Res Ther. 2012; 14(3): R155
Sundrud MS, Koralov SB, Feuerer M, Calado DP, Kozhaya AE, Rhule-Smith A, Lefebvre RE, Unutmaz D, Mazitschek R, Waldner H, Whitman M, Keller T, Rao A. Halofuginone inhibits TH17 cell differentiation by activating the amino acid starvation response. Science. 2009 Jun 5; 324(5932):1334-8.
Every year in the United States, 12.7 million people are diagnosed with cancer. Among the most prevalent diseases in the U.S., cancer is second only to heart disease. In 2017, there were 591,699 cancer-related deaths nationwide, and the percentage of total deaths that result from a cancer diagnosis is 22.5 percent. If you are currently one of the 2.8 million people serving as a caregiver for a loved one who’s going through cancer treatment, here are a few tips to help.
Types of Cancer
Cancer is a condition in which cells divide uncontrollably, breaking down your tissue. Some common forms of cancer include non-melanoma skin cancer, lung, breast, prostate, colorectal, bladder, melanoma, kidney, and leukemia. These are all prevalent. Skin cancer, for instance, affects more than 1 million people per year. Even lesser-known forms of cancer like thyroid are diagnosed at an alarming rate. In 2018, an estimated 53,990 new cases of thyroid cancer were diagnosed. The number of deaths that occurred was 0.5 per 100,000 men and women per year. Approximately 1.2 percent of people will be diagnosed with thyroid cancer at some point in their lives.
The Role of Caregiver
A cancer caregiver provides mental, physical, and emotional assistance to a person with cancer. That person might be your child, spouse, sister, neighbor, favorite cousin, or anyone else. Your role is a composite of different roles bundled together. For instance, you might act as that person’s medical advocate, making appointments or finishing paperwork on his behalf. Or you act as a domestic nurse, which means preparing meals and feeding that person, or making sure the medication dosages are correct. Many times, too, you’re his counselor, making sure he doesn’t feel overwhelmed or succumb to despair. Or you might step in as the household’s office manager, paying the bills, doing the laundry, and caring for pets or children.
Making Your Own Space
Patients with cancer need to attend to physical ailments but also should take steps to calm their mind. As a caregiver, you might prepare a quiet space within that person’s home where he can meditate. Set your sights on the attic, basement, or an enclosed outside patio. Every day, make sure that person spends at least some time in that room. While meditation is not a clinical method of treating cancer, its benefits are timeless. Easing pain, reducing stress, curbing memory loss, enlarging attention span, and boosting emotional wellness are all benefits of meditation. If they help the person you’re caring for, encourage him to meditate every day.
Caring for Yourself
Being a caregiver is a full-time job, and also frequently an unpaid family obligation. That means many caregivers have to still work 40 hours a week in addition to caring for someone. The scale of that responsibility can be overwhelming. So you need to take care of yourself, too. Practice self-care by getting enough sleep, taking up a hobby, and being around people who make you laugh (which has been shown to improve self-esteem and make people feel younger). In between all your duties, carve out at least some time during the day to relax so that you don’t burn out.
To combat cancer, seek the expertise of an oncologist to run tests, draw blood, and prescribe medicine or chemotherapy. But as a cancer caregiver, you can also supplement that medical attention and assist your loved one on the path toward recovery.
Scott Sanders is the creator of CancerWell.org, which provides resources and support for anyone who has been affected by any form of cancer. He is also the author of the book Put Yourself First: A Guide to Self-care and Spiritual Wellness During and After Cancer Treatment.
Rosmarinic acid is a molecule, first extracted from rosemary herb (since the similarity of the name) which is caffeic acid derivative, present in a number of herbs of mint (family Lamiaceae) such as Mentha spp (garden mint, spearmint), Origanum vulgare (oregano), Melissa officinalis (lemon balm), Rosmarinus officinalis (rosemary), Prunella vulgaris, Coleus spp, Ocimum spp (basil, holy basil), Origanum majorana (marjoram), thyme, Salvia officinalis (sage) and even small amounts in Lavandula angustifolia (English lavender). It is also present in some members of Boraginaceae family, including Lithospermum. Rosemarinic acid acts as a protective molecule in these plants. In a comparative study Mentha spicata (garden mint), Salvia officinalis and Melissa officinalis were shown to contain highest amounts of rosmarinic acid. The content of rosmarinic acid in rosemary was much lower but may vary in plants in different countries (12).
I will talk about studies regarding rosmarinic acid for thyroid autoimmunity and the herbs which contain it. Some herbs containing rosmarinic acid are beneficial for Graves’ disease (GD) and others for Hashimoto’s thyroiditis (HT) and hypothyroidism as they contain other different active components which may affect thyroid hormone levels and how they work in body cells.
The majority of studies on rosmarinic acid are in vitro (in the lab). There are some positive human studies on herbs containing rosmarinic acid for Graves’ disease (see my previous blogs). Melissa officinalis and Lycopus virginicus bugleweed (Lamiaceae) have been used in treatment of mild hyperthyroidism and GD. Generally herbs of the mint family (but not all) are thyro-suppressive possibly due to phenolic and cinnamic acid-flavonoid-type plant components. Bugleweed extract was found to reduce peripheral T4 to T3 conversion and thus it may lower the levels of T3 thyroid hormone levels in rat liver (23).
There is no specific scientific human research (that I could find) in regards to rosmarinic acid molecule and HT. However, there are laboratory studies indicating that it can indeed be a beneficial anti-inflammatory agent for thyroid autoimmunity (both GD and HT) as I will discuss in this blog.
The herbs containing rosmarinic acid, such as rosemary and sage may be beneficial for HT and hypothyroidism. They contain rosmarinic acid but also high amounts of carnosic acid, among other components, which improve thyroid hormone sensitivity within body cells. They have many minerals and vitamins. It has been shown in laboratory studies that carnosic acid in rosemary improves thyroid hormone action on DNA level by improving the signalling of thyroid receptor. Carnosic acid helps to promote the function of Retinoid-X- receptors and improve thyroid receptor coupling and expression of target genes thus increasing sensitivity to thyroid hormones. Another component of rosemary herb, carnosol, supports thyroid hormone metabolism and production of active thyroid hormone T3. Rosemary also improves learning and memory. Sage is believed to “heal” a memory.
Generally, many thyroid support supplements contain rosemary herb extracts and powders as it has been observed by naturopaths and herbalists that they improve thyroid function.
Let’s then discuss rosmarinic acid. It is a natural molecule which may be helpful in pharmaceutical therapy for some autoimmune disorders (rheumatoid arthritis, SLE, MS) and thyroid autoimmunity.
Here is why:
It is a potent antioxidant, anti-inflammatory agent, antimicrobial, anti-carcinogenic agent with tissue healing and protective abilities. It may help with allergies.
Rosmarinic acid is anti-inflammatory and helps with balancing of the immune system. There are a number of laboratory studies indicating that rosmarinic acid may disrupt the cascade of thyroid damage in thyroid autoimmunity by interfering with complement molecules of the immune system.
When too much free radicals are produced in the thyroid (for example when selenium levels are too low), they affect the TPO enzyme which is the enzyme involved in thyroid hormone synthesis. TPO enzyme was found to bind specific molecules of immune system called complement C4 (11). This then may start inflammatory responses cascade, formation of complement C5 and other complement components resulting in thyroid tissue destruction. A study (11) reported over-expression of C4 and all the subsequent components in the complement cascade by Hashimoto’s thyroiditis (HT) tissue thyrocytes.
Rosmarinic acid has been found (10) to inhibit a molecule called Complement 5 convertase which generates complement component C5. This molecule is a dominant inflammatory mediator in the development of many inflammatory and some organ specific autoimmune diseases, such as rheumatoid arthritis, SLE and thyroid autoimmune disease. It is involved in generation of other complement molecules and eventual tissue damage. Study on complement expression in GD disease and HT showed that C5 and C6 complements were over expressed in thyroid tissue from people with Graves’ disease compared to normal tissue. People with HT over expressed all complement components. In a study (10) Rosmarinic acid inhibited C5 convertase and covalent attachment of C3b to cells which indicated that it may stop the formation of complement cascade molecules in the thyroid that damage thyroid in autoimmunity.
Rosmarinic acid also has other actions (1). It promotes death of aberrant T lymphocytes and balances the immune system by inhibiting a nuclear factor in these cells. It thus reduces autoimmune antibodies. Studies of herbs (3,4) containing rosmarinic such as Melissa officinalis showed that it inhibits the binding of thyroid stimulating hormone (TSH) and TSH specific antibodies to TSH receptors in Graves’ disease (3,4) thus blocking thyroid overstimulation and lowering the formation of excessive thyroid hormones Lithospermum officiale and Melissa inhibit Graves’ IgG (antibody) and the long-acting thyroid stimulator (LATS) response. In studies, the relative potency of the inhibition was greatest for Melissa which seem to help with the actions of anti-thyroid medications.
The Journal of Restorative Medicine (1) states: Rosmarinic acid also reduces gamma interferon driven T cell responses and reduces interleukin production following T cell stimulation. Furthermore, rosmarinic acid affects signal transduction inside T cells by affecting specific tyrosine kinase enzymes inside the cell. By direct effects on T cells as well as other anti-inflammatory and antioxidant effects, rosmarinic acid may be a safe and valuable tool for reducing autoimmune inflammation. It may also be safe and advantageous to use in tandem with pharmaceutical treatment of autoimmune diseases.”
Rosmarinic acid also modulates neuro- endocrine function. It has calming properties. Rosmarinic acid is helpful against hair loss (massaging scalp with rosemary oil or rinsing with rosemary tea) may be beneficial.
There are rosmarinic acid containing supplements on the market (extracted from rosemary). I have not seen human studies in regards to rosmarinic acid and thyroid autoimmunity although laboratory studies, as described above, look very promising for rosmarinic acid. I believe it is too early at the present time to take rosmarinic extract supplements for thyroid autoimmunity. It would be great to see more studies and human trials. Rosmarinic acid from rosemary is considered safe but you need to consult your doctor before considering using rosmarinic acid extracts or if you suffer any side effects while taking them.
Rosmarinic acid or rosemary extract powders extracts should not be used by children, pregnant, breastfeeding women and people taking specific med (heart or diabetic medications importantly), with specific medical conditions or if allergic to herbs from Lamiaceae family.
It is important to consult your doctor regarding any herbs containing rosmarinic acid.
Herbal teas can provide rosmarinic acid which it is water soluble. Since I have had my thyroid removed, I no longer have GD but there are still some autoimmunity markers in my body (ANA antibodies- the antinuclear antibodies) which are common in people who have had autoimmune issues. I try to reduce my ANA antibodies in a number of ways but one of them is by the use of rosemary and sage cooking herbs. I drink sage tea very often. I use rosemary and sage in cooking as much as possible. I like sage tea and it seems to make me feel better. Rosemary tea is more of an acquired taste for me but I have it occasionally. I find that adding some lemon slices and bit of honey to my rosemary leaf or sage in hot water infusion helps. I use fresh herbs or dried herbs. I grow rosemary in a pot and I have had the same plant for years now. I have roughly calculated that 2tbl of dried rosemary leaves would roughly contain standard daily dose of rosmarinic acid but do not quote me on that calculation…
This blog is for educational purposes only.
Stansbury, Jill; Saunders, Paul; Winston, David; Zampieron, Eugene R. Rosmarinic acid as a novel agent in the treatment of autoimmune disease. Journal of Restorative Medicine. 2012(1):115, pp. 112-116(5).
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Auf’mkolk, M. Ingbar, J.C., Kubota, K., Amir, S.M., Ingbar, S.H. Extracts and auto-oxidized constituents of certain plants inhibit the receptor-binding and biological activity of Graves’ disease Immunoglobulins. Endocrinology. 1985 May; 116(5):1687-93.
Kang MA, Yun SY, Won J. Rosmarinic acid inhibits Ca2+-dependent pathways of T-cell antigen receptor-mediated signaling by inhibiting the PLC-gamma 1 and Itk activity: M.A. Kang, et al.; Blood 2003:101(9): 3534-42.
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Stephanie Blanchin, Valerie Estienne, Josee-Martine Durand-Gorde, Pierre Carayon, Jean Ruf. Complement activation by direct C4 binding to thyroperoxidase in Hashimoto’s thyroiditis. Endocrinology. 2003 Dec. 144(12). Url: https://academic.oup.com/endo/article/144/12/5422/2880991
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New formulations of thyroxine available in Australia
A new brand of thyroxine is now available in Australia. The Therapeutic Goods Administration has approved a new generic and new strength brand of thyroxine under product names of Eltroxin, Aspen thyroxine and Thyroxine Aspen in 2014, sponsored by Aspen Pharma Pty Ltd. This brand of throxine has been widely used in Europe and other countries. Previously we only had two brands of thyroxine in Australia, Oroxine and Eutroxsig.
Eltroxin tablets come in a plastic bottle in new strengths of thyroxine sodium – 25, 50, 75, 88, 100, 112, 125, 137, 150 or 200mcg tablets. They also do not need refrigeration (not above 25 degrees C) which may be useful when traveling for example or for finer adjustment of hormones. Eltroxin might be an easier option for some people who are taking two doses of Eutroxsig at different days of a week (like myself). When changing from on brand of thyroxine to another, it is important to note that dosing may not be interchangeable due to different fillers present in tablets as they may change the bio-availability of thyroxine in individuals. It is important to monitor hormonal levels when changing from Eutroxsig/Oroxine to Eltroxin, which may be slightly less bio-available when compared to Oroxine (you might need to take a slightly higher dose). I have not tried Eltroxin but would be very interested in any comments from people who take it or switched from one brand to another.
New liquid thyroxine (not available in Australia just yet)
SERB company in France has developed a liquid formulation of thyroxine, levothyroxine in drops. One drop contains 5 mcg of thyroxine. This formulation might be beneficial for young children and older people who have problems swallowing tablets.
FDA in USA has also approved a liquid formulation-Tirosint-SOL (levothyroxine sodium oral solution; IBSA). It is supplied in unit gel capsule containing following strengths (mcg/mL): 13, 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200 (colour labelled). It contains only levothyroxine, gelatin, glycerin, and water. It has been developed by Italian Swiss Company IBSA and it has been available in Italy since 2012.
Salvatore Benvenga, Giovanni Capodicasa and Sarah Perelli. Thyroxine in an oral liquid or softgel formulation ensures more normal serum levels of Free T4 in patients with central hypothyroidism. Front Endocrinol (Lausanne). 2017; 8: 321.
Hypothyroidism and a low resistance to colds and flu- natural remedies
This blog will only discuss scientific research on natural remedies which may help to fight off a respiratory infection during the flu season. The flu and the common cold are caused by different viruses with flu being generally more severe than a cold and harder to overcome.
My experience with sub-optimal thyroid hormonal replacement made me aware that my risk of getting common colds and flu increases when I was hypothyroid. In fact, I used to have a constant cold during winter which lasted for months when I was hypothyroid. The flu was also more severe and hard to overcome. Number one resistance from colds and flu in thyroid patients is to have optimal levels of thyroid hormones (TSH, T4 and T3) in my opinion. This is important as sub-optimal hormonal replacement affects all body systems negatively, including the immune and digestive systems.
Nutritional deficiencies are common with hypothyroidism which affect cause a lowered resistance to viruses. Common deficiency with thyroid autoimmunity are iron, B vitamins and vitamin C, D and vitamin A with hypothyroidism. It is also important to have adequate vitamin D levels. Vitamin D is a steroid hormone that balances the immune system obtained from the sun, therefore a reasonable sun exposure is beneficial. I personally supplement with vitamin D during winter months to have optimal levels. It is common do have low levels of vitamin D with thyroid autoimmunity.
The winter season is approaching in the southern hemisphere and so too here in Australia. However I feel that the warmer months are the time to boost the immune system. Vitamin D from the sun, fresh seasonal fruits and vegetables, swimming in the ocean, outdoor walks, relaxing summer holiday, all these enjoyable things leave healthy deposits in our body so that we are stronger during the colder months and are more able to fight off colds and flu virus faster. We need strong adrenals to overcome winter illnesses. Certainly when we are stressed, our immune system is not strong enough to be effective in fighting viruses. When we are hypothyroid we are severely weakened, we have lowered immunity and other hormonal imbalances. Therefore resistance to flu viruses involves a whole body approach.
Viruses are tiny (much smaller than bacteria) and they only replicate inside of a host cell. They can attach and then invade a human cell. Viruses are like tiny protein robots which carry genetic material that instructs the host cell to make more viruses, destroying the host cell in the process. Respiratory viruses like the Influenza virus are spread by coughing and sneezing. They can be breathed in but viruses can survive on surfaces for up to 24 hours so touching a contaminated surface and then touching your nose, mouth or face can cause an infection. Really, our immune system is our best defense against a viral infection.
Viruses can be ‘killed’ by heat (75-100 degrees C) and by some cleaners, detergents, soaps or hand gels. Hand gels and sanitizes are mainly antibacterial but also work for viruses given sufficient time of contact so it is good idea to rub the gel until hands feel dry.
Viruses are not really killed as they are not alive to start with but their protein and genetic material becomes damaged so they become are unable to invade a host cell. Antibiotics work only on bacteria and do not work on viruses and there are limited antiviral medications. Antibiotics are given for secondary bacterial infections as mucous membranes damaged by viruses are easily invaded by opportunistic bacteria.
Here I would like talk about some of the current research into natural remedies for overcoming colds/flu much easier.
It is beneficial to have lots of colorful vegetables in a diet, mainly because they can alkalize body cells which then become are more resistant to invasion by viruses. Anthocyanins (a type of flavonoid) is a group of compounds with amazing antioxidant effects. A scientific study (3) has discovered that certain gut bacteria called Clostridium orbiscindens, degrades flavonoids to produce a metabolite called desaminotyrosine which boosts the immune system and prevents influenza-related lung damage in the mice.
Colostrum may also be an effective supplement for flu prevention. Italian researches have stated in their study (20) on Colostrum: “Colostrum, both in healthy subjects and high-risk cardiovascular patients, is at least 3 times more effective than vaccination to prevent flu and is very cost-effective.”
We all know benefits of garlic for combating colds. A study (21) of one hundred forty-six volunteers investigated allicin containing garlic supplement for flue prevention. It has concluded that: “An allicin-containing supplement can prevent attack by the common cold virus.”
Raw apple cider vinegar is believed to be great for the immune system as it improves the balance of gut bacteria. It also stimulates absorption of nutrients from food.
A prominent physician in 1925 has made an observation that Bicarbonate of Soda had some protective effects on fighting influenza while working for U. S. Public Health Service during 1918- 1919 flu epidemic. Some people believe that small amount of baking soda in water can help to resolve colds, taken on onset by alkalizing the body. I have not tried this myself and have not found any current research in support of this remedy but for those interested, there are a number of interesting websites which discuss it, I include some (15, 16 and 17).
A great alkalizing fruits are lemons, even though they taste acidic, they change in the body to alkalizing substances.
People with autoimmunity need more antioxidants in their diet. One amazing vegetable with incredible amount of anthocyanins is red cabbage. It is a worthwhile vegetable to include in your diet in winter. Fruits such as blueberries also contain lots of anthocyanins and if you can have these in winter months, it might be beneficial. Fermented foods and probiotics might also help.
Adrenal support might be important especially if you are stressed or overworked. Good sleep is important for the immune system. Adrenal glands need lots of vitamin C and B to function well. Adequate levels of zinc and magnesium are also important. Zinc tablets and lozenges are beneficial for sore throats. Epsom salt baths or rubbing with magnesium gels may be beneficial to increase magnesium levels as it gets absorbed through skin. Very warm Epsom salt feet soak is wonderful when you have a chill. It is beneficial to keep your feet warm. Last winter I found that if I had a teaspoon of vitamin C powder 3 times a day in some water, it helped with my cold and muscular aches.
Everybody has their own cold remedies passed through generations. The goal is to get over a virus as soon as possible without getting a secondary infection which would require antibiotics. Having an appropriate rest is important.
A study has found that some essential oils attenuate influenza virus infections. These oils are: wild orange peel, clove, cinnamon, eucalyptus, thyme and rosemary. A scientific study (5) has shown that several oil blends such as On Guard have antiviral activities.
Few drops of these oils may be added to some vodka in a small spray bottle and used to spray in the house. The oils may be used in diffuses or vaporizers.
Good old chicken soup or bone broths provide many glutathione building nutrients. Glutathione molecule is important for the immune system to function well. Most of us know the benefits of garlic, black elderberry, cinnamon, ginger, raw honey in fighting of colds. A hot toast with butter, honey and sprinkled with cinnamon is soothing as well as garlic and butter toast. My friends swears by a smoothie containing lemon juice, ginger, garlic and parsley. Some people like the benefits of Echinacea extract. It was found to stop the virus binding to cells in an in vitro study (6). However some people with ragweed or pollen allergy might be allergic to Echinacea as their molecules are similar. Ragweed or pollen allergy are quite common in people with thyroid autoimmunity. Lots of warm drinks with lemon, ginger and honey helps to soothe a sore throat. Green, black and liquorice teas have some antiviral activity. Polyphenols in black tea called theaflavins have antiviral activities (7). Coffee components (such as caffeic acid and natural flavonoids) have also been shown to have anti influenza virus activities. Resveratrol in grapes is also known for antiviral properties. Guava leaf tea was shown to have a stronger anti-virus activity than green tea in a study, probably due to the presence of flavonoids (8). Olive leaf extract has also shown to have anti influenza effects (11). Gurgling a sore throat with olive leaf tea may bring some relief. Hibiscus tea may help as it is rich in vitamin C.
A study (1) on mice has shown that extract from leaves of wild black currants (500 micrograms) given to mice through nose stopped the replication of the human influenza A virus in lungs by 85% when compared to other mice. The extract was also effective in cell cultures infected with influenza virus. The scientist believe that this extract may also be beneficial to humans. The leaves are rich in phenolic compounds in particular flavonoids and tannins which are believed to be responsible for the antiviral effects.
Cistus incanus tea may also be beneficial for influenza. A scientific study (2) has shown that Cistus inacus extract has anti influenza virus activity in cell cultures study blocking the virus entry into the cells.
Herbs known for its antiviral properties include rosemary, thyme, sage, fennel seeds and oregano. Marshmallow root and black elderberry extract (Sambucol) can soothe inflamed membranes. Inhalers with tea tree oil, rosemary, eucalyptus, lemon, thyme, oregano or lavender may be beneficial. The oils can be used in steam breathing, vaporizers, baths, compresses and for rubs in massage carrier oils.
Andrographis paniculata (King of bitters) study (18) has shown Kan Jang tablets containing this herb had a preventive effect against common colds during the winter period. Astragalus root is also known for the anti-viral and immune boosting properties.
Let’s not forget about iodine, a potent killer of viruses. Iodine is used to make a thyroid hormones in the thyroid gland. Some people with hypothyroidism may be iodine deficient. Iodine should be used carefully by people with Grave’s disease as it may aggravate the symptoms in some cases.
Aerosol sprays with iodine can kill viruses, iodine gargling preparation from your local chemist may also be effective. Scientists, Burnet and Stone had experimented with iodine and influenza viruses on mice in Melbourne laboratories in 1945 and had found out that putting iodine on mice snouts prevented the mice from being infected with live influenza virus from 10 min exposure in high concentration virus mists.
I always make sure that I have my own herbal remedies for winter (recipe below) for winter coughs and colds. This tea is helpful for coughs, irritated throat and it makes sleeping easier.
Soothing tea for colds and coughs:
4tbl spoons dry marshmallow root
2tbl spoons thyme dried
2tbl spoons dried fennel seeds
2tbl spoons dried sage.
Please note: this blog is for educational purposes only, please speak to your doctor first before using natural remedies mentioned here.
Emanuel Haasbach, Carmen Hartmayer, Alice Hettler, Alicja Sarnecka, Ulrich Wulle, Christina Ehrhardt, Stephan Ludwig and Oliver Planz. Antiviral activity of Ladania067, an extract from wild black currant leaves against influenza A virus in vitro and in vivo. Front Microbiol. 2014; 5: 171.
Ehrhardt C., Hrincius E. R., Korte V., Mazur I., Droebner K., Poetter A., et al. (2007). A polyphenol rich plant extract, CYSTUS052, exerts anti influenza virus activity in cell culture without toxic side effects or the tendency to induce viral resistance. Antiviral Res. 76 38–47.
Ashley L. Steed, George P. Christophi, Gerard E. Kaiko, Lulu Sun, Victoria M. Goodwin, Umang Jain, Ekaterina Esaulova, Maxim N. Artyomov, David J. Morales, Michael J. Holtzman, Adrianus C. M. Boon, Deborah J. Lenschow, Thaddeus S. Stappenbeck. The microbial metabolite desaminotyrosine protects from influenza through type I interferon. Science, 2017; 357 (6350).
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Pleschka S, Stein M, Schoop R, Hudson JB. Anti-viral properties and mode of action of standardized Echinacea purpurea extract against highly pathogenic avian influenza virus (H5N1, H7N7) and swine-origin H1N1 (S-OIV). Virol J. 2009 Nov 13; 6:197.
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