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How to choose a surgeon when considering thyroid surgery

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!


  1. The American association of endocrine surgeons. Patients Education site. URL:
  2. Finding a qualified thyroid surgeon. Tips for Assessing Experience and Credentials. URL:
  3. 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 for good health

Hops for good health

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.


  1. 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.
  2. 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.
  3. 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.
  4. 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
  5. 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.
  6. Salter, S. and Brownie, S. Treating primary insomnia – the efficacy of valerian and hops. Aust. Fam. Physician 2010;39(6):433-437)
  7. 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)
  8. 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).
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  1. 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.
  2. 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.
  3. 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




Anti-malarial medications and autoimmunity

Anti-malarial medications and autoimmunity.

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).


  1. Road back foundation. Mycoplasmas and Autoimmune Diseases. URL:
  3. 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
  4. 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.
  5. Ben-Zvi I, Kivity S, Langevitz P, Shoenfeld Y. Hydroxychloroquine: from malaria to autoimmunity. Clin Rev Allergy Immunol. 2012 Apr;42(2):145-53
  6. 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.
  7. 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
  8. 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.

Caring for a Loved One With Cancer

Caring for a Loved One

With Cancer

Article by Scott Sanders

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, 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.

Image via Unsplash



Rosmarinic acid and thyroid autoimmunity


Rosmarinic acid and thyroid autoimmunity

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.



  1. 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).
  2. Kennedy DO, LittleW, Schley AB. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). Psychosom Med. 2004 Jul-Aug; 66(4):607-13.
  3. Francis Brinker. Inhibition of Endocrine Function by Botanical Agents. I Boraginaceae and Labiatae. Journal of Naturopathic Medicine. 1990 (1):10-19.
  4. 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.
  5. 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.
  6. Won J, Hur YG, Hur EM. Park SH, Kang MA,Choi Y,Park C, Lee KH, Yun Y. Rosmarinic acid inhibits TCR-induced T cell activation and proliferation in an Lck-dependent  European Journal Immunol. 2003 Apr 33(4): 870–9.
  7. Anshita Gupta, Suchita Wamankar, Bina Gidwani, Chanchal Deep Kaur. Herbal drugs for thyroid treatment. Shri Rawatpura Sarkar Institute of Pharmacy. India. 2016 Jan-Mar; 6(1):62-70. URL:
  8. Peake PW, Pussell BA, Martyn P, Timmermans V, Charlesworth JA. The inhibitory effect of rosmarinic acid on complement involves the C5 convertase. Int. J Immunopharmacol. 1991. 13 (7):853-7.
  9. Potluková E1, Limanová Z. [The role of complement in autoimmune thyroid disorders]. [Article in Czech]. Cas Lek Cesk. 2007; 146(3):210-4.
  10. Sahu A, Rawal N, Pangburn MK. Inhibition of complement by covalent attachment of rosmarinic acid to activated C3b. Biochem Pharmacol. 1999 Jun 15; 57(12):1439-46.
  11. 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:
  12. Maryam Shekarchi, Homa Hajimehdipoor, Soodabeh Saeidnia, Ahmad Reza Gohari and Morteza Pirali Hamedani. Comparative study of rosmarinic acid content in some plants of Labiatae family. Pharmacogn Mag. 2012 Jan-Mar; 8(29): 37–41.
  13. Auf’mkolk M, Amir S, Kubota K, Ingbar S. The active principles of plant extracts with antithyrotropic activity: oxidation products of derivatives of 3,4-dihydroxycinnamic acid. Endocrinology. 1985; 116(5):1677-1686.
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  20. Panahi Y, Taghizadeh M, Marzony ET, Sahebkar A. Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial. Skinmed. 2015 Jan-Feb; 13(1):15-21.
  21. Steiner M, Priel I, Giat J, Levy J, Sharoni Y, Danilenko M. Carnosic acid inhibits proliferation and augments differentiation of human leukemic cells induced by 1,25-dihydroxyvitamin D3 and retinoic acid. Nutr Cancer. 2001; 41(1-2):135-44. [PMID: 12094616]
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  24. Rosmarinic- URL:

New formulations of thyroxine for treatment of hypothyroidism

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.


    1. URL:
    2. URL:
    3. 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.
    4. URL:
    5.  URL:
    6. URL:


Hypothyroidism and a low resistance to colds and flu- natural remedies

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.


  1. 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.
  2. 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.
  3. 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).
  4. Wolkerstorfer A., Kurz H., Bachhofner N., Szolar O. H. Glycyrrhizin inhibits influenza A virus uptake into the cell. Antiviral Res. 2009. 83 171–178.
  5. Shuhua Wu, Krupa B Patel, Leland J Booth, Jordan P Metcalf, Hsueh-Kung Lin and Wenxin Wu. Protective essential oil attenuates influenza virus infection: An in vitro study in MDCK cells. BMC Complement Altern Med. 2010; 10: 69. URL:
  6. 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.
  7. Nakayama M, Suzuki K, Toda M, Okubo S, Hara Y, Shimamura T. Inhibition of the infectivity of influenza virus by tea polyphenols. Antiviral Res. 1993 Aug; 21(4):289-99.
  8. Sriwilaijaroen N, Fukumoto S, Kumagai K, Hiramatsu H, Odagiri T, Tashiro M, Suzuki Y. Antiviral effects of Psidium guajava Linn. (guava) tea on the growth of clinical isolated H1N1 viruses: its role in viral hemagglutination and neuraminidase inhibition. Antiviral Res. 2012 May; 94(2):139-46.
  9. Zakay-Rones Z, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, Mumcuoglu M. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995 Winter; 1(4):361-9.
  10. Hulisz D. Efficacy of zinc against common cold viruses: an overview. J Am PharmAssoc, 2004 Sep-Oct;44(5):594-603.
  11. Renis HE. In vitro antiviral activity of calcium elenolate. Antimicrob Agents Chemother (Bethesda). 1969; 9:167-72.
  12. David Derry, MD, PhD. Iodine: the Forgotten Weapon against Influenza Viruses. Thyroid Science 4(9):R1-5, 2009. URL:
  13. Burnet, F.M., Holden, H.F., and Stone. J.D. Action of iodine vapour on influenza virus in droplet suspension. Austral. J. Sci.1945; 7:125-126.
  16. Dr Sircus. Sodium Bicarbonate (Baking Soda) for Cold And Flu. URL:
  18. Cáceres DD, Hancke JL, Burgos RA, Wikman GK. Prevention of common colds with Andrographis paniculata dried extract. A Pilot double blind trial. Phytomedicine. 1997 Jun;4(2):101-4
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  20. Cesarone MR, Belcaro G, Di Renzo A, Dugall M, Cacchio M, Ruffini I, Pellegrini L, Del Boccio G, Fano F, Ledda A, Bottari A, Ricci A, Stuard S, Vinciguerra G. Prevention of influenza episodes with colostrum compared with vaccination in healthy and high-risk cardiovascular subjects: the epidemiologic study in San Valentino. Clin Appl Thromb Hemost. 2007 Apr; 13(2):130-6.
  21. Josling P. Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey. Adv Ther. 2001 Jul-Aug; 18(4):189-93.

Thyroid dysfunction and lungs


Thyroid dysfunction and lungs

Thyroid dysfunction affects the way the lungs work. It is not surprising as thyroid hormones have receptors in every tissue and drive the energy formation in every cell including the lung tissue.

I remember way back when I was on suboptimal thyroid hormonal replacement (levothyroxine only), I was short of breath often. I remember that once I was not able to catch a breath for few minutes, I was trying to breathe and no air was getting in my lungs. It was a very scary experience and I made an appointment to see a doctor the same day. I explained my symptoms to the doctor but since I was better, the doctor was clueless to a cause of my problem. Looking back, I now know what my respiratory distress was caused by. It was caused by thyroid hormonal imbalance and insufficiency of T3 hormone. My T4 hormone then was truly up in the top range but my T3 was just low borderline in the reference range. My TSH was swinging up and down, which is quite common even with minimal T3 insufficiency.

Lung function is compromised with thyroid dysfunction, both hypothyroidism and hyperthyroidism. Both of these conditions may result in respiratory muscle weakness and a compromised lung function and capacity.

Respiratory distress and hyperthyroidism is more evident on physical exertion. Shallow, faster breathing may be a feature of hyperthyroidism. Sometimes, the breathing can be difficult or labored even at rest. I remember when I had active Graves’ disease I tried to breathe in a shallow way sometimes when I had experienced a sharp pain in my chest. People with Grave’s disease may also feel like having a tight collar around their neck due to a compression of trachea by an enlarged thyroid which makes breathing more strenuous. This can also occur with nodular goiter and thyroid cancers. I remember when as a student I was testing my lung capacity as a part of our studies. I was surprised then that it was much lower than my fellow classmates.

In hypothyroidism, that is when the thyroid function is low, respiratory symptoms are more common. Respiratory distress can be seen with exertion or at rest but can also be seen as sleep apnoea, air hunger, constant colds and dry coughs. The range of symptoms varies according to the degree of severity of hypothyroidism, from mild difficulties in breathing up to respiratory failure.

A study (1) on interstitial lung disease (when lung tissue is damaged and scarred) associated with autoimmune thyroiditis (ILD-AT) suggest that “Patients with interstitial lung disease of unknown origin should be tested for AT.”

The respiratory muscles are weaker and lungs have reduced capacity with thyroid dysfunction. In a study (2) it was shown that “Patients with idiopathic chronic cough and unexplained airflow obstruction in non-smokers have been shown to have an increased prevalence of hypothyroidism and other organ specific autoimmune disorders.”

The respiratory problems in people with hypothyroidism are much more common than in general population. Hypothyroid person may have asthma like symptoms at times and feel like trying to breathe through a straw. This is also common when adrenal dysfunction is lowered, which often co- occurs with thyroid problems. Hypothyroidism may cause some changes to pulmonary tissue and fluid retention. Additionally, people with autoimmune thyroiditis may have problems with low iron levels which may also contribute to a respiratory distress causing breath shortness. It is not easy climbing high stairs with hypothyroidism and low iron…

People with hypothyroidism can improve their lung function with levothyroxine (10). However, it was noted in a study (4) that hypothyroid patients under levothyroxine treatment had impaired exercise capacity. Therefore it might be important to look at optimizing the hormonal replacement by adding T3 hormone or natural desiccated thyroid which many patients consider a superior hormonal replacement. The respiratory problems can be reversed with optimal thyroid hormonal changes although some changes might not be reversible depending on a duration/ severity of hypothyroidism and the age of a person.

Also, a study revealed that females on levothyroxine only hormonal replacement have a higher chance of getting a lung cancer (11) due to an increased oxidative stress. The study had found no correlation of levothyroxine only hormonal replacement with breast, colorectal and gastric cancer.

On a personal note, my respiratory distress went away with optimal thyroid hormonal replacement (combined levothyroxine and natural desiccated thyroid hormonal replacement).

Weight reduction (though not easy with thyroid issues), gentle exercise (like walking), breathing exercises and essential fatty acids (omega 3) help lung function get better. Selenium, magnesium and potassium minerals are important for healthy lungs and for people with thyroid autoimmunity. Diet rich in organic leafy greens may help. Eating small variety of fish (such as sardines) 2-3 times a week may provide the omega 3.

Please see your doctor if you have shortness of breath and difficulties in breathing.

This blog is for educational purposes only.


  1. Igor Stepanyan, Marina Kovalevskaya, Evgenij Shmelev. Interstitial lung disease associated with autoimmune thyroiditis (ILD-AT). European Respiratory Journal. 2014. URL:
  2. S. Birring, A J Morgan, B Prudon, T M McKeever, S A Lewis, J F Falconer Smith, R J Robinson, J R Britton, I D Pavord. Respiratory symptoms in patients with treated hypothyroidism and inflammatory bowel disease. BMJ. URL:
  3. Samiaa Hamdy Sadek, Walaa Anwar Khalifa, and Ahmad Metwally Azoz. Pulmonary consequences of hypothyroidism. Ann Thorac Med. 2017 Jul-Sep; 12(3): 204–208. URL:
  4. Biondi B, Fazio S, Cuocolo A, Sabatini D, Nicolai E, Lombardi G, et al. Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine. J Clin Endocrinol Metab. 1996; 81:4224–8.
  5. Caraccio N, Natali A, Sironi A, Baldi S, Frascerra S, Dardano A, et al. Muscle metabolism and exercise tolerance in subclinical hypothyroidism: A controlled trial of levothyroxine. J Clin Endocrinol Metab. 2005; 90:4057–62.
  6. Cakmak G, Saler T, Saglam ZA, Yenigun M, Ataoglu E, Demir T, Temiz LU. Pulmonary functions in patients with subclinical hypothyroidism. 2011 Oct; 61(10):951-3.
  7. Seethalakshmi Krishna Iyer, Sunil K Menon, and Biju Bahuleyan. An Analysis of Dynamic Pulmonary Functions of Hypothyroid Patients. J Clin Diagn Res. 2017 Mar; 11(3): CC10–CC12. URL:
  8. Bassi R, Dhillon SK, Sharma S, Sharma A, Tapdiya M. Effect of thyroid hormone replacement on respiratory function tests in hypothyroid women. Pak J Physiol. 2012; 8(2):20–23.
  9. Hellermann J, Kahaly G. Cardiopulmonary involvement in thyroid gland diseases]. [Article in German] 1996 May;50(5):375-80.
  10. Akha O, Kashi Z, Poor AS, Zadeh ZT, Zakeri HR. Evaluation of levothyroxine effect on pulmonary function in hypothyroidism. J Mazandaran Univ Med Sci. 2008;18:1–6.
  11. Umberto Cornelli, Gianni Belcaro, Martino Recchia and Annarosa Finco. Levothyroxine and lung cancer in females: the importance of oxidative stress. Cornelli et al. Reproductive Biology and Endocrinology 2013, 11:75 URL:

Thyroid dysfunction and how it affects your liver

Thyroid dysfunction and how it affects your liver

Thyroid hormone imbalance affects liver structure and function. Thyroid health depends on liver and vice versa. Liver is the largest body organ which has many function. It is a processing, manufacturing, detoxifying and storage plant. Liver relies on thyroid hormones and it is a major user of them. Liver converts about 60% of T4 hormone into active T3 hormone and also plays a role in processing of excessive thyroid hormones. The D1 enzyme which does this conversion is mainly found in the liver and kidneys and is stipulated to determine T4:T3 serum ratio. This enzyme is completely inhibited by the antithyroid drug propylthiouracil (PTU) used in treatment of Grave’s disease. A good liver function is important for thyroid health. Thyroid hormone binding proteins have to be produced optimally in the liver as a smaller reservoir of bound T4 may result in greater fluctuations in the thyroid hormone levels.

Everything we absorb in our intestines is first delivered to liver via portal vein to be processed. Toxic molecules are processed into less harmful forms and go back to intestines through bile duct or through blood to be excreted in urine. Unhealthy gut will affect liver negatively. For example if you have microbial imbalance in your gut, you will have lots more toxic metabolites from these ‘bad microorganisms’. Regular bowl movement is also important for detoxifying the body. Thyroid hormonal imbalance affects the liver negatively as it does many organs in the body and as everything is connected, the burden on each organ increases. Liver may also struggle to detoxify the body, especially in any illness, when the load of toxic molecules increases.

Liver function tests to determine liver health:

Alkaline phosphatase (ALP)

Alanine transaminase (ATP)

Aspartate aminotransferase (AST)

Blood bilirubin

Liver detoxification profile, which measures how caffeine, paracetamol and aspirin are excreted from the body in saliva (usually ordered by integrative medical doctors).

Others: albumin, total protein, gamma-glutamyl transferase (GGT), lactate dehydrogenase, and prothrombin time.

Hypothyroidism and liver

Low T3 levels = sluggish liver= many negative health effects. Some people with hypothyroidism may have liver problems over time. Hypothyroidism can cause liver disease like symptoms. The symptoms connected to a poor liver function can be sore muscles, fatigue, muscle cramps, dull right-upper-quadrant abdominal discomfort. Other symptoms may include abdominal swelling, fluid retention, raised blood pressure, irritation and allergies. Sometimes there are no liver related symptoms at all until the liver disease progresses.

Liver function tests results commonly seen in hypothyroidism

Liver injuries or biochemical test abnormalities can be seen in hypothyroidism.

Decreased levels of alkaline phosphatase ALP test (enzyme in liver) usually due to lack of specific nutrients connected with hypothyroidism

Elevated aspartate aminotransferase (AST)

Elevated alanine transaminase (ALT) – less so than AST (commonly seen with fatty liver disease)

The ALT and AST are enzymes in the liver and the tests measure them in blood. Liver releases them in response to albumin and increased levels are indicative of liver damage.

Bilirubin – (product of breakdown of old red blood cells) may be reduced due to reduced bile flow and a reduced activity of an enzyme which directs bilirubin excretion. This can be rarely associated with cholestatic jaundice (symptoms are Itchiness, jaundice, pale stool and dark urine).

Biological changes and symptoms of hypothyroidism and liver connection

  1. Lipid metabolism is affected, higher total cholesterol levels seen and other lipids like LDL and triglycerides.
  2. Metabolism of cholesterol into bile salts lowered and consequently fat is not properly digested. Fat soluble vitamins (A, K, D and E) and the essential fatty acids are not properly absorbed.
  3. Problems with detoxifying hormones such as excessive oestrogens and other toxic molecules which may increase the risk of cancer and increases inflammation in the body
  4. Poor sugar control. Hypothyroid people store less glucose in the liver as glycogen and are more prone to hypoglycaemia and insulin resistance (see my previous blog). Insulin growth factor (similar to insulin and secreted by liver) is reduced.
  5. Not efficient production of copper binding proteins in liver causing metabolic syndrome problems (obesity, oestrogen dominance, insulin resistance)
  6. The liver plays a part in maintaining normal iron levels and when it is sluggish due to hypothyroidism, levels of iron become low. Dark circles under the eyes and tiredness may indicate low iron levels in the body.
  7. Non- alcoholic ‘Fatty liver’ (not necessary in an overweight person or person who drinks alcohol) represented by a reduced hepatic clearance and elevations in the amino transaminases. It is seen as build-up of fat and scarring in the liver. Nutrients such as choline, inositol, SAMe and betaine may help with fatty liver. Fatty liver may progress to liver scarring, damage and liver cirrhosis. There is a correlation of non- alcoholic liver disease and hypothyroidism, it was seen in 26 – 36% of patients with hypothyroidism in a study (5).
  8. Production of SAMe is reduced in liver which is linked to depression, high histamine (lots of allergies), insulin resistance, lowered glutathione levels and poor detoxification in liver, especially of excessive oestrogen.
  9. Hyperammonaemia (increased ammonia load) can be seen in severe untreated hypothyroidism as liver changes ammonia (a toxic by-product of protein metabolism) into urea, which is then excreted in urine.
  10. Poor detoxification of toxic molecules resulting in muscle pain, headaches, migraines and feeling tired

Detoxification processes in liver and hypothyroidism

Phase one of liver detoxification may be low with hypothyroidism, that is toxic substances in the body will not be properly processed into less toxic, more water soluble molecules so that they can be farther processed in phase II. The liver processes metabolic body products (such as body steroid hormones), microorganisms, contaminants, insecticides, pesticides, food additives, medications, heavy metals and other toxins in the 1st phase. If the phase I is low, the body will have a higher toxic load, one can feel unwell, sluggish, tired, itchy, have allergies, headaches, migraines, etc. Cytochrome P450 enzymes are involved in this phase of detoxification and they do not work properly if you have a low thyroid or iron deficiency (these commonly co-exist).  Also, if you are sensitive to coffee for example and it keeps you awake and hyper, your phase I of detoxification might not be working properly.

Phase II will be affected as a consequence of poorly functioning phase I and hypothyroidism, especially glycination (vitamin B2 and magnesium are important for glycination) which can make a person less tolerant to aspirin, nuts and preservatives such as benzoic acid. Phase II is sluggish if one has a low protein diet. Alkaline diet may also help (lots of vegetables). Bone broth with lots of vegetables may provide lots of glycine. Glycine is found in many meats with highest content in gelatins. Having meat and broth from pigs or chicken feet /drumsticks contains high amounts of glycine.

One indicator of sluggish phase II might be strong smell of urine after eating asparagus.

Remedy for improving your liver detoxification: optimal hormonal replacement (hormonal replacement with levothyroxine- T4 only may is not be optimal for many people), avoidance of toxins, alcohol and remedies to keep the gut and liver healthy.

Remedies: Apart from optimal hormonal replacement and good anti-inflammatory diet, B vitamins (including vitamin B12), natural vitamin C, glutathione (and precursors- selenium, vitamin E, glycine, glutamine and cysteine) and magnesium may help. Since absorption of all vitamins and minerals is lowered with hypothyroidism, this also have an impact on detoxification processes. Improving stomach acid and home remedies such as apple cider vinegar might help. Cruciferous vegetables, bitter vegetables (mustard greens), Swedish bitters, red beets and green tea may also be beneficial. Also, if you are low in iron (also common with thyroid conditions), the detoxification will not work properly. Phase I of detoxification is inhibited by grapefruit juice so if your detoxification is low in phase I, as commonly seen with hypothyroidism, grapefruit juice is not recommended (but oranges and lemons are fine). Grapefruit juice is only recommended for people whose phase I is too fast (like in people who are sensitive to chemicals). Phase I and II work together and need to be optimal and in balance.

Healthy, anti-inflammatory diet is important for people with thyroid autoimmunity. It might be important to avoid toxins and certain medications as well as alcohol. There are products on the market, which integrative doctors can prescribe for the improvement of liver detoxification phases, such as P2 Detox powders. However they only are prescribed if liver struggles with optimal thyroid function due to other reasons other than thyroid problems.


Let’s examine the other spectrum of thyroid dysfunction-hyperthyroidism:

Liver and Hyperthyroidism

Some liver injury is relatively common with hyperthyroidism. Untreated hyperthyroidism can lead to fatty change to cirrhosis of liver (scarred and enlarged) and in few cases even liver failure. Excessive T3 can cause death of liver cells. People with untreated Graves’ disease may have heart problems due to congested liver.

The problem with Graves’ disease and hyperthyroidism is that the antithyroid medications can be toxic to the liver. Sometimes jaundice may result as a consequence of antithyroid medications and there might be some mild liver injury due to the antithyroid therapy. This is especially important for children. PTU is mainly known for its possible higher toxicity to liver as in about 30% liver enzymes are elevated with PTU-(15). Rarely, PTU has been associated with a severe liver disease and liver failure. The signs of a liver toxicity can be: loss of the appetite, severe fatigue, urine turning dark and brown, pale stools, yellowing of skin and eyes (jaundice), abdominal pain, nausea and general itching. Contact your doctor immediately if you have any negative symptoms with antithyroid meds as early identification of clinical signs of liver troubles is important. Medication is discontinued if liver function is affected and liver health monitored.

Regular liver functions should be done while on antithyroid medications to monitor liver function within 3 months after starting on antithyroid medications, especially important with PTU. Liver function test before starting the therapy would also be beneficial to monitor for changes.

Liver function test commonly seen in hyperthyroidism:

– Elevated levels of alkaline phosphatase (in 64% of cases (14)). Alkaline phosphatases act by splitting off phosphorus (an acidic mineral) from many molecules to try to create an alkaline (basic) pH in the body. An increased level of alkaline phosphatase may be due to hyperthyroidism, and decreased level to hypothyroidism.

-Increase in the enzymes-aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels (in about 27- 37% 0f cases) (13). They are markers of liver health, may be elevated during antithyroid medication therapy, also indicate thyroid dysfunction as thyroid hormones modulate liver function.

-Elevated bilirubin (due to the thyroid hormone effects on liver) -jaundice can be seen due secretion of bilirubin

– Elevation of γ‐glutamyl transpeptidase GGT, gamma-GT (elevated levels are seen in liver injury)

 -A low cholesterol level is seen in hyperthyroidism. It is related to changes in the expression of certain genes and regulation of certain cell receptors. Cholesterol is needed for making many hormones (such as progesterone, cortisol), formation of vitamin D, formation and health of cell membranes and production of bile salts. Thus low cholesterol leads to many health problems.

– Iron levels become abnormal due to changes in liver functioning.

-Abnormal sugar control due to increased release of glucose form liver and other thyroid hormone effects on hormones and pancreas function

-The by-products of protein breakdown are toxic (such as ammonia) and need to be detoxified by liver which can become overwhelmed. They increase in blood and urine, causing headaches and nausea.

Detoxification process in liver is impaired due to hyperthyroidism and increased toxic load in the body.

Things which may help: healthy, organic food. Fish is high in methionine which is needed for detoxification of excessive thyroid hormones in the liver. L-carnitine, known as acetyl-L-carnitine or carnitine, is synthesised in the liver, kidney, and brain and actively transported to other areas of the body. In order for carnitine to be made in the body, essential amino acids, such as lysine, methionine, vitamins: B3 (niacin), B6 and iron are required. L- carnitine may help with Graves’ disease as shown in some studies. Glutathione is synthesised in many parts of the body but the main side of production is in the liver. It is a molecule consisting of three amino acids:  L-cysteine, L-glutamic acid and glycine. Boosting natural N-Acetyl-Cysteine (NAC) levels might be helpful for people with autoimmune disorders as it believed to be a rate limiting amino acids for the formation of glutathione. Curcumin, an active ingredient of the Indian spice turmeric might help as it is anti-inflammatory and helps with detoxification process in liver. However how curcumin works in individuals with GD may vary depending on cytokine profile of an individual. Chlorophyll, the green pigment in plants contains high amounts of magnesium. Having green drinks every day can detoxify the liver and provide this mineral. Magnesium is also available in oil and gel forms that can be put on skin. Vitamin C helps to displace toxic halogens from the body in place of iodine. It also has positive effects on liver detoxification. It works in synergy with copper mineral. Vitamins B help with detoxification of the liver. Brewer’s or nutritional yeast has glutathione building nutrients. Beet juice is a great liver detoxifier; it also helps to remove bad form of estrogen from the liver and oxygenates the blood. Beets are important as they provide body with lots of methyl groups. Cruciferous vegetables help in many detoxification processes in the liver and are very important for glutathione function and removal of many toxins from the body, including heavy metals. Sulfation is the main pathway, which detoxifies steroid hormones, thyroid hormones, neurotransmitters, paracetamol, xenobiotics and phenolic molecules. Nutrients, which are needed for this step, are cysteine, methionine, molybdenum, glycine and taurine. Taurine is found in meats, seafood and eggs. Turkey meat is very high in cysteine. The process of sulfation can be increased by increasing sulfur containing foods (onion, garlic). Those foods contain sulfur amino acids, such as cysteine. After the final phase of detoxification, the molecules are released in urine, stool and sweat. Infra-red sauna may assist in releasing those molecules from the body as well as a good hydration and enough fibre in the diet. Dandelion root tea might also benefit the liver. Milk thistle is another beneficial herb but some people with Graves’ disease might be sensitive to milk thistle.

Link of thyroid autoimmunity with autoimmune liver diseases

There is a rare association between thyroid autoimmunity and liver autoimmunity such as primary biliary cirrhosis (PBC) as a part of autoimmune polyglandular syndrome and it is due to common genetic factors with the presence of high titre of antinuclear antibody (ANA) and presence of anti-mitochondrial antibodies (AMA). Hashimoto’s thyroiditis is more frequently associated with PBC than Grave’s disease. A case study reported association of Hashimoto’s thyroiditis, primary biliary cirrhosis, and myasthenia gravis (16). However, the most common autoimmune illness associated with PBC is Sjögren’s syndrome.

Please note this blog is for educational purposes only. Consult your health care practitioner regarding any problems and before trying any remedies and supplements mentioned in this blog.


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Supplements I take to feel better

Supplements I take to feel better

I had a subtotal thyroidectomy due to Grave’s disease. The supplements in the picture above help me feel better while on optimal thyroid hormonal replacement. They are suggestions you might consider. However as we are all individuals, speak to your own health care practitioner before taking them, as always. There are many helpful supplements for hypothyroidism.

Brewer’s yeast or nutritional yeast

I find it a very calming remedy. I feel better when I take it, usually a teaspoon per day in the morning. I use it as my source of vitamins B as I do not tolerate synthetic vitamins well. I prefer Brewer’s yeast over nutritional yeast (they are grown and processed slightly differently). I put Brewer’s yeast directly into your food, I like it on scrambled eggs but I also put it into sauces or soups before serving. It is slightly bitter in tasting so I like to mask the taste a little.

Brewer’s and nutritional yeast is are made from yeast called Saccharomyces cerevisiae (used in baking, beer making process) which is grown and then deactivated (it is no longer alive) for nutritional supplement. It is a very rich source of natural vitamins B, chromium, potassium and selenium. It can help to improve insulin sensitivity (as it contains B1 and chromium), it helps the immune system function properly (rich in selenium) and also supports the adrenal glands (so important for thyroid patients) with vitamins B. Brewer’s yeast and nutritional yeast generally to not contain vitamin B12 unless it is fortified with it so if you are deficient in B12 you need to supplement with it separately. Also some products are not gluten free is you are sensitive to gluten.

Aussie favorite Vegemite is also a yeast spread (not gluten free), rich in vitamins B.

Brewer’s yeast can interact with some medications such as monoamine oxidase inhibitors (for treatment of depression), meperidine (pain medication) and diabetic medication. It is also on advisable in certain conditions. Some people may be allergic or sensitive to Brewer’s /nutritional yeast.

Vitamin C

My favorite supplement is natural Vitamin C powder from organic acerola cherries. Firstly because it is a complete vitamin C not just ascorbic acid. It is a powerful antioxidant, detoxifying vitamin and support for adrenal glands. I dissolve a teaspoon in some water and drink it few times a week. I had noticed it gave me an energy boost so I take it before midday. I see benefits of vitamin C powder for my general well being but as with any supplements, it is advisable to ask your doctor before taking it.

Rhodiola rosea (Arctic root, golden root)

It is a great herb to take for adrenal support. It is helpful for the first stage of adrenal exhaustions but not for later stages when cortisol is low. Basically, it is useful during stressful times. It is an adaptogen, a buffer for all endocrine organs involved in stress reactions. However, when a person feels chronically stressed for a long time, exhausted most of the time and has difficulties getting out of bed, it usually indicates later stages of adrenal exhaustion and low cortisol. Rhodiola may not be as effective as it reduces the secretion of cortisol in stressful situations thus balancing the output of adrenals.

Rhiodiola can be useful in Grave’s disease sometimes cases but it is specifically used and recommended in hypothyroidism. Rhodiola influences beta-endorphin and can lift mood. It can also enhance thyroid function, thymus gland function and improve adrenal gland reserves.

I take it for few weeks when I feel stressed but not exhausted. It is considered safe in recommended doses and is wildly used in Russia and Scandinavian countries. It is not recommended in people with bipolar disorder and for pregnant/breastfeeding women.

Licorice root

Licorice has been approved by The German Commission E for ulcer treatments. It also has other important effects. Licorice is useful for exhausted adrenal glands, which is very common with hypothyroidism. Licorice root contains plant components mimicking the effects of cortisol. Therefore it might be useful when you feel ran down, tired and stressed and when cortisol is low (in the later stages of adrenal exhaustion).

I take licorice supplement when I feel ran down, stressed and tired. I usually take it for about 3 weeks at a recommended dose and then take a break.

Licorice is considered safe in low doses. People with cardiovascular, renal and liver problems should take caution. Licorice may interact with warfarin, corticosteroids and oestrogen therapies. Not to be taken with bipolar disorders, in those taking hypertensive and hypoglycemic medications. It can raise blood pressure after prolonged use. Pregnant and breastfeeding women are not advised to use it as the safety in pregnancy has not been established. Apart from these cases, it is recommended in literature to take it sporadically at recommended doses and to have a break after 4-6 weeks of use.