Review and Information from Mary Shomon
In this interview, Elaine Moore, author of a wonderful new book, Graves' Disease A Practical Guide, shares some thoughts about Graves' disease, and information about this recently published book, which I personally believe should be on the bookshelf of every patient with Graves' or hyperthyroidism, and every practitioner who treats them!
Mary: First, Elaine, many congratulations on the book. I'm very excited to see such a comprehensive, unbiased book on Graves' available to patients, and I've been recommending it to people who write me looking for Graves' disease information. What in particular motivated you to dedicate such tremendous effort to writing Graves' Disease A Practical Guide?
Elaine: I truly regret not being adequately informed of treatment options
when I was diagnosed with Graves' disease (GD). Not understanding the
autoimmune nature of this disorder, I rushed into having aggressive
treatment despite having few symptoms. When my doctor said radioiodine was
my only option, I believed him. Now I'm permanently hypothyroid and have
more problems than I ever had from being hyperthyroid. It's important for
patients to realize that the immune system, not the thyroid, is at fault in
GD. Patients need to realize all of their treatment options, including
alternative medicine. They also need to understand that GD runs its own
course and spontaneously resolves in up to 25% of patients each year.
Although everyone needs to be monitored, not everyone requires aggressive
treatments. Too many people are being pushed into having radioiodine
ablation and destroying their thyroids, and they're often erroneously told
that radioiodine therapy is without risk. My reason for writing this book
was to let people know that destroying one's thyroid has serious
consequences. It's not a matter to be taken lightly.
My second goal is addressing the long-term consequences of Graves'
disease, particulary the concerns of people who have never addressed the
underlying immune disturbance responsible for Graves' disease. My book is
all GD patients, the newly diagnosed as well as those who were treated for
Graves' disease fifty years ago.
Mary: What are some unique things that you feel are covered in
your book that would be of particular interest to Graves' disease
patients, things they wouldn't be likely to find in other books?
Elaine: I go into great detail explaining how and why Graves' disease
develops. Specifically, I describe how GD develops in individuals with a
certain combination of genes who are exposed to certain environmental
triggers, including stress. With this knowledge, patients can see how the
thyroid gland in GD is the victim, not the cause in autoimmune thyroid
In describing conventional and alternative treatment options I explain
therapy affects the underlying immune system defect and how this influences
the long-term consequences of treatment. I also list the pros and cons of
individual therapies and explain why no one treatment works best for all
patients. My primary focus is on the autoimmune nature of GD. if the
underlying immune system defect isn't addressed, patients generally go on
to develop another autoimmune disease such as fibromyalgia or celiac disease.
Although I've included the results of several long-term treatment outcome also included an anecdotal chapter in which patients treated with the various treatment options describe their experiences.
I've also included chapters describing the special considerations in
pregnancy and in children and the progressive hypothyroidism that can occur .
Because of my extensive background in laboratory medicine, I'm
versed in the pitfalls of laboratory testing. Many people on anti-thyroid
drugs (ATDs) are abruptly taken off these drugs too soon. When they have a
relapse, they're told they must have radioiodine ablation. This could be
avoided if more doctors ordered the appropriate thyroid antibody tests.
Other patients on ATD are sometimes kept severely hypothyroid
reliance on certain thyroid function laboratory tests. I
know you've expressed concerns about this reliance in your book too. Also,
many people with hyperthyroidism are diagnosed with GD when they actually
have other thyroid disorders, but the wrong diagnostic tests are relied on.
To help patients take charge, I've included an extensive chapter on
laboratory testing and test interferences and a chapter on autoantibodies.
Mary: After reviewing your book, I find it's an extremely well--
written, very thorough overview of the variety of approaches, both
conventional and alternative, that could be considered for Graves'
disease. In fact, my feeling is that this should be THE book a
Graves' disease patient first picks up, in order to better understand
the condition. But I understand that some of the conventional
thyroid authorities are coming out in opposition to your book -- an
experience I can well relate to with my own book! Any idea why?
Elaine: I believe it has to do with my recommendation to research treatment
options instead of rushing into having radioiodine. 50 years ago in the
United States, scientists and physicians debated whether radioiodine was a
safe therapy. Initially, after reviewing the cancer mortality rates for
patients with enlarged thymus glands treated with radioiodine, a number of
scientists decided that radioiodine was unsafe. Unfortunately, however,
those in favor of radioiodine kept the debate going until they got their
Consequently, radioiodine is now the major treatment for
hyperthyroidism in the
United States, but not in Europe or Japan. In most European countries,
radioiodine is never administered to women younger than 40. In Europe and
Japan, anti-thyroid drugs are the treatment of choice. The former head of
the Atomic Energy Commission has dedicated his life to proving how unsafe
Relying on studies of survivors of Hiroshima and the Chernobyl
disaster, in the last decade researchers have learned a great deal about
effects of radioiodine. Consequently, a number of physicians in
the United States have quit recommending radioiodine ablation. But
radioiodine is the cheapest therapy and medicine today is driven by cost.
Many doctors, especially those in HMO's and those who trained before 1990,
insist that radioiodine is safe. One of my goals in writing this book is to
present studies showing both point of views.
Also, even though it's been long known that a number of people with
Graves' disease achieve spontaneous remission without treatment, some
doctors think that hypothyroidism is preferable to hyperthyoidism. People
like me who have mild symptoms are having their thyroid glands destroyed
although wiser doctors monitor symptoms and determine the disease's natural
progression before even suggesting treatment.
And even though the German Commission E has described certain herbs
both safe and efficacious for the treatment of hyperthyroidism, few
doctors in the United States are familiar with herbal therapy. They object
to trying something new although they don't think twice about destroying
the thyroid of someone with subclinical or mild symptoms. The moderators of
one popular thyroid board do a great disservice to Graves' disease patients
in that they try to scare people into having aggressive treatment by
suggesting that the rare condition of thyroid storm is a common event, and
they refuse to publish reports of spontaneous remission. They ban reports,
even published studies, listing the benefits of alternative medicine and
pull posts of patients who object to the use of radioiodine. There are
several support groups who receive funding from drug companies and
consequently perpetuate the notion that hypothyroidism is a simple easily treated condition.
Fortunately, Mary, neither of us have to worry about offending
sponsors. We're able to present factual, well-researched information
objectively. Just as you did in Living Well with Hypothyroidism, in my
I've included numerous citations so that anyone who objects to certain
can go right to the source and learn that much has changed since the
1950's when radioiodine first came into vogue. Mary, I know you've helped
millions of people with hypothyroidism. You've taught people the
of being involved in their own healing plans. With my book, I hope to do
same for Graves' disease patients.
Mary: I know many Graves' disease patients who are interested in
finding out more about Block and Replace Therapy, as well as long-
term antithyroid drug treatment, as alternatives to Radioactive
Iodine, which seems to be the only option many U.S. doctors
understand or are willing to offer. Can you tell us a little bit about
your coverage of these topics in the book?
Elaine: Chapter 8, which discusses conventional treatment options,
describes the advantages of block and replace therapy. In this chapter, I
included recommendations from some of the top endocrinologists at Harvard
University who state that all patients with GD should undergo a minimum 18
month trial of ATDs before even considering aggressive treatment. By 18
months most patients on ATDs will have achieved remission. Those who
haven't will by then have a better idea of their disease course and can
decide if they want to pursue ATD therapy or try another approach. Some
people have symptoms that wax and wane causing them to have natural periods
of remission that alternate with variable symptoms. These are factors that
must be taken into consideration. One's unique disease course and personal
health status are important factors in choosing therapy. While all patients
need to have their symptoms monitored by a conventional or alternative
medicine practitioner, all patients do not need the same standard treatment.
Mary: Can you give us a bit of a preview of some of the alternative
approaches you discuss?
Elaine: This is probably my favorite chapter because in researching it, I
met lots of people, including one physician, who achieved remission using
alternative medicine. Topics discussed include homeopathy, herbal medicine,
energy healing, stress reduction techniques, dietary changes, strong
solution of saturated iodine (SSKI or Lugol's solution), craniosacral
therapy, Ayurveda, traditional Chinese medicine, Kampo, acupuncture, yoga
and tai chi. Graves' disease is associated with many nutrient deficiencies
caused by an increased metabolism. Many symptoms in GD are related to these
deficiencies. Again, relying on sources from the medical literature, I
explain how correcting these deficiencies may help reduce certain symptoms.
Mary: What would you like Graves' disease patients to take away
from reading your book?
Elaine: I'd like them to understand that everyone with Graves' disease is a
unique individual. Predominant symptoms and their severity vary from person
to person. We all have unique genes and clusters of autoantibodies that
determine the severity of our symptoms and how our disease will progress.
Because of all these variables, we all respond to treatment differently.
Some people achieve remission in weeks while for others, it takes years.
Many people who ended up achieving remission with
anti-thyroid drugs reported that their doctors were amazed and commented
that they'd never seen such a favorable response with anti-thyroid drugs
(some doctors admitted they'd never tried using ATDs before). I'd like it
if more patients helped their doctors understand that remission is an
attainable goal. I've also met hundreds of people who regret having had
their thyroid glands destroyed and who are now suffering from the
consequences. Some people say I'm on a mission to save thyroid glands. It's
true. I'd like more patients to survive Grave's disease with their thyroid
intact. Destroying any organ should not be taken lightly.