Home' Australian Pharmacist : Australian Pharmacist Nov 2013 Contents 62 Australian Pharmacist November 2013 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
By Dr Liza Oates
THE COMPLEMENTARY APPROACH
Liza Oates, PhD, GradCert Evid-based
CompMed, BHSc (Naturopathy), is the
course co-ordinator for 'Food as Medicine'
and 'Wellness Practices & Perspectives' in
the online Master of Wellness program at
RMIT University. She has taught 'Nutrition',
'Complementary Medicine in Chronic
Diseases' and 'Health Enhancement' to
naturopathic and medical students.
The terms hyperthyroidism and thyrotoxicosis tend to be used
interchangeably, regardless of whether the disorder is caused by endogenous
overproduction or excessive ingestion of thyroid hormones.
Thyroid hormones affect virtually every
cell in the body and hyperthyroidism
can cause many body functions to speed
up. In people with hyperthyroidism,
thermogenesis (and thus the basal
metabolic rate) is increased and body
weight tends to decrease, although
weight gain occurs in around 10%
of people.1,2 The most common
symptoms are nervousness, agitation,
palpitations, fine tremor, hyper-reflexia,
heat intolerance, diarrhoea and
fatigue.2 The most common cause of
hyperthyroidism in Australia is Grave's
disease, an autoimmune condition
where auto-antibodies bind to and
stimulate thyroid stimulating hormone
(TSH) receptors, mimicking the effect of
prolonged TSH stimulation, and causing
hyperfunction of the thyroid gland. It can
affect people of all ages and is 5--10 times
more common in females than males.
Conventional treatment may involve
anti-thyroid drugs (ATD) (for example,
methimazole or propylthiouracil);
thyroidectomy or radioactive iodine
ablation (I131) but these have potential
adverse effects and may not always
Not all forms of hyperthyroidism
are appropriate for or amenable to
standard conventional treatments.
Subclinical hyperthyroidism is becoming
more commonly recognised, and is
characterised by normal circulating levels
of free thyroxine (T4) and triiodothyronine
(T3) and low levels of TSH.5
Mild hyperthyroid symptoms may be
experienced and the condition has been
associated with an increased risk of atrial
fibrillation and mortality, and decreased
bone mineral density in postmenopausal
After reading this article, pharmacists
should be able to:
• Discuss potential uses for
hyperthyroid nutritional and herbal
• Counsel customers on the
appropriate use of nutritional and
herbal therapies for hyperthyroidism
• Identify potential adverse effects
and interactions associated with the
use of hyperthyroid- nutritional and
Competency standards (2010)
addressed: 6.1, 6.2, 6.3.
Accreditation number: CAP131111d
This article has been independently researched and peer reviewed.
women. Treatment is controversial, due to
a lack of research showing clinical benefit
with restoration of the euthyroid state.5
This condition should be distinguished
from transient TSH suppression which can
occur in acute illness or after drug therapy
(e.g. high-dose glucocorticoids).
Subacute thyroiditis is a self-limiting
condition, and symptoms can vary from
mild to debilitating and last up to a year.
Antithyroid drug therapy is not effective
and treatment is usually symptomatic e.g.
beta-blockers, aspirin, and non-steroidal
anti-inflammatory drugs or prednisolone.
The hyperthyroid phase is usually followed
by a hypothyroid phase before returning
to a euthyroid state.3
Patients may turn to Complementary and
Alternative Medicine (CAM) therapists
to minimise or avoid the need for
conventional treatment or to assist with
improving quality of life. CAM therapists
such as naturopaths generally take a multi-
pronged approach to complex conditions
such as hyperthyroidism. This may involve
nutritional supplementation, herbal
therapies, dietary and lifestyle advice. CAM
therapies have not been thoroughly tested
in controlled human clinical trials, yet
there is preliminary evidence supporting
the use of some therapies. Nevertheless
practitioners recognise that treatment
of thyroid conditions is complicated and
will generally work alongside general
practitioners and/ or endocrinologists in
the careful management of the patient.
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