Abstract
Integrative Management
Patients with thyroid disorders may present with fatigue, sleep disturbance, weight abnormalities, and mood disorders that are often not improved with the normalization of thyroid function tests. The lack of resolution of these symptoms may drive patient dissatisfaction with traditional medical care.
A widely used nontraditional approach for hypothyroidism is compounded thyroid extracts. The number of patients using these compounded formulations continues to grow as many integrative and holistic practitioners promote these therapies over traditional thyroid hormone supplementation. 1 While current guidelines do not advocate their use, data in certain populations suggest combination thyroxine and triiodothyronine therapy and desiccated thyroid extracts may improve symptoms of fatigue and depression. 2 Careful counseling for both the patients and primary care providers on risks and benefits of these extracts will help to manage patients' expectations and guide safe practical use.
There is minimal evidence for micronutrient supplementation in thyroid disease, except for selenium supplementation in Graves' eye disease, which is widely accepted for its therapeutic benefit. 3 Nevertheless, many patients with thyroid disease have comorbid autoimmune and/or malabsorptive disorders that increase the risk of micronutrient deficiencies, which can contribute to symptoms of fatigue, pain, and depressed mood. Measurement of micronutrient levels such as vitamin B12 and vitamin D and supplementation as indicated can be a helpful adjunctive therapy.
Finally, use of mind–body techniques such as mindfulness, yoga, and t'ai chi have strong evidence for benefit in patients with mood disorders, chronic fatigue, and pain. 4 Many patients with thyroid disease struggle with these same issues, and early incorporation of these modalities often empowers patients to feel well, even before the normalization of their thyroid status.
Ultimately, normalizing thyroid function, identifying the root cause of the patient's symptoms, and individualizing a treatment strategy to incorporate alternative therapies designed to address the patient's concerns is the mainstay of an integrative approach to thyroid disease.