But now Myers, a physician who practices in Austin, Texas and author of The Autoimmune Solution (Harper Collins, 2017), is convinced that that bout of mononucleosis was not the end of her struggle with the virus. She believes the infection she had as a teen was a major contributing factor to her developing an autoimmune thyroid condition later in life, and there is new medical evidence for the long-abandoned theory that Epstein-Barr and other viral infections are a significant underlying cause of thyroid disease.
Years after her infection, while in her second year of medical school, Myers was diagnosed with Graves' disease—a condition in which the immune system mistakenly attacks the thyroid gland, and it in turn becomes hyperactive.
Myers was in her 20s, tossing and turning in bed at night, unable to sleep and yet exhausted, day and night. She dropped three dress sizes while binging on pizza and oatmeal cookies, and she noticed that she was always in a mild sweat and her heart would race wildly without apparent reason.
She felt a deep fatigue in her legs, and for the first time in her life she was having panic attacks. It was the tremor in her hands, which others noticed too, that pushed her to visit a doctor.
As many people with thyroid disease have experienced, Myers' doctor brushed off her symptoms. He said they were just a result of stress from medical school. Having already undergone the stress of her mother dying from cancer, however, Myers was convinced that her symptoms were not just stress-related. She asked for a full workup and was diagnosed with Graves' disease.
The thyroid epidemic
The American Association of Clinical Endocrinologists estimates that 27 million Americans have a thyroid disease, about half of whom are undiagnosed,1 and the British Thyroid Foundation estimates that one in 20 people in the United Kingdom has a thyroid condition.
Women are especially vulnerable to thyroid disorders—one in eight women will develop a thyroid condition in her lifetime. In fact, the epidemic of thyroid problems has grown year after year, for decades, and is showing no sign of stopping.
Frequently described as being shaped like a butterfly, the thyroid gland has two lobes on either side of the windpipe and sits low on the front of the neck just below the Adam's apple. Every cell type in the body has receptors for thyroid hormone. An overactive thyroid, as in the case of Graves' disease, usually produces symptoms similar to those Meyers experienced, including weight loss, anxiety, rapid heart rate and tremors. Another common symptom is sore, gritty eyes.
An underactive thyroid (hypothyroidism), which produces too little hormone, results in a wide range of symptoms too—most commonly a slowed heart rate, constipation, fatigue, feeling cold, weight gain, poor concentration and depression. The most common type of hypothyroidism is called Hashimoto's disease.
The majority of both underactive and overactive thyroid conditions are thought to be the result of an immune system gone awry—launched into self-attack on components of the thyroid gland. Depending on which particular thyroid protein is under attack by the hyperactive immune system, different symptoms appear, and different autoimmune diagnoses and labels are given.
Recent studies have shown that numerous cytokines—small proteins that are important players in regulating the immune system—are on the move in thyroid disorders, fueling the fire of inflammation. A 2015 review of the subject concludes that they are critical to the overall picture of thyroid disease, but just how these cytokines work is still hasn't been established.2
But a wildfire in the immune system may explain why thyroid conditions are often accompanied by other immune system disorders—like vitiligo,3 juvenile diabetes4 and the gut autoimmune disorder celiac disease.5
All this adds to an increasingly clear picture that autoimmune thyroid disruption is part of a larger out-of-control inflammatory response that may affect other parts of the body. The thyroid is sick because the immune system is sick.
The role of the virus
EBV, which causes mononucleosis, is one of those nasty herpes viruses that seems to be everywhere. Once it has finished its infection phase, it has not died or vacated; it lays dormant inside of its host for the host's lifetime, not replicating, not active, just there—and it may be reactivated years later when the opportunity is ripe.
When the immune system is stressed and depleted, the virus springs into action again, replicating itself. It may not be noticeable to the host, but each time this process takes place, the immune system is 'activated,' and each subsequent activation makes the immune system more likely to fall into autoimmunity in the future. In an autoimmune attack, the overactive immune system attacks the body's own cells, which genetically resemble parts of an offending virus.
A 2009 study by Japanese researchers looked at what happens to the immune system of mice when it is repeatedly stimulated (by immunization) beyond its steady state—"like testing the capability of an automobile," as the scientists described it. They demonstrated that autoimmunity arises "as a natural consequence of normal immune response when stimulated maximally."6
In the 1970s, EBV infection was linked to autoimmune diseases like multiple sclerosis and lupus erythematosis. But since most people have been infected with EBV (tests show that 96 percent of the population over age 40 have antibodies to the virus) and most people don't develop autoimmunity, the theory fell out of fashion.
It was resurrected in 1997, when researchers in Oklahoma published strong evidence that EBV infection was a necessary feature of developing the autoimmune condition lupus, and that the virus was circulating in virtually all lupus sufferers at levels much higher than that of healthy individuals.7
Since then, EBV has been similarly pinpointed as a key feature of other common autoimmune conditions including multiple sclerosis, rheumatoid arthritis and autoimmune hepatitis. Higher than normal levels of EBV antibody have been detected in patients with thyroid disorders too.8
A 2016 literature review on EBV's role in autoimmune thyroiditis—inflammation of the thyroid—concluded that the virus "can be considered a contributory factor" to the disease, although its precise role is not yet understood.9
But other infections such as Mycoplasma pneumonia have been implicated in thyroid autoimmunity too and have been largely unexplored by mainstream medicine.10
The question remains why some people have a more controlled reaction to EBV infection, where the virus lies dormant for life, while in others it resurrects time and again and wreaks havoc on the immune system.
The answer seems to lie in the ability of each individual's immune system to combat EBV in the first place, their particular genetic weaknesses, their nutritional deficiencies and stresses, but also the number and timing of other infections and immunizations that may have set the immune system up for a fall into autoimmunity.
Most alternative practitioners recommend diets to eliminate food triggers, and that usually includes starting with cutting out gluten, grains and legumes, which are common triggers for autoimmunity. And they advise lifestyle changes to remove toxins that hamper immune and thyroid function. But it is also important to address underlying nutritional deficiencies and to tackle a virus head-on to prevent autoimmunity as a step toward healing.
Supplements to fix an infection-fueled thyroid condition
Vitamin C is necessary in thyroid hormone conversion. Though it has long been popular as an immunity-boosting tool among alternative health practitioners and anyone with a common cold, it has also been enjoying a new limelight since it was demonstrated last year to be a powerfully effective weapon against killer sepsis infection, which claims millions of lives annually worldwide.11
According to a 2017 review of the literature on vitamin C and infections, 148 animal studies have shown its ability to fight infections from bacteria to protozoa and viruses.12 Epstein-Barr seems to be no exception. One study found that EBV virus levels were lower in patients with higher vitamin C levels in their blood after intravenous (IV) vitamin C treatment.
The researchers concluded that high doses had a positive effect on both disease duration and viral antibody levels.13
But if IV vitamin C is not available, liposomal vitamin C is an option, as it's more readily absorbed and less likely to irritate the digestive tract in regular high doses.
Suggested daily dosage: The above study used 7.5-50 grams, and some practitioners recommend liposomal vitamin C doses as high as 6 g. But work with your practitioner to establish the right dose for bowel tolerance (how much your body can take of the vitamin before you develop very loose stools).
Scores of studies have drawn a connection between deficiency in vitamin D, the 'sunshine vitamin,' and autoimmune thyroid conditions.14
If your doctor won't agree to a vitamin D test, you can order it yourself through the Vitamin D Council (www.vitamindcouncil.org).
The Vitamin D Council considers anything below 40 ng/mL insufficient.
Suggested daily dosage: The Vitamin D Council suggests that adults get 5,000 IU of vitamin D per day either through direct sunshine exposure to unprotected skin or by supplementation with vitamin D3.
The hormones secreted by the thyroid are combinations of iodine and the amino acid tyrosine. Not enough iodine means the thyroid gland cannot make its essential hormones.
The World Health Organization recognizes iodine deficiency as an enormous global problem, and recent studies have found that a majority of British women of childbearing age and pregnant women are iodine deficient,15 a massive concern since iodine is essential for the brain development of babies in utero, and iodine deficiency is a leading cause of reduced intelligence in children.
As a result of the recent studies, the UK was recently ranked as the seventh most iodine-deficient country in the world.16
Many alternative practitioners have long held that the same massive deficiency exists in other countries such as the United States, but that the trace amounts of iodine added to dietary salt here have masked the problem by eliminating most obvious cases of goiter—where the thyroid becomes swollen and inflamed as a visible lump on the neck.
Some foods, including raw turnips, cabbage, soybeans and peanuts, block the utilization of iodine, but holistic physician David Brownstein, author of Iodine: Why You Need It, Why You Can't Live Without It (Medical Alternatives Press, 2009), thinks our increasing exposure to toxic halide chemicals is a far more likely culprit for the high rates of iodine deficiency.
Chlorine and its derivatives (in drinking water), bromine (added to bread to make the dough more elastic, and in pesticides and plastics) and fluoride (in water and toothpaste) all bind to receptors meant for iodine on the thyroid gland and impede the production of thyroid hormone.17
Many mainstream doctors seem unaware of the problem of deficiency and are more worried about high iodine levels inducing autoimmunity. Most table salts are not iodized in the UK, and as Americans have been widely advised to cut down on salt in public health campaigns, they have been getting less iodine from salt, too. Other major food sources of the mineral include seafood such as shrimp and cod, and dairy products.
Mainstream medicine and public health generally frown on the idea of giving iodine supplements to people with thyroid disorders, which some think could worsen the autoimmune attack. But to the contrary, says Brownstein: "I can state that it is impossible to treat thyroid illness if there is an inadequate level of iodine in the body and this includes autoimmune thyroid disorders."
Suggested daily dosage: Although the US recommended daily dose is 150 micrograms (mcg)/day of iodine for adults and 220 mcg/day for pregnant women, alternative practitioners suggest doses ranging from 325 mcg in kelp supplements to 12.5 milligrams (equivalent to 12,500 mcg) of iodine (Japanese women consume on average 13.5 mg per day).
If you decide to supplement with high doses, enlist the help of a practitioner to monitor your thyroid markers and avoid taking supplements before bedtime.
Selenium is critical to thyroid function. Some studies have shown that selenium supplementation can reduce blood levels of antibodies that attack thyroid proteins, but the jury's still out as to whether this change in antibody levels leads to a tangible improvement in clinical symptoms.18
However, it may be that looking at selenium in isolation is misleading because it is the simultaneous uptake with other minerals, including iodine, that contributes to an improved balance in thyroid hormones.
Some doctors routinely prescribe selenium supplements to patients with thyroid disease.19 But caution is warranted, because excess selenium can cause symptoms such as fatigue and gastrointestinal upset, as well as hair loss and white blotchy fingernails.20
Suggested daily dosage: A daily dose of 200 micrograms is standard (400 mcg is considered the safe upper limit), but if you would rather have a natural source, eat two brazil nuts per day, demonstrated to have the same effect as taking a 100 mcg supplement.21
Thiamine (vitamin B1) is critical for the conversion of carbohydrates into energy and the digestion of proteins and fats. In an interesting case study, three patients with Hashimoto's autoimmune thyroiditis experienced a partial or complete regression of their fatigue within hours or days of taking high-dose thiamine (600 mg per day orally or 100 mg injected every four days).22
People with autoimmune disorders including thyroid conditions have been found to be deficient in this vitamin, but mild thiamine deficiency is not detected by current standard testing. The women in the above study were not considered thiamine deficient.
Suggested daily dosage: Standard supplements commonly contain 1-2 mg of thiamine. Since thiamine is water-soluble, it does not build up in the body to toxic levels, but talk to a practitioner before considering supplementing with high doses.
Magnesium is necessary for iodine uptake. A 2017 study in Canada discovered that nearly one-sixth of adults and adolescents had blood magnesium levels below what would be considered a severe magnesium deficiency (below 0.75 mmol/L).23
Magnesium is counterbalanced by calcium, and even a small uptick in calcium intake has been shown to exacerbate magnesium deficiency,24 so avoid taking calcium supplements if you're looking to boost magnesium.
Suggested daily dosage: Up to 600 mg of magnesium citrate daily, in divided doses if you tend to be constipated, or if you tend to be on the 'looser' side, 600 mg of magnesium glycinate. This will reduce the symptoms of anxiety and palpitations, constipation, insomnia and cramps in the short-term, and in the long-term create improvements in thyroid condition.
Natural thyroid supplement
Most alternative practitioners who treat thyroid conditions prescribe natural desiccated thyroid derived from animal thyroid (mostly porcine and bovine), which was routinely and effectively used in medicine for more than a century, with few side-effects. Work with a practitioner to find the correct dosage for you.
From too much to too little
A form of radiation using radioactive iodine is a commonplace treatment for hyperthyroidism, and higher doses are used to treat thyroid cancer. Mainstream doctors insist this is safe. However, the vast majority of patients who are treated this way are then left with an underactive thyroid, a different set of symptoms to manage, and told they will have to remain on thyroid hormone replacement drugs for life.1
No better than a sugar pill
The thyroid secretes a balance of two hormones, called thyroxine (T4) and triiodothyronine (T3), into the blood, and these regulate metabolism, body temperature and many other critical functions.
For those with an underactive thyroid (hypothyroidism), levothyroxine is the drug of choice. In fact, its use is so widespread for this condition that it is the number one most prescribed drug in the United States for five years running and the third most prescribed drug in the UK.1
But the fact is that the drug doesn't always work. Many studies have looked at the "residual symptoms" in those treated with levothyroxine. A review published in 2015 admitted that "available clinical evidence suggests that levothyroxine monotherapy does not represent a universally adequate replacement for thyroid function."2
A 2017 study published in the New England Journal of Medicine showed that levothyroxine is no more effective than a placebo, or sugar pill, in older adults who have a hypothyroid condition that is sub-clinical, meaning that there are no obvious symptoms.
Lead researcher and University of Glasgow Professor David Stott called the drug a "waste of money and waste of time" after his team tested levothyroxine on a group of 737 patients with an average age of 74 who had been diagnosed with subclinical hypothyroidism, and found that there were no apparent benefits. Symptoms from poor muscle strength to speed of thought, weight gain and circulatory problems were the same whether the person was taking the drug or a placebo, though it did result in normal results on thyroid function blood tests.3
The standard thyroid testing protocol has been used worldwide since the 1970s. It has been widely derided for providing patients with their numbers on a very wide bell curve (based on test results from both sick and healthy people combined), while ignoring clear clinical symptoms of distress. Until the lab numbers fall into the right boxes, doctors overlook obvious physical thyroid symptoms such as swollen tongues and thinned outer eyebrows and dismiss complaints of fatigue and brain fog as 'normal,' as Amy Meyers experienced.
Furthermore, the most frequently used tests—those for thyroid stimulating hormone (TSH) and T4 (thyroxine)—do not measure the more active T3 (triiodothyronine) hormone generated from T4.
But even if all the available tests are performed, none offers a clear picture of thyroid function, and many lab tests miss several thyroid conditions.
The best test to discover if you have a malfunctioning thyroid is still the naturopathic basal body temperature (BBT) test. As soon as you wake up, place a thermometer under your armpit for 10 minutes. Normal readings are 97.8-98.2°F (36.6-36.8°C). Anything lower could be an underactive thyroid, and anything higher, an overactive one. If you're a premenopausal woman, the most accurate measurement is on the second or third day of your menstrual cycle. The BBT will slightly rise and fall just before and after ovulation, so take the measurements outside of this time of the month.
Another diagnostic tool, both for early diagnosis and control during treatment, is infrared thermography—which measures temperature as infrared radiation. Inflammation is readily visualized by thermography on the plum-sized lobes of the gland just beneath the skin's surface.