Complementary and Alternative Medicine in Thyroid Disease (CAM)

WHAT IS THE THYROID GLAND?

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormones help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

WHAT IS COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)?

Complementary and Alternative Medicine (CAM) is defined as a medical system, practice or product that is not usually thought of as standard care. Standard medical care is based on scientific evidence that the treatment is effective and safe, or has acceptable risks. For example, standard care for papillary or follicular thyroid cancer often includes surgery, radioactive iodine and thyroid hormone suppression therapy. Standard care for different thyroid diseases will depend on the specific condition.

The National Institutes of Health National Center for Complementary and Integrative Health (NCCIH) defines complementary medicine as being used along with standard medical treatments, and alternative medicine as being used in place of standard medical treatments. Integrative medicine is a comprehensive approach to care that includes patients’ mind body and spirit; this combines standard medicine with CAM practices.

REASONS PATIENTS WITH THYROID CANCER/THYROID DISEASE CHOOSE CAM

Studies looking at why patients with thyroid disease choose CAM have suggested that some reasons are to:

  1. Help cope with the side effects of medication and treatments including fatigue, dry mouth, weight gain and mental “fogginess”
  2. Ease the stress and anxiety of medication and treatments, or worries about having a lifelong diagnosis
  3. Try to help with their care
  4. Try to treat or cure their disease

MAKING CHOICES

A new diagnosis of any kind can be stressful or worrisome. Some patients with a new diagnosis of thyroid disease may want to add to their physician’s recommendations or even avoid standard treatment entirely. It is natural to want to be well and to think about what else can be done to improve ones health. There is a lot of information available, and new approaches for treating disease are always being tested. It can be hard to tell the difference between what is “standard” care and what is “complementary and alternative” medicine.

Some patients worry that their doctor won’t understand or approve of using CAM. Some doctors may not be familiar with CAM or approve of their use, but physicians know that their patients want to take an active role in their treatment. We want the best for our patients and would prefer an open line of communication.

Talking with your physician about CAM is particularly important because physicians want to ensure that their patients’ treatments work well, and some CAM that may seem safe could potentially interfere with standard treatment. The most important message is to talk with your doctor about anything you are taking and before you try anything new. This brochure is intended to help you understand what to consider as you make these choices.

TYPES OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)

The NIH NCCIH categorizes CAM approaches including biologically-based products, mind-body practices, and others. It would be difficult to create a comprehensive list, but some examples are included below.

Biologically-based practices are especially important to consider. These include products made from things in nature, often sold as dietary supplements and herbal products. Examples include: Vitamins; Minerals; Herbs; Diets; Probiotics.

These are rarely a part of standard care because there is not strong evidence that they are effective and safe. Many claims are made about the benefits of a product, but it is most important to note that there is no special diet or vitamin that eliminates cancer or removes thyroid disease. However, biological treatments may be used by physicians for patients with thyroid disease in selected situations.

Iodine is an important example. Diets that avoid excessive iodine or diets/supplements to increase iodine are both commonly recommended to patients with thyroid diseases. Physicians may use a low-iodine diet for a few specific reasons, but generally this is not beneficial. Excess use of iodine (in the diet or through liquid or pill supplements) can be harmful to the thyroid. Iodine supplements are recommended in certain situations, such as pregnancy.

Because of possible risks, it is important to talk with the doctor managing your treatment about any diets or supplements you are thinking about using. In addition, please talk with your doctor before stopping prescribed medication (or altering the dose) or cancelling any scheduled procedures.

If you have questions about the risks and benefits of a particular supplement, the National Institutes of Health Office of Dietary Supplements (NIH ODS) is a good source for credible, evidence-based information.

Mind-body medicine practices: These are based on a belief that the mind is able to affect your body. These may primarily focus on the mind, body movement, or energy fields to promote wellness. Examples include: Yoga; Message; Chiropraxy; Meditation; Hypnosis; Pilates; Tai Chi; Qi Gong; Acupuncture

Other forms of CAM: Often involve systems or belief practices from throughout the world’s cultures. Examples include: Naturopathy; Homeopathy; Chinese medicine; Vodun/Expiritism; Ayurvedic Medicine; Functional Medicine

A “NATURAL” PRODUCT DOES NOT MEAN A “SAFE” PRODUCT

Supplements do not have to be approved by the Federal Government before being sold to the public, and a prescription is not needed to buy them. The same is true for most CAM practices. There are ads and claims that products have been used for many years, or that they are effective in fighting cancer; these claims do not prove that these approaches are safe or effective. Some of these therapies can cost thousands of dollars. It is important for you to decide what is best for you, but you should be careful. Tell your physician if you are using any form of CAM, no matter how safe you think it is. Here are some facts about biological products you may find surprising:

  • Herbs and other products may interfere with how other medicines work in your body.
  • Supplements and cleanses can act like drugs in your body.
  • Taking more of a good vitamin is not necessarily better.

CHOOSE PRACTITIONERS WITH CARE

CAM practitioners are people who should have training and experience in CAM treatment. Choosing one should be done as carefully and thoughtfully as choosing a physician. It is important to be cautious about claims that a product offers a “cure” but does not give specific information about how well their product works, or claims that there are only positive results without side effects.

Here are some approaches to remember when finding a practitioner:

  1. Ask your physician or a professional at your treatment center if they can recommend a CAM practitioner
  2. Ask whether your hospital has a center for integrative medicine or integrative or functional medicine practitioners.
  3. Ensure your CAM provider is certified in their field. For example, massage therapists may have certifications through the American Massage Therapy Foundation and acupuncturists through NCCAOM (the National Certification Commission for Acupuncture and Oriental Medicine).

WHERE TO GET MORE INFORMATION AND HOW TO TRUST IT

There is a lot of information about CAM and it is difficult to know who to trust. Good places to start are listed at the end of this brochure. Here are some key questions to ask learning about CAM:

  1. Who benefits from the information given? If something is being sold or promoted, even indirectly, this should raise caution that the information may be unreliable. A review board, expert review and a well-known and respected organization are important for reliability.
  2. Where does the information itself come from? Information about CAM can be made to seem authoritative, but patients should look critically at the information. Do the authors have credentials in their reported field and/or are they recognized experts? Are the sources listed for the information from credible independent sources and not self-produced? Is information “anecdotal” (based on stories from a handful of people) or from published scientific results?
  3. How current is the information? Information about CAM and standard care changes quickly.
  4. Does the information take into account your specific condition? Patients with thyroid cancer and thyroid disease have special needs that not all CAM practitioners fully understand. It is important to ask questions and talk with your doctor before using CAM.
  5. What does your doctor say? Ask your doctors if they know of any CAM that might help with your condition or symptoms. Ask if a CAM you are considering will interfere with your treatment or medicines. Ask for help understanding what you have read/heard about CAM?

RESOURCES – GOVERNMENT AGENCIES

NATIONAL CANCER INSTITUTE – Office of Cancer Complementary and Alternative Medicine (OCCAM)
http://cam.cancer.gov

NATIONAL INSTITUTES FOR HEALTH – National Center for Complementary and Alternative Medicine (NCCAM) http://nccam.nih.gov
Toll-free: 1-888-644-6226
TTY: 1-866-464-3615

CANCER INFORMATION SERVICE (CIS)
http://www.cancer.gov/aboutnci/cis
http://www.cancer.gov
Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615

PHYSICIAN DATA QUERY (PDQ®)
http://www.cancer.gov/cancertopics/pdq/cancerdatabase

NATIONAL LIBRARY OF MEDICINE
http://www.nlm.nih.gov/

FOOD AND DRUG ADMINISTRATION (FDA)
http://www.fda.gov/

FEDERAL TRADE COMMISSION (FTC)
http://www.ftc.gov/

NATIONAL CANCER INSTITUTE-SPONSORED CANCER CENTERS
http://cancercenters.cancer.gov/

BENSON HENRY INSTITUTE FOR MIND BODY MEDICINE
at Massachusetts General Hospital
https://www.bensonhenryinstitute.org/

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March 5, 2013 in Thyroid Disease and Complementary and Alternative Medicine

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FURTHER INFORMATION

For information on thyroid patient support organizations, please visit the Patient Support Links section on the ATA website at www.thyroid.org