Monday, September 14, 2015

Hypothyroidism: Could it be treated with LIGHT?

1. Preface

One of the most popular articles of my blog has been about the therapeutic effects red and near-infrared light. An edited version the article has also been published at Perfect Health Diet blog.

Hundreds of studies have shown that red or near-infrared light can be used in the treatment of various medical conditions. According to some of the studies, it could possibly...
 The treatment is called "low level laser (light) therapy" (LLLT).

LLLT treatment often looks like this. However, the beam
size varies a lot (1mm2 - 32cm2) in different studies.
(Image source: SpinalStenosis)

LLLT is based on the research showing that red light and near-infrared radiation can boost cellular energy metabolism by activating the enzyme complex called cytochrome c oxidase. This energy-boosting effect can apparently protect tissues from stress and inflammation.

2. LLLT and hypothyroidism

Many interesting results have been published regarding the treatment of hypothyroidism with LLLT. Here's my short summary of the results.

1) In a Brazilian pilot study (2010), 47% of the hypothyroid patients receiving 10 treatment sessions of LLLT maintained normal thyroid hormone levels without thyroid medication at the end of the 9-month follow-up.

Other benefits were also noted:  TPOAb levels decreased by 39%, echogenicity index (EI) increased by 22% and normalization of thyroid volume was noted in three of the seven patients with abnormal thyroid volume.
(Höfling et al. 2010)

2) In a Brazilian randomized controlled trial (2013), 48% of the hypothyroid patients receiving 10 sessions of LLLT maintained normal thyroid hormone levels without thyroid medication at the end of the 9-month follow-up.

Other benefits were also noted: TPOAb levels decreased by 49%, echogenicity index (EI) increased by 19%  and normalization of thyroid volume was noted in five of the seven patients with abnormal thyroid volume. Thyroid vascularization was corrected in 16 of 22 patients who had abnormal vascularization at the baseline.
LT4 = levothyroxine ; L-group = LLLT group ; P-group = placebo group
(Höfling et al. 2013)

3) In an Ukrainian dissertation study by Viktor Dubovik (2003), it was concluded that LLLT can decrease medication requirements by 50-75% in people with postsurgical hypothyroidism. Antibodies for Tg and TPO were decreased after the treatment.

4) Another Ukrainian study by Yulia Buldygina (2002) concluded that LLLT might be beneficial for hypertrophic forms of autoimmune thyroiditis.

In this long-term study, they treated patients with euthyroid, subclinically hypothyroid and clinically hypothyroid hormone levels. In all groups, the decrease in TSH and TgAb was remarkable.
Laser therapy allows in 92% of patients delay the development of the pathological process, and 40% - to reach its full or partial regression or prevent progression to hypothyroidism and eliminate its initial manifestations, as evidenced by normalization of thyroid stimulating hormone. [...]
Laser therapy can be used as an independent method of treatment of hypertrophic form of autoimmune thyroiditis or as an additional method that increases the effectiveness of traditional drug therapy." [Translated from the original text by Google Translate]

Consecutive LLLT treatments were able to decrease TSH levels in (1) euthyroid,
(2) subclinically hypothyroid and (3) overtly hypothyroid patients with hypertrophic
 form of autoimmune thyroiditis. The most pronounced effect was seen after 4 

courses (each course included 10-15 treatment sessions). 

Consecutive LLLT treatments decreased thyroid gland volume
(left side and right side) in euthyroid patients with hypertrophic
form of autoimmune thyroiditis.
During this ~2-year study, the TgAb levels of the patients decreased
dramatically. [Image translated/edited by me]

5) Ukrainian study by Katerina Misura (2006) showed that LLLT can improve the treatment results in hypothyroid patients who also suffer from cardiovascular disease. These patients don't usually take adequate amounts of oral thyroxine, because of the possibility of severe cardiovascular symptoms.

Both groups received various drugs including levothyroxine, lovastatin and aspirin, but intervention group also received LLLT treatment. In this group, significant improvements in thyroid hormone and cholesterol levels were observed.

In LLLT group, TSH decreased 53% and T4 increased 95% in 3 months.
In the control group, the hormone concentrations remained unchanged.
In LLLT group (n=27), total cholesterol decreased from 8.23 to 6.09 in
3 months. In the control group, the decrease was much less pronounced (8.20 -> 7.67).

6) In a Russian dissertation study (2010), 17% of the hypothyroid patients receiving LLLT on the thyroid area could discontinue thyroid medication, and 38% could decrease the dose by 25-50µg.

Groups 2 and 4 received LLLT on their thyroid glands, while
group 5 served as a control group. This table shows LLLT's
effect on thyroid antibodies (TPO, Tg).

Some symptoms decreased after treating hypothyroid patients
with LLLT: Discomfort in the region of thyroid gland, dry skin,
constipation, lethargy/drowsiness and fatigue.

7) In an Russian report (2014), the treatment of 347 subclinically hypothyroid women was described.

Their baseline TSH averaged at 9.1 mIU/L, but after ten sessions of LLLT, the TSH was normalized in 337 (97%) of these women. Their TSH averaged at 2.2 mIU/L after the LLLT treatments.

The paper says: "The infrared spectrum of the laser radiation is effective
and safe treatment for patients with SH (subclinical hypothyroidism)
due to autoimmune thyroiditis[...]
In our opinion, it is the method of choice in the treatment
of the pathology, especially in the elderly."
(Puzin 2014)

8) A Russian study by Alexander Poljakov (1997) includes some data of chronic autoimmune thyroiditis patients who underwent a thyroid surgery.

Low-level laser therapy (LLLT) was found to improve thyroid hormone levels of these patients. It was also mentioned that the patients treated with LLLT require half as much thyroxine as usually.

In the laser group, T3 and T4 levels were significantly increased
at 6 months and 5 years after the operation, while the levels
tended to decrease in the "standard treatment" group. 

9) Ukrainian researchers also conducted an animal study, in which they they induced experimental autoimmune thyroiditis to rabbits (n=40). Apparently, low-level laser therapy (LLLT) reversed most of the thyroiditis-associated changes to the thyroid tissue.

KG = control group; EAIT = experimental autoimmune thyroiditis;
LT = low-level laser therapy; Klein index = Average diameter of 100 follicles

(Note: Since most of the reports cited are in Russian/Ukrainian language, I hope that I'll find a native person to proofread and confirm my summaries. I'm only half-Russian, and I cannot read these languages perfectly.)

3. Conclusions

(Höfling et al. 2013)

I would say these results are very impressive. I'm not aware of any other treatment that could improve several markers related to hypothyroidism and even allow some patients to discontinue their thyroid medication. This would make LLLT a very appealing future treatment to hypothyroid patients.

Since ~400 papers on LLLT are being published annually, I guess that it won't take many years until we know much more about possibilities in the use of light in the treatment of hypothyroidism and many other diseases.

4.  Addendum: How can we apply these results in real life? 

Hypothyroidism studies have been conducted mostly with two different laser devices (Thera Lase in Brazil; Mustang 2000 in Russia/Ukraine). But these devices are expensive and difficult to obtain.

Why laser? Why not normal light bulbs or LED lamps? How can these results be applied in real life?

That's the billion dollar question. :-)

If we look at the history of light treatments, we can see that approximately 110 years ago there were some books that recommended the light of incandescent bulbs in the treatment of various diseases such as obesity, diabetes, balding and chronic fatigue. They understood it's the red/infrared part of the light that is responsible for these beneficial health effects.

However, this research was mostly forgotten in the 60s, when a Hungarian researcher Endre Mester started focusing on the biological effects of laser light. Since then, most of the light research was conducted with laser light instead of ordinary light.

The term "laser" refers to a specific type of light. It has some differences compared to ordinary light you get from light bulbs. Laser light is usually coherent and monochromatic.

I think one reason why they have favoured laser is the fact that it's easy to control several dose parameters accurately when you are using laser light instead of light bulbs: wavelength, power output, power density, spot size, pulsing, total energy per spot...

However, LED and halogen lamps have been successfully used in the treatment of some other indications than hypothyroidism, so it's likely that laser light isn't necessarily needed to get the benefits of red/near-infrared light.

It's possible that even ordinary incandescent/heat/halogen bulbs and near-infrared LED lamps could be beneficial since they emit the right wavelengths (red light and near-infrared). The only problem is that nobody has studied those light sources in the treatment of hypothyroidism. We don't know how efficient it is or what is the optimal dosage.

Joseph Cohen's LLLT review on has some product recommendations, but I haven't studied these products yet.

5. References

[1] Lasers Surg Med. 2010 Aug;42(6):589-96. Low-level laser therapy in chronic autoimmune thyroiditis: a pilot study. Höfling DB, Chavantes MC, Juliano AG, Cerri GG, Romão R, Yoshimura EM, Chammas MC.

[2] Lasers Med Sci. 2013 May;28(3):743-53. Low-level laser in the treatment of patients with hypothyroidism induced by chronic autoimmune thyroiditis: a randomized, placebo-controlled clinical trial. Höfling DB, Chavantes MC, Juliano AG, Cerri GG, Knobel M, Yoshimura EM, Chammas MC.

ISRN Endocrinol. 2012;2012:126720. Assessment of the effects of low-level laser therapy on the thyroid vascularization of patients with autoimmune hypothyroidism by color Doppler ultrasound. Höfling DB, Chavantes MC, Juliano AG, Cerri GG, Knobel M, Yoshimura EM, Chammas MC.

[3] Dubovik V. The postoperative rehabilitation of the autoimmune thyroiditis patients with the use of low­intensive laser radiation. [I also paid for an Ukrainian translator to make an English copy of the Ukrainian article, so I have an English PDF]

Gopkalova I, Dubovik V, Danilevsky V. Effectiveness of using laserotherapy in the treatment of autoimmune thyreoiditis. CAOL 2003. Institute of Endocrine Pathology Problems of Academy of Medical Sciences of Ukraine (IEPP)

[4] Buldygina Y. Possibilities of low-intensive laser radiation in treatment of hypertrophic form of autoimmune thyroiditis. – Manuscript. Dissertation for degree of candidate of medical science by speciality 14.01.14 – endocrinology. – V.P. Komissarenko Institute of Endocrinology and Metabolism of AMS Ukraine, Kiev, 2002.

[5] Misura E.V. A complex method for treating patients with autoimmune thyroiditis in presence of hypothyroidism and accompanying coronary disease. - Manuscript. The dissertation competing for a scientific degree of Candidate of Medical Science in specialty 14.01.14 – Endocrinology. V. Danilevsky Institute of Endocrine Pathology Problems of the Academy of Medical Sciences of Ukraine, Kharkov, 2006.

[6] Вера Александровна Кривова: Неинвазивная гемолазеротерапия в системе реабилитации больных аутоиммунным тиреодитом (Диссертация, 2010) [A Russian dissertation]

[7] Д.А. ПУЗИН: Лазеротерапия в лечении субклинического гипотиреоза различной этиологии (2014)

[8] Поляков АВ. Применение низкоинтенсивного лазерного излучения в комплексном лечении хронического аутоиммунного тиреоидита (1997)

[9] Dubovik V. The postoperative rehabilitation of the autoimmune thyroiditis patients with the use of low­intensive laser radiation.

Gopkalova I, Dubovik V. Reparative regeneration processes of thyroid gland and timus at experimental autoimmune thyroiditis after laserotherapy. (2010)