I decided to create a series of episodes covering the different factors that can help you lower and eventually normalize your thyroid antibodies. In today’s episode, I’m starting with the basics. I discuss the complexities of thyroid antibodies, the importance of proactive testing, why we need to address underlying causes rather than solely focusing on symptom management, the role of supplements, and more. If you would prefer to listen to this part, you can access it by Clicking Here.
This is the first of multiple episodes where I focus on how to lower and normalize thyroid antibodies. While I do have other episodes where I discuss this topic, since many people have questions related to thyroid antibodies, I figured I would create a series where I dedicate individual episodes to different factors that can help you lower and eventually normalize thyroid antibodies.
I want to start out by mentioning that lowering as well as normalizing thyroid antibodies is not an easy process. It can be challenging to accomplish this. I might make it sound like it’s easy at times, but it definitely is not. It can be challenging to find and remove the triggers, to heal the gut. Just wanted to let you know that up front.
This is also why I decided to dedicate specific episodes. Having one single episode to talk about thyroid antibodies can be helpful as well, but still, just because it can be challenging, I thought it would be helpful to have a series of episodes where I go into greater detail about this.
Let’s talk about what antibodies are. An antibody is a Y-shaped protein that is part of an immune system response to something called an antigen. An antigen is a foreign substance that causes an immune response. Examples include pathogenic bacteria, food proteins, chemicals. These antibodies are secreted by something called B cells of the immune system. They essentially serve as a form of protection.
Why do some people develop thyroid antibodies? There is something called the triad of autoimmunity. It has three components. Component #1 is a genetic predisposition. #2 is exposure to one or more environmental triggers. #3 is an increase in intestinal permeability, which is the medical term for leaky gut. Those three factors are necessary for autoimmunity to develop and thus thyroid antibodies to develop.
There are different types of auto antibodies. We will focus on the ones that relate to thyroid autoimmunity here, but there are many other autoimmune conditions, which are all associated with different types of antibodies.
The most common type of thyroid antibody is called thyroid peroxidase (TPO) antibodies. TPO is an enzyme that is important in the formation of thyroid hormone.
When you have these antibodies, the actual antibodies aren’t doing anything. Well, they’re not always a consequence. Thyroid stimulating immunoglobulins (TSIs), which I’ll talk about next, do affect the thyroid. Many times, these antibodies are a consequence of the autoimmune component. That’s the case with TPO antibodies. They are not doing damage to the thyroid gland.
But when you have TPO antibodies, it could indicate that there is damage happening in the background. It doesn’t always mean you have damage to the thyroid gland, but that definitely can be the case. Over time, if you don’t address the autoimmune component, it can lead to hypothyroidism, low thyroid hormone levels. If you have elevated TPO antibodies, I recommend to do things to try to lower and normalize them, which is what this series is about.
Next, TSIs. These are associated with Graves’. These actually do affect the thyroid directly. These bind to or stimulate the TSH receptor of the thyroid gland, resulting in the excess production of thyroid hormone.
I should also mention TSIs are a type of TSH receptor antibody (TRAB). You can actually measure TRABs as well. I usually stick with TSI because they are more specific to Graves’. I’ll talk shortly about TRAB more because there is another antibody associated with that, not just TSI.
Let’s next talk about thyroid globulin antibodies. They are associated with Hashimoto’s thyroiditis. Thyroid globulin is a protein of the thyroid. If you have those antibodies, the antibody itself isn’t damaging the thyroid gland, but the presence of these antibodies may indicate that you’re experiencing damage to thyroid globulin.
You can also test for thyroid globulin, too. Don’t get that confused. If you are trying to look at the antibodies, you want to test for thyroid globulin antibodies, not thyroid globulin itself.
I should also add that it’s not uncommon for people to have all of these antibodies. You could have TPO, TSIs, thyroid globulin antibodies. Some people have a combination of TPO and TSI. In fact, literature shows that 60-80% of people with Graves’ will also have TPO antibodies.
When I dealt with Graves’, I did not have TPO antibodies; I just had TSIs. A lot of people do have those TPO antibodies.
Then there is another type of antibody I briefly want to mention called thyroid binding immunoglobulin or TSH binding inhibitor immunoglobulins. These are also a type of TRAB. Many labs don’t offer this type of test. Even if you wanted to, you can’t necessarily test for it. It is a type of TRAB.
I usually just test TSI, but if you tested TSI and TRAB, and TRAB was positive, but TSI was negative, then one can maybe conclude that if you were able to test the TSH binding inhibitor immunoglobulin, that would be positive.
I’m actually going to have another Q&A episode where I focus more on TSH binding inhibitor immunoglobulins, so stay tuned for that. A little bit confusing in the literature. Some associate it with Graves’. Some say it has nothing to do with Graves’. I’ll talk more about that in a future episode.
If you’re not following this, I wouldn’t worry about it. It’s not important when it comes to lowering thyroid antibodies. I’m giving an overview of the different types of antibodies. Like I said, the main ones you are going to test for are TPO, TSI, thyroid globulin antibodies. Those are the three main ones I would focus on. Like I said, it’s really just an overview as far as going over the different types of antibodies.
When should you test thyroid antibodies? Most medical doctors, including endocrinologists, don’t test the thyroid antibodies at all. The only time they may test thyroid antibodies is if someone is diagnosed with hyperthyroidism or hypothyroidism, high thyroid or low thyroid hormones.
Let’s say they do a TSH. Unfortunately, a lot of doctors will only do TSH as part of a physical. If TSH is within the lab range—it might not be in the optimal range, but in the lab range–they won’t look at thyroid antibodies.
If someone has elevated TSH, or on the higher side, like 3.5, which is within most lab reference ranges but is above the optimal range, they very well might have thyroid antibodies, especially TPO and/or thyroid globulin antibodies. Most medical doctors would wait until the TSH is outside of the reference range before testing thyroid antibodies.
The thing is, thyroid antibodies develop before the thyroid gland is affected. The presence of thyroid antibodies doesn’t always mean that the thyroid is being affected. Still, if you have a family history of Graves’ or Hashimoto’s, doing predictive antibody testing, even if it’s every few years, is a good idea, just so you’re aware that you have those antibodies.
If you have the antibodies, that doesn’t mean you’ll develop hyperthyroidism or hypothyroidism, but you very well might. It’s good to know that, yet most doctors will wait until the thyroid gland is actually affected.
As far as when you should test for thyroid antibodies, I would say it would be a good idea to test them- Arguably, most people listening to this have Graves’ or Hashimoto’s. If you’re listening to this, and you have Graves’ or Hashimoto’s or antibodies for both, and you have children- I’m not saying you should test your three-year-old for thyroid antibodies. In the future, when they get a blood test, I would test for thyroid antibodies. I wouldn’t go out of your way to test for thyroid antibodies in family members. I do think it should be more of a prescreening process, predictive antibody testing.
For those who have already been tested for thyroid antibodies, which probably describes most people listening to this, ideally, if everything was free, I would say test for it every single month. Honestly, I don’t think that’s always necessary. Sometimes, it can cause more stress because especially in the beginning, when you’re trying to restore your health, the antibodies might fluctuate. It might stress you out if you test them every month.
That being said, I wouldn’t go six months between retesting. I would say at least every 3-4 months. If you could do it every two months, that would be great. I do like to keep an eye on the thyroid antibodies.
In the beginning, not as important, when someone is starting to make changes to their diet and lifestyle, and maybe doing some functional medicine testing. As their health improves, eventually, we do want to see positive changes in those antibodies.
Which of these thyroid antibodies should you test? Should you test all of them? A lot of people, when they see me with Graves’, they might just have TSIs, for example. Should they test these other two antibodies? Or if someone has Hashimoto’s, and they have TPO and thyroid globulin antibodies, should they test TSI?
I don’t think it’s always necessary to do this. In the case of Hashimoto’s, they might have positive TSIs. I know I just said predictive antibody testing, but if someone had a family history of Graves’, and they have Hashimoto’s antibodies, then I would say it’s a good idea. If someone has a family history of Hashimoto’s, but they tested positive for Graves’, maybe they should also test TPOs. It’s not going to hurt to look at all three antibodies. If you are paying out of pocket, might be a little bit pricey.
I will say the approach isn’t going to be different. At least, my approach and most functional medicine practitioners, if one has a single thyroid antibody, it’s not like we’re going to change our approach if someone has three thyroid antibodies.
If someone has hyperthyroidism compared to hypothyroidism, the symptom management option is going to be different. As far as the treatment approach, it won’t be different.
That being said, if someone does have multiple thyroid antibodies, sometimes you’ll see one normalize but the other remain high or fluctuating. If you only test one, and it’s elevated, but eventually normalizes, that doesn’t mean the other antibodies will normalize. That’s also something to keep in mind.
Another question you probably don’t have, but I’m going to bring up: How common are false negative thyroid antibodies? Can you have Graves’ or Hashimoto’s yet have negative antibodies? Can you have Graves’ and have negative TSIs? Can you have Hashimoto’s and not have either TPO or thyroid globulin antibodies?
The answer is yes. In the case of Graves’, it’s not as common. Most people with Graves’ will have elevated TSIs. It is a little bit more common, it seems like, in those with Hashimoto’s to have false negative antibodies. You could do a thyroid ultrasound, if you have elevated TSH and the antibodies are negative, and see what the ultrasound says.
I do have an upcoming interview with Dr. Alan Christianson. He talks more about this. Definitely would tune into his interview if you’re interested in learning more about the potential of negative thyroid antibodies. I want to say it is possible.
Let’s say someone has hyperthyroidism, and they have negative TSIs, but they have the symptoms of thyroid eye disease, which is commonly associated with Graves’. Chances are they probably have Graves’ even if they don’t have TSIs present on a blood test. Something to keep in mind.
The million-dollar question: How can you lower and then normalize thyroid antibodies? I won’t get into great detail in this episode because that’s why I put together a series of episodes. I am going to talk about food triggers and stress and chemicals and infections and healing the gut. I am not going to cram all of this into a single episode, which I have done in previous episodes. I am going to dedicate individual episodes, talking about the different factors that can play a role in thyroid antibodies. That means you would want to address those factors in order to lower and normalize thyroid antibodies.
I just want to remind you again that it’s not easy to lower and normalize thyroid antibodies. In some cases, some might go gluten-free, and those antibodies lower and in some cases even normalize. I can’t say it’s never easy, but many times, it’s challenging and not that easy, where you can just eliminate gluten, clean up your diet, and the antibodies will normalize. Sometimes, it is; many times, it isn’t.
That’s pretty much all I wanted to cover here. Of course, I hope you found the information to be valuable. I’m sure you’ll find the future episodes related to lowering and normalizing thyroid antibodies to be valuable as well. As usual, I look forward to catching you in the next episode.
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