This episode starts by discussing what are Graves’ Disease antibodies? I should mention that if anyone has Hashimoto’s who is listening to this, most of the information will also apply to you as well. When talking about the different types of antibodies, thyroid stimulating immunoglobulins (TSI) are TSH receptor antibodies (TRAB). These are the antibodies associated with Graves’. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
Let’s start by discussing what are Graves’ Disease antibodies? I should mention that if anyone has Hashimoto’s who is listening to this, most of the information will also apply to you as well.
When talking about the different types of antibodies, thyroid stimulating immunoglobulins (TSI) are TSH receptor antibodies (TRAB). These are the antibodies associated with Graves’.
It’s also important to mention that people who have Graves’ can also have antibodies for Hashimoto’s. Let’s discuss all the antibodies.
I mentioned one of them, TSIs. When you do a test, you have a choice by the way. Usually, you will have a choice to do either TSI or TRAB. Some will order both tests. I usually just recommend TSI because TSI is more specific to Graves’. You can certainly look at both.
In most cases, when you have an elevated TSI, you have elevated TRAB, but not always. The reason for this is there are two types of TRABs; I have spoken about this before. TSI is typically the one that I recommend testing for.
Now, thyroid peroxidase antibodies (TPO) are the most common type of antibody. They are more closely associated with Hashimoto’s, but a lot of people with Graves’ will have them as well. The literature shows that anywhere from 60-80% of people with Graves’ will have elevated TPO antibodies, whereas around 90% of those with Hashimoto’s will have elevated TPO antibodies.
There are thyroid globulin (TG) antibodies. They are more specific to Hashimoto’s. If you have elevated TSIs and elevated TGs, you have the antibodies for both Graves’ and Hashimoto’s. Many people have all three antibodies. When I say “many,” I mean 20-30%. It is common to have all three. Very common to have both TSIs and TPOs.
When I dealt with Graves’, I only had TSI. You do see some people who just have TSI.
What is the significance of having more than one antibody? You could have different triggers for different antibodies. We’ll be talking more about triggers during this episode. Let’s say if you have positive TSIs and positive TPOs, you might see the TSIs consistently decrease, whereas the TPOs maybe don’t decrease. That doesn’t mean that you haven’t found the trigger.
Over time, antibodies can fluctuate, too. I’d love to say that antibodies always consistently decrease over time, but that’s not always the case. It can be very challenging to lower thyroid antibodies. That being said, let’s go ahead and talk about the five different things you can do to lower antibodies.
First, you want to incorporate the foundations of thyroid healing. What are the foundations? Diet, eating whole, healthy foods. Stress management. You’re not going to get rid of all your stressors, but you can do things to improve your perception of stress, to improve your stress handling. Getting sufficient sleep. Regular movement. These are the foundations of healing and overall wellness. It’s not just specific to thyroid healing. Diet and lifestyle essentially.
Diet and lifestyle is a piece of the puzzle. I talk about this in my book The Hyperthyroid Healing Diet. I have a separate section that talks about going beyond this diet. Going beyond not just diet but diet and lifestyle because if all you do is clean up your diet, and even if you block out time for stress management and get sufficient sleep, many times, that won’t be enough to restore your health, to normalize those antibodies.
But if you don’t incorporate these foundations, you won’t be able to restore your health. In other words, doing this is usually not enough, but it is an important piece of the puzzle.
When people work with me one-on-one, it’s not uncommon for people to have already incorporated some of these. Some people have already read my book before coming to me. “I’ve read your book. I’ve made diet changes. I’ve followed an AIP or Level 3 diet for a few months and am not seeing the changes I’d like to see.” That doesn’t mean that it wasn’t helpful. It means you need to do more than just changing your diet and incorporating other lifestyle factors that I discuss in the book and briefly mentioned here.
It is important. If you haven’t read my book, I definitely would recommend doing that. There are also episodes where I give the CliffsNotes version of The Hyperthyroid Healing Diet, talking for 20-30 minutes. If you prefer listening, it is also in audio format on Audible. Something to keep in mind.
That’s one way to lower thyroid antibodies. When I talk about five different ways, keep in mind that with maybe an exception of one of these, you usually will have to incorporate multiple things. It’s not just doing one thing. There are five ways, but you usually have to combine a few different things. The foundations, you want to apply.
The second way is also something everyone with Graves’ wants to do, which is to find and remove your Graves’ triggers. There’s what’s called the triad of autoimmunity: genetic predisposition, which we can’t change genetics. Exposure to one or more environmental triggers. We will get to the third component, which will be the third thing you need to do to lower and normalize thyroid antibodies.
Finding and removing your Graves’ triggers is important. I talk about four main categories of triggers: food, stress, toxins/toxicants, and infections. With the foundations, they cover diet/food and stress, but you need to do things to reduce your toxic burden. There is a lot we are exposed to with environmental toxins and toxicants. A toxin is something naturally occurring, like mycotoxins from mold. Microplastics or glyphosate are examples of toxicants. Those are manmade.
Either one can be potentially a trigger. Not always direct triggers of autoimmunity. Some of them, like glyphosate, can disrupt the gut and play a role in the development of Graves’ and other autoimmune conditions. A lot of people still have mercury amalgams. There is methylmercury from fish, which can be a concern. Other heavy metals.
Infections, like EBV, H-pylori, parasites, Yersinia enterocolitica, Lyme, bartonella. I mentioned mycotoxins like mold. There is a lot to consider.
Getting back to food. I didn’t get specific here. Most people know gluten is one to avoid while healing. Arguably, it’s a good idea to avoid gluten permanently. At the very least, while healing. Typically, the common allergens are gluten, dairy, corn, soy. Other foods, especially if you’re following AIP/Level 3, like nightshades, grains.
There is an older book from 2016, No Pain No Grain by Dr. Peter Osborne, which is really good, about numerous reasons why you want to avoid grains. Not just gluten grains but gluten-free grains as well. They can be harsh on the gut. A lot of gluten-free grains are moldy, so that’s another reason, too.
Stress. I briefly spoke about it. It’s not just chronic stress. That is certainly a big factor. When I dealt with Graves’, many of you who have been listening to this for a while know it wasn’t just emotional stress that I dealt with, but overtraining, exercising too much. It can be a problem in some people.
Trauma, like stored trauma, dysregulates your adrenals and nervous system. Your nervous system controls everything, including your immune system. That can be a factor as well.
The second way is to find and remove your Graves’ triggers. The third way is healing your gut. That is the third component of the triad of autoimmunity. There is genetic predisposition, exposure to one or more environmental triggers, and an increase in intestinal permeability, which is the medical term for a leaky gut.
If you have an unhealthy gut, most of the immune system cells are located in the gastrointestinal tract. Also, that leaky gut is part of that triad of autoimmunity. You really do need to have a healthy gut in order to have a healthy thyroid and healthy immune system. Really difficult, if not impossible, to heal your thyroid and restore your health if you don’t have a healthy gut.
When I say “healthy gut,” it doesn’t mean 100% perfect. I bring this up because someone asked me this. I had this conversation on someone else’s podcast. The truth is, in this day and age, probably nobody has a 100% healthy gut. Whenever I do a comprehensive stool panel such as a GI Map, there is always some imbalances. Even when we do a retest, it’s still not going to be perfect.
If we do an initial test on someone, and there’s a lot going on. Someone follows a certain protocol based on the findings, and then we do a retest. It’s not like the retest will be perfect. It’s a constant battle because a lot of these toxins and toxicants will affect the gut, and we are exposed to them on a regular basis. Even if you are strictly avoiding gluten and doing a good job with a diet and other factors, without question, that will help with gut health. It won’t be perfect. You want it to be good enough.
If you have obvious GI symptoms, stomach pain, acid reflux, bloating, gas, you ideally want those to resolve. You want to have regular bowel movements. I’m just saying from a testing perspective, it’s probably not going to be 100% perfect. If you have H-pylori, parasites, certainly you want to address those. A healthy gut is important to lower and normalize thyroid antibodies.
The fourth way to lower and normalize thyroid antibodies is by taking supplements that reduce oxidative stress. Of course, you want to do as much as you can through food, but there are some supplements that can be helpful when it comes to oxidative stress.
There are a lot of supplements that can be helpful in general. Vitamin D can be helpful. I’m not including it here. A Vitamin D deficiency for example could be a reason why someone’s antibodies remain high. I could have easily mentioned a sixth way is correcting deficiencies. Keep that in mind.
Selenium, for example. You could have a selenium deficiency. Even without having a deficiency, you don’t want to take selenium in excess because selenium toxicity is an issue. The point is that selenium has been shown to decrease not just oxidative stress but thyroid antibodies. Other things like NAC and alpha lipoic acid can also decrease oxidative stress and thyroid antibodies.
There is a lot of studies with selenium and thyroid autoimmunity. A recent study that I actually had a past podcast episode about shows that selenium, when combined with L-carnitine, can help with thyroid antibodies. I also spoke about how it could result in you taking less antithyroid medication, for those who take methimazole.
Arguably, when it comes to the antibodies, it’s moreso the selenium that is responsible for that, when compared to L-carnitine.
There are studies showing that alpha lipoic acid can help, and can help with conditions like thyroid eye disease, which involves a lot of oxidative stress.
NAC is a precursor to glutathione.
I’m not saying you have to take all three of these. I do recommend selenium to a lot of my patients. I also commonly recommend NAC and alpha lipoic acid. It depends. You could also take, instead of NAC, liposomal glutathione. There are different options.
Taking supplements that reduce oxidative stress, when combined with these other things. If all you do is take selenium, it might lower antibodies. The study with selenium and L-carnitine, it doesn’t seem like they were doing anything else.
If you’re not finding and removing your triggers, healing your gut, and addressing that triad of autoimmunity, or incorporating the foundations, in my opinion, just taking selenium or any of these supplements I just mentioned isn’t going to be a big game changer. It will temporarily lower thyroid antibodies perhaps. We want long-lasting changes.
That brings us to the fifth way to lower and normalize thyroid antibodies. That is by taking low-dose naltrexone (LDN). Keep in mind, I am not recommending taking this. I am saying it has the ability—not in everybody, it is hit or miss—to modulate the immune system and normalize antibodies.
The problem with LDN is that besides it not working in everybody, even if it does work, it’s not doing anything to address the cause of the problem. There are some people with Graves’ and other autoimmune conditions who take LDN, and that’s all they do. It will calm the immune system; it’s not addressing the cause. As long as it’s working, that’s fine. People are happy with that.
That’s not a goal of mine, just to do that. If someone is taking LDN while addressing the cause of the problem, I think that’s okay. The only issue is it might be difficult to tell if someone’s health is improving based on other things we’re doing. If the LDN is suppressing thyroid antibodies and making them normal, how do we know that everything else we’re doing is working?
Some will ask the same thing about taking bugleweed, for example, or antithyroid medication. How do I know the natural approach is working? Those are having minimal effects on antibodies. If someone is taking antithyroid medication or bugleweed or a higher dose of L-carnitine for antithyroid properties, you could still monitor the antibodies. If LDN normalizes antibodies, you can’t look at them. The only real way that you might find out if you are in true remission is by eventually stopping the LDN.
Those are the five different ways to lower thyroid antibodies. Let me summarize. 1) Incorporate the foundations of thyroid healing through diet, stress management, sleep, and regular movement. Regular movement is not too much movement. You don’t want to be sedentary. You do want to be careful when dealing with hyperthyroidism. If you have an elevated resting heart rate, you should do light walking. Resistance exercise is also good. They tend to lose muscle mass and bone density. Definitely listen to your body.
2) Find and remove your Graves’ triggers. 3) Heal your gut. 4) Consider taking supplements that reduce oxidative stress, such as selenium, NAC, and alpha lipoic acid. 5) Not the way I typically recommend, but taking LDN can be effective.
If you want to learn even more about how to lower your Graves’ antibodies, you might be interested in my upcoming free Find Your Graves’ Disease Triggers Challenge. Just to let you know, it’s free. I had this previously for free. It’s free this time. In the future, I think it’s not going to be free. It will be low-cost but not completely free. If you’re interested, take advantage this time.
This will be taking place in my free Healing Graves’ Naturally community. It’s on a platform called School. I used to do these challenges in Facebook Groups. The last time I did it was in School, and it worked really well. As of recording this, we have close to 400 people in the Healing Graves’ Naturally community. It’s an engaged community. By the time this episode comes out, the numbers will be higher.
To register for the free challenge, you can visit SaveMyThyroid.com/FindYourTriggers. This challenge is for you if you have Graves’, and you want to do everything you can to avoid radioactive iodine and thyroid surgery, even though your endocrinologist tells you that these two options along with antithyroid medication are the only options.
It’s also for you if you’re sick and tired of dealing with Graves’ symptoms. Not everyone experiences the same symptoms. Some of the more common symptoms include increased resting heart rate, palpitations, tremors, anxiety, insomnia, weight loss. Not everybody experiences all of these. Thyroid eye disease is quite common.
Also, if you understand that there is an underlying cause for your condition. Just about every endocrinologist will tell you that there is nothing you can do to reverse Graves’, and diet and lifestyle changes won’t make a difference. Finding and removing triggers, healing the gut, etc. Thousands of people have restored their health by finding and removing triggers.
I have been working with people who have Graves’ since 2009. As of recording this, over 16 years now. Hard to believe. There are a lot of people with Graves’, but not as many as those who have Hashimoto’s. As I mentioned earlier, a good number of people with Graves’ also have antibodies for Hashimoto’s.
Another reason to consider joining is you want to do everything you can to save your thyroid and regain your health. Many of you know I personally reversed my Graves’ condition, and I have been helping others accomplish the same since 2009. It’s not a quick and easy process, but it’s definitely possible to save your thyroid and feel great again.
As far as the way this challenge works, it’s a five-day challenge. Every day, I will go live and give a presentation. There will also be Q&As.
There is a VIP upgrade option, which you don’t have to do. I will say the first time we did this challenge, we had about 750 people register, and we had 46 people upgrade to VIP, which is a small fee. The people who upgraded had a separate hour-long VIP session. An extra five hours of support. Not just Q&As. We did hot seats. They got a lot of value out of it. I highly recommend upgrading to VIP.
Day 1, we will discuss the three biggest mistakes people with Graves’ make. Day 2, I will get into the four main categories of triggers. Not just listing them like I did here but talking more about them. Day 3, we will discuss how to detect your triggers on a budget. Trying to do as much as you can on your own. Day 4, detecting your Graves’ triggers through testing. I do recommend some functional medicine testing. Day 5, removing your Graves’ triggers. To register for this free challenge, visit SaveMyThyroid.com/FindYourTriggers.
That’s all I wanted to discuss with this episode. A lot of people have struggles lowering their antibodies. Again, it’s not even easy when working with a practitioner. Arguably, it’s more difficult when doing it on your own, but even when working with me or someone else, it’s not like it’s a quick and easy process.
Most people aren’t doing anything to find and remove their triggers. If they are just working with endocrinologists and following recommendations, the endocrinologist won’t do anything to find and remove your triggers. Check out this challenge.
That’s it. I’ll wrap this episode up. Hope you found the information I presented to be valuable. Hope to see you in the upcoming Find Your Graves’ Disease Triggers challenge. I also look forward to catching you in the next episode.
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Hopefully, you enjoyed this episode. I get a lot of questions about thyroid antibodies. I realized I have a lot of episodes that focus on antibodies, including a six-part podcast series on lowering antibodies. If you want more information, this was late 2024 into early 2025. You might want to check out those episodes.
This episode was more specific to Graves’ antibodies. The six-part series is related to all thyroid antibodies. Quite frankly, this conversation could also benefit people with other types of antibodies as well.
When it comes to lowering thyroid antibodies, definitely challenging. I will say out of the three main antibodies, there is more than three, but the main ones are TSIs, TPOs, and TGs. Graves’ antibodies seem like, I don’t want to say they’re easy to normalize because it could take quite a while for them. I will say they’re easier. More fluctuations with the TPO and TGs. That’s not with everybody. Everybody is different.
Regardless, it’s not going to take you three months or many times not even six months to normalize thyroid antibodies. I would say 6-12 months on average. Six months is on the lower side. Probably more like 9-12 months. I could even say 9-15 months. Some people go beyond that.
Just want to find the triggers and remove them. Those are two separate things. I combine the two. Just because you find them doesn’t mean it will be easy to remove them. You do both of those, but you also have to heal the gut. It’s a process. That’s also why I have a lot of episodes on this. If it wasn’t such a challenge, it wouldn’t be as common a question as far as how to lower thyroid antibodies.
I spoke about mainly TSIs. I mentioned how those are the main type of TRABs. There are actually two types. There is also thyroid binding inhibitory immunoglobulins.
I have a separate episode. I think it’s when I did the Q&A episodes. There is not a number associated with those episodes. I did episodes twice a week for a while. I did a Q&A on Thursdays. I didn’t count those. As of recording this, there is over 400 episodes on the podcast, but I only number the main ones. If you look at the numbers, there is only 220-something. There is actually over 400 episodes because of the Q&As. Kind of like a mini episode where I spoke about the other type of TRAB.
According to the study, even though the TSIs are more specific for Graves’, the other one, you would think inhibitory means you have hypothyroidism. Maybe more common for Hashimoto’s. You could also have those in Graves’ as well.
Regardless of whether someone is hyper or hypo, let’s say someone is hyperthyroid, and they test the TRABs and TSIs. TSI is negative, but TRAB is positive. It’s probably that other antibody. Not all labs will allow you to test the other antibody. I wanted to mention this.
Dealing with fluctuating antibodies. I already spoke about this with TPOs and TGs fluctuating more than TSIs. TSIs fluctuate, too. I just had a consultation as of recording this today with someone whose TSI was gradually decreasing. All of a sudden, it increased. We can’t say it never does that. Now, we’re trying to figure it out. Her job has been really stressful. She admitted she hasn’t been strict with her diet. That could be a factor, too. There could be other things as well.
With all the antibodies, you can see them fluctuate. Over time, you want to see the improvement. That’s why you don’t necessarily have to test them every month, but over time, you want to see them gradually decrease. Like I said, sometimes, it could be challenging to lower and normalize them. Another reason to work with an expert. Even when working with an expert, it’s not like it’s easy. It’s definitely more challenging to do it on your own.
Getting antioxidants through food compared to supplements. Can you just eat vegetables for antioxidants or Brazil nuts instead of taking selenium? I have spoken about Brazil nuts in the past. You’re not going to get enough. You don’t know how much selenium is in a single Brazil nut. It can be anywhere from 20mcg-80mcg. If you want to take 200mcg, you could eat 10 Brazil nuts or three Brazil nuts. There’s no way of knowing.
I do recommend supplementation more while trying to restore one’s health. When someone is maintaining a state of wellness, I am fine with eating Brazil nuts and getting as many of the antioxidants through food rather than supplementation. When restoring your health, you want to do both. Brazil nuts, you might not eat if you’re following AIP. You also don’t want to take too much selenium. Do one or the other.
As far as antioxidants, if you’re eating plant-based foods and not following a carnivore-type diet, eat plant-based foods. If you take some antioxidants like NAC or selenium, that’s fine.
That’s all I’ll cover here. Once again, if you’re really interested in learning more about thyroid antibodies, you might want to check out that six-part podcast series that I had. You could just search “thyroid antibodies,” and you should see parts 1-6.
Anyway, thank you so much for listening to another episode. Hope you found this to be valuable. Look forward to catching you in the next episode.

