I was doing some recent research and came across a journal article entitled “Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?“.  Even before finding this article I realized that there was a relationship between the gut and thyroid health, but it was nice to see a published journal article discussing this.  So I’d like to go ahead and summarize the relationship between the thyroid and the gut based on the information in this recent journal article.

In the introduction the authors mention how an impaired microbiota can lead to the development of autoimmune conditions, including Graves’ disease and Hashimoto’s.  They remind us that thyroid autoimmunity likely develops due to the combination of genetics, immune impairment, and environmental factors such as nutrient deficiencies and the gut microbiota.  They end the introduction by mentioning that patients often report changes in their quality of life and thyroid function in relation to dietary changes.  This of course is true, although as I’ve mentioned in previous blog posts, there can be other factors as well.

Intestinal Influences on the Thyroid

The next section starts off by discussing how the gut microbiota modulates both the innate and adaptive immune system, and how it is fundamental in the development of gut-associated lymphatic tissue (GALT). You might have heard that most of the immune system cells are located in the gut, and this article reinforces this, mentioning that more than 70% of the entire immune system is situated in the GALT. It adds that the GALT plays an important role in the development of tolerance to self-antigens.  For more information on immune tolerance you can check out my article entitled ” Thyroid Autoimmunity and Loss of Self Tolerance “.

What You Need To Know About Butyrate and Thyroid Health

In past articles I’ve discussed the importance of regulatory T cells (Tregs), and how these help to keep autoimmunity in check. As a result, you want to have an abundance of Tregs, and the journal article mentions that there is a positive correlation between butyrate and the number of Tregs.  Butyrate is a short chain fatty acid, and the authors also mention how it can help to strengthen intracellular tight junctions together with thyroid hormones.  In other words, butyrate can increase Tregs AND help to maintain the integrity of the gut barrier. I briefly spoke about butyrate in an article entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and SCFA”.

Next they discussed how an alteration in the composition of intestinal bacteria, an increase in intestinal permeability (leaky gut), and a shift to proinflammatory cells are some of the ways the gut microbiota impacts the thyroid.  They also mentioned another study where the authors found that intestinal dysbiosis (imbalance of the gut flora) and bacterial overgrowth was more common in those with hypothyroidism/Hashimoto’s when compared to a euthyroid group (1). I will say that it’s possible that bacterial overgrowth can be a consequence of hypothyroidism. In other words, while intestinal dysbiosis might be a factor in the development of Hashimoto’s (and Graves’ disease), hypothyroidism can lead to altered GI motility, which in turn can lead to small intestinal bacterial overgrowth (2).

Celiac Disease, NCWS, and Thyroid Autoimmunity

The authors then went on to discuss how there is a higher prevalence of thyroid autoimmunity in both Celiac Disease and Non-Celiac Wheat Sensitivity (NCWS).  As for why this is the case, they brought up different possible mechanisms, including 1) shared cytokines, 2) cross-reaction of antibodies (molecular mimicry), malabsorption of micronutrients essential for thyroid health, and 4) increased intestinal permeability.

Nutrient Deficiencies and Thyroid Health

Next they discussed how the microbiota influences the uptake of minerals that play an important role in thyroid health.  This includes iodine, selenium, zinc, and iron.  They also mention how Lactobacillus and Bifidobacterium species are decreased in those with Hashimoto’s thyroiditis and Graves’ disease, and this can also have an effect on the minerals.  This is yet another reason to eat probiotic-rich foods and perhaps consider taking a probiotic supplement.

Speaking of probiotics, the authors discuss how probiotics can help support thyroid health.  They specifically mentioned a study in mice that showed that supplementing with Lactobacillus reuteri resulted in an increase in free T4, and another animal study which showed that supplementing with probiotics increased T3 and T4 (3).  I’m sure there might be a few people with hyperthyroidism/Graves’ disease who are wondering if they should avoid probiotics, and all I can say is that I’ve worked with many hyperthyroid patients over the years, I commonly recommend probiotic supplements, and I don’t recall anyone’s hyperthyroidism worsening by supplementing with probiotics.

The authors brought up another study looking at the influence of Lactobacilli and Bifidobacterium species on thyroid hormone replacement…specifically levothyroxine.  They found a significantly lower adjustment requirement of T4 in the study compared to the control group, reasoning that microbiota modification increases the availability of levothyroxine and stabilizes thyroid function. They also concluded that probiotics can play a role in lowering serum hormone fluctuations, and mentioned how probiotics seem to be able to accumulate trace elements such as selenium, zinc, and copper, and incorporate them into organic compounds.

Bariatic Surgery and Thyroid Health

The article also discussed how bariatric surgery can potentially affect the thyroid.  Bariatric surgery is considered for some people who are obese, as it can result in substantial weight loss. In this journal article they discussed a meta-analysis that showed a significant decrease in the TSH, free T3 and total T3 in obese patients after receiving bariatric surgery, but it didn’t affect the free T4 or total T4 (4).  They also said that subclinical hypothyroidism was completely resolved in 87% of Roux-en-Y gastric bypass (RYGB) patients one year after surgery.  Other studies observed an improvement in hypothyroidism in around 35% of patients and resolution in about 15% (5).

Thyroid Cancer, Nodules, and the Gut Microbiota

The final section discusses the relationship between the gut microbiota and thyroid cancer.  They start off by mentioning how those people with thyroid cancer and thyroid nodules present with higher microbial richness and distinct composition compared to the healthy control group, which suggests that imbalances in the gut microbiota is correlated with thyroid cancer and nodules. They then mention that in thyroid cancer there are higher levels of Clostridiaceae, Neisseria, and Streptococcus, while in thyroid nodules there are increases in Streptococcus and Neisseria when compared to healthy control groups (6).  So while in past articles and blog posts I’ve discussed the role of insulin resistance and estrogen metabolism in thyroid nodules, a healthy gut can also play a role.

Then they mentioned how Lactobacillus is significantly decreased in those with thyroid cancer and nodules.  They remind the reader how Lactobacillus is important for the utilization of trace elements such as selenium, which plays an important role in thyroid health. While most probiotic supplements include Lactobacillus, unfortunately no specific species or strains of Lactobacillus was mentioned in the study.

So hopefully you understand how a compromised gut can have a negative effect on thyroid health.  In the past I’ve mentioned numerous times how a leaky gut is part of the triad of autoimmunity, but this journal article gave a much more comprehensive overview of how problems with the gut can affect thyroid health.  Here is a summary of some of the key points included in this journal article:

• More than 70% of the entire immune system is located in the gut-associated lymphatic tissue (GALT)
• An impaired microbiota can lead to the development of autoimmune conditions, including Graves’ disease and Hashimoto’s
• Butyrate can increase Tregs AND help to maintain the integrity of the gut barrier
• Intestinal dysbiosis and bacterial overgrowth was more common in those with hypothyroidism/Hashimoto’s
• There is a higher prevalence of thyroid autoimmunity in both Celiac Disease and Non-Celiac Wheat Sensitivity (NCWS).
• The microbiota influences the uptake of minerals that play an important role in thyroid health, including iodine, selenium, zinc, and iron
• Probiotics can support thyroid health
• A meta-analysis that showed a significant decrease in the TSH, free T3 and total T3 in obese patients after receiving bariatric surgery
• Imbalances in the gut microbiota is correlated with thyroid cancer and nodules

If you have Graves’ disease or Hashimoto’s thyroiditis, and if you want to do more than just manage your thyroid symptoms, then you might be interested in joining our 21-Day Overcoming Graves’ Disease and Hashimoto’s Challenge (starts November 2nd!):

The 21-day challenge will include the following…

Component #1: Daily Overcoming Graves’ Disease and Hashimoto’s Video Lesson

During this daily 20-30 minute recorded lesson I will focus on a different topic that is essential to overcoming your autoimmune thyroid condition. There will be one lesson every day for 21 consecutive days (although a few lessons include multiple videos). If you’re interested in the specific topics that will be presented please check out the video where I discuss the 21-day challenge calendar (the website link is below).

Component #2: Daily 30-45 minute live group coaching session

The live group coaching calls will take place on Zoom, which is very easy to use on computers, mobile phones, and tablets. And if you are unable to attend live you’ll have the opportunity to email your questions during the separate Q & A sessions (discussed below). For those who choose to join live, the way it works is that I’ll send you a link to join the call, and if you are using a mobile phone or tablet you’ll need to install the free app. I will record every coaching session and post the recordings in a private membership area for those who are unable to attend live. As for the time of the coaching sessions, I will rotate them to accommodate those in different time zones. Most of the live calls will take place either 1pm or 8:30pm Eastern time (New York time zone).

Component #3: Recording of each coaching call for those who are unable to attend live

I hope most people will be able to attend at least 2 or 3 live sessions per week, although I’ll add that with my last two challenges there were participants who didn’t attend the live calls, but simply watched the recordings and emailed their questions for me to answer during the Q and A sessions (discussed below).

Component #4: Daily priority action step

I want people to take action, but I want the action steps to be attainable, which is why there will be a single priority action step each day, although at times there will be one or two additional action steps that aren’t as urgent.

Component #5: Access to a private members-only group

We want you to build relationships with one another and enjoy this challenge together. One way we accomplished this in previous challenges was through the live coaching calls, but another way was through the private members-only communities we had. Since not everyone wants to be on Facebook we initially hosted the group on a platform called Kajabi, and while we did have a lot of people participate, we realized that there are some limitations to Kajabi. So for second challenge I had two private members-only groups…one in Kajabi, and one in Facebook, and it worked out well. And so you can join either one of these groups, or both if you’d like! In our last challenge we had in June approximately 100 people joined the Facebook group and around 25 people joined the Kajabi group. I’ll pop into these groups every now and then, but I plan on having my nutritional health coaches moderate the groups.

Component #6: Weekly 90 minute live Q & A session

Although I’ll be answering some questions during the daily coaching calls, these will be around 45 minutes, and I will focus on answering live questions. But there will also be three separate live Q & A sessions (one per week) during the 21-day challenge. These will be at least 90 minutes long, although with both of my longer challenges I exceeded two hours with each of the Q & A sessions, as my goal is to answer ALL questions! I’ll once again rotate the day and times to accommodate those in different time zones, and so they will either be at 12pm, 1pm ET or 8pm ET. However, unlike the daily coaching calls, if you are unable to attend any of the Q & A sessions live you can email your questions ahead of time.

You Get All of This For A Single Payment of $49

If you watch the video on top of the registration page (the link is below) you’ll see dozens of people rave about my challenges, and I think it’s safe to say that just about everyone easily got back their investment.  I do want to mention that this past summer I had a 5-day challenge, but the testimonials on the website are from participants of my two longer challenges.

Optional Upgrade: 45-minute one-on-one diet and lifestyle call with a certified nutritional health coach

Both of my nutritional health coaches are excellent, and I thought it was important to include an option for affordable one-on-one support with all of the stress everyone is dealing with, although I’m confident the daily group coaching calls will also help with this. You have the option of doing this over the phone or through Skype/Zoom. If you listen to some of the video testimonials from members of the past challenges you’ll hear some rave reviews about the diet and lifestyle call! And so if it’s in your budget I’d highly recommend taking advantage of it for the discounted rate of $50. But if not you still will receive a ton of value from the rest of the challenge.

For more information on the 21-day challenge visit the link below:

www.ThyroidHealthChallenge.com/Enroll2020

Since 2009 I have had a practice that focuses on thyroid and autoimmune thyroid conditions, and while I do work with people who have non-autoimmune thyroid conditions (i.e. toxic multinodular goiter), most people I work with have Graves’ disease or Hashimoto’s thyroiditis.  Some people have the antibodies for both Graves’ disease and Hashimoto’s.  Every now and then someone will ask what the difference is between these two conditions, and so I figured I’d put together a blog post that discusses the similarities and difference between Graves’ disease and Hashimoto’s.

Let’s first start out by discussing the differences between these two conditions:

What Are The Differences Between Graves’ Disease and Hashimoto’s?

1. They involve different autoantibodies.  Those with Graves’ disease have elevated thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody.  Hashimoto’s thyroiditis is usually diagnosed when someone has an elevated thyroid stimulating hormone (TSH) in the presence of thyroid peroxidase and/or anti-thyroglobulin antibodies.  However, it’s worth mentioning that many people with Graves’ disease also have elevated TPO antibodies, and some people have all three of these thyroid antibodies.

2. Hashimoto’s involves damage to the thyroid gland.  Whereas Graves’ disease involves the thyroid stimulating immunoglobulins binding to the TSH receptors without causing permanent damage, this isn’t the case with Hashimoto’s.  In Hashimoto’s there is damage to the thyroid gland.  And while the thyroid gland can regenerate, it does so slowly, and sometimes the damage is so extensive that the person needs to remain on thyroid hormone replacement.  Keep in mind that it can take many years before there is sufficient damage to the thyroid gland that results in an elevated TSH and thyroid hormones that are out of range.

3. Graves’ disease involves hyperthyroidism, and Hashimoto’s involves hypothyroidism.  The truth is that not everyone with Hashimoto’s experiences overt hypothyroidism, as many times it’s subclinical.  In other words, they might have an elevated TSH with the thyroid hormone levels within the lab reference range.  It’s also important to mention that some people with Hashimoto’s experience hyperthyroidism due to Hashitoxicosis.  On the other hand, most people with Graves’ disease will experience overt hyperthyroidism, although there are exceptions.

4. The symptom management differs.  Because most people with Graves’ disease experience overt hyperthyroidism, most endocrinologists will recommend antithyroid medication (i.e. methimazole, PTU) to their patients.  Of course many will recommend radioactive iodine or thyroid surgery.  With Hashimoto’s, thyroid hormone replacement is commonly recommended.  This is true even if the thyroid hormone levels are looking good, as many medical doctors will go by the TSH alone.

5. Unmanaged hyperthyroidism is arguably a greater risk than unmanaged hypothyroidism.  The truth is that there are risks of both unmanaged hyperthyroidism and hypothyroidism.  But arguably unmanaged hyperthyroidism is a greater risk, as it can lead to heart arrhythmias, decreased bone density, and in rare cases thyroid storm, which is a life threatening situation.  On the other hand, myxedema is a severe form of hypothyroidism that can be life threatening, although it’s very rare.

6. The autoimmune triggers can differ.  While there is an overlap of certain triggers, there can also be different triggers for different autoimmune condition.  For example, while stress can be a factor with both Graves’ disease and Hashimoto’s, in the research it shows that it’s a greater factor with Graves’ disease.  And while there is a case report suggesting that Blastocystis Hominis might be a trigger of Hashimoto’s, nothing in the research suggests that it’s a potential trigger of Graves’ disease.

What Are The Similarities Between Graves’ Disease and Hashimoto’s?

So now that you know some of the differences between Graves’ disease and Hashimoto’s, let’s take a look at some of the differences:

1. They are both autoimmune thyroid conditions.  Both Graves’ disease and Hashimoto’s are autoimmune conditions that affect the thyroid gland.

2. Most medical doctors don’t do anything to address the underlying cause of either condition.  Every medical doctor knows that Graves’ disease and Hashimoto’s are autoimmune conditions, yet they never do anything to address the autoimmune component.  Of course this comes down to their training in medical school, and fortunately some medical doctors are open minded enough to look into underlying causes, although not nearly enough.

3. It’s possible to reverse the autoimmune component.  Although there are genetic factors behind autoimmune conditions, it still is possible to reverse the autoimmune component of both Graves’ disease and Hashimoto’s.  This admittedly isn’t easy to do, as one needs to find and remove the autoimmune triggers, and since a leaky gut is a factor with autoimmunity it is also necessary to heal the gut.

 

One of the most common questions I have received in 2020 is whether or not those with autoimmune thyroid conditions are more susceptible to getting Covid-19. It’s a good question, as both Graves’ disease and Hashimoto’s are immune system conditions, and viruses are more likely to impact those people with a compromised immune system.  Up until this point my response to this question has been that I don’t think having an autoimmune condition itself is the biggest factor, but of greater concern is that many people with thyroid autoimmunity have other things “dragging down” their immune system, which might make them more susceptible to getting Covid-19 (as well as other viruses).

But now that Covid-19 has been around for awhile there have been a few studies evaluating its effects on thyroid health, and whether people with thyroid autoimmunity are more susceptible to contract this virus.  In June of this year a study came out in the United Kingdom showing that there was no data available at that time suggesting that patients with an autoimmune thyroid condition remain at higher risk of getting Covid-19 (1). The study also mentioned that in patients severely affected by Covid-19, changes in thyroid function might be a result of a “sick euthyroid” syndrome, although the authors did mention that there might be specific thyroid-related damage which requires further investigation.

However, in July a journal article was released entitled “Thyroid disease is associated with severe coronavirus disease 2019 (COVID-19) infection” (2).  The article looked to explore the relationship between thyroid conditions and severe cases of Covid-19. Based on the data the authors concluded that thyroid disease seems to be associated with an increased risk of severe Covid-19 infection, and they gave the following three reasons why this may be the case:

1. Thyroid hormones are important in the regulation of the innate immune response. Therefore, an excess or deficiency of thyroid hormones levels observed in thyroid disease will lead to dysregulation of the innate immune response.

2. Increased levels of proinflammatory cytokines such as TNF-α and IL-6 was observed in patients with thyroid disease. Increased levels of these cytokines were also observed in patients with severe Covid-19 and correlates to the development of severe outcomes.

3. Some thyroid patients, especially those with subacute thyroiditis, were taking corticosteroids. Meta-analysis showed that corticosteroid treatment in Covid-19 patients was associated with higher mortality, longer length of hospital stay, and higher rate of bacterial infections. This isn’t surprising since corticosteroids suppress the immune system.

Most of the people I work with aren’t taking corticosteroids, and I think it’s safe to say that “point #3” doesn’t apply to most people with Graves’ disease or Hashimoto’s, although I should mention that some people with moderate to severe thyroid eye disease will take corticosteroids such as Prednisone, thus making them more susceptible to getting Covid-19 (or another viral infection).  The first and second points mentioned above do apply to most of the people I work with.  But as I mentioned earlier, there are other factors that can be having a negative effect on one’s immune system that can make them more susceptible to viruses such as Covid-19, including having weak adrenals, an unhealthy gut (most of the immune cells are located in the gut), an increased toxic load, certain nutrient deficiencies, exposure to toxic mold, etc.

Can Covid-19 Cause Subacute Thyroiditis?

Subacute thyroiditis is an inflammatory condition of the thyroid gland which causes damage to the thyroid follicles, and as a result, large amounts of thyroid hormones are released into the circulation, resulting in overt hyperthyroidism.  However, unlike Graves’ disease, this state usually self resolves after a few months, although many will first experience a transient period of hypothyroidism.  To learn more about this condition you might want to check out my blog post entitled “Graves’ Disease vs. Subacute Thyroiditis: What’s The Difference?“.

A case study in July showed that an 18-year-old woman developed subacute thyroiditis after getting infected with Covid-19 (3). Another study revealed that a substantial proportion of patients with Covid-19, requiring high intensity of care, present with thyrotoxicosis and low serum thyroid stimulating hormone (TSH) concentrations, possibly as a consequence of subacute thyroiditis induced by SARS-CoV-2 (4).  In other words, SARS-Cov-2 can directly infect the thyroid gland, leading to subacute thyroiditis.

Black Cumin and Covid-19

While on the subject of Covid-19, I would like to mention that there are a few studies which show that Nigella Sativa (black cumin) might benefit those with Covid-19.  Black cumin has numerous health benefits, as it has demonstrated antiviral, antioxidant, anti-inflammatory, immunomodulatory, bronchodilatory, and antihistaminic properties (5).  It also shows anti-hypertensive, anti-obesity, anti-diabetic, anti-hyperlipidemic, anti-ulcer, and antineoplastic activities, which can help with comorbidities commonly found in Covid-19 patients (5).  In addition, the active constituents of N. sativa such as nigellidine and α-hederin have been identified as potential inhibitors of SARS CoV-2, and thymoquinone (the chief bioactive constituent of black cumin) suppresses mRNA expression which downregulate interferon genes and other inflammatory responses (5) (6).

Even though I have written a blog post on black cumin, in the past this is something I’ve mainly given as part of a protocol to those with H. pylori.  And while I’m not suggesting for everyone to take black cumin specifically to reduce their chances of getting Covid-19, keep in mind that it can potentially help to minimize the impact other viruses have on your health as well, and as I listed above, it has numerous other health benefits. So at the very least it might be something to have on hand.  There is one more thing I would like to mention, as the blog post I wrote related to black cumin focused on hypothyroidism and Hashimoto’s, but it’s also fine for most people with hyperthyroidism and Graves’ disease to take black cumin.

In summary, according to the research people with Graves’ disease and Hashimoto’s thyroiditis seem to be more susceptible to getting Covid-19. However, as I mentioned earlier, the reason for this might be related to other imbalances commonly found in people with these conditions that can further compromise the immune system.  Either way the goal should be to do everything you can to improve the health of your immune system, and black cumin might also be something to consider adding to your supplement arsenal when combating viruses.  You also might want to check a blog post I released earlier this year entitled “5 Ways To Improve Your Immune Health Without Taking Supplements”.

I’ve written separate articles on thyroid peroxidase (TPO) antibodies and anti-thyroglobulin antibodies, but I haven’t put together a post on thyroid stimulating immunoglobulins…until now!  These antibodies are associated with Graves’ disease, and it’s unfortunate that some endocrinologists don’t test their hyperthyroid patients for these antibodies, but instead will test the TPO and/or anti-thyroglobulin antibodies.  While it’s common for people to have two or three different thyroid antibodies, everyone with hyperthyroidism should get the thyroid stimulating immunoglobulins tested.

So what are thyroid stimulating immunoglobulins (TSI), and how do they differ from other types of thyroid antibodies?  TSI are a type of thyrotropin (TSH) receptor antibody (TRAB). There are actually two types of TSH receptor antibodies. In addition to thyroid stimulating immunoglobulins, there are also thyroid binding inhibitory immunoglobulins (TBII), which is a type of thyrotropin receptor blocking antibody.  These antibodies bind to the TSH receptor and inhibit the binding of TSH, thus blocking the synthesis and secretion of thyroid hormones.  These aren’t commonly tested, and one reason is because not all labs offer this.

What Do Elevated TSI Levels Indicate?

Elevated TSI levels are associated with Graves’ disease.  What happens is that the TSI bind to the TSH receptors, which results in the excessive production of thyroid hormone.  This is why most people with Graves’ disease have hyperthyroidism, although some people have subclinical Graves’ disease, which is when the TSI are elevated, the TSH is depressed, but the thyroid hormone levels are within the lab reference range.

What Causes Elevated Thyroid Stimulating Immunoglobulins?

As I have mentioned, elevated TSI levels are associated with Graves’ disease, which is an autoimmune condition.  In the past I’ve discussed the triad of autoimmunity, and according to this, in order for autoimmunity to develop the following three factors need to be present: 1) genetic predisposition, 2) exposure to an environmental trigger, 3) a leaky gut.  So just as is the case with any autoimmune condition, someone with elevated TSI levels has a genetic predisposition for Graves’ disease, but having the genetics alone doesn’t mean they will develop thyroid autoimmunity, as they will need to be exposed to an environmental trigger and have a leaky gut.

What Is The Lab Reference Range?

Unfortunately different labs will use different units of measurements, and you can’t compare them with one another.  For example, the Labcorp reference range is 0.00-0.55 IU/L, whereas the reference range for Quest Diagnostics is <140%.  As for the thyrotropin (TSH) receptor antibody test, Labcorp has a reference range of 0.0−1.75 IU/L, while Quest Diagnostics has a range of ≤2.00 IU/L.  If at all possible I recommend getting the thyroid stimulating immunoglobulins tested, although it of course is fine to get both the TSI and TRAB tested.

Some reading this might wonder what the “optimal” reference range is for these markers, and whether the goal should be to have a level of zero.  While you want the levels to be well below the lab reference range, I wouldn’t say that they have to be zero in order for someone to be in a state of remission.  As for the optimal reference range, I like to see the TSI less than 80% or less than 0.30 IU/L, although this is just what I look for, as I haven’t seen any other practitioners list optimal reference ranges.  It’s also important to mention that some labs don’t reveal a numerical value below the reference range.  For example, if the TSI is below the reference range it might show up on the report as <0.55 IU/L or <120%.

The Relationship Between Thyroid Stimulating Immunoglobulins and Thyroid Eye Disease

Because a higher TSI level usually indicates a more vigorous immune system response, typically the higher the TSI, the more likely someone is to have thyroid eye disease.  For example, if someone has a TSI greater than 300% they are more likely to have thyroid eye disease symptoms when compared to someone with a TSI less than 300%.  Of course there are always exceptions, as I’ve had patients with very high TSI levels who didn’t experience any signs or symptoms of thyroid eye disease.

How Can You Decrease Thyroid Stimulating Immunoglobulins?

As for how to decrease and normalize thyroid stimulating immunoglobulins, the approach is similar to lowering other autoantibodies:

1. Find and remove your triggers. I mentioned the triad of autoimmunity earlier, and exposure to an environmental trigger is one of the factors that causes the development of an autoimmune condition.  As a result, it makes sense that in order to reverse the autoimmune component and lower thyroid stimulating immunoglobulins you will need to find and remove any immune system triggers.

2. Heal the gut. Another component of the triad of autoimmunity is a leaky gut, and so you of course need to heal the gut.  Check out the blog post I wrote on the “5R protocol” for more information on how to heal your gut.  But I’ll say here that you usually need to do more than take probiotics and gut healing agents, as these won’t be effective if you don’t address the factor that is compromising the gut.  For example, if someone has a gut infection that is causing a leaky gut, this needs to be addressed. Similarly, if someone is eating gluten and this is causing a leaky gut, you can’t fix this problem by taking digestive enzymes, probiotics, and drinking bone broth.  In this situation you would need to eradicate the gut infection.

3. Correct other imbalances.  Other imbalances can also be a contributing factor.  For example, having certain nutrient deficiencies can make someone more susceptible to developing an autoimmune condition, such as selenium.  In fact, the research shows that selenium can potentially lower both TSH receptor antibodies and TPO antibodies (1), although you still need to remove the trigger and heal the gut.

4. Break the chronic inflammatory cycle.  While removing the triggers and healing the gut will usually resolve the inflammation, this isn’t always the case.  Sometimes additional measures need to be taken in order to break this cycle, such as taking high doses of natural anti-inflammatory agents (vitamin D, EPA and DHA, curcumin, resveratrol).  Low dose naltrexone might also help to break the chronic inflammatory cycle, and thus is something to consider, although I would first try the natural anti-inflammatory agents.

Do You Have Elevated Thyroid Stimulating Immunoglobulins?

If you have elevated TSI levels, I’d love to hear if you have done anything to try to lower them.  Perhaps you took a natural treatment approach, natural anti-inflammatory agents, low dose naltrexone, or did something else to modulate your immune system.  Either way, please feel free to share your experience in the comments section below.