A lot of people are in a state of panic over coronavirus disease 2019 (COVID-19).  Many supplement companies have sold out of immune enhancing supplements such as elderberry, silver, and even zinc.  While taking supplements can help to support the immune system, keep in mind that you can take a dozen different immune-related supplements and still end up out of commission due to a viral infection (and not just coronavirus).  What I plan on doing is to first discuss five things you can do to improve your immune system health without taking any supplements.  That being said, while I personally focus on diet and lifestyle factors, I do take some supplements to support my immune system health, and so for those who want to add a few supplements for additional support, towards the end of this blog post I’ll list a few nutritional supplements that I’m taking to support my immune system.

So let’s take a look at five ways to improve your immune system health without taking any nutritional supplements or herbs:

1. Try not to get stressed out.  These are stressful times for most people, and for good reason.  Many people are afraid of getting COVID-19, while others are stressed out due to the impact the virus has had on their job or business.  Some people are stressed because their spring break vacation had to be cancelled.  Some are stressed due to all of these reasons.  Look, I’d be lying if I told you that I wasn’t more stressed than usual, as while I’m not afraid of getting coronavirus, there is no question that this has had a negative impact on my practice so far.  I was also planning on visiting my parents for spring break and it looks like this won’t happen.  On top of this my father is 82, lives in NY, and isn’t in the best state of health, and so while I’m not panicking like many others are, I’m still concerned about his health.  But I’m in no position to complain, as I realize that many people have it much worse than I do.

The problem is that stress suppresses the immune system.  This not only can make you more susceptible to coronavirus, but other infections as well.  So what can you do?  After all, we’re talking about some big problems here.  Even if you’re in a situation where you can’t get rid of the stressful situation, which describes many people reading this, you can do things to improve your stress handling skills.  For example, if you are out of work I understand you probably are concerned about paying your bills.  While things might look bleak now and in the near future, it will get better, and you can use this time to improve your health…especially your stress handling skills.  Practice deep breathing and meditation, yoga, or a different type of mind body medicine.  Take a hot bath and do some reading.

2. Eat healthy.  If you live in the United States, as well as some other countries that might be facing a lockdown, you probably have done quite a bit of shopping to make sure you have enough food to last for at least a few weeks, if not longer.  While I understand people wanting to stock up on certain non-perishable foods, you want to try your best to eat healthy during this time.  I realize this can be a challenge, especially when there are “slim pickings” at some grocery stores, with food hoarding a big reason for this.  This past Tuesday morning my wife went to Trader Joes right when they opened, and while there was grass fed beef and organic chicken available, she mentioned that one woman took half the packages of organic chicken that were on the shelves.

Of course it would be great if you can eat organic meat and produce, but either way, the priority is to eat whole healthy foods.  In other words, if you are unable to purchase organic food, at the very least try to eat whole healthy foods.  And if you have to purchase non organic fruits and vegetables you can refer to the Dirty Dozen and Clean Fifteen lists, which can be found on the website for the Environmental Working Group (www.EWG.org).  This list should be updated soon for 2020.

3. Get sufficient sleep.  Getting sufficient sleep is important for optimal immune system health (1).  I would aim for at least 7 to 8 hours sleep each night.  And this doesn’t mean 7 to 8 hours in bed, but actual sleep time.  So for example, if you go to bed at 10 and don’t fall asleep until 11, I wouldn’t count this period as one hour of sleep.  I’m sure this stressful situation with COVID-19 is interfering with many people’s sleep, which is another reason why it’s important to block out time for stress management.

4. Stay active.  Another downside of being home most of the time for many people is that they will become inactive.  I’m going to miss going to the gym, but I’m fortunate to have a treadmill in my home.  Others might be even more fortunate and have exercise equipment in their home.  But even if you don’t have any equipment in your home this doesn’t mean that the only option is to hang out and be on electronics all day.  Of course you want to be cautious about any exercising you do, as you don’t want to overtrain or hurt yourself.  But you also don’t want to be sedentary.

Research shows that regular exercise increases immunity and reduces the risk of infection when compared to a sedentary lifestyle (2) (3).  Most people know that elderly individuals are more susceptible to coronavirus (as is younger people with certain co-morbidities).  However, middle-aged and elderly individuals who participate in moderate-intensity exercise are less likely to develop an infection when compared to those who are sedentary (4).

5. Reduce your toxic load.  Numerous studies demonstrate that heavy metals can have a negative effect on the health of the immune system (5) (6).  This shouldn’t be surprising, and the truth is that other chemicals will have a negative effect on immune system health.  And please don’t overlook the impact that electronic pollution can have on your immune system.  At the very least you want to spend your resting hours free from electromagnetic fields, and so consider unplugging the Wi-Fi at night, as well as any electronics in your bedroom.  And try to avoid being on electronics one to two hours before going to bed.  In January I wrote a detailed blog post on how to reduce your toxic load, which I would recommend to check out.

5 Basic Supplements To Support Your Immune System

Before I discuss a few of the basic supplements you can take to support your immune system, just remember to focus on improving your immune system health through diet and lifestyle.  Also, you of course want to make sure you take good quality nutritional supplements and herbs.  If you’re not sure how to choose good quality supplements please check out my blog post from 2015 entitled “How To Choose Quality Supplements and Herbs For Your Thyroid Condition”.

1. Vitamin D.  I’ve spoken about vitamin D in numerous articles and blog posts.  Healthy vitamin D levels are important for a healthy immune system (7), and while some people are able to maintain healthy levels through getting regular sun exposure, supplementation is frequently necessary to correct a vitamin D deficiency.  Also, you always want to take vitamin K2 when supplementing with vitamin D, as this helps to guide calcium into the bone.  Ideally I would recommend to first test for vitamin D in the blood before supplementing with vitamin D3, and while I’m sure many people reading this already have done this, others haven’t and understandably don’t plan on visiting a lab anytime soon with everything going on.   You might want to check out this video I put together entitled “How To Boost Vitamin D To Optimal Levels“.

2. Zinc.  Although all of the minerals are important for optimal health, zinc is perhaps the most important mineral when it comes to immune system health.  Once again, testing would be ideal, and while there are numerous ways to test for zinc, including doing an RBC zinc test or looking at zinc on a hair mineral analysis, a low alkaline phosphatase on a comprehensive metabolic panel can also be an indication of a zinc deficiency (8).  You want to be careful about supplementing with very high doses of zinc for a prolonged period of time (i.e. >50mg), as this can lead to a copper deficiency, which can also compromise the immune system.

3. Vitamin C.  Many people take vitamin C can to prevent and/or reduce the severity of the common cold, and research shows that vitamin C has an anti-viral immune response at the early time of infection against the influenza virus, which is associated with the flu (9).  More recently I’ve been recommending liposomal vitamin C due to its superior absorption and bioavailability, although another option is to take a whole food vitamin C supplement.  That being said, most of the research involves using “regular” vitamin C in the form of ascorbic acid, and so even this can help to support the immune system.  Unfortunately there isn’t a good test out there for vitamin C.  The organic acids test from Great Plains Laboratory does have a metabolite related to vitamin C, but it’s not the most accurate marker.

4. Selenium.  Selenium can help to support the immune system and to prevent viral infections (10) (11).  It is a cofactor for glutathione peroxidase, which can help to decrease the oxidative stress associated with infections.  If recommending selenium separately I’ll usually recommend for my patients to take 200 mcg of selenium, although some multivitamins have a good amount of selenium, including a multivitamin I commonly recommend to my patients.  Since selenium toxicity is a concern you want to be cautious about taking too much selenium.

5. Probiotics.  Having a healthy gut is necessary for a healthy immune system, and the research shows that probiotics can support the immune system (12).  When choosing a probiotic supplement you want to make sure that you use a company that’s third-party tested, as a few years ago Consumer Labs discovered that many probiotic supplements don’t include the ingredients listed on the bottle.  The truth is that it’s a good idea to use companies that utilize third-party testing for all of your supplements.  In addition, you want to choose a probiotic supplement that lists the specific strains, and not just the species.  Two of my favorite probiotic supplements are Xymogen ProbioMax Daily DF and Designs for Health ProbioMed.

The Truth About Other Immune Enhancing Supplements

Of course there are other supplements that can support immune system health, including elderberry, colloidal silver, and monolaurin.  I mentioned these in a recent article I wrote on the “coronavirus and thyroid health“.  Just keep in mind that nobody has an elderberry deficiency or a deficiency in colloidal silver.  Once again, this doesn’t mean that these can’t be beneficial, as I’ve been taking silver since being diagnosed with chronic Lyme disease in 2018.  But if you have a deficiency in vitamin D, zinc, or any other nutrient, then without question this needs to be addressed in order to have optimal immune system health.  One nutrient I didn’t mention above that’s also very important for optimal immune system health is vitamin A.

What Are You Doing To Keep Your Immune System Healthy?

I’d love to hear what you’re doing to maintain your immune system health.  Are you focusing more on diet and lifestyle factors?  Are you taking certain supplements to support your immune system?  Perhaps you’re doing both of these, which is the approach I take.  Please share what you’re doing for your immune system in the comments section below.

Update on My Overcoming Infections Masterclass

Before all of this chaos involving COVID-19 happened I was planning on having an overcoming infections masterclass, which focuses on the different infections that can be triggers of thyroid and non-autoimmune thyroid conditions.  So this IS NOT a masterclass that focuses on COVID-19.  Originally I was hoping to launch this in March, but it looks like it will be sometime in April that this will be available.  If you want to be notified immediately when it’s released you can sign up for my “Overcoming Infections” VIP waitlist by clicking here.

Although most cases of thyroid eye disease are mild, some people with this condition do experience moderate to severe symptoms.  This can include symptoms such as eye bulging, pain, difficulty closing the eye, and double vision.  While the goal should be to address the underlying cause of the problem, there are situations when conventional treatment is necessary.  On January 21st 2020 a new medication was approved by the FDA that looks very promising for those with moderate to severe thyroid eye disease.

Whenever I write a blog post related to conventional medical treatment I’m sure there are some people who question why a natural-related site would put out such content.  The obvious reason is because while the focus of this website will always be on “natural solutions”, there is a time and place for conventional medical treatment, and I think it’s important to keep an open mind.  Everything comes down to risks vs. benefits, and while I’ve had success using natural treatment methods in people with thyroid eye disease, more severe cases are less likely to respond to a natural treatment approach.

So while I would like to say that everyone with thyroid eye disease can benefit from natural treatment methods, unfortunately this isn’t the case.  I admit that sometimes it can be challenging to know when conventional treatment is necessary, as I’ve had some people with moderate cases of thyroid eye disease respond to a natural treatment approach, but I’ve also had others who didn’t respond.  Not surprisingly, many people prefer not to receive corticosteroids, even when their eye symptoms are severe, but I’m sure some will be more open to this new treatment option I’m about to discuss.

The Relationship Between IGF-1R and Thyroid Eye Disease

Graves’ disease is an autoimmune condition that involves the binding of thyroid stimulating immunoglobulins to the TSH receptor, which causes the excess secretion of thyroid hormone.  The autoimmune component is also responsible for the development of thyroid eye disease.  And while the same thyroid stimulating immunoglobulins might play a role in thyroid eye disease, it’s not as simple as these antibodies attacking the tissues of the eyes.  I also should mention that a small percentage of people who don’t have Graves’ disease develop thyroid eye disease.

Insulin-like growth factor 1 (IGF-1) is a 70-aminoacid polypeptide hormone with endocrine, paracrine, and autocrine effects (1).  It is produced in the liver, and it acts to provide an inhibitory feedback signal on growth hormone secretion in the hypothalamus (1).  IGF-1 has different roles in the initiation and progression of different diseases, as in some cases it can help with cell survival, but in other cases it can lead to the development of cancer (2).

A 2012 journal article discussed the role of the insulin-like growth factor 1 (IGF-1) receptor in the development of thyroid eye disease (3).  Fibroblasts are cells that produce connective tissue proteins, and they also play a role in the development of thyroid eye disease.  The journal article discusses how elevated levels of the IGF-1 receptor have been found in orbital fibroblasts as well as B and T cells from patients with Graves’ disease (3).  Apparently IGF-1R forms a complex with the TSH receptor, and inhibiting this complex can greatly help people with thyroid eye disease.

What Is Teprotumumab?

Teprotumumab (the brand name is Tepezza) is the new medication that can help people with thyroid eye disease.  The way it works is by binding to the IGF-1R, which causes degradation of the antibody-receptor complex I mentioned above.  This in turn has been shown in trials to decrease proptosis, double vision, and other symptoms associated with moderate to severe cases of thyroid eye disease.  Unlike other non-surgical options for thyroid dye disease (i.e. corticosteroids), teprotumumab can stop the progression of thyroid eye disease.

Teprotumumab vs. Other Thyroid Eye Disease Treatments

Glucocorticoid therapy and orbital radiation can help to reduce orbital inflammation.  However, unlike teprotumumab they don’t do anything to stop the progression of thyroid eye disease.  Surgery is sometimes indicated for severe cases of thyroid eye disease, as some receive orbital decompression, while others will receive eye muscle surgery and/or eyelid surgery.  But the research shows that teprotumumab can be as effective as surgical intervention.  So while taking teprotumumab usually shouldn’t be the first treatment option for those with thyroid eye disease, if someone has a severe case and surgery is recommended it makes sense to give teprotumumab a try first.

That being said, it’s important to mention that teprotumumab is only effective during active thyroid eye disease.  This usually lasts from 6 to 24 months, although in some cases it can be present for up to three years.  Inactive thyroid eye disease is usually stable, and since significant improvement is less likely, surgery is commonly indicated for severe cases.

What Does The Research Show?

Both phase 2 and phase 3 trials show that patients treated with teprotumumab improved significantly compared with the placebo group (4) (5).  Even though the treatment consists of 8 intravenous infusions given every 3 weeks, many people showed improvement after only 6 weeks (3 infusions), and the phase 2 trials showed that 71.4% of teprotumumab-treated patients had ≥2 mm reduction in proptosis at week 24 (5).  For the most part teprotumumab was well-tolerated, but I’ll discuss some of the common side effects shortly.

Dosing and Administration

As I briefly mentioned when discussing the research, teprotumumab has to be administered through intravenous infusions, which of course is a major inconvenience.  The good news is that it’s only given once every 3 weeks for a total of 8 infusions.  The dose depends on the patient’s weight, and the starting dose used in the studies is 10 mg/kg, followed by 20 mg/kg.

Side Effects and Contraindications

These are some of the potential side effects of teprotumumab:

• Muscle cramps
• Spasms
• Nausea
• Hair loss
• Diarrhea
• Fatigue
• High Blood pressure
• Hearing problems
• Taste changes
• Headache
• Dry skin

As for the contraindications, since teprotumumab can cause harm to a fetus it is contraindicated during pregnancy, and therefore cycling women receiving treatment should use effective contraception during treatment, and for 6 months after the last dose (6).  Teprotumumab can also worsen inflammatory bowel disease (Crohn’s disease and ulcerative colitis), and because it can cause hyperglycemia (increased blood sugar) those with diabetes need to be cautious when taking this medication, and should be under the guidance of a competent healthcare practitioner.

Are There Long Term Side Effects?

Because teprotumumab is new there are no long term studies, and because of this some people might be hesitant to take it.  In fact, if I had severe thyroid eye disease the lack of long term studies would make me think twice about taking this medication.  But if I had moderate or severe thyroid eye disease that was getting worse and the only other option was surgery I still might choose taking this medication.

Obviously one also has to consider the common side effects I listed above, but it’s the same situation with antithyroid medication.  Many people don’t want to take methimazole and other types of antithyroid medication due to common side effects, and this also described me when I was diagnosed with Graves’ disease.  But there are certain situations when the benefits of taking methimazole are greater than the potential risks, and while I’m not a big fan of this drug, I think it’s safe to say that a lot more people with hyperthyroidism would receive radioactive iodine and thyroid surgery if it wasn’t available.  And the hope is that teprotumumab will help many people with severe cases of thyroid eye disease avoid surgery.  I’ll add that from the trials side effects seem to be less common when compared to antithyroid medication, and not as severe.

Does Teprotumumab Address The Cause of Thyroid Eye Disease?

Most people reading this probably know that the answer to this question is clearly “no”.  Teprotumumab doesn’t remove the triggers associated with the autoimmune component.  On the other hand, neither does antithyroid medication, and there are some people who need to take methimazole or a different type of antithyroid medication for symptom management.  The truth is that most people with thyroid eye disease won’t need to take teprotumumab, but some people with moderate to severe cases might want to consider it.

Because teprotumumab doesn’t address the cause of the problem some people might be hesitant to take it, which I understand.  As I mentioned earlier, everything comes down to risks vs. benefits.   When I was dealing with Graves’ disease I chose not to take methimazole and instead took the herb bugleweed.  If bugleweed didn’t successfully lower my thyroid hormone levels I would have considered taking methimazole, and even though side effects are common with methimazole, if someone is trying to avoid radioactive iodine and thyroid surgery they might need to take antithyroid medication on a temporary basis.  Similarly, while I can understand someone wanting to try taking a natural treatment approach for their thyroid eye disease condition, if it doesn’t help AND the eye symptoms are severe they might want to consider teprotumumab.

Where Can You Learn More About Teprotumumab?

For those who want to learn more about Teprotumumab I’ll include a few links below that you might want to check out.

https://www.ncbi.nlm.nih.gov/pubmed/31971679

https://www.tepezza.com/

https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-thyroid-eye-disease

Anti-thyroglobulin antibodies are one of three main types of thyroid autoantibodies, and they are commonly associated with Hashimoto’s thyroiditis.  However, it’s not uncommon for those with Graves’ disease to also have elevated anti-thyroglobulin antibodies (along with elevated TSH receptor antibodies).  In this blog post I’m going discuss anti-thyroglobulin antibodies in detail.

So why do anti-thyroglobulin antibodies develop?  Well, anti-thyroglobulin antibodies develop when there is damage to thyroglobulin, which is a glycoprotein secreted by follicular cells of the thyroid gland.  The most common reason for damage to thyroglobulin is from the autoimmune process of Hashimoto’s Thyroiditis.

According to the triad of autoimmunity, in order for an autoimmune condition to develop you need 1) a genetic predisposition, 2) exposure to an environmental trigger, and 3) a leaky gut.  In the past I wrote a blog post on thyroid peroxidase (TPO) antibodies, and I discussed how there can be genetic variations of the TPO gene, which in turn can affect thyroid hormone production.  As for thyroglobulin, the research suggests that there is a possible correlation between thyroglobulin gene polymorphisms and thyroid autoimmunity (1) (2).  In other words, having variations in the thyroglobulin gene can increase the risk of someone developing Hashimoto’s thyroiditis.

Anti-thyroglobulin Antibodies: Hashimoto’s vs. Graves’ Disease

As I mentioned in the opening paragraph, anti-thyroglobulin antibodies are more closely associated with Hashimoto’s thyroiditis, although they are also common in those with Graves’ disease.  As for their prevalence, it depends on the source, as one source stated that the prevalence of anti-thyroglobulin antibodies was 60-80% in Hashimoto’s and 50-60% in Graves’ disease patients, where another source stated that they were identified in 70-80% of those with Hashimoto’s, and 30-40% of Graves’ disease patients (3).  What’s the significance of having elevated anti-thyroglobulin antibodies?  Well, besides confirming the presence of an autoimmune response, having elevated anti-thyroglobulin antibodies usually means that damage is taking place to thyroglobulin.  And since thyroglobulin plays an important role in thyroid hormone production, if sufficient damage to thyroglobulin takes place this can eventually result in hypothyroidism.

Of course we also need to keep in mind that many people with both Hashimoto’s and Graves’ disease have anti-TPO antibodies, which also can lead to hypothyroidism.  And while having anti-TPO and/or anti-thyroglobulin antibodies doesn’t guarantee that the person will develop overt hypothyroidism, I think it’s safe to say that if someone has both of these thyroid antibodies there is a greater chance of them developing overt hypothyroidism in the future when compared with someone who only has one of these thyroid autoantibodies.  Many people with Hashimoto’s don’t present with overt hypothyroidism, as while many will have an elevated TSH, their thyroid hormone levels are commonly within the lab reference range, although frequently below the optimal reference range.  Either way, the goal is to do things to improve the health of the person’s immune system so that further damage to the thyroid gland doesn’t take place.

What is The “Normal” Reference Range of Anti-Thyroglobulin Antibodies?

Although different labs commonly have different reference ranges, as of 2020, the range of anti-thyroglobulin antibodies according to both Labcorp and Quest Diagnostics is <1 IU/mL.  However, other labs use different methodologies which can result in different reference ranges.  For example, if you visit the Labcorp website and do a search for anti-thyroglobulin antibodies, the methodology currently used is called “Immunochemiluminometric assay (ICMA)”.  On the lab reports they specifically say that it’s “measured by Beckman Coultor Methodology”.  However, I had a patient get the anti-thyroglobulin antibodies tested at a different lab that used the “Rouche Elecays electrochemiluminesence method”, and the reference range was 0-115 IU/mL.

In addition, on the lab report it stated that “Thyroglobulin antibody results cannot be compared across different methods.”  So even if the units of measurement are the same between labs (i.e. IU/mL), due to different testing equipment, chemical reagents used, and analysis techniques you can’t necessary compare results from different labs, which is one reason why it’s a good idea to try to use the same lab on a regular basis.

As an example, in May of 2019 I had a patient who tested the anti-thyroglobulin antibodies through Vibrant America and had a value of >4,000 IU/mL.  In August of 2019 she retested the anti-thyroglobulin antibodies at Labcorp and had a value of 43.2 IU/mL, and two months later she retested them through Vibrant America and the value was once again >4,000 IU/mL.  Of course ultimately you want the thyroid antibodies to normalize regardless of which lab you use, but I’m just using this example to demonstrate why you can’t always compare the same marker using different labs.

Serum Thyroglobulin vs. Anti-Thyroglobulin Antibodies

It’s also important to mention that there is a separate test for serum thyroglobulin.  Once again, thyroglobulin is a protein produced by the cells of the thyroid gland, and normally its concentration in blood is low.  But there are a few factors that can increase serum thyroglobulin levels.  First of all, having elevated anti-thyroglobulin antibodies can cause an elevation in serum thyroglobulin levels.  Second, it can also be elevated in some cases of thyroid cancer, including thyroid adenoma, thyroid papillary and follicular cancer.  So in some cases thyroglobulin is used as a tumor marker.

A third reason why serum thyroglobulin can be elevated is because someone has an iodine deficiency.  This is an overlooked cause of elevated serum thyroglobulin levels, but numerous studies shows that thyroglobulin can be used as a functional biomarker of iodine status (4) (5) (6).  I usually don’t rely on this marker to determine if someone has an iodine deficiency, as I like urinary iodine testing.  But some feel that thyroglobulin is a superior marker because it reflects long-term iodine intake.

Additional Information On Anti-Thyroglobulin Antibodies

Before talking about how to lower anti-thyroglobulin antibodies, it’s important to mention that most conventional medical doctors, including endocrinologists, don’t pay much attention to thyroid antibodies.  Some don’t test them at all, while many medical doctors will test them initially for diagnostic purposes.  But since most medical doctors don’t do anything to improve the health of the person’s immune system, they won’t typically retest the thyroid antibodies to see if they decrease.

It’s also worth mentioning that there isn’t always a correlation between high anti-thyroglobulin antibodies and the severity of the autoimmune process.  In other words, if someone has anti-thyroglobulin antibodies that are 100 IU/mL, while someone else has anti-thyroglobulin antibodies that are 1,000 IU/mL, this doesn’t mean it will be more challenging to restore the health of the person with the higher thyroid antibodies.  It really does come down to finding triggers and correcting other imbalances.

For example, if someone has very high anti-thyroglobulin antibodies and their triggers are found and removed relatively quickly, it’s likely for the thyroid antibodies to normalize faster than someone who has much lower anti-thyroglobulin antibodies and the triggers aren’t found and addressed.  This should make sense, although as I’ll mention below, sometimes removing the triggers doesn’t stop the inflammatory process associated with the autoimmune component.

How To Lower Anti-Thyroglobulin Antibodies

I just mentioned how lowering thyroid antibodies comes down to finding and removing triggers, along with correcting other underlying imbalances.  I also mentioned how if someone finds and removes their triggers relatively quickly then their thyroid antibodies can normalize quickly.  That being said, I don’t want to give anyone the impression that restoring the autoimmune component of someone with Hashimoto’s or Graves’ disease is a quick and easy process, as this usually isn’t the case.  For example, if someone finds their triggers quickly, it still usually takes time to lower and normalize their thyroid antibodies.  And of course if it takes awhile for someone to find their triggers it will take a longer amount of time to restore their health.

But either way, the first step to lower anti-thyroglobulin antibodies is to find and remove your triggers.  Sometimes this is as easy as changing your diet and eliminating certain food allergens, but many times it’s more complex than this.  Testing is usually required to find the triggers, and at times it can be challenging to know what testing is needed.  I deal with this in my practice on a daily basis, and I’ve discussed this in past articles and blog posts, as I try to be more conservative when it comes to testing because I don’t want the person to spend more money than they have to, but I also don’t want to be too conservative and miss something important.

Don’t Forget To Incorporate The 5-R Protocol

In addition to finding and removing autoimmune triggers, since a leaky gut is part of the triad of autoimmunity, it makes sense to do things to heal the gut.  In the past I have spoken about the 5-R protocol, which involves the following 5 components:

1. Remove the factor that’s causing the leaky gut.

2. Replace (i.e. digestive enzymes, stomach acid, dietary fiber)

3. Reinoculate (with pre- and probiotic foods and supplements)

4. Repair the gut

5. Rebalance through stress management, adequate sleep

It’s also important to mention that while removing the triggers and healing the gut will frequently resolve the inflammatory process, this isn’t always the case.  There is a transcription factor called Nuclear Factor Kappa B (NF-kB), and the deregulated activation of NF-kB may contribute to autoimmunity and inflammation (7).  What happens is that NF-kB becomes chronically activated, and sometimes outside help is needed to inactivate it.

Some of the natural agents that have been shown to inhibit NF-kB include turmeric, resveratrol, vitamin D, ginger, and omega-3 fatty acids.  While many people  with autoimmune conditions take one or more of these, remember that you also need to find and remove the triggers (and heal the gut).  While taking some natural anti-inflammatory agents initially can be beneficial, the point here is that in some cases it might be even more important to take them AFTER the triggers have been removed and the gut has been healed.

This is just one of the many complexities of autoimmunity, and admittedly when a patient of mine has followed my recommendations, yet their antibodies haven’t significantly lowered, there are times when I will question whether all of their triggers have been found and removed.  But in some cases the triggers may have been found and removed, but the chronic activation of NF-kB is still present.  The challenge is that there is no way to measure NF-kB outside of a laboratory setting, and so if someone has followed a natural treatment protocol and their autoantibodies are still elevated, the practitioner and patient has to decide whether further testing is the best option, or if the person should instead do things to inhibit NF-kB.

What’s Your Experience With Anti-Thyroglobulin Antibodies?

If you currently have elevated anti-thyroglobulin antibodies, or have had elevated anti-thyroglobulin antibodies in the past, I’d love to hear if you have done anything to try to decrease them.  Did changing your diet help?  Perhaps there was another trigger you found that was responsible for your elevated anti-thyroglobulin antibodies.  If you have elevated anti-thyroglobulin antibodies but haven’t had any success lowering them, feel free to share your experience as well.  Thank you!

Can Infections Cause Elevated Anti-Thyroglobulin Antibodies?

This time last week I wasn’t planning on writing a blog post related to viruses, but with a lot of people concerned about the new type of coronavirus I figured I’d go ahead and put this together.  The truth is that we’re all exposed to viruses, some more virulent than others.  In fact, before the most recent type of coronavirus was discovered, there were 6 other human coronaviruses (HCoVs) identified, and a few of them are associated with the common cold.  So there is a pretty good chance you have been exposed to a type of coronavirus.

That being said, some types of coronaviruses are highly pathogenic, which I’ll discuss in this blog post.  Human coronaviruses affect the respiratory system, and with the new type of coronavirus, there are now seven known human coronaviruses that have been identified:

• HCoV-229E
• HCoV-NL63
• HCoV-OC43
• HCoV-HKU1
• Severe acute respiratory syndrome coronavirus (SARS-CoV)
• Middle East respiratory syndrome coronavirus (MERS-CoV)
• 2019 Novel Coronavirus (2019-nCoV)

The first four coronaviruses listed above circulate in the human population, and are responsible for approximately one-third of the common cold (1).  However, in severe cases these viruses can cause life-threatening pneumonia and bronchiolitis (2).  This is especially true in the elderly, children, and those with a weakened immune system.  Although these four coronaviruses are most commonly linked to respiratory illnesses, they also have been linked to enteric and neurological diseases (2).

SARS-CoV and MERS-CoV are more virulent coronaviruses, and they share some similarities with the most recently identified coronavirus.  SARS-CoV first emerged in 2002–2003 in Guangdong, China, and resulted in a type of pneumonia marked by a fever, headache, and eventually the onset of respiratory symptoms such as cough and pneumonia, which later develop into life-threatening respiratory failure and acute respiratory distress syndrome (3).  Similar to the most recent type of coronavirus identified, SARS-CoV was highly transmissible among humans, and as a result it quickly spread across 29 countries, infecting more than 8,000 individuals with a mortality rate of about 10% (4).

The MERS-CoV epidemic was discovered in Saudi Arabia in 2012.  It had similar clinical symptoms as SARS-CoV but with a much higher mortality rate of about 35% (5).  However, even though it had a higher mortality rate than SARS-CoV, it has been geographically limited to the Middle East.

What Do We Know About The Most Recently Identified Coronavirus?

The 2019 Novel Coronavirus (2019-nCoV) was first detected in Wuhan, China.  Just as is the case with the other coronaviruses, it seems like it was initially spread from an animal to a human, but because it is spreading so quickly, and since not everyone infected has had exposure to animal markets, it seems as if it is highly transmissible among humans.  This shouldn’t be surprising when you consider that the other coronaviruses can also be transmitted from person to person.

As of 2/5/2020, at least 562 people have died in China, with 27,378 people being infected globally.  The United States has 12 confirmed cases of the virus, and many other countries have people who are infected.  The most common symptoms include fever, cough, and shortness of breath.  Symptoms seem to occur anywhere between 2 and 14 days after exposure to the virus.

Can Coronavirus Affect Thyroid Health?

Since 2019-nCoV was recently identified it is unknown whether or not it affects thyroid health. But it’s worth mentioning that while SARS-CoV primarily affects the respiratory system, the research shows that a substantial number of patients with SARS developed abnormalities in thyroid function (6) (7).  However, there hasn’t been much research in this area, as a small study involving five SARS autopsies demonstrated the pathology of the thyroid gland.

The next question you may have is whether coronavirus can trigger thyroid autoimmunity.  I haven’t seen any evidence of any of the coronaviruses triggering Graves’ disease or Hashimoto’s.  However, Th17 cells are associated with autoimmunity, and a 2018 study showed that MERS-CoV infection in humans is associated with an increase in Th1 and Th17 cytokines (8).  But once again, I couldn’t find any research that showed any direct relationship between any coronaviruses and thyroid autoimmunity, let alone other autoimmune conditions.

What Treatment Options Are Available?

In the conventional medical world there is no treatment available for coronaviruses, including the new type, which is why many people are panicking.  Don’t get me wrong, as I’m not suggesting that there is no reason to be concerned, but there is more than you can do than to just wash your hands frequently and minimize contact with others.

1. Improve your immune system health through diet and lifestyle factors.  Eat mostly whole foods, organic whenever possible.  Try your best to reduce stress in your life, and even if this isn’t possible you can still work on improving your stress handling skills.  Make sure you get sufficient sleep, as this is also necessary for optimal immune system health.

2. Enhance your immune system health by improving your gut microbiome.  In order to have a healthy immune system you need to have a healthy gut.  And so you want to do things to increase the health of your gut microbiome.  Not only is eating well important, but probiotic foods and supplements can help, as can prebiotics.  And of course try to avoid gut disrupting medications and other environmental chemicals, including antibiotics, proton pump inhibitors, and glyphosate.

3. Take colloidal silver.  Silver has antiviral properties, and while I couldn’t find any studies which showed that silver is effective against human coronavirus, I did come across a study that showed that it was effective against feline coronavirus (9).

4. Take resveratrol.  Resveratrol also has anti-viral properties, and one in vitro study showed that resveratrol effectively inhibited MERS-CoV (10).

5. Licorice root.  Glycyrrhizin, which is the active component of licorice root, has been shown to interfere with SARS-CoV replication (11).  However, the study showed that higher concentrations were needed, and it’s important to mention that glycyrrhizin can increase blood pressure, and so anyone with a history of hypertension will probably want to avoid taking licorice root.

6. Black elderberry.  Elderberry is commonly taken to help support the immune system for those who have the common cold, and so it shouldn’t be surprising that there is evidence that it might help with the replication of coronavirus (12).

What Happened With SARS-CoV and MERS-CoV?

Since these both are more similar to the recently identified coronavirus (especially SARS-CoV), you might be wondering what happened to these two viruses.  Well, I mentioned earlier that MERS-CoV has been contained in the Middle East.  As for SARS-CoV, this virus spread to more than two dozen countries in North America, South America, Europe, and Asia before it was contained (13).  And according to the CDC, since 2004 there hasn’t been any known cases of SARS reported in the world.

Do You Want To Learn More About Infections?

Since being diagnosed with chronic Lyme disease in 2018 I’ve been more fascinated with all different types of infections, and I’ve decided to put together an “Overcoming Infections Masterclass” for those with thyroid and autoimmune thyroid conditions.  If you want to be notified immediately when it’s released you can sign up for my “Overcoming Infections” VIP waitlist by clicking here.

Although many of my patients with hyperthyroidism take methimazole, or a different type of antithyroid medication (i.e. PTU, carbimazole), when I was dealing with Graves’ disease I chose not to take medication.  The truth is that in some cases it is a wise choice to take antithyroid medication, and the goal of this blog post is to discuss this.  I will discuss the benefits and risks of taking antithyroid medication, as well as the benefits and risks of natural antithyroid agents.  So the goal of this blog post isn’t to convince those with hyperthyroidism to take the same approach I did and avoid antithyroid medication.  In fact, while it’s great when people can manage their symptoms naturally, one reason why I decided to write this is because there are some people who probably should take the medication, but refuse to do so, and as a result are putting their health at risk.

If you’re interested in learning about the different types of antithyroid medications I’d recommend checking out an article I wrote in 2017 entitled “Comparing The Different Types of Antithyroid Medications”.  In the United States methimazole is usually prescribed by most endocrinologists.  If someone is unable to tolerate methimazole then Propylthiouracil (PTU) might be prescribed, although some people react to both types of antithyroid medication.  Another scenario when PTU is usually given is during the first trimester of pregnancy.

What Are The Benefits of Taking Antithyroid Medication?

So let’s go ahead and take a look at some of the benefits of antithyroid medication:

• Antithyroid medication is usually effective in helping to manage the symptoms of hyperthyroidism.  In most people with hyperthyroidism, antithyroid medication does a good job of lowering thyroid hormone levels, which in turn will help with the symptoms of hyperthyroidism, including an elevated heart rate, palpitations, tremors, weight loss, loose stools, etc.
• Taking antithyroid medication can prevent many people from receiving radioactive iodine or thyroid surgery.  As you know, most endocrinologists recommend either antithyroid medication, radioactive iodine, or surgery to their patients with Graves’ disease and toxic multinodular goiter.  While all three of these options aren’t ideal, antithyroid medication is the least invasive of these, and many people have preserved the health of their thyroid gland by temporarily taking antithyroid medication.  So while it’s not offering a permanent solution in most cases, at the very least it can buy you time while trying to address the cause of the problem.
• Some people who take antithyroid medication will go into remission.  I just mentioned how antithyroid medication doesn’t offer a permanent solution, yet there are some people who take it and go into remission.  The problem is that many of these people who go into remission eventually relapse, and when this happens the endocrinologist is even more likely to pressure the person to receive radioactive iodine or surgery.  I realize that many people don’t know about natural treatment methods pertaining to hyperthyroidism, and so they’re just following the advice of their doctor and not trying to address the cause of the problem while taking the medication.  Of course most people reading this know that they should also be doing things to improve their health, and not just do things to manage their symptoms.

What Are The Risks of Taking Antithyroid Medication?

Now that you know some of the benefits of taking antithyroid medication, let’s take a look at some of the risks:

• Antithyroid medication frequently causes side effects. This is one of the primary problems with antithyroid medication, as while over the years I’ve had many patients take it without experiencing symptoms, I also have had a lot of patients who did experience one or more symptoms.  Some of the more common symptoms associated with methimazole/Tapazole include stomach upset, nausea, vomiting, skin rash/itching, headaches, dizziness, muscle/joint/nerve pain, swelling, and hair loss (1).  The symptoms are similar with other types of antithyroid drugs, including PTU (2).
• Antithyroid medication can cause an elevation of liver enzymes.  Both methimazole and PTU commonly cause an elevation of liver enzymes, which is an indication of damage taking place to the liver (3).  The three main enzymes commonly affected include alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP). For more information on these enzymes you can check out my article entitled “How To decrease Elevated Liver Enzymes in Hyperthyroidism and Graves’ Disease“.
• Antithyroid medication doesn’t address the autoimmune component of Graves’ disease.  While some people with Graves’ disease do seem to get into remission while on antithyroid medication, it’s not because antithyroid medication removes the autoimmune triggers and corrects the underlying imbalances.  In addition to lowering thyroid hormone levels, methimazole does have some immunosuppressive effects (4), and as a result, some people who take it might experience a lowering of thyroid stimulating immunoglobulins, which are the antibodies associated with Graves’ disease.  The problem is that because it’s not addressing the cause of the autoimmunity, over time the person is likely to experience an elevation of these antibodies again, along with hyperthyroidism.
• Antithyroid medication doesn’t address the underlying cause of other types of hyperthyroidism.  If someone has a non-autoimmune hyperthyroid condition such as toxic multinodular goiter, taking antithyroid medication on a temporary basis may help to manage the symptoms, but just as is the case with Graves’ disease, it of course isn’t doing anything to address the underlying cause of the condition.

What Are The Benefits of Taking Natural Antithyroid Agents?

What I’d like to do is take a look at some of the benefits of natural antithyroid agents.  Bugleweed is the most popular antithyroid agent, and this herb is the most effective in lowering thyroid hormone levels.  L-carnitine also has antithyroid properties when taken in higher doses (i.e. 2 to 4 grams).  Lithium also has antithyroid properties.

• Natural antithyroid agents can help to manage the symptoms of hyperthyroidism.  When natural antithyroid agents effectively lower thyroid hormone levels it’s wonderful, as I know that when I took bugleweed it felt good to avoid taking medication while I was addressing the cause of the problem.
• Natural antithyroid agents don’t cause the same side effects as antithyroid medication.  This perhaps is the most important benefit of taking natural antithyroid agents, as side effects aren’t nearly as common as they are with antithyroid drugs.  This doesn’t mean that people never experience side effects, as it’s possible to react to any herb, and bugleweed is no exception.  And there are some people who experience side effects with other natural antithyroid agents (i.e. lithium).  But it’s still a lot less frequent when compared to antithyroid medication.
• Natural antithyroid agents usually don’t cause elevated liver enzymes.  This is yet another important benefit of taking natural antithyroid agents, as rarely does someone need to stop taking them due to the stress they’re putting on the liver.
• Mentally it feels good to avoid antithyroid medication.  As I mentioned earlier, when I took bugleweed for my Graves’ disease condition it felt good to avoid taking medication.  This isn’t meant to make those who are currently taking medication to feel bad or discouraged, as everything comes down to risks vs. benefits, and if someone has to take methimazole but at the same time they’re able to address the root cause of their condition then they should still feel pretty good about themselves.

What Are The Risks of Taking Natural Antithyroid Agents?

So let’s take a look at the risks of taking natural antithyroid agents:

• Natural antithyroid agents aren’t as effective as antithyroid medication.  There is no question that antithyroid medication is more effective in lowering thyroid hormone levels when compared to natural antithyroid agents.  For example, bugleweed is probably the most effective natural antithyroid agent for hyperthyroidism, and I see it work approximately 70-75% of the time.  But of course this means that 25-30% of the time it isn’t effective in lowering thyroid hormone levels.  Antithyroid medication such as methimazole is more likely to work, but as you know, it’s also more likely to cause side effects.
• Natural antithyroid agents don’t address the autoimmune component of Graves’ disease.  While it’s great to use natural antithyroid agents to lower thyroid hormone levels, just remember that it’s not doing anything to improve the health of the immune system for those who have Graves’ disease.  So you still need to find and remove the autoimmune triggers, as well as correct other underlying imbalances.
• Natural antithyroid agents don’t address the underlying cause of other types of hyperthyroidism.  Just as is the case with Graves’ disease, taking natural antithyroid agents don’t address the underlying cause of other hyperthyroid conditions, such as toxic multinodular goiter.

Choosing Between Medication and Natural Antithyroid Agents

So should you take antithyroid medication, or should you choose to manage your symptoms naturally?  Sometimes it can be a challenge to decide whether you should take antithyroid medication such as methimazole, or an antithyroid herb such as bugleweed.  As you know, when I was diagnosed with Graves’ disease I decided to take bugleweed, and if it didn’t help to manage my symptoms I would have considered taking methimazole.  Similarly, if one of my patients consults with me and initially they’re not taking anything to manage their symptoms, taking bugleweed is an option to consider.  Of course there is a risk they will take it and it won’t help, which means they might go a few additional weeks with an elevated heart rate.  But there is also a chance they can take methimazole and experience negative symptoms and/or an elevated heart rate.

It’s also important to mention that some people feel more comfortable taking antithyroid medication, and that’s perfectly fine.  If someone is taking methimazole and is doing well with it and it’s not causing elevated liver enzymes or a low WBC count then there’s nothing wrong with them continuing to take it.  Sometimes a patient of mine is taking methimazole when first consulting with me, and they’re doing fine with it, but they prefer to take bugleweed.  When this is the case I can’t tell the person to stop taking the antithyroid medication, but what some people do is to take both the methimazole and bugleweed at the same time, and the goal of doing this is to try to wean off of the methimazole sooner (under the guidance of their medical doctor).

The Risks of Uncontrolled Hyperthyroidism

While I can understand someone wanting to do everything they can to avoid taking medication, you also need to consider the risks of uncontrolled hyperthyroidism. So if you happen to be dealing with hyperthyroidism and aren’t doing anything to lower the thyroid hormone levels, while you certainly can try taking a natural approach with an herb such as bugleweed, if this doesn’t work (and assuming the dosage was high enough), then you should consider taking the medication.

It’s also worth mentioning that some people refuse to take antithyroid medication but are fine with taking a beta blocker. This of course can help to lower the heart rate, which is very important, and some beta blockers also can affect the conversion of T4 to T3, which is also a good thing in someone who has hyperthyroidism. However, just keep in mind that elevated thyroid hormone levels also have a negative effect on bone density, and so if you’re taking a beta blocker and still have high thyroid hormone levels, you still should consider taking something with antithyroid properties. Once again, natural antithyroid agents are an option to consider, but if they aren’t effective, then you should consider taking the medication.

Whether you take methimazole, bugleweed, or something else, eventually the goal is to be off of all antithyroid agents.  I personally took bugleweed for approximately 9 months, and I haven’t been on it since 2009.  The duration of taking bugleweed of course depends on the person.  While I took it for 9 months, others need to take it for a shorter period of time, and there are some people who take it for a longer period of time.

What Have You Done To Manage Your Hyperthyroid Symptoms?

For those with hyperthyroidism, including Graves’ disease, toxic multinodular goiter, and other types of hyperthyroidism, I’d like to know what you have done to manage your hyperthyroidism symptoms.  Did you take antithyroid medication such as methimazole, PTU, or carbimazole?  Or did you take natural antithyroid agents such as bugleweed, L-carnitine, lithium, etc.?  Perhaps you didn’t take anything with antithyroid properties, but took something else such as a beta blocker or motherwort.  Either way I’d love to hear about your experience in the comments section below.  Thank you!