For those people with Graves’ Disease and Hashimoto’s Thyroiditis who follow a natural treatment protocol, one of the primary goals should be to suppress the autoimmune response. As you probably know, most endocrinologists don’t pay attention to the autoimmune component, as they just focus on getting the TSH and thyroid hormone levels within the normal lab reference range. But remember that Graves’ Disease and Hashimoto’s Thyroiditis are not thyroid conditions, but instead they are autoimmune conditions which affect the thyroid gland. Although not everyone with an autoimmune thyroid condition will test positive for thyroid antibodies, many people do have elevated levels. And it’s not uncommon for these antibodies to remain high even after following a natural treatment protocol for a prolonged period of time. Why is this the case?
Before I answer this question, let’s briefly discuss the different types of thyroid autoantibodies. Hashimoto’s Thyroiditis is characterized by thyroid peroxidase antibodies and/or thyroglobulin antibodies. Graves’ Disease is characterized by TSH receptor antibodies, also known as TSI antibodies. There are a few other types of thyroid antibodies, but these are the most common ones associated with these conditions. It’s also possible for people to have both types of antibodies, as I’ll frequently see people have both TSI antibodies and TPO antibodies, and every now and then I’ll see someone with all three of these antibodies.
What Causes Elevated Thyroid Antibodies?
In order to better understand why thyroid antibodies might remain elevated after following a natural treatment protocol, it is probably a good idea to discuss why these antibodies become elevated in the first place. Once again, Graves’ Disease and Hashimoto’s Thyroiditis are autoimmune conditions. There are many different types of autoimmune conditions, and the primary difference is that each one attacks different tissues of the body. While Hashimoto’s Thyroiditis involves antibodies that attack and damage the thyroid gland, the TSH receptor antibodies of Graves’ Disease attack the TSH receptors. Other autoimmune conditions will attack other parts of the body. For example, with multiple sclerosis the immune system attacks the myelin, which covers the nerve cells of the brain and spinal cord. Another example involves rheumatoid arthritis, which is a condition where the immune system attacks the synovial joints.
Although autoimmunity involves a genetic component in most cases, not everyone with a genetic marker develops an autoimmune condition. It takes a combination of genetic, lifestyle, and environmental factors to trigger an autoimmune condition. This isn’t just my opinion, as there are many journal articles which discuss this as well, and studies involving identical twins prove that genetics alone won’t lead to the development of an autoimmune condition. So when someone develops an autoimmune condition, they most likely had a genetic predisposition, but something triggered the autoimmune response, and this causes the formation of thyroid antibodies.
Removing The Autoimmune Trigger Is The Key
If someone follows a natural treatment protocol and if their thyroid antibodies remain elevated, this usually indicates one of the following three problems:
1) The autoimmune trigger hasn’t been removed. This probably is the most common reason why elevated thyroid antibodies will remain high. For example, one of the common autoimmune triggers is a leaky gut. As a result, if I confirm that someone has a leaky gut and then help the person correct this problem by removing the leaky gut trigger and repair the gut, if this was the one and only trigger then it should resolve the autoimmunity issue, and thus normalize the thyroid antibodies. However, it is possible for someone to have multiple triggers. In other words, it is possible for someone to have a leaky gut, but perhaps the main factor which triggered the autoimmune response was a certain toxin. In this scenario, while it’s important to correct the leaky gut, the toxin issue would need to be addressed in order to normalize the thyroid antibodies.
This has happened to me numerous times while working with patients, as I’ve dealt with many people who have leaky gut syndrome, and while correcting this problem will frequently be the key in restoring the person’s health back to normal, this isn’t always the case. Having multiple triggers admittedly is frustrating to both the doctor and patient. And sometimes it can be a challenge to find all of the triggers. This is especially true with a factor such as toxins, as there are so many toxins we’re exposed to, and it’s impossible to test for all of them. Plus, even if it were possible to measure all of them, we need to keep in mind that not everyone reacts the same to toxins. This is demonstrated by the Chemical Immune Reactivity Screen from Cyrex Labs, as this test measures the immune system response to certain toxins. For example, one person might not have any problems when being exposed to large amounts of formaldehyde, whereas another person might have a negative reaction when exposed to smaller amounts of this toxin. And the same concept applies with other toxins.
2) The autoimmune response hasn’t been suppressed. Many times just removing the trigger alone won’t “balance” the immune system. So for example, if someone has a leaky gut due to eating gluten, if the person completely removes gluten from their diet and successfully goes through a gut repair protocol, the autoimmune component still might be active. Another example involves exposure to a pathogen which triggered the autoimmune response, as while addressing the pathogenic infection is necessary, doing so might not suppress the autoimmune response. In a previous blog post entitled “The Role Of Cytokines In Autoimmune Thyroid Conditions [1]“, I spoke about something called nuclear factor kappa B (NFkappaB). I discussed how this becomes chronically activated in autoimmunity, and while it is essential to remove the autoimmune trigger in order to restore the person’s health back to normal, NFkappaB might remain active even after removing this trigger. When this scenario arises it becomes necessary to do things to help suppress the autoimmune component of the condition. Certain nutrients which can help with this vitamin D, omega 3 fatty acids, curcumin, and resveratrol.
3) Other compromised areas of the body need to be healed. Getting back to the leaky gut example, if a pathogen such as H. Pylori or candida caused a leaky gut, then not only is it important to get rid of the pathogen, but it is also important to restore the health of the gut. Some will assume that removing the trigger which caused the leaky gut is enough, but many times this isn’t the case. Another example involves gluten, as if someone has a condition such as Celiac disease and consumes gluten, and this in turn caused a leaky gut over time, in addition to eliminating gluten from that person’s diet, certain measures usually need to be taken to repair the gut. Another example involves stress. Let’s look at the scenario where someone is dealing with chronic stress, which in turn causes HPA-axis dysregulation and weakened adrenal glands, thus making the person more susceptible to inflammation and resulting in autoimmunity. While the person needs to improve their stress handling skills, doing this alone won’t always restore the health of the adrenals and the HPA-axis.
So in summary, in order to reverse autoimmunity and thus lower elevated antibodies one needs to 1) remove any autoimmune triggers, 2) suppress the autoimmune response, and 3) address other compromised areas of the body which might be contributing to the autoimmune component. This can be very challenging, which is why I recommend for those looking to restore their health to work with a competent natural healthcare professional who has experience dealing with these conditions. But even when working with someone it can be a challenge. Although some people gradually improve with no setbacks, other cases are more challenging. Obviously poor patient compliance can be a big issue, but some people don’t receive optimal results even when they are fully compliant. And when this is the case one needs to look at these three factors I just mentioned.
Warning: The Thyroid Antibodies Can Fluctuate
While it’s great to see the thyroid antibodies gradually decrease as someone’s health improves, this doesn’t always happen. In some people the thyroid antibodies will fluctuate, and so it’s not uncommon to see them decrease, and then to do another blood test one or two months later and see the antibodies increase. This not only can become frustrating to the patient, but at times it can also become confusing, as their TSH and thyroid hormone levels might be improving, yet the thyroid antibodies will sometimes further increase. Just remember that the thyroid antibodies don’t always gradually decrease, and they probably won’t normalize until the trigger has been removed and the autoimmune response has been suppressed.
Should The Autoantibodies Be Zero In A Healthy Person?
A question I get asked every now and then is whether or not the thyroid antibodies should be zero, or is just having them fall below the reference range sufficient? First of all, if someone is negative for thyroid antibodies, many times the lab won’t give a specific value. For example, for the thyroglobulin antibodies a common reference range used is between 0 to 40 IU/mL (keep in mind that the reference range may differ depending on the lab you use), and you might show up as being less than 20. In this example you would be considered to be negative, although you wouldn’t know the exact number, and there is the possibility that the value wouldn’t be zero. To me this is satisfactory. However, if someone has TSI antibodies of 125%, and the normal reference range is <140%, one might not consider this to be satisfactory since they still have some TSH receptor antibodies present. If someone has TSI antibodies of 400 and then this eventually gets them down to 125 and it remains there, then in my opinion this is considered to be excellent progress, although I of course would prefer to see them get even lower than this.
Just remember what I said earlier about the antibodies fluctuating. Some people do experience a gradual decrease in their antibodies, and so for example, if someone had TPO antibodies that were 1,500, and then they gradually decreased over time until they were undetectable, then this would of course be a positive finding. However, if they were 1,500 and then one month later they were undetectable, then I would be more suspicious of the levels fluctuating. Either way I would want to retest the levels in a month or two, but if someone experienced a gradual decrease in the antibodies over a number of months until they eventually were undetectable I would be more confident about the autoimmune response being suppressed.
Another thing to keep in mind is that not everyone with an active autoimmune component will test positive for thyroid antibodies. Although the majority of people with Graves’ Disease and Hashimoto’s will have positive thyroid antibodies, some people with autoimmunity don’t test positive for elevated autoantibodies. When this is the case this obviously makes it more challenging to determine if the autoimmune response has been suppressed. But even if someone has elevated thyroid antibodies you don’t just want to rely on this alone to monitor their progress. This is why other types of testing is important, as if someone has tested positive for a leaky gut or compromised adrenals, then of course you want these conditions to be corrected. And even though you don’t want to rely on signs and symptoms, this can be important. For example, if someone has a depressed TSH and elevated thyroid hormone levels, negative TSI antibodies, but they have swelling and bulging of the eyes, then this is a pretty god indication that they have Graves’ Disease, even though the TSH receptor antibodies tested as negative. In this scenario one would look for an improvement not only with the TSH and thyroid hormone levels, but with the eye symptoms as well.
In summary, for those with an autoimmune thyroid condition who are following a natural treatment protocol, one of the goals is to normalize the thyroid antibodies. However, if the thyroid antibodies remain elevated after following a natural treatment protocol, this means that either the autoimmune trigger hasn’t been removed, the autoimmune response hasn’t been suppressed, and/or other compromised areas of the body need to be healed. It’s also important to understand that not everyone with Graves’ Disease or Hashimoto’s Thyroiditis has elevated thyroid antibodies, and it also is important to understand that the thyroid antibodies can fluctuate. Even though it can be challenging to reverse autoimmunity, this is possible to accomplish.