I think it’s safe to say that many people reading this hope to achieve a state of remission…and remain in remission! Many of you know that I was diagnosed with Graves’ disease, and I’ve been in remission since 2009. It wasn’t easy getting into remission, and I face the same challenge with helping my patients restore their health, but of course it beats the alternative. While achieving a state of remission isn’t easy, it can also be challenging to maintain a state of wellness. I’ll discuss both of these in this blog post.
When Is Someone Considered To Be In Remission?
In the past I’ve discussed the difference between remission and cure, and at least with regards to Graves’ disease and Hashimoto’s thyroiditis, I’m not a big fan of using the word “cure”. And the reason for this is because genetics do play a role in the development of thyroid autoimmunity, and might even play a role in some non-autoimmune thyroid conditions. So while I would love to say that “my Graves’ disease condition has been cured”, because there is a genetic component there is always a chance that a relapse can occur.
As for when someone is considered to be in remission, here is how I knew I achieved remission when I was dealing with Graves’ disease:
- My thyroid panel (TSH, free T3, free T4) was optimal without taking anything that influences these markers. In my situation I took the herb bugleweed, but many people with hyperthyroidism take antithyroid medication, and you can’t be in a state of remission if you’re still taking either one to maintain optimal levels. With hypothyroidism/Hashimoto’s it’s a little bit different, and I’ll further elaborate on this shortly.
- My thyroid stimulating immunoglobulins were negative (I have always tested negative for thyroid peroxidase and anti-thyroglobulin antibodies
- The above markers remained normal a few months after testing multiple times. In other words, you can’t rely on a single negative reading.
- Other triggers/imbalances were corrected, such as my adrenals and depressed secretory IgA levels
- Hyperthyroid symptoms were completely gone
So if you have Graves’ disease or Hashimoto’s, or the antibodies for both of these conditions, then in order to be in a “true” state of remission you need to at the very least have 1) a normal thyroid panel, 2) normal thyroid antibodies, 3) normal markers upon retesting. The reason why I say a “true” state of remission is because most medical doctors consider someone with thyroid autoimmunity to be in remission if their thyroid panel looks good and they are off of any thyroid medications. As I mentioned earlier, the scenario is a little different with hypothyroidism/Hashimoto’s, and so to make it easier to understand I’d like to separately take a look at Graves’ disease and Hashimoto’s:
Achieving Remission in Graves’ Disease
When is someone with Graves’ disease considered to be in remission? I briefly discussed how I knew that I was in remission, and so I have already answered the question, but I’ll summarize it below:
- Optimal thyroid panel (TSH, free T3, free T4)
- Not taking any antithyroid agents (i.e. methimazole, PTU, carbimazole, bugleweed, etc.)
- Negative thyroid stimulating immunoglobulins which aren’t a result of taking an immune-modulating agent such as low dose naltrexone (LDN). I discussed LDN in greater detail in a previous blog post entitled “5 Things To Know About LDN and Thyroid Autoimmunity [1]”.
- The above markers remain normal a few months after testing multiple times. In other words, you can’t rely on a single reading.
- Other triggers/major imbalances have been corrected.
- Hyperthyroid symptoms are completely gone
Achieving Remission in Hashimoto’s
With Hashimoto’s it’s a different situation, as while some people are able to avoid taking thyroid hormone replacement or are able to wean off of it, sometimes the damage to the thyroid gland is severe enough where the person needs to take thyroid hormone on a long term basis. So while it’s great when someone is able to reduce the dosage of their thyroid hormone medication and eventually wean off of it completely, not being able to do this doesn’t mean that the person hasn’t achieved remission.
I know this might be confusing to some people, as with Graves’ disease I mentioned how the person needs to be off of antithyroid medication and/or antithyroid herbs before concluding that they’re in remission. So what’s the difference between remission in Graves’ disease and Hashimoto’s? First of all, in Graves’ disease antithyroid agents such as methimazole, PTU, and bugleweed are of course taken to lower thyroid hormone levels, but nobody has a “methimazole deficiency”, or a “bugleweed deficiency”. On the other hand, it is very possible to have a thyroid hormone deficiency, and if this is the case AND the damage to the thyroid gland can’t be reversed then the person will probably need to take thyroid hormone replacement.
So if someone has Hashimoto’s and the autoimmune response has normalized, they still might not have an optimal thyroid panel unless if they take thyroid hormone replacement.
To summarize, in order for someone with Hashimoto’s to be in remission the following need to occur:
- Optimal thyroid panel (TSH, free T3, free T4) with or without thyroid hormone replacement
- Negative thyroid peroxidase and/or anti-thyroglobulin antibodies, which aren’t a result of taking an immune-modulating agent such as low dose naltrexone (LDN).
- The above markers remain normal for at least a few months after retesting multiple times. In other words, you can’t rely on a single negative reading.
- Other triggers/imbalances have been corrected
- Hypothyroid symptoms are under control
So with thyroid autoimmunity, while there are a few different things I look at before I consider whether someone is in remission, the number one thing that needs to be normal is the thyroid antibodies. With Graves’ disease, if the thyroid antibodies are negative it’s usually just a matter of time before the thyroid panel normalizes, and thus the person won’t need to take antithyroid agents. On the other hand, if the thyroid antibodies are normal with Hashimoto’s, the person still might need to take thyroid hormone replacement, depending on how much damage to the thyroid gland has taken place.
Achieving Remission in Non-Autoimmune Thyroid Conditions
With non-autoimmune thyroid conditions there of course are no thyroid antibodies, and so the primary goal is to normalize the thyroid hormone levels, while addressing the underlying imbalances responsible for the thyroid condition. For example, if someone has toxic multinodular goiter, then the goal should be to correct the underlying imbalances responsible for the goiter and nodules, normalize the thyroid panel, etc. Having problems with estrogen metabolism and/or insulin resistance can lead to multinodular goiter, and so if either of these problems were the cause then they would need to be addressed in order to improve the person’s thyroid health.
Does Every Imbalance Need To Be Corrected In Order To Achieve Remission?
When I was dealing with Graves’ disease I ordered an adrenal saliva test, and I had depressed cortisol levels, a depressed DHEA, a depressed 17-OH progesterone, and a depressed secretory IgA. I worked on improving my adrenal health and retested the adrenal saliva panel, and eventually all of these markers normalized. But you need to keep in mind that not every out of range marker necessarily relates to your thyroid or autoimmune thyroid condition.
For example, let’s say someone with Graves’ disease or Hashimoto’s gets a comprehensive stool panel, and it reveals parasites, along with some opportunistic bacteria. While it would be great to see a perfectly normal test (if one chooses to retest), it’s not uncommon for people to have elevated opportunistic bacteria, but if this were the only positive finding then it wouldn’t mean that the person with Graves’ disease or Hashimoto’s isn’t considered to be in remission. In other words, in this situation the opportunistic bacteria wouldn’t need to be normal in order to conclude that the person is in remission.
Another example involves Epstein-Barr. Most people will test positive for Epstein-Barr, and while testing positive for the Epstein-Barr virus viral-capsid antigen (EBV VCA) IgM antibodies indicates that Epstein-Barr is active, having very high values of the IgG antibodies associated with Epstein-Barr (there are three of these) can also mean that Epstein-Barr is causing trouble. If someone has very high EBV IgG levels but everything else looks great and they’re symptom-free, does this mean that they’re not in remission? If the person was feeling great, the thyroid panel and thyroid antibodies were well within range, and certain other imbalances were corrected then I would say that the person is in remission, although perhaps they still need to work on improving their immune system so that Epstein-Barr (or other infections) won’t cause problems in the future.
How I Have Maintained a State of Wellness Since 2009
Every now and then someone will ask me how I have maintained a state of wellness since achieving remission in 2009. While I’m sure a certain amount of luck has played a role, without question I’ve also done a lot of things to maintain my health, including the following:
- Eating well most of the time. I definitely haven’t been perfect with the diet since 2009, and while I eat well most of the time, I do occasionally indulge in “bad” foods such as pizza, ice cream, cookies, etc. I’m hoping this will serve as encouragement for those who think they might need to be super-strict on a permanent basis, as this usually isn’t the case. Once again, I do eat well most of the time, usually following a modified-Paleo diet.
- Blocking out time for stress management daily. Stress was a huge factor in the development of my Graves’ disease condition, although I was in denial when I was diagnosed with Graves’ disease, as I greatly overestimated my stress-handling skills. But once I saw the state of my adrenals I started incorporating stress management on a daily basis, and I recommend for all of my patients to do the same.
- Getting sufficient sleep. I’ve always been an “early bird”, and so staying up super late wasn’t something I ever did on a regular basis.
- Being aggressive with detoxification. This is something that separates me from a lot of people, as I’m always working on reducing my toxic load. I try to do as much as I can through diet (i.e. cruciferous vegetables, dandelion leaves, cilantro), I go in my infrared sauna at least twice per week for 25-30 minutes, and I usually follow a detoxification program on a quarterly basis. I realize that many people don’t have access to a sauna, but you can accomplish a lot through diet and supplementation, and of course you also want to do as much as you can to avoid chemicals. So avoid drinking out of plastic water bottles, use natural cleaners and cosmetics, eat organic whenever possible, and do other things to minimize your exposure to environmental toxins.
How Can YOU Achieve Remission?
I’m sure some people are wondering how they specifically can get into remission. It comes down to finding and removing triggers, correcting other underlying imbalances, and healing the gut. I’ve written hundreds of articles and blog posts on this website that can help you with this, and I also have two books, one on hyperthyroidism and Graves’ disease [2], and another on Hashimoto’s thyroiditis [3]. In addition, if you haven’t yet joined my “Graves’ Disease and Hashimoto’s Natural Solutions Support Group” you can do so by clicking here [4].