In this episode, Dr. Eric Osansky tackles a question that often surprises thyroid patients: Can Hashimoto’s thyroiditis turn into Graves’ disease, and can Graves’ disease eventually become Hashimoto’s? While these conditions are commonly viewed as opposites—one causing hypothyroidism and the other hyperthyroidism—Dr. Eric explains why the relationship between them isn’t always so straightforward.
Dr. Eric breaks down the differences between the thyroid antibodies associated with each condition, explains how antibody patterns can overlap, and discusses why some people test positive for both Graves’ and Hashimoto’s antibodies at the same time. He also explores possible reasons these transitions occur, including immune dysregulation, environmental triggers, gut health issues, nutrient deficiencies, chronic stress, infections, mold exposure, and hormonal changes. Along the way, he clarifies common misconceptions about Hashitoxicosis, “thyroid burnout,” and the importance of proper antibody testing.
Most importantly, Dr. Eric emphasizes that both Graves’ disease and Hashimoto’s are immune system conditions rather than simply thyroid disorders. By focusing on identifying triggers, restoring immune balance, and supporting gut health, it’s possible to improve symptoms, lower antibodies, and achieve long-term remission. If you want a clearer understanding of how autoimmune thyroid conditions can evolve over time—and what you can do about it—you’ll get a lot out of this episode.
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Dr. Eric Osansky:
Most people think Hashimoto’s and Graves’ are complete opposites. One causes hypothyroidism, and the other causes hyperthyroidism. End of story, right?
What many people don’t realize is that some people with Hashimoto’s later develop Graves’, and some people with Graves’ later develop Hashimoto’s. In this episode, I’m going to explain why this can happen and how you should handle this from a natural treatment perspective.
Here are a few things you need to keep in mind. First, Hashimoto’s and Graves’ are of course both autoimmune thyroid conditions. As a result, the immune system, not the thyroid gland itself, is the underlying issue.
Another thing to keep in mind is these conditions can overlap. While some people have the antibodies associated with Hashimoto’s, and other people have the antibodies associated with Graves’, others have the antibodies associated with both conditions at the same time.
Let’s discuss the traditional overviews of Hashimoto’s and Graves’, starting with Hashimoto’s. Hashimoto’s is usually associated with hypothyroidism, lower thyroid hormones. Many times, thyroid hormones are within the lab range. Most medical doctors focus on TSH, which is thyroid stimulating hormone and a pituitary hormone. If TSH is high in the presence of certain antibodies, that is when they make the diagnosis of Hashimoto’s.
Which antibodies are we talking about? If someone has elevated TSH associated with TPO antibodies (thyroid peroxidase) or TG antibodies (thyroid globulin), that person typically will be diagnosed with Hashimoto’s. I’ll talk more about antibodies later.
In a nutshell, when you have these antibodies, it means your immune system can be damaging thyroid tissue, which can lead to lower thyroid hormones as well as the elevation in TSH.
Some of the more common symptoms associated with Hashimoto’s: fatigue, weight gain, cold intolerance, constipation, brain fog.
Many of you know I personally dealt with Graves’ many years ago. Graves’ usually is associated with hyperthyroidism. The antibodies associated with Graves’ are typically TSIs (thyroid stimulating immunoglobulins). TSI is a type of thyroid receptor antibody (TRAB). On a lab, it could say either. These antibodies actually stimulate the thyroid gland.
It’s a little bit different than Hashimoto’s. With Hashimoto’s, it’s not the antibodies themselves that are damaging the thyroid gland; it’s the immune system. With Graves’, from what we understand, it’s the antibodies that are stimulating those TSH receptors. That will lead to the increase in the production of thyroid hormone.
As a result, some of the more common symptoms associated with Graves’ include heart palpitations, tachycardia, anxiety, tremors, heat intolerance, weight loss, insomnia. Not everybody will experience these symptoms. I have worked with countless people over the years with Graves’ who are actually gaining weight and not losing weight. Every now and then, someone is more subclinical, where they might not have increased resting heart rate or palpitations.
I want to expand on why these conditions are a bit complicated. Once again, usually, when you go to an endocrinologist, it’s either Graves’ or Hashimoto’s. Either you have Graves’ or Hashimoto’s. Again, it’s not uncommon for some people to have the antibodies for both Graves’ and Hashimoto’s simultaneously.
The problem is they won’t always test all the antibodies. I’m not saying everybody should have all the antibodies tested. I’m going to talk more about thyroid antibodies shortly. Essentially, they will just focus on one or the other. They’re not doing anything for the autoimmune component, but that’s why they are not focusing mostly on the antibodies but focusing more on whether someone has hyperthyroidism or hypothyroidism.
In my experience, I will say I have seen many people who have overlapping antibodies. I have seen where thyroid function can shift over time. This is in the absence of taking medication. Obviously, if someone has Graves’ and is taking antithyroid medication such as methimazole or PTU, then we would expect them to become hypo.
If someone is dealing with Hashimoto’s and taking too much thyroid hormone replacement, whether it’s levothyroxine or desiccated thyroid, they might become a little bit hyper.
I’m not talking about the shifts in thyroid function when someone is taking medication, but when they’re not taking anything at all, based on the autoimmune component that we discussed earlier.
The diagnosis of Graves’ or Hashimoto’s by an endocrinologist or other medical doctor usually depends on which antibodies are dominant and how the thyroid is functioning at the moment.
The million-dollar question: Can Hashimoto’s turn into Graves’? The research does show that people make the transition from Hashimoto’s to Graves’. Sometimes, this can occur years after the original diagnosis. It definitely can happen. I have had people come in with Graves’ but with a history of Hashimoto’s. This isn’t uncommon. They might have had Hashimoto’s five, 10, 15 years ago.
Why does this happen? We’ll also talk about the opposite, too. Let’s first focus on Hashimoto’s turning into Graves’.
One mechanism is antibodies shift. There is overlap between Hashimoto’s turning into Graves’ and Graves’ turning into Hashimoto’s. Antibody shifts relate to both of these. If you have TPO and TG antibodies, maybe you have those initially. Maybe someone didn’t have TSIs. The problem is usually you’re not testing for all the antibodies. If someone is diagnosed with Hashimoto’s, maybe they do have TSIs, but they were never tested for it. Eventually, Initially, the Hashimoto’s is dominant, but over time, the Graves’ becomes more dominant. There could be different reasons for this. The point is, the person might have had both the antibodies for Graves’ and Hashimoto’s many years ago, but they weren’t tested.
Another possibility is maybe the person didn’t have Graves’ antibodies, but they were exposed to a different trigger years later. Then they developed Graves’ antibodies. The research clearly shows, and I have discussed this on other podcast episodes, is if you have one autoimmune condition, you’re at greater risk for developing other autoimmune conditions in the future.
It’s not like if someone has antibodies for Hashimoto’s and Graves’, and on top of that, they have antibodies to rheumatoid arthritis and multiple sclerosis, it’s not like these people developed all these antibodies at the same time. Maybe they started out with one type of antibody. Over time, they developed other antibodies.
Even if someone did have all three antibodies (TPO, TG, and TSI), it’s not as if they developed them all at the same time. It is possible still when they started developing Hashimoto’s, maybe they did have all three antibodies that they were never tested for. It’s also possible they didn’t have Graves’ antibodies at first and developed them later on.
When it comes to autoimmune conditions, there is immune dysregulation, the loss of immune tolerance, regulatory T cell dysfunction. Regulatory T cells help keep autoimmunity in check. You want to have an abundance of them. There could be different factors that decrease them. Even nutrient deficiencies in selenium, Vitamin D, Vitamin A can cause a decrease in regulatory T cells.
There are different triggers that can trigger different autoimmune conditions. I have spoken about these in detail in other episodes. I have had episodes dedicated to all these that I will mention briefly here. There is chronic stress, gut infections, viral infections, mold exposure, hormonal shifts, excess iodine.
I am not anti-iodine, but excess iodine in certain susceptible individuals can be a potential trigger. I personally have had good experience with iodine when I dealt with Graves’. I didn’t have bad experiences. Over the years, I have seen people not have a good experience. There is a lot of controversy when it comes to iodine. There are separate episodes on the podcast on this.
Graves’ can also turn into Hashimoto’s. I would say this is probably more common than Hashimoto’s turning into Graves’. I could easily have made the title of the podcast episode the vice versa. Either way, the answer is yes.
Some people will initially present with hyperthyroidism in the presence of those Graves’ antibodies. Over time, if they have those other antibodies, either TPO or TG, they can become hypothyroid. This is probably the most common way for Graves’ to turn into Hashimoto’s.
It’s not as if I was going to say it’s not as if someone has Graves’ antibodies, and then they disappear and develop Hashimoto’s. That being said, someone could have Graves’. Then they are doing things to restore their health. Then their Graves’ normalizes, and then they develop Hashimoto’s.
The truth is, when someone is following a natural treatment protocol of some type, it should help with other autoimmune conditions. You shouldn’t get Graves’ into remission and develop Hashimoto’s. I’m not saying it never happens.
For example, I have been in remission since 2009. I could relapse. I could also develop a different autoimmune condition. If I’m keeping my immune system in a healthier state, the goal is not to develop any autoimmune condition. It’s not foolproof. There is always a chance.
Like I said, maybe if I fell off the wagon with my diet or stress management or something else, maybe I wouldn’t relapse and develop Graves’. Maybe I would develop a different autoimmune condition.
Autoimmunity is complex. There are so many things going on in the body. We don’t know everything. That’s why you want to do everything you can to optimize your immune system. It’s a constant work in progress.
What I’d like to do next is talk briefly about the role of antibodies. I’m not going to get into great detail because I have a good number of episodes where I talk about antibodies. I have separate episodes on TPO, TG, and TSI. I have a six-part series where I discuss how to lower antibodies because that’s another question I commonly get asked. There is a lot of information on the podcast about antibodies and lowering antibodies.
I’ll briefly mention antibodies here. TPOs are the most common type of thyroid antibody. They are more commonly associated with Hashimoto’s. A lot of people with Graves’ have them as well. When I dealt with Graves’, I did not have TPO antibodies. According to the literature, approximately 60-80% of people with Graves’ also have TPOs.
There are TG antibodies, sometimes known as anti-TG antibodies. These are, like TPOs, more closely associated with Hashimoto’s. TPOs are very common in those with Graves’, and TGs are in people with Graves’ about 20-30% of the time.
TSIs or TRABs are typically associated with Graves’. People can have 2/3 antibodies. People could have all three antibodies. If you start out with Graves’ with all three antibodies, it doesn’t mean you’re always going to progress to Hashimoto’s. It doesn’t always mean you will be hypothyroid. Even if you do, it can take quite a long time for that to happen.
Similar with the opposite. If you have antibodies to Hashimoto’s, and you’re predominantly hypothyroid, yet you also have the antibodies for Graves’, it doesn’t mean you will eventually develop Graves’. It all comes down to trying to do everything you can to optimize your immune system health, your gut health.
As far as some of the takeaways here, the diagnosis isn’t always the full story. Just because you were diagnosed with Hashimoto’s or Graves’ doesn’t mean you can’t develop another autoimmune thyroid condition.
Another thing to keep in mind is sometimes misdiagnoses happen. There is also what’s called Hashitoxicosis. Someone presents with hyperthyroidism, so elevated thyroid hormones, but they have negative Graves’ antibodies. They only have the antibodies associated with Hashimoto’s, TPO and/or TG antibodies.
What happens is in this situation, the immune system damages the thyroid gland, which causes a rush of thyroid hormone into the bloodstream, presenting with hyperthyroidism. This is usually transient.
Many times, a person with Hashitoxicosis will be diagnosed with Graves’. You figure that endocrinologists would know the difference. I am not saying they don’t. A good number who I have seen over the years, even with Graves’ patients, where someone is hyper, and they have only tested TPO and/or TGs. They haven’t tested the Graves’ antibodies. Yet they diagnose the person as having Graves’. You can’t make that diagnosis.
They will use other methods as well such as a radioactive iodine uptake test. If they didn’t do an uptake test, which I am not a huge fan of, or test the TSIs or TRABs, and someone is hyper in the presence of TPO and/or TGs, the truth is, we don’t know. It could be Hashitoxicosis or Graves’. If they test the antibodies for Graves’, and they are positive, it’s probably Graves’, and they also have the antibodies to Hashimoto’s.
There are signs that someone might be transitioning first from Hashimoto’s to Graves’. They had Hashimoto’s. Maybe they are taking thyroid hormone replacement because they had low thyroid hormone. What typically happens if someone is taking thyroid hormone replacement, but they don’t need it, is they will become hyper.
If you’re not hyper or hypo, yet you take levothyroxine or desiccated thyroid, you will start feeling hyper. You will get heart palpitations or increased resting heart rate. You might feel anxious, lose some weight, or get heat intolerance. When you do your next thyroid panel, you will probably have lower TSH or increased thyroid hormones.
From a symptom management perspective, it’s usually not too difficult to know when someone is becoming hyper. It could simply be too much medication. It doesn’t mean if someone has Hashimoto’s and are on thyroid hormone replacement and start experiencing hyper symptoms, it doesn’t mean you are transitioning to Graves’. Maybe you need your medication dosage reduced. It might be worth, next time you do a blood test, testing for Graves’ antibodies just to make sure. If they’re negative, it might be just an adjustment in thyroid hormone. If they’re positive, you want to monitor the situation.
If someone has Graves’ and are making a transition to Hashimoto’s, you will see the hyperthyroid symptoms improve. Maybe you will get some hypo symptoms, like fatigue, cold intolerance, weight gain. On a blood test, TSH will rise. Thyroid hormone levels would probably decline. Maybe they will still be within the reference range but on the lower side.
Again, if you have Graves’ and are taking antithyroid medication, we would expect your numbers not to become hypo. It’s common for people who are on antithyroid medication to become hypo. The point is if you’re on antithyroid medication, we don’t know if you’re experiencing those symptoms because you need the dosage to be reduced.
If you have a history of Graves’, and you’re not taking any antithyroid medication or natural antithyroid agents like bugleweed or L-carnitine, but eventually you are experiencing hypo symptoms, then maybe you are making a transition. It could be a little bit more challenging. There are other factors that could cause fatigue, weight gain, and other hypo symptoms. At the very least, look at all three antibodies.
As far as why this matters clinically, first of all, you want to avoid misdiagnosis. Symptoms can overlap. People with Hashimoto’s sometimes can have hyper symptoms. People with Graves’, it’s not as common to have hypo symptoms, but as I mentioned, some people with Graves’ will gain weight or have coldness or other hypo symptoms. I am not talking about if someone is taking antithyroid medication because that will commonly lead to hypothyroidism. In the absence of taking antithyroid medication.
Once again, you want to not just look at the thyroid panel, but testing the right thyroid antibodies. Monitoring the situation is important. Doing regular thyroid panels. One of the biggest mistakes I see endocrinologists make for someone, especially if someone was recently diagnosed, if they are still taking medication, they won’t test frequently enough.
Especially with Graves’, if someone is put on methimazole or PTU, they might in some cases say, “Let’s retest in three months.” I am not saying that’s the norm. You want to make sure to retest every 1-2 months, four weeks to eight weeks. Eight weeks max. Depends on the situation.
If someone is dealing with Hashimoto’s and have been on levothyroxine for a long time, in that situation, I could understand not testing every couple of months. Maybe they will go longer. If someone is experiencing a change in symptoms, definitely don’t be shy about reaching out to your doctor and getting a thyroid panel. If you’re not working with someone or paying out of pocket, there are plenty of places you could do your own labs and look at your own thyroid numbers.
Also remember from a natural healthcare perspective or functional medicine perspective, you don’t just want to focus on the thyroid. It’s really about the immune system. Graves’ and Hashimoto’s are both autoimmune conditions, so it’s really about addressing the underlying immune dysfunction.
In previous episodes, I have spoken many times about the triad of autoimmunity, also known as the three-legged stool, which is genetics, exposure to one or more environmental triggers, and that increase in intestinal permeability, a leaky gut. You can’t change your genes, but you can find and remove triggers and do things to heal the gut.
When we talk about gut health, it’s not just leaky gut, but other changes to the gut microbiome, which is called dysbiosis, an imbalance in the gut flora. There is a lot people can do to improve their gut health. A lot of this can be done through diet and stress management. A lot affects the gut microbiome in positive and negative ways. Stress is huge. If you’re in fight or flight constantly, that will have a negative effect on your overall health and adrenals, but even your gut microbiome.
In this day and age, all these environmental toxins and toxicants dysregulate the immune system and also affect permeability of the gut and cause dysbiosis. We’re talking about the microplastics, glyphosate, mold and mycotoxins. There is a lot of things to consider.
Of course, we don’t want to neglect the foundations. Eating a healthy anti-inflammatory diet. Blocking out time for stress management. Getting regular sleep. Moving regularly. All these are important.
The final question is whether remission is possible. It can become really frustrating. When someone has a history of Hashimoto’s, and then 10-15 years after being diagnosed, they get diagnosed with Graves’. Many times, when this happens, they haven’t done anything for the Hashimoto’s. They might just be taking thyroid hormone replacement.
But sometimes they did. Maybe this person saw a natural healthcare practitioner, and they did things to improve their health. Maybe they didn’t have to go on thyroid hormone replacement. That took place many years ago. All of a sudden, 10, 12, 15 years later, they think their health is good, and they develop Graves’.
In that case, it could be very frustrating. It’s frustrating in any situation, but if all they did was go on thyroid hormone replacement and later developed Graves’, based on everything I’ve said here and in other episodes, it’s understandable why that might happen. The levothyroxine or desiccated thyroid is not doing anything for the autoimmune component. It wouldn’t be a big shocker to develop another autoimmune condition in the future.
Even if you were doing things from a natural standpoint, years ago, and then ended up making a transition from Hashimoto’s to Graves’, yes, you could restore your health. You could get into remission. It’s similar if someone has a history of Graves’ and makes the transition to Hashimoto’s.
Can you lower and normalize antibodies? Yes. It’s not easy but definitely can be done.
Can you resolve all the symptoms associated with hyperthyroidism and hypothyroidism? Yes. Might not be easy but definitely possible.
Can you eventually get to the point where your body doesn’t need the medication? With Graves’, definitely. It’s not damaging the thyroid gland. If someone is taking antithyroid medication for 5, 10, 15 years, and many endocrinologists won’t allow that, but some will, there is research showing you could take methimazole in lower doses for that long. Some endocrinologists will allow that. If you have been on medication for a long time, and you have been dealing with Graves’, then it’s definitely possible to get your body to the point where you don’t need medication.
With Hashimoto’s, it’s a little bit different. You can get to that point. There are also some people who need to be on thyroid hormone replacement, I don’t want to say permanently, but for a prolonged period of time.
It depends on how much damage has been done to the thyroid gland. It’s not necessarily tied to how long you’ve had hypothyroidism or been on thyroid hormone replacement. It’s related to the dosage. If you’re on a higher dose of levothyroxine, like 125mcg compared to 50mcg, you’re probably on the higher dose because there is more damage taking place to the thyroid gland. It would be more challenging to get to the point where you don’t need the thyroid hormone replacement. I am not saying it isn’t possible, but it can take more time.
There are other options to consider that might help in that situation, like cold laser therapy, which I have interviewed some practitioners about. That’s different than red light therapy.
Lowering and normalizing antibodies is possible. Getting rid of symptoms is possible. Getting to the point where you don’t need thyroid medication is possible. Long-term remission is possible. I am a perfect example of this.
Some people hate when I use the term “remission.” I am cautious about using “cured.” I am superstitious. If I start saying I’m cured from Graves’. I’ll relapse. Either way, I use the term “permanent remission,” which essentially is cured. Regardless of the term, it is possible. All these are possible. Maintaining a state of wellness is possible.
Keep in mind that there is no one size fits all approach. Ultimately, the goal is to restore the health of the person’s immune system.
A few final thoughts here. Hashimoto’s and Graves’ are both more autoimmune conditions that affect the thyroid. I had someone recently in my Healing Graves’ Naturally Scool community who was surprised when they heard me say in this case that Graves’ was more of an immune system condition. They thought the thyroid caused Graves’.
I make the assumption that most people know because I have said it so many times. Some people are listening to this and are not as familiar with Graves’ and Hashimoto’s and might think that the thyroid is what you want to focus on. Not that you want to neglect the thyroid, but it’s more of the immune system that you want to focus on.
As we have been chatting about during this episode, some people can transition from one condition to the other. It’s possible to have multiple antibodies. It’s actually quite common. It’s not rare to have all three antibodies. There are other antibodies other than the ones I mentioned here. I discuss this on other episodes. Those are the three main antibodies.
Addressing immune system health is just as important as managing thyroid hormone levels, arguably even more important.
Some questions that people commonly ask me, starting with: Can you have Graves’ and Hashimoto’s at the same time? This hopefully answered that question. You can have the antibodies for both at the same time, and it’s quite common.
Should people test for all three antibodies, regardless of which diagnosis they receive? We could look at it a few different ways. If you are taking a natural approach, it might not make a difference. If you are addressing the autoimmune component of Graves’, there is a lot of overlap between addressing Graves’ and Hashimoto’s naturally.
That being said, it’s not a bad idea. If you have health insurance, and it will be covered, definitely not a bad idea. The TSIs are typically a little more costly than TPO and TG. Also depends on which lab you go to. Maybe your insurance will cover it if your doctor is willing to order all three. In a perfect world, I’d say go ahead and test for all three.
When I dealt with Graves’, I only had TSIs tested and TPOs tested, which were negative. I did not have TGs tested until years later, after I was in remission. It’s not as if it’s necessarily going to change anything. Then again, if someone has multiple antibodies, and after six months or nine months, however long it takes, you have your TSIs negative, but you still have the other antibodies as positive, then you might still want to do things to improve your immune system health.
Can gut healing reduce thyroid antibodies? Gut healing is a piece of the puzzle. If you have Graves’ or Hashimoto’s or antibodies for both without a healthy gut, it will be difficult to normalize thyroid antibodies. When someone has a problem and are struggling with thyroid antibodies, I would look into gut health.
How often should thyroid antibodies be retested? I usually recommend a thyroid panel every 6-8 weeks. Usually no longer than two months. If someone is maintaining a state of wellness, that’s a different story.
Let’s say you’re having your thyroid panel tested every six weeks. If you could get the antibodies tested every time, great. If you’re paying out of pocket, and money is tight, then do it every other time. Or maybe your endocrinologist is ordering them sometimes, but some refuse to do thyroid antibody testing, especially after the first time. They will do it for a diagnosis, but after that, it can be difficult to get them to retest.
If you’re not already subscribed to this podcast, please go ahead and subscribe now. If you liked what you’ve listened to, feel free to give a review.
I’ll also mention a few other resources you might want to check out. First, there is my books. I have three books. The first book that came out is Natural Treatment Solutions for Hyperthyroidism and Graves’, which came out in 2011 originally but is now in its third edition. It came out in 2023.
Hashimoto’s Triggers came out in 2018. The information is still relevant for finding and removing triggers. I still recommend this.
My latest book is The Hyperthyroid Healing Diet, which focuses on diet and lifestyle for those with hyperthyroidism and Graves’.
I also have a Healthy Gut, Healthy Thyroid newsletter, whether you have Hashimoto’s, Graves’, or the antibodies for both. SaveMyThyroid.com/Newsletter is how you can sign up. This newsletter comes out every other Sunday.
Healing Graves’ Naturally is a Substack. If you have Graves’, you might want to sign up for this. You could sign up by visiting SaveMyThyroid.com/GravesNewsletter.
As usual, I hope you found this episode to be valuable. Thank you so much for listening. Look forward to catching you in the next episode.
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One thing I want to say when someone has Graves’ and eventually become hypothyroid, you will hear many endocrinologists tell the patient that their thyroid is essentially burning out. The question is can your thyroid burn out? I have a separate episode from a couple of years ago on the topic.
The thyroid gland does not burn out if you have Graves’. If someone has Graves’, and eventually they become hypo, typically, it’s because they also have the antibodies for Hashimoto’s in the background. Maybe the endocrinologist tested for them or maybe not.
Either way, in the background, there is damage taking place to the thyroid gland. For the time being, the person is predominantly hyperthyroid. You get the immune system stimulating the TRABs. Over time, as more damage occurs, the body won’t be able to do that, and the person will become more hypo. No, your thyroid cannot burn out.
Graves’ versus Hashitoxicosis. I discussed this a little bit. For some people, it’s confusing. For some endocrinologists, it’s confusing. Over the years, I’ve had some endocrinologists diagnose someone with Graves’ when they really have Hashitoxicosis. I can’t say I’ve had that happen a lot.
False negative Graves’ antibodies is possible, but it’s not too common. If someone has hyperthyroidism—elevated thyroid hormone levels and depressed TSH—and they have elevated TPO and/or elevated TGs, and if both the TRABs and TSIs are negative, then the person probably has Hashitoxicosis.
It’s important to mention that over the years, I’ve favored TSIs because it’s more specific than TRAB. I have seen a few cases where TSI was negative, but TRAB was positive. If someone tests TPO, TG, and TSI, and TPO and TG are positive, but TSI is negative, and the person is hyperthyroid, this doesn’t automatically rule out Graves’. I would look at TRAB.
I want to briefly talk about different triggers for different thyroid antibodies. This is why you will see some thyroid antibodies decreasing and others not. Maybe you see TSI decrease and TPO not decrease and maybe even increase. I am not saying it’s only related to different triggers.
In all honesty, it does seem more challenging to lower TPO and TG when compared to TSI. Usually, something is missing if the other antibodies aren’t lowering and normalizing. They might rollercoaster back and forth, so you won’t always see them gradually decrease. Over time, the goal is to have them decrease and normalize.
Even if you have Hashimoto’s, with elevated TPO and TG antibodies, and one of those normalizes, but the other doesn’t, that is also an indication that something is missing.
Testing for other auto antibodies. Not just thyroid antibodies, but if you have one autoimmune condition, you are more likely to develop other autoimmune conditions. I have had a few people over the years ask me why not test for other antibodies? You could. You could do this through a blood test if your insurance covers it. Cyrex Labs has an Array #5, which looks at a few dozen antibodies. I do think those with Graves’ or Hashimoto’s, if you’re currently consuming gluten, it’s a good idea to test for Celiac because that is more common.
I can’t say I recommend widespread antibody testing in people with Graves’ and Hashimoto’s. if your insurance covers it, that’s fine. You could go to your doctor and ask for that. When I recommend blood tests, I don’t have people test for dozens of other auto antibodies.
The reason is by addressing the autoimmune component of Graves’ and Hashimoto’s, there is definitely overlap when it comes to other autoimmune conditions. You should also be addressing other autoimmune conditions and prevent other autoimmune conditions from developing.
Like I said, you might see one or two thyroid antibodies decrease and the other one not decrease. Is there a chance you might have other auto antibodies that don’t decrease and normalize? There is that chance. Based on that, maybe you want to test all antibodies.
I will say this. With Graves’, I only had TSI positive. Over the years, I’ve tested pretty much the ones I mentioned. I have never been positive for TPO or TG. TRAB, I didn’t test back then when I dealt with Graves’, but since then, I have tested. All the thyroid antibodies have been negative, but I haven’t tested for other autoimmune conditions other than Celiac. If you’re testing for Celiac, you need to be consuming gluten for the test to be accurate.
My point is there is a chance I might have other autoimmune antibodies, and maybe I should test for them. I just haven’t done so. That’s my approach. Of course, you’re welcome to do that.
Sometimes, I will have patients who work with other practitioners who test all the antibodies. Most of the time, they are negative. There are times when they are positive. I will see someone who has RA antibodies or lupus antibodies.
That is really all I want to discuss here. Again, hope you found the episode to be valuable. Thank you for listening. Look forward to catching you in the next episode.
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