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How Do You Know When You’re In Remission?

When someone with Graves’ Disease or Hashimoto’s Thyroiditis takes a natural treatment approach, the ultimate goal is to achieve a state of remission.  But one of the questions I commonly get asked is “how can someone tell if they are in remission?”  In this blog post I am going to discuss what someone should expect when they reach this state.  I’ll also discuss what you can do to maintain a state of wellness once remission has been achieved.

Before I talk about this, I’ll admit that I don’t like the word remission.  I like the word “cure” much better, as it of course sounds better to say “my autoimmune thyroid condition has been cured”, rather than say that “my autoimmune thyroid condition is in remission”.  While I have been guilty of using the word “cure” in the past, since genetics plays a role in the development of autoimmune thyroid conditions, the word remission is more appropriate.  However, I like to aim for a “permanent” remission, which is the next best thing to a cure.

The Difference Between Cancer And Thyroid Autoimmunity

If you visit www.cancer.gov [1] they explain the difference between cure and remission with regards to cancer.  They mention that a “cure” means that there are no traces of cancer after treatment and the cancer will never come back.  On the other hand, they label “partial” remission as meaning the signs and symptoms of cancer have been reduced, whereas in complete remission the signs and symptoms of cancer have completely disappeared.  And when it has been completely gone for at least five years this is frequently labeled as being a cure.

But then they go on to say that even after five years there is a chance that the cancer can come back.  And when cancer returns after five years then a so-called cure was essentially a prolonged remission.  And I’d say that there are similarities between cancer and thyroid autoimmunity, as someone like myself who has been in remission for over five years is less likely to relapse than someone who has been in remission for less than five years.  But I’ve also worked with people who have been in remission for over five years and relapsed, which is why I can’t honestly say there is a permanent “cure” for thyroid autoimmunity.  On the other hand, there is a chance to achieve remission and stay there without relapsing, which is why I prefer to use the term permanent remission.

3 Signs That You Have Achieved A State Of Remission

So how do you know when you have achieved a state of remission?

1. Your symptoms have completely resolved.  One of the main goals is to get complete resolution of your symptoms.  For example, when I was dealing with Graves’ Disease I had an elevated resting heart rate, palpitations, tremors, weight loss, an increased appetite, and a few other symptoms.  All of these symptoms eventually resolved upon taking a natural treatment approach, and the same thing occurs with most of my Graves’ Disease patients.  And of course the same goal applies to my patients with hypothyroidism and Hashimoto’s Thyroiditis.

While most people who take responsibility for their health receive great results, unfortunately not everyone who follows a natural treatment protocol will get complete resolution of their symptoms.  Why is this the case?  When someone doesn’t get into remission, in most cases it’s because the underlying cause of their condition hasn’t been addressed.  Thyroid autoimmunity can be challenging, and finding the autoimmune trigger isn’t always easy.

But symptom resolution doesn’t always come down to finding and removing triggers, as sometimes certain imbalances can’t be completely resolved.  For example, if someone with Graves’ Disease or Hashimoto’s Thyroiditis has small intestinal bacterial overgrowth (SIBO) due to damage to the migrating motor complex, which in turn is caused by an autoimmune process, not everyone will have complete resolution of their symptoms.  This doesn’t mean that tremendous improvement isn’t possible, but a person in this situation might still have some mild symptoms after treating SIBO, and in order to prevent SIBO from coming back they might need to take prokinetics on a continuous basis after treatment.

2. Your thyroid panel and other blood tests are normal.  Of course we want the thyroid panel to normalize, and this includes the thyroid antibodies.  But other markers that were out of range initially should normalize as well.  For example, if someone had low or depressed vitamin D levels upon starting the natural treatment protocol, then upon restoring their health this should be within a healthy reference range.  If someone has elevated liver enzymes, which is common with hyperthyroidism, then these should normalize upon remission.

It’s important to understand that certain markers on a blood test might be important to normalize, but at the same time don’t directly relate to your condition.  And if this is the case, then these markers might remain out of range, even if someone is in a state of remission.  For example, some people will have an elevated homocysteine, but this doesn’t always directly relate to one’s thyroid or autoimmune thyroid condition.  This doesn’t mean that we don’t want to do things to lower the person’s homocysteine, but my point is that it’s possible to be in remission even with elevated homocysteine levels.  However, one wouldn’t be in an optimal state of health in this situation.

By the way, I’m not suggesting that having a high homocysteine level isn’t significant, but only that it might not be directly related to one’s thyroid or autoimmune thyroid condition.  However, an elevated homocysteine level indicates problems with methylation, which can be a factor.  I spoke about homocysteine and methylation in an article entitled “Methylation, MTHFR, and Thyroid Health [2]”.

3. Other tests have normalized.  When I was dealing with Graves’ Disease I obtained an adrenal saliva panel, and the initial test results revealed depressed cortisol levels, a depressed DHEA, and a depressed secretory IgA.  All of these markers eventually normalized, and I expect the same with my patients who have compromised adrenals.  If someone tests positive for a gut infection in the blood or stool, such as H. Pylori or Blastocystis Hominis, then of course you want them to test negative for this in the future.

Does this mean all tests need to be perfect before someone achieves a state of remission?  Just as is the case with the high homocysteine example I gave above, some markers are more significant than others.  Let’s look at a different example that relates to testing the sex hormones.  If someone has low levels of progesterone and testosterone, even though these low levels are causes of concern, it still is possible to get into a state of remission.  However, a person with low or depressed hormone levels isn’t in an optimal state of health, and if chronic stress is the cause of the low sex hormones then this can prevent the person from maintaining a state of wellness.

How Can You Maintain A State of Remission?

So once you have achieved a state of remission, how can you maintain your health?  I admit that maintaining a state of wellness can be a challenge, especially initially.  But even after being in remission for many years there still is always a chance of a relapse.  However, doing the following will greatly increase the chances of maintaining a state of wellness:

1. Continue to eat well most of the time.  What do I mean by “most of the time”?  In other words, does the 80/20 rule apply here where someone can eat healthy 80% of the time, and indulge 20% of the time?  The truth is that it depends on the person, as some people are able to get away with eating “bad foods” more than others, while others need to eat more strictly in order to maintain a state of wellness.  But since you won’t know what you can get away with when you’re in remission I wouldn’t indulge too much…at least not initially.  I definitely don’t eat a perfect diet, but I do try to eat healthy most of the time.

In addition, over the last couple of years I’ve been following a 21-day liver detoxification program three or four times per year.  And while eliminating toxins is important, during the 21 days I also follow a very strict diet.  And so essentially I’m following a gut repair diet for 21 days.  As a result, even if I get into a bad eating spell, which I admit does happen every now and then, I can count on giving my body a 21-day break every three or four months.  Once again, this doesn’t mean I eat poorly for 3 or 4 months and then go on a 21-day liver detoxification, as I do try to eat well most of the time in between.

2. Always work on stress handling.  Stress was a big factor in the development of my Graves’ Disease condition, and it’s a factor with many of the people I work with.  In fact, when someone relapses it frequently is due to chronic stress.  This might be a concern to some people reading this, mainly because stress is a factor with just about everyone.  This is true, and this is why managing your stress is important.

However, just as is the case with diet, this doesn’t mean that you need to be perfect in the stress department.  And while completely getting rid of your stressors isn’t feasible, improving your stress handling skills is something you can do.  I’m not suggesting that it’s easy to do, but just like anything else you need to block out the time to do it and get into a routine.  If necessary I’d start by blocking out five minutes per day, and make sure you choose some type of mind body medicine that you enjoy doing.  Then once you’re in the routine of blocking out five minutes per day for stress management you can work on increasing the duration.

3. Minimize your exposure to other autoimmune triggers.  Sometimes this is easier said than done.  For example, in addition to food allergens and stress, two other potential autoimmune triggers include environmental toxins and infections.  While avoiding certain foods and improving your stress handling skills can be challenging, it’s impossible to avoid all of the environmental toxins you’re regularly exposed to.  And it’s not always possible to prevent an infection such as H. Pylori, Blastocystis hominis, Lyme disease, etc.  In the case of environmental toxins you obviously won’t be able to avoid exposure to every chemical out there, but you can do a lot of things to change your home environment, which can help a great deal.  And you can also do regular detoxifications like I do.

Just keep in mind that your body is always detoxifying, and so while every three or four months I personally follow a 21-day program to further support my detoxification pathways, you don’t necessarily have to take this approach.  Eating healthy foods on a daily basis, especially plenty of vegetables, will help to support your detoxification pathways.  If you have access to an infrared sauna then this can also help with the elimination of toxins.  And so in no way am I suggesting that most people need to follow three or four 21-day liver detoxifications per year.

With regards to preventing infections, the best way to do this is to improve the health of your immune system.  And of course this is the main goal for anyone who has Graves’ Disease or Hashimoto’s Thyroiditis, although even if you have a thyroid condition that doesn’t have an autoimmune component you still want to have a healthy immune system.  As for how to achieve a healthy immune system, I talk about this in other articles and blog posts, but I will say that following some of the advice given in this post will greatly help.

4. Get sufficient sleep.  Once you achieve a state of remission, in order to maintain a state of wellness you also want to get sufficient sleep on a consistent basis.  This doesn’t mean that staying up late once in awhile will cause you to relapse, but most people need to get at least a minimum of six or seven hours sleep each night, and many people do better getting seven or eight hours of sleep each night.  And “catching up” on sleep doesn’t work.  For example, if you only get four hours sleep Monday through Friday, and then sleep 10 to 12 hours on Saturday and Sunday, the extra sleep on the weekend isn’t going to compensate for the sleep deprivation during the week.

In summary, the primary goal of following a natural treatment protocol should be to achieve a state of permanent remission.  Three signs that you have achieved remission include 1) complete resolution of your symptoms, 2) normalization of your thyroid panel and other blood tests, and 3) normalization of other tests.  As for how to maintain a state of remission, you of course want to eat well most of the time, you should always work on improving your stress handling skills, minimize your exposure to other autoimmune triggers, and you also need to get sufficient sleep on a regular basis.