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Can Epstein Barr Trigger Graves’ Disease and Hashimoto’s Thyroiditis?

Published January 2 2017

Viruses are a potential trigger for autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  One of the most common viruses humans get infected with is Epstein Barr, which is a member of the herpes virus family.  In fact, most people will get infected with Epstein Barr virus (EBV) at some point in their life, and if this person has a genetic predisposition for Graves’ Disease or Hashimoto’s Thyroiditis then this can lead to the development of these conditions.

But how do people get infected with EBV?  Well, this virus spreads through bodily fluids, especially saliva, although it can also be transmitted through blood and semen.  Getting exposed to the EBV can cause infectious mononucleosis, and the following are some of the symptoms associated with an EBV infection (1) [1]:

How Can The Epstein Barr Virus Trigger Thyroid Autoimmunity?

The research shows a potential connection between EBV and autoimmune thyroid conditions.  One study suggested that the high prevalence of EBV infection in cases of Hashimoto’s and Graves’ Disease imply a potential role of EBV in triggering thyroid autoimmunity (2) [2].  Another study looked at the influence of EBV reactivation in patients with Graves’ Disease, and it spoke about how EBV persists mainly in B lymphocytes, and how EBV may affect the antibody production of B lymphocytes that would normally produce TSH receptor antibodies (3) [3], which are the antibodies associated with Graves’ Disease.  In other words, if EBV is in a dormant state in your B lymphocytes but then becomes active, this can potentially cause the B lymphocytes to stimulate the production of TSH receptor antibodies.

I’m not going to go into detail about the mechanisms that viruses such as Epstein Barr utilize to trigger autoimmunity, as I spoke about this in another article entitled “Which Viruses Can Trigger Thyroid Autoimmunity? [4]”  In the article I talk about three of the main proposed mechanisms, which include molecular mimicry, epitope spreading, and direct bystander activation.  If you’re interested in learning more about how being exposed to a virus can trigger an autoimmune response I’d read this article when you get the chance.

Can Epstein Barr Trigger Other Autoimmune Conditions?

Although the focus here is on thyroid autoimmunity, the research shows a correlation between EBV and other autoimmune conditions.  One study shows that EBV might play a role in the development of systemic lupus erythematosus (SLE), rheumatoid arthritis, and Sjögren’s syndrome (4) [5].  Another study showed that lupus patients have unusual immune responses to EBV, and that this virus can be important in some patients for the initiation of lupus autoimmunity (5) [6].  EBV might also be a trigger for some cases of multiple sclerosis (6) [7], although more research needs to be conducted in this area.

Can The Epstein Barr Virus Be Eradicated?

Unlike bacteria, yeast, and parasites, viruses aren’t typically eradicated.  After Epstein Barr is activated, in most cases it eventually becomes dormant.  But the bad news is that it can reactivate in the future.  Later during this article I’ll discuss some of the things you can do to prevent the virus from reactivating.

But why is it difficult to eradicate viruses?  Viruses live and replicate inside the cells, and they actually insert their own genetic material into our DNA.  Most active viral infections will eventually result in the death of the host cell, although cells in which the virus is in a dormant state usually function normally (7) [8].  But the only way to eradicate the virus is by killing the infected cell.  The alternative is to do things to prevent the virus from replicating.

How Can You Determine If You Have An Active Epstein Barr Virus Infection?

Blood tests can be used to determine if someone has been exposed to the EBV.  However, not all tests will show whether someone has an active Epstein Barr infection.  To better understand this, let’s look at a serum Epstein-Barr Virus antibody profile.  This will look at the following three markers:

1. Viral capsid antigen (VCA)-IgM.  The presence of these IgM antibodies indicates a recent infection with EBV.

2. VCA-IgG.  The presence of these IgG antibodies indicates a past infection.

3. Epstein Barr nuclear antigen (EBNA).  These antibodies will develop 6 to 8 weeks after being infected initially with EBV, and will remain detectable for life.

So just to summarize, the presence of VCA IgM antibodies indicates a recent infection, while the presence of VCA IgG antibodies indicates a past infection.  So if someone tests positive for the VCA IgM antibodies then this usually indicates an active infection.  On the other hand, positive VCA IgG antibodies along with negative VCA IgM antibodies indicates that the person had a past EBV infection, and so the EBV is in a dormant state.  It’s important to point out that over 90% of adults will test positive for IgG antibodies to VCA and EBNA (8) [9].

Chronic Active Epstein-Barr Virus Disease

Before talking about treating EBV, we need to keep in mind that many people are infected during infancy and early childhood, and if someone has a dormant case of EBV then treatment usually isn’t indicated.  However, some people do have something called “chronic active” Epstein Barr Virus Disease, which is when EBV remains in an active state for a prolonged period of time.  This is very rare, and is usually due to the virus being present in either T cells or natural killer cells (9) [10].  Antiviral treatment with drugs such as acyclovir, ganciclovir, and vidarabine is usually ineffective for this disease (9) [10].  Immunosuppressive agents, such as corticosteroids and cyclosporine, are often used to temporarily reduce symptoms in patients with CAEBV (9) [10].  But of course these don’t do anything to address the cause of the problem.

What Are The Different Treatment Options For Viruses?

Antiviral medication.  If someone has an active case of EBV then antiviral drugs might be used.  The way these drugs work is by inhibiting the viral DNA polymerase, which in turn inhibits replication of the virus in the infected cells (9) [10].

Spironolactone.  Recently it was found that spironolactone, which is a mineralocorticoid receptor antagonist, has a different mechanism of action against EBV.  Unlike antiviral drugs which just target the DNA replication, this drug affects other steps in the cycle of the virus, as it specifically inhibits something called viral capsid antigen synthesis and capsid formation (10) [11].  But of course this also isn’t doing anything to improve the health of the immune system.

Licorice root.  A few studies have shown that glycyrrhizic acid, which is a component of licorice root, can prevent EBV replication (11) [12] (12) [13].  Apparently glycyrrhizic acid interferes with an early step of the EBV replication cycle (12) [13].

Quercetin.  Quercetin is a naturally occurring flavonoid, and there is also evidence that quercetin has antiviral activity and can help to inhibit EBV (13) [14].  And while I wouldn’t recommend for anyone to take licorice root on a continuous basis to prevent EBV from becoming active, quercetin might be something to consider taking if you’re concerned about Epstein Barr reactivating in the future.

Lysine.  Many people take lysine as a preventative measure for herpes outbreaks, and as I mentioned earlier, EBV is a member of the herpes family.  A few different studies show that supplementing with lysine might help to prevent the reactivation of herpes simplex viruses (14) [15] (15) [16], although I couldn’t find any evidence showing that it can help to prevent the recurrence of the Epstein Barr Virus.

Sauna. Although I commonly recommend infrared sauna therapy to help with detoxification, some suggest that the high temperatures can help with active viral infections, and might help to prevent dormant viruses from becoming active again.  There isn’t much evidence in the research proving this, although a few studies have shown that regular sauna therapy might reduce the incidence of common colds (16) [17] (17) [18], which are typically viral in nature.

The Goal Should Be To Improve Overall Immune System Health

Whether you are dealing with an active or latent virus, the goal should be to do things to improve your immune system health.  Since most of the immune system cells are in the gut, having a healthy gut is important for optimal immune system health.  And so you want to make sure you have a healthy gut, and in order to accomplish this I would read a blog post I wrote entitled “What Is The 5R Protocol? [19]

In summary, viruses such as Epstein Barr can be a trigger for the autoimmune thyroid conditions Graves’ Disease and Hashimoto’s Thyroiditis.  And EBV can also trigger other autoimmune conditions as well, such as systemic lupus erythematosus, rheumatoid arthritis, Sjögren’s syndrome, and perhaps even multiple sclerosis.  If someone has an active EBV infection the goal usually is to prevent the virus from replicating and to put it into a dormant state.  An active EBV is characterized by VCA-IgM antibodies, whereas the presence of VCA-IgG antibodies indicates a past infection.  Some natural agents which can help with viruses include licorice root, quercetin, and lysine, and sauna therapy might also be beneficial, although the primary goal should be to improve the overall health of the immune system.