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Can Those With Graves’ Disease and Hashimoto’s Benefit From Organic Acids Testing?

Published July 2 2018

There are many tests that can be useful in helping people find imbalances that can be a factor in their health.  Some of the more well-known tests include adrenal saliva testing, testing for nutrients, heavy metal testing through the hair and urine, and stool testing to determine the health of someone’s gut.  Organic acids testing is becoming more and more popular, but there are still many people who are unfamiliar with this type of testing.  And so I figured I’d go ahead and write an article that discusses the different components of this test, and explain how some of these components can benefit people with thyroid and autoimmune thyroid conditions.

Before talking in detail about organic acids testing, let’s go ahead and discuss some basic facts about this type of testing.  First of all, this test requires a urine sample, which means that it’s non-invasive, and in most cases it’s easy to collect.  As for the purpose of doing an organic acids test, this type of panel evaluates what’s happening from a metabolic standpoint in the body.

Although you can order organic acids testing through a conventional lab such as Labcorp or Quest Diagnostics, these labs offer very basic panels.  The two most well known companies that offer comprehensive organic acids testing are Great Plains Laboratory and Genova Diagnostics.  Both of these are great companies, but in this article I’m going to focus more on the organic acids test from Great Plains Laboratory.  The reason for this is because 1) I recently attended a conference on organic acids testing that was conducted by Great Plain Laboratory, and 2) I mostly utilize this panel in my practice.

The Different Markers Of The Organic Acids Test

I’m not going to discuss all of the markers of the organic acids test, but instead will focus on some of the more important ones.  On the organic acids test from Great Plains Laboratory, each of these markers are separated into different categories, and so to make it easier to understand I’ll separately discuss each of these categories in this article.  If you want to look at a sample organic acids report you can Click Here [1].

Yeast and Fungal Markers

These markers can help determine if someone has a Candida overgrowth.  And while there are other tests one can do for Candida, including testing for Candida antibodies in the blood, as well as a comprehensive stool panel, I have found organic acids testing to be more accurate for detecting a Candida overgrowth.  There are a few different markers that relate to a yeast overgrowth on the organic acids test, with Arabinose being the most specific marker relating to Candida albicans.

Some of these markers can also be a sign that someone has problems with mold.  The markers that are linked to mold problems include 5-hydroxymethyl-2-furoic, furan-2,5-dicarboxylic, and furancarbonylglycine.  Keep in mind that if all three of these markers are negative this doesn’t rule out a mold toxicity problem.  On the other hand, if one or more of these mold markers are elevated, then this can be an indication that the person is being exposed to food and/or airborne sources of mycotoxins.

What Should You Do If You Have Yeast Overgrowth and/or a Mold Toxicity Problem?

I’m not going to go into detail about what you should do if you have a yeast overgrowth and/or mold toxicity problem, as I’ve dedicated separate articles on my website that discuss this.  One of these is entitled “Candida and Thyroid Autoimmunity [2]”, where I discuss the diet and some supplement options I recommend for Candida.  I also wrote a more recent blog post you might want to check out that is entitled “5 Things To Know About Candida and Thyroid Health [3]”.  As for dealing with a mold toxicity problem, the number one thing you want to do is to remove the source of the mold.  You might also need to do things to eliminate mycotoxins from your body, and I discuss this in an article I wrote entitled “Mycotoxins, CIRS, and Thyroid Health [4]”.

I’ll add that if someone suspects a mold toxicity problem, then the number one goal should be to eliminate the source of the mold.  This may sound like common sense, but some people focus on eliminating mycotoxins from their body, but don’t do anything to eliminate the source.  Part of the reason for this is because addressing the mold problem isn’t always easy to do, as it very well might require remediation of your home, or in some cases moving (or changing jobs if this is where the source of the mold is).

Bacterial Markers

The organic acids test also measures a few markers that relate to bacteria.  And while some of these might be a sign of dysbiosis, other tests are more valuable in determining if someone has a specific bacterial infection, such as H. pylori or Yersinia enterocolitica.  That being said, the organic acids test from Great Plains Laboratory evaluates some of the markers related to different pathogenic clostridia strains.  Not all clostridia are pathogenic, and so while some other panels (i.e. comprehensive stool panel) can test for the presence of clostridia, these panels don’t differentiate between pathogenic and commensal species of clostridia.

Getting back to the organic acids test, when attending a workshop conducted by Great Plains Laboratory, the instructor discussed how he looks at the clostridia markers first, as elevated clostridia markers are considered to be a high priority.  If you conduct an organic acids test and have one or more elevated markers for clostridia, I think it’s a good idea to work with a competent healthcare professional for guidance on how to treat the problem.

I skipped over the first few bacterial markers on the organic acids test, which are nonspecific markers.  These include hippuric, 2-hydroxyphenylacetic, 4-hydroxybenzoic, 4-hydroxyhippuric, and DHPPA.  These can be influenced by diet or supplementation (i.e. probiotics), and it’s common to see one or two of these markers elevated.  If someone has three or more of these markers elevated and/or they are extremely high, this might be a sign of small intestinal bacterial overgrowth (SIBO), although the only way to confirm this would be through a breath test, as you can’t accurately diagnose SIBO through an organic acids test.  That being said, if someone has the symptoms of SIBO and is unable to conduct a breath test, but if they have multiple markers on the organic acids test that are significantly elevated, then perhaps one can justify following a SIBO protocol.  For more information on SIBO please check out an article I wrote entitled   “Can SIBO Trigger Thyroid Autoimmunity? [5]

Oxalate Metabolites

As of writing this article, Great Plains Laboratory is currently the only lab that measures oxalate metabolites.  There are three main causes of high oxalates, with the most common cause being related to dietary consumption of foods high in oxalates, such as spinach, soy, berries, and nuts.  An overgrowth of yeast and mold can also lead to high oxalates.  A third cause of high oxalates is problems with oxalate metabolism.  For more information on oxalates please read an article I wrote entitled “5 Things To Know About Oxalates and Thyroid Health [6]”.

What  Should You Do If You Have Elevated Oxalates?

If you have elevated oxalates, the first thing you want to do is evaluate your diet, and if your diet consists of a lot of high oxalate foods then start by following a low oxalate diet.  I realize that some people reading this are already following a strict diet, such as an autoimmune Paleo diet [7], and thus you might find it difficult to follow a low oxalate diet as well.  Just keep in mind that I’m not suggesting that you completely avoid all foods that are high in oxalates, although if you have elevated oxalate markers then I do think it would be wise to avoid extremely high oxalate foods, such as spinach, while at the very least reducing your consumption of other foods that are higher in oxalates.  I also mentioned how an overgrowth of yeast and/or mold can be a factor, and so for example, if you have a Candida overgrowth, then addressing this can help to reduce oxalate levels.

Glycolytic and Mitochondrial Markers

I’ve spoken about the importance of the mitochondria in other articles and blog posts.  Mitochondria are often referred to as the “energy powerhouse” of cells.  The reason for this is because one of the main functions of mitochondria is the production of adenosine triphosphate, which is also known as ATP.

Unfortunately there is no perfect test for determining if someone has mitochondrial dysfunction.  However, organic acids testing can provide some valuable information related to the health of the mitochondria.

What  Should You Do If You Have Elevated Mitochondria Metabolites?

Nutrient deficiencies are a big factor behind mitochondrial dysfunction.  Some of the more important nutrients related to mitochondrial health include magnesium, CoQ10, the B vitamins, alpha lipoic acid [8], and carnitine.  As I’ll discuss later in this article, the organic acids test measures some of these nutrients, although for other nutrients you might have to utilize other types of testing.

Other factors can cause mitochondrial dysfunction besides nutrient deficiencies.  This includes infections.  On the organic acids test, elevated yeast and/or clostridia markers may cause an elevation of one or more mitochondrial markers.  However, in some cases additional testing (i.e. comprehensive stool panel) may be required to determine if you have an infection.  It’s also worth mentioning that environmental chemicals such as heavy metals can also cause mitochondrial dysfunction.

Neurotransmitter Metabolites

The organic acids test evaluates phenylalanine and tyrosine metabolites, as well as tryptophan metabolites.  Homovanillic (HVA) relates to the neurotransmitter dopamine, while vanillylmandelic (VMA) is a metabolite of epinephrine and norepinephrine.  While low levels of HVA can indicate decreased production of dopamine, elevated levels can indicate the presence of clostridia and/or heavy metals.  The reason why clostridia can lead to elevated levels of HVA is because clostridia inhibits dopamine beta hydroxylase, which is the enzyme that converts dopamine to norepinephrine.

Low levels of HVA and VMA can be due to low dietary intake of the amino acid precursors phenylalanine or tyrosine.  However, it can also be an indication of one or more deficiencies of nutritional cofactors, including magnesium [9], vitamin B6, or biopterin.

As for the tryptophan metabolites, 5-hydroxyindoleacetic (5-HIAA) is a serotonin metabolite.  Low levels may indicate lower production of serotonin, while supplementing with 5-hydroxytryptophan (5-HTP) can cause elevated levels of this metabolite.  Quinolinic acid is another tryptophan metabolite, and when this is high this can be a sign of neuroinflammation and/or neural excitotoxicity (1) [10] (2) [11].

What  Should You Do If You Have Imbalances of the Neurotransmitter Metabolites?

One of the main concerns is if someone has elevated HVA and/or quinolinic acid levels, and so this is what I’ll focus on here.  If the HVA levels are high and one or more of the clostridia markers are elevated, then the goal should be to eradicate the clostridia, which in turn should lead to a decrease of the HVA levels.  Heavy metals can also cause an elevation of the HVA levels.  As a result, if someone has elevated HVA but normal clostridia markers, then they will want to consider doing testing for heavy metals.  Of course it’s also possible that someone has both elevated clostridia markers and heavy metals, which is something to keep in mind if you treat clostridia and the HVA doesn’t normalize.

As for how to reduce elevated quinolinic acid levels, if you’re taking tryptophan supplements then reducing these can help.  Infections [12]can lead to elevated levels of this metabolite.  Niacinamide may also reduce quinolinic acid levels by reducing tryptophan shunting to the involved pathway.

Pyrimidine Metabolites

The metabolites uracil and thymine relate to folate metabolism.  If either of these are elevated this typically means there’s a problem with folate metabolism.

What  Should You Do If You Have Elevated Pyrimidine Metabolites?

If one or both of these markers are elevated then you’ll want to support folate metabolism…typically by supplementing with methyl folate.  You might also want to consider further testing to see if you have an MTHFR genetic polymorphism.   I talk more about this in an article entitled “Methylation, MTHFR, and Thyroid Health [13]”.

Ketone and Fatty Acid Oxidation Metabolites

The markers under this section relate to fatty acid oxidation, which in turn can be a factor in the health of the mitochondria.  In other words, elevated levels of one or more of these markers may be a sign of mitochondrial dysfunction, although you would also want to look at the glycolytic and mitochondrial markers.  It’s also important to understand that other factors that can cause elevations of these markers include a Candida overgrowth, clostridia, a carnitine deficiency, fasting, or an increased consumption of fats.  For example, if someone is eating a low carbohydrate/high fat diet consisting of large amounts of medium-chain triglycerides (i.e. coconut oil [14]), then this can lead to elevated ketone and fatty acid oxidation markers.

What  Should You Do If You Have Elevated Ketone and Fatty Acid Oxidation Markers?

In most cases, having one or more slightly elevated ketone and fatty acid oxidation markers isn’t a concern.  However, if they are moderately or severely elevated then you will want to evaluate the glycolytic and mitochondrial markers, and address any mitochondrial dysfunction.  Sometimes the solution is to simply take 500 to 1,000 mg of acetyl-l-carnitine to help with fatty acid oxidation.

Nutritional Markers

Organic acids testing also measures certain metabolites related to nutrients.  This includes some of the B vitamins (vitamins B2, B5, B6, B12), biotin, vitamin C, and CoQ10.  You of course would want to correct any nutritional deficiencies you test positive for.

Indicators of Detoxification

A few of the markers under this category are linked to glutathione [15]status.  Elevated levels of pyroglutamic acid usually indicate a glutathione deficiency.  2-hydroxybutyric is another metabolite related to glutathione, and it is elevated when there is increased production of sulfur amino acids derived from homocysteine.  When either of these two markers are elevated it is a good idea to do things to increase glutathione production, although there can be other problems, such as a genetic polymorphism of the cystathione beta synthase (CBS) enzyme.

High levels of orotic acid can be an indication of ammonia excess, and is commonly associated with gut dysbiosis.  Elevated levels of 2-hydroxyhippuric can also be related to dysbiosis, although it can also be caused by the consumption of aspartame and salicylates.

What  Should You Do If You Have Elevated Detoxification Metabolites?

As I already mentioned, if someone has elevated levels of pyroglutamic acid or 2-hydroxybutyric then it would be a very good idea to do things to support glutathione production.  For more information on both food sources and supplements that can help to increase glutathione levels, please refer to an article I wrote entitled “Glutathione and Thyroid Autoimmunity [15]”.

Amino Acid Metabolites

These markers are related to inborn errors of metabolism, along with other metabolic imbalances.  Ideally you want these markers to be low.  Slight elevations usually aren’t a concern, although high levels of mandelic acid usually is caused by exposure to styrene, which is is widely used in the manufacture of synthetic rubber, resins, polyesters and plastics, and is carcinogenic (3) [16].

High Priority Markers

Just as is the case with any test, the goal is to correct any imbalances found.  But with the organic acids test, some imbalances are considered to be a greater priority than others.  For example, if someone has elevated clostridia markers and a Candida overgrowth, the clostridia is considered to be a higher priority than the Candida.  Don’t get me wrong, as the goal would be to address both of these problems.  But elevated clostridia markers and elevated oxalates are both considered to be the highest priority on this panel.

Who Should Order An Organic Acids Test?

I can’t say that I have all of my patients order an organic acids test, as I don’t think it’s necessary for everyone with a thyroid or autoimmune thyroid condition.  While some people choose to order this test initially to see what imbalances they might have, which may or may not be related to their condition, others won’t order this test unless if their health isn’t improving, which can be an indication that further testing is needed.

So hopefully you have a better understanding of the organic acids test.  Although I don’t recommend organic acids testing to all of my patients, in some cases it can be a very valuable test in helping to detect certain imbalances.  The organic acids test from Great Plains Laboratory evaluates yeast, fungal, and bacterial markers, oxalate metabolites, glycolytic and mitochondrial markers, neurotransmitter metabolites, pyrimidine metabolites, ketone and fatty acid oxidation metabolites, nutritional markers, indicators of detoxification, and amino acid metabolites.  While the obvious goal is to address any imbalances that are present, some markers are considered to be a higher priority than others, such as clostridia.