Episode - How To Lower Thyroid Antibodies


How To Lower Thyroid Antibodies

In this episode Dr. Eric discusses how people with Graves’ disease and Hashimoto’s thyroiditis can lower their thyroid antibodies.

During this episode you’ll learn:

  • Why some people develop thyroid antibodies
  • The most common type of food triggers
  • How chronic stress can trigger thyroid autoimmunity
  • Some of the environmental toxicants that can trigger thyroid autoimmunity
  • Which infections can play a role in thyroid autoimmunity
  • Other potential causes of elevated thyroid antibodies
  • How to address these triggers, which in turn can lower your thyroid antibodies
  • What to do if your thyroid antibodies don’t decrease

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Here is the transcript for this episode:

Welcome back to the Save My Thyroid podcast. This is Dr. Eric Osansky. In this episode, I am going to discuss how to lower thyroid antibodies. Just to let you know, some of the information discussed in this episode will be a review of a few previous episodes.

Let’s go ahead and start out by reviewing what are thyroid antibodies. An antibody is a Y-shaped protein that is part of an immune system response to an antigen. An antigen is a foreign substance that causes an immune response. Examples of antigens include pathogenic bacteria, food proteins, and environmental toxicants. These antibodies serve as a form of protection.

With autoimmunity, the antibodies bind to the body’s own tissues. As far as why some people develop thyroid antibodies, there are both genetic and environmental factors. Not everyone with a genetic predisposition to Graves’ or Hashimoto’s will develop these conditions even when exposed to an environmental trigger.

I also discussed something called the triad of autoimmunity in previous episodes. There are three components necessary for autoimmunity to develop. One of those components is a genetic predisposition. A second component is an environmental trigger. A third component is an increase in intestinal permeability, which is the medical term for a leaky gut. Also, a decrease in regulatory T-cells or T-regs as well as a loss of immune tolerance are associated with the development of thyroid autoimmunity.

I’m briefly going to mention the different types of thyroid antibodies. There are four main types: thyroid stimulating immunoglobulins, TPO antibodies (thyroid peroxidase), anti-thyroglobulin antibodies, and thyrotropin blocking antibodies. These are referred to as autoantibodies. Those with Graves’ will usually have thyroid stimulating immunoglobulins. Those with Hashimoto’s will typically have anti-thyroglobulin antibodies and/or TPO antibodies. I will say that it’s common for people with Graves’ to have TPO antibodies.

You could have multiple thyroid antibodies. Sometimes it gets confusing. I would say that it’s very common for me to see people with at least two of these thyroid antibodies, and it’s also common, although not as common, for me to see people with all three main types of antibodies. The thyrotropin blocking antibodies, I don’t talk about a lot because not all labs test for it, so I focus on the other three. For more detail on each of these antibodies, you could refer to episode #31.

Let’s dive into the details of how to lower your thyroid antibodies. As you know, most endocrinologists won’t give any recommendations to lower antibodies. Many will refuse to retest the thyroid antibodies. Every now and then, an endocrinologist won’t initially test the antibodies. The reason is because the treatment will be the same. If someone has hyperthyroidism, they will give antithyroid medication, radioactive iodine, or thyroid surgery. If someone has hypothyroidism/Hashimoto’s, the person usually will be put on thyroid hormone replacement. That being said, at least for hyperthyroidism, most endocrinologists will test the antibodies. For hypothyroidism, it depends on the practitioner.

In order to lower thyroid antibodies, I mentioned the triad of autoimmunity, where one factor was environmental triggers. You want to detect and remove the triggers. I also mentioned another factor was the leaky gut. You want to heal the gut. Then you want to correct other underlying imbalances. An example would be nutrient deficiencies. I wouldn’t necessarily say that it’s a trigger. Some refer to nutrient deficiencies as triggers. I refer to them as underlying imbalances.

I am going to discuss four main categories of autoimmune triggers. The first category is food. Second is stress. Third is infections. Fourth is chemicals or environmental toxicants.

As far as how we find these triggers, most practitioners will perform a comprehensive health history. You also want to do the appropriate testing. That’s what I do in my practice. Not all practitioners will do testing. Most will do some type of testing. Some will do applied kinesiology or muscle testing. I like different types of tests such as saliva testing or dried urine testing or a comprehensive stool panel. I’ll talk more about these.

Let’s start by discussing the first main category of triggers: food. Of course, most people are familiar with gluten as being a common allergen, and it is a potential trigger of thyroid autoimmunity as well as other autoimmune conditions. You hear it a lot with regards to both Graves’ and Hashimoto’s. Also, dairy could be a potential trigger. Corn is also a trigger.

When I bring up these triggers, this is according to the research. I am not going to bring up every food that could potentially be considered a common allergen. Not all common allergens are necessarily autoimmune triggers. According to the research, gluten, dairy, and corn have all been associated with thyroid autoimmunity as a potential trigger. Correlation doesn’t always mean causation.

Salt has also been shown to increase TH17 cells, which are associated with autoimmunity. Doesn’t mean you should avoid salt. I usually recommend for my patients to add some sea salt, like Celtic Sea salt, to their food. You just don’t want to overdo it. The problem is the processed salts. If you are eating a lot of packaged foods, refined foods, fast foods, then you are going to get a lot of sodium. That could potentially be at least a factor when it comes to autoimmunity. Once again, the research shows it’s not just a factor but a potential trigger.

I would tune into episode #21 if you want to hear me talk about other foods in greater detail. The four I mentioned here are the main triggers. In episode #21, I talk about eggs, nightshades, etc. Once again, as far as being autoimmune triggers, I wouldn’t consider eggs or nightshades to be triggers, but they do play a role in gut healing. If you eat nightshades, it can affect the permeability of the gut. Same thing with egg whites. They have compounds that can affect the permeability of the gut.

What I want to mention now is how do you know if food is a trigger? It could be challenging. There are a few different ways that practitioners use, including myself. For years, I’ve recommended an elimination diet to my patients. The way that works is you start out by eliminating common allergens and other foods. Autoimmune Paleo (AIP) diet is a type of elimination diet. After a period of time, you will start reintroducing certain foods. Let’s say 30-90 days later, introduce certain foods one at a time. Then you want to pay close attention to symptoms. It could be challenging at times. If you reintroduce a food and get a headache, there is no way to know for sure if that food was causing the headache, or maybe it was just a stressful day. You would want to eliminate that food, document you got the headache, and maybe try again a few weeks later to see if you get the same symptom.

There is also food sensitivity testing. I have never been a big fan in the past of this testing. I have been opening up a little bit more. Not to say I haven’t been open—I consider myself to be open-minded. With IgG food sensitivity, I just don’t find it to be reliable. That’s just not my experience. It’s the experience of many other practitioners though. That being said, some practitioners recommend IgG food sensitivity testing to every single patient. I won’t say there is right or wrong. Some tests are better than others. I have used Cyrex Labs in the past. If I were to choose a food sensitivity panel, that would be one company. Alletess is another one I have used.

More recently, I have been learning about mediator release testing (MRT). I have been experimenting with MRT. We’ll see how it goes. I had a few past podcast episodes where I chatted with practitioners who were using MRT and received great results. Like I said, I’m using it with some patients. It’s not something I’m requiring people to get done. I can’t say I’ve had a lot of people do it up until this point. I’ve had some, and it is very interesting. Whether or not it is more reliable or accurate than IgG testing, at this point, I’m not sure. I know there are some practitioners that combine elimination diet with a food sensitivity test. That’s something to consider because there is no perfect method.

When it comes to food, just to summarize, you not only want to avoid common allergens, but you want to try to eat organic whenever possible. We need to factor in things like pesticides in the food or glyphosate. Drink purified or spring water. I didn’t get into water here, but you want to be aware of some of the environmental pollutants in water.

Let’s move on to trigger #2, stress. Our body was designed to handle acute stress situations. The problem is that many of us, if not most of us, deal with chronic stress. Chronic stress causes dysregulation of the immune system and a pro-inflammatory state. That is how it could be a potential trigger of autoimmunity. Chronic stress also can cause a leaky gut. There is a marker called secretory IgA. It’s not a specific leaky gut marker. There are other markers such as zonulin. Cyrex Labs has an intestinal permeability test, which includes zonulin and other markers. There is a lactulose mannitol test. I can’t say I find all of these to be reliable. Chronic stress will decrease secretory IgA, which can make someone more susceptible to a leaky gut.

How do you know that stress is a trigger? It’s not always easy. When I dealt with Graves’, stress definitely was a trigger, but at the time, I honestly didn’t know. I was in denial that stress was a trigger. In my situation, I did an adrenal saliva test and saw that my adrenals were in pretty bad shape. My cortisol was low, and my DHEA was low. Pretty much everything was low. My secretory IgA was low. I thought back and realized stress was a factor. It’s not that I was in denial that I had dealt with chronic stress, but I thought I did a good job of handling the stress. When I looked at my saliva test, I realized that wasn’t the case.

There is always dried urine testing. I still recommend a lot of saliva testing, but I also do dried urine testing. A specific test is the Dutch test. That is the most popular of what’s out there. One way is doing testing. That is really the only way to see it on paper. That’s the only way to know if you have adrenal imbalances.

In my situation, I had low cortisol levels. If someone has high cortisol levels, most people, if not everyone, needs to work on stress handling. What I advise my patients to do, and I’m advising you as well, is to block out time every single day for stress management. Even if you don’t feel stressed, still do 5-10 minutes. In fact, if you’re not doing anything, I would say only start out with five minutes. You want to get into the routine of blocking out time for stress management.

While there might be some people listening to this who are gung-ho and feel like they will be able to block out 30 minutes per day, I would say just to play it safe and do five minutes a day. Just about everyone can block out five minutes per day. Once you’re in the routine of blocking out time, you can gradually increase the duration to 10 minutes, 15 minutes. I will say that some days, you could do more.

Currently, if you’re already blocking out time 2-3 days a week to do yoga or meditation, the other days of the week, block out five minutes those days. Continue your routine of yoga and meditation or whatever you’re doing the other days. Do at least five minutes per day. If you could do more, that’s great.

Trigger #3: environmental toxicants. I’m guilty of using the word “toxins,” and I might slip and say it here. When we look at these external chemicals, these man-made chemicals, they are really toxicants. If we talk about mold and mycotoxin, that is more natural. The artificial man-made chemicals are toxicants. Something more natural like mold is a toxin. We live in a toxic world obviously. It’s only getting worse. There are many different environmental toxicants, including heavy metals, pesticides, BPA, parabens, PBDEs, solvents. We want to do what we can to minimize our exposure to them.

How can you tell if environmental toxicants or toxins or chemicals are a trigger? First of all, there is assumption. You could assume that if you’re being exposed to a certain chemical frequently, it may be a trigger. Testing is an option, too. The downside of testing is you can’t test for everything. When there is testing, there is different types of testing. You could test for levels. Hair testing, which I have done in my practice. Urine testing. Even blood testing. This could be valuable.

If you are testing for heavy metals in the hair or urine, if someone has real high levels of mercury or aluminum or lead, of course, that’s not a good thing. Not everybody responds to these environmental chemicals the same way. That’s why there are now tests that look at the immune system response. Cyrex Labs has their own test. It looks at the immune system response to not only some heavy metals but other environmental toxicants such as bisphenol A, formaldehyde. If someone’s test shows that their immune system is reacting to a certain chemical, you want to do everything you can to minimize your exposure to that chemical.

There is no way of testing for all toxicants. I’m sure there are many tests out there, but another one I am familiar with is from Great Plains Laboratory. I can’t say I use it on all patients because it’s not perfect. It’s great to give a general idea of what types of toxicants you’re exposed to, but it’s not perfect. Sometimes it’s challenging to find the source of exposure. There is no test that looks at everything.

As far as how to deal with these environmental chemicals, you want to do everything you can to reduce your toxic load. You want to eat organic whenever possible. Use natural cleaners and cosmetics. Even natural furniture. I can’t say I have all natural furniture in my home. I do have a natural mattress. I do recommend next time you get a mattress, look into getting a mattress such as an Avocado mattress or Naturepedic. When you sleep, you’re in bed for hopefully at least six, seven hours. More than that would be even better. You’re in bed for at least a quarter of your life, hopefully a third of your life, sleeping. You don’t want to be exposed to any chemicals while sleeping. Or at least minimally. I wouldn’t go crazy.

If you’re using a regular mattress, don’t stress out about it. For years, I had a regular mattress as well, and eventually I switched to an Avocado mattress. I recently learned I have an Avocado pillow as well. I completely forgot. I was doing another interview. During the Q&A, someone asked about pillows. I completely forgot that I had an Avocado pillow. My wife listened to the episode, and she reminded me.

You want also to increase your elimination of toxins. Not only minimize your exposure. An air purification system is a great method. We have a few in our home, one in our office. We use Blue Air. IQ Air is another one. There are other good brands, too.

You want to try to detoxify through food, certain supplements such as n-acetyl cysteine, or taking a liposomal or acetyl glutathione supplement. Many have heard of milk thistle.

Sweat and sauna is another good way. If someone is dealing with hyperthyroidism and has high hormone levels with an elevated resting heart rate, I would probably say not to go into a sauna right now. When I dealt with Graves’, I didn’t do sauna therapy. For the last several years, we got our sauna around 2014/2015, I have been doing it.

There are other ways like colon hydrotherapy, coffee enemas. I can’t say I do those, but those are options to consider.

The fourth trigger category is infections. Bacteria, viruses, parasites can all be potential triggers. That includes gut infections such as H-pylori, which is a real big trigger when it comes to both Graves’ and Hashimoto’s. As far as viruses, Epstein-Barr is the most well-known. There is parvovirus. Even our most recent virus, COVID-19, has been shown in the literature to be a potential trigger of hyperthyroidism especially. There is some evidence for Hashimoto’s, but it has been shown to be a trigger of Graves’ and also subacute thyroiditis. I do have a separate Q&A episode where I discuss that. There are stealth infections. Many of you are familiar with my experience with chronic Lyme in 2018. Thankfully, it did not retrigger my Graves’ condition, but it can potentially be a trigger in some people. Bartonella can be a potential trigger, which I also dealt with.

There are parasites like blastocystis hominis. When it comes to thyroid autoimmunity, mainly because there are a few case studies that show the association with Hashimoto’s. I have seen it with both Hashimoto’s and Graves’ patients.

As far as detecting infections, some of these you can look at in the blood, whereas others, you want to do a stool test. H-pylori, there are three different ways: blood, stool, and a breath test. I like doing a comprehensive stool panel; the GI Map is what I currently use. That looks at H-pylori in great detail. The urea breath test is okay as well. There is a stool antigen test. There is no perfect test, but I find the one from GI Map to be the most accurate because it is DNA-based.

Blood testing for viruses, like Epstein-Barr and cytomegalovirus, parvovirus. In Lyme disease, bartonella and coinfections can be tricky. Blood testing can be done at a regular lab, but false negatives are common. Same thing with parasites. You want to look at them in the stool, but it can be tricky to find them. If you do a stool test, and you have parasites, then you have them and want to address them. If it’s negative, it doesn’t completely rule out parasites.

When it comes to other triggers, I won’t go into great detail here. Estrogen dominance can be a potential trigger. I mentioned dried urine testing earlier; that is a great way of looking at estrogen metabolism as well as estrogen levels, which you can also look at elsewhere. I mentioned mycotoxins earlier. There is a urinary mycotoxins test at a few different labs.

I won’t go into detail about iodine here, but iodine potentially can be a trigger of Graves’ and Hashimoto’s. Some people do extremely well with iodine though. In the past, I did great with iodine. I am not saying iodine is all bad, but you do want to be cautious with it. I’m not suggesting for you to do a test, but I know some people might wonder how to test for it. There is no perfect test. In my opinion, looking at iodine in the urine is more accurate than blood. Still not perfect, but that’s another potential trigger.

The 5R protocol is something else I want to briefly discuss here. I did mention this in at least one past episode. With the 5R protocol, these consist of five components, five R’s that are necessary to address in order to heal your gut. Remove is food such as gluten or infections or chemicals. Replace things like digestive enzymes or stomach acid. Reinoculate with prebiotics and probiotics. Repair with bone broth or cabbage juice if you are vegan/vegetarian. Rebalance your parasympathetic nervous system by taking hot and cold showers or vigorous gargling, even just mind/body medicine.

Some might ask, “Should you test for a leaky gut?” I briefly mentioned leaky gut testing earlier. I used to do a lot of this testing through Cyrex. I saw just about everyone had a leaky gut. Even when it was negative, I would question if it was a true negative. According to the triad of autoimmunity, everyone with an autoimmune condition should have a leaky gut. Over the last few years, I’ve just assumed they do have one. That is the approach many practitioners take.

Sometimes, when someone does a comprehensive stool panel, they will add zonulin. I don’t find that to be accurate. Most of the time, I see that it’s negative. That’s not why I conclude it’s not accurate. The research is iffy as well when it comes to zonulin. If you do zonulin and it’s elevated, then you probably have a leaky gut. If it’s negative, it doesn’t necessarily rule out a leaky gut.

What can you do if your antibodies don’t decrease? If that’s the case, you want to think about whether the environmental trigger(s) haven’t been found. Or maybe they have been found but haven’t been removed. You might need to do more detective work. You might need to do more testing. You might need to do retesting to see if what you suspect to be the current environmental trigger has been removed.

If you have H-pylori, you follow a protocol for two months. Probably a good idea to retest. I say two months because that’s how long it takes with a natural protocol. If you take antibiotics for 10 days or two weeks, same thing. Eventually you want to retest to make sure it has been eradicated.

Autoimmune response hasn’t been suppressed. Maybe you removed the trigger, but you might need to do things to suppress the inflammatory component. The AIP diet could potentially help, but usually that’s not enough. You have to get a little more aggressive. Taking high-dose EPA/DHA as part of your Omega-3s can help. Making sure you have healthy Vitamin D levels is important. Greater than 50 ng/l. Turmeric or resveratrol can also potentially help. Another factor could be the gut hasn’t been healed. Refer back to that 5R protocol.

Low-dose naltrexone (LDN) is something that might suppress that inflammatory component. I like LDN, but it is a medication, so I can’t say it is something I commonly recommend. When I say I like it, I like it as an alternative if nothing else is working. It’s not addressing the cause of the problem. It may calm down the immune system, break that inflammatory cycle. That’s possible.

Getting back to not healing the gut, you need to remove the factor that caused the leaky gut. A lot of people will drink bone broth or do other things, but they are not removing the factor in the first place. A lot of people will go gluten-free, but many times, you need to do more than that. Maybe other compromised areas have not been addressed. That also might be a reason why your antibodies don’t decrease.

I mentioned nutrient deficiencies as being an underlying imbalance. They’re not a trigger, but if you’re deficient in selenium, magnesium, other nutrients, then that could also be a reason. Selenium is important for regulatory T-cells. I mentioned earlier how they are a factor with autoimmunity. Other nutrients also play a role when it comes to having heathy levels of regulatory T cells. Those keep autoimmunity in check.

What is the deal if one antibody decreases, but another one increases? I mentioned it’s not uncommon to have multiple antibodies. Sometimes we see one antibody increases, and another one decreases. Just keep in mind that different antibodies can have different triggers. You might have removed one trigger, but you might have one or more additional triggers. That is usually what that indicates. Sometimes it’s hard to tell. Sometimes the body is a little bit complex, so you can’t always rely on a single blood test. Sometimes you need to do another one to see if it’s following that same pattern.

I would recommend working with a natural health care practitioner, especially if you’re doing things on your own and are not seeing things head in the right direction. I have a lot of experience working with people with thyroid and autoimmune thyroid conditions, especially hyperthyroidism and Graves’. There are other practitioners out there as well. If you are not getting the results you want when it comes to antibodies, consider working with someone. A lot of people who see me have already seen other practitioners. You might need to see multiple. Not all of them are the same. If you work with a functional medicine practitioner, and it’s not helping with the antibodies, don’t be afraid to get a second opinion.

That’s pretty much all I want to discuss with regard to lowering thyroid antibodies. As usual, I hope you found this episode to be valuable, and I look forward to catching you in the next episode.