Thyroid Antibodies: What You Need To Know
Elevated thyroid antibodies are characteristic of both Graves’ disease and Hashimoto’s thyroidits, and in this episode Dr. Eric discusses what you need to know about thyroid antibodies.
During this episode you’ll learn:
- What are thyroid antibodies, and why do some people develop them?
- The four different types of thyroid antibodies
- The significance of negative thyroid antibodies
- How to lower your thyroid antibodies
- What to do if your 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 the different types of thyroid antibodies. I will also briefly discuss how to lower thyroid antibodies.
Let’s begin by answering the question of 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, chemicals. With autoimmunity, the antibodies bind to the body’s own tissues, but they don’t actually cause damage.
Why do some people develop thyroid antibodies? There are both genetic and environmental factors. Not everyone with a genetic predisposition to Graves’ Disease, Hashimoto’s, or a different autoimmune condition will develop whatever autoimmune condition we’re discussing, even when exposed to an environmental trigger.
There is the triad of autoimmunity, which I have discussed in at least one pervious episode. There are three factors necessary for autoimmunity to develop. There is that genetic predisposition; exposure to one or more environmental triggers; as well as an increased intestinal permeability, which is the medical term for a leaky gut. Also, in order for autoimmunity to develop, you need a decrease of regulatory T-cells or T-regs. These help to keep autoimmunity in check, to suppress autoimmunity. You also need a loss of immune tolerance.
Let’s discuss the different types of thyroid antibodies. There are four main types of thyroid antibodies. There are thyroid stimulating immunoglobulins (TSI), thyroid peroxidase antibodies (TPO), thyroglobulin antibodies, and thyrotropin blocking antibodies. These are referred to as autoantibodies. It’s also common to have multiple antibodies. I see this all the time with my patients. I see some that have two thyroid antibodies. They might have TSI as well as TPO. There are people who have three different types of thyroid antibodies. It is very common to have multiple thyroid antibodies.
What I’d like to do now is discuss each of the four types of antibodies, starting with thyroid stimulating immunoglobulins. Thyroid stimulating hormone receptor, this is mainly found on the surface of thyroid follicular cells. The TSI binds to this receptor and stimulates the overproduction of thyroid hormone. TSI is a type of thyrotropin receptor antibody or TSH receptor antibody, also known as TRAB. On a blood test, you will see TRAB. TSI is the most common type of TRAB. These TSIs are associated with Graves’.
Then there is TPO antibodies. TPO is an enzyme that is vital in the production of thyroid hormone. It also might be called anti-TPO antibodies on some labs, or it will be spelled out as thyroid peroxidase antibodies. These are the most common type of thyroid antibody. They are present in over 90% of people with Hashimoto’s as well as 60-80% of people with Graves’. This does depend on the source. Some sources say that it’s actually greater than 80% of people with Graves’. Either way, they are very common. A little bit more common in Hashimoto’s. When I dealt with Graves’, I only tested positive for the TSI; I did not have any other antibody. But I do see a lot of people with positive TSI as well as elevated TPO antibodies.
These TPO antibodies are associated with destruction of thyroid follicles, so people with these are likely to become hypothyroid if the autoimmune response isn’t addressed. Of course, it takes time for this to happen, so this usually isn’t going to happen in a manner of weeks or even months. It does usually take years for this to happen, but it’s something to keep in mind, which is why you want to address that autoimmune response.
The third different type of thyroid antibody I’d like to discuss is thyroglobulin antibodies. Thyroglobulin is a glycoprotein that is secreted by thyroid follicular cells and stored in thyroid follicles. These antibodies are more commonly associated with Hashimoto’s. One source did show that 30% of Graves’ patients will test positive for these as well. I’m not sure if it’s that high in my patients; I don’t keep track of the percentage of these antibodies, but I’d probably say maybe around that, maybe a little bit lower. 20%, if I had to guess.
On a blood test, you will usually ask to test for thyroglobulin antibodies, or anti-TG antibodies. When testing in the blood, it’s important to understand that not only can you test for thyroglobulin antibodies, but you can test for thyroglobulin. That is the glycoprotein, and then there is the antibody, which means the immune system is attacking and damaging the thyroglobulin.
Elevated thyroglobulin levels can be an indication of an iodine deficiency, rarely thyroid cancer. Also, they could elevate when someone has thyroglobulin antibodies. It wouldn’t be a big surprise to see elevated thyroglobulin as a result, but an iodine deficiency can also be a cause. If you do have elevated thyroglobulin levels, I would not panic. It probably doesn’t mean cancer, but if the levels are really high, it’s still something you might want to run by a doctor.
Lastly, there are thyrotropin blocking antibodies. This is one I usually don’t test for. A big reason is because most labs don’t offer this. Rarely does a lab offer this type of test. The thyrotropin blocking antibodies block the TSH receptor to prevent TSH from binding. This in turn results in hypothyroidism, so it’s not one I commonly see. Unless LabCorp or Quest Diagnostics, those are some of the more well-known labs within the United States, recently started testing for these, I’m pretty sure they don’t offer this. I have seen some lesser-known labs test for these.
Now I’d like to discuss the significance of negative antibodies. Not everyone who has Graves’ or Hashimoto’s will have positive thyroid antibodies. As a result of what I just said, having negative thyroid antibodies does not always rule out having Graves’ or Hashimoto’s. Thyroid antibodies are what’s called the immunoglobulin G or IgG class. Some people might have depressed IGG levels, which can result in a false negative result.
The good news is that you can test for serum IgG in most labs. That’s something to consider. I can’t say that I have everyone test for serum IgG. If someone is suspecting that they have Graves’ or Hashimoto’s, and the antibodies are negative, then maybe they should test for serum IgG. Also, a thyroid ultrasound might provide some answers. Usually, it won’t be diagnostic of Graves’ or Hashimoto’s, but it can provide some additional information.
In the case of Graves’, there is something called the radioactive iodine uptake test, which is commonly used as a diagnostic tool for Graves’. I have an episode I dedicated to the radioactive iodine uptake test. I will say I’m not a huge fan of this test. If someone tests positive for the TSI, you don’t need the uptake test to diagnose Graves’. There are other purposes of the radioactive iodine uptake test. I won’t get into detail here. You can tune into that episode.
I’d like to briefly discuss how to lower your thyroid antibodies. I’m not going to spend too much time here. I will have a future episode where I go into greater detail on how to lower thyroid antibodies.
Keep in mind that most endocrinologists won’t give any recommendations to lower your antibodies. A lot of them will be hesitant to test for thyroid antibodies. Most of them will test them initially, so if you have Graves’, they will test the TSI or TRAB. If someone has hyperthyroidism in the presence of the TRAB, that is pretty much diagnostic of Graves’, even though TSI is not the only type of TRAB. Most endocrinologists will test the antibodies.
Actually, it’s interesting, in the case of Hashimoto’s, many times they will not test the antibodies. If someone is hypothyroid, the treatment is typically the same: thyroid hormone replacement. If someone has elevated TSH levels, regardless of what the thyroid hormone levels look like, they will usually be put on thyroid hormone replacement, and the antibodies aren’t going to change that. But if they do test the antibodies, they are not going to do anything to improve the health of the immune system, which in turn can help to lower and normalize the antibodies. Many will refuse to retest the thyroid antibodies.
At least for hyperthyroidism, most of them will test the TSI or TRAB. For Hashimoto’s, they may or may not. But when they do test for the antibodies initially, many will refuse to retest the thyroid antibodies. The reason for this is because they are not doing anything to address the autoimmune component of Graves’ and Hashimoto’s. They figure it’s worthless to retest those thyroid antibodies. Some of my patients will be successful in talking them into doing a retest. It probably won’t be every single time. Every now and then, there will be an exception, and an endocrinologist will test them all the time. Often, it is a struggle to get an endocrinologist to retest those antibodies.
What you want to do when it comes to lowering thyroid antibodies is refer back to that triad of autoimmunity. You have the genetic predisposition, which of course you can change, but the good news is that those other two components—the exposure to one or more environmental triggers and the leaky gut—are extremely important. If you address those two, you can get into remission, whether you have Graves’ or Hashimoto’s or a different type of autoimmune condition. Detecting and removing the environmental trigger(s) is important. Healing the gut is extremely important.
Also, correcting other imbalances. For example, this won’t fall under the category of triggers, but it still is important to correct certain nutrient deficiencies. An example is selenium. Any nutrient deficiency is important to eventually correct. In a previous episode, I discussed the four categories of Graves’ Disease triggers. This applies to Hashimoto’s as well. Food could be a trigger. Stress could be a trigger. Infections could be a trigger. Chemicals could be a trigger. As of recording this episode, we have a few episodes on all of these triggers, but there will definitely be more episodes in the future which go into greater detail on these different categories of triggers.
When it comes to detecting these triggers, with food, of course, you could do an elimination diet. Some practitioners will do food sensitivity testing. Just about all practitioners will do a comprehensive health history. I like to do testing. I like to do certain testing. I don’t go overboard with the testing. I do what I feel is necessary. In my practice, I use testing to detect triggers.
In a previous episode, I discussed the 5R protocol, which is important when it comes to healing the gut. The first component is Remove. A lot of people skip over this component. They will go through the other four components, which are Replace, you could replace digestive enzymes, stomach acid in the form of betaine HCL or apple cider vinegar; Reinoculate with prebiotics and probiotics; Repair, things like drinking bone broth or cabbage juice or taking L-glutamine; and Rebalance the parasympathetic nervous system. You want to incorporate all five of these components.
A lot of people won’t focus on remove. For example, if gluten is causing a leaky gut, obviously you need to remove gluten from your diet. If an infection such as H-pylori or a parasite is causing that leaky gut, you need to eradicate the infection. You need to incorporate all of these components. As I mentioned, a lot of people will just take probiotics and digestive enzymes or drink bone broth or take L-glutamine, but they won’t focus on removing what is causing the leaky gut.
You might wonder what to do if your antibodies don’t decrease. Some people listening to this have likely tried what I mentioned, and they haven’t decreased. If they haven’t decreased, the environmental autoimmune trigger might not have been removed. It might not have been detected. You might need to do more testing for example, or maybe if you had an infection and followed a protocol, maybe the protocol didn’t do the job of eradicating the infection. You need to find and remove the trigger.
Also, the autoimmune response maybe hasn’t been suppressed. Most of the time, when you remove the trigger, that will suppress the autoimmune response, but that isn’t always the case. Sometimes you need to do other things to suppress that autoimmune component, to suppress the inflammatory component.
The autoimmune paleo diet is something I give as a starting point to many of my patients. It’s not a perfect diet. There is no perfect diet that fits everyone. An anti-inflammatory diet can help. Many times, people need to take certain supplements such as Omega-3 fatty acids. Make sure they have healthy Vitamin D levels. Things like turmeric, resveratrol. Sometimes they need to take higher doses than what is indicated. You don’t want to go crazy and overdose. That’s why it’s a good idea to work with a health care practitioner.
Also, LDN, which I have discussed as well, is not a natural supplement. This is a medication, but LDN sometimes can help to suppress that autoimmune component. If you’re taking LDN, it should be temporary, even though some people do take it long-term. You don’t really want to take this on a permanent basis ideally. If someone can’t find the autoimmune trigger and remove it, then I guess in some cases, taking it on a long-term basis is okay, but that’s not ideal.
The gut. If the antibodies haven’t decreased, maybe you found and removed the trigger(s), but you haven’t completely healed the gut. Go through that 5R protocol that I mentioned. Speaking of that protocol, you need to remove the factor that caused the leaky gut. All five of those components are important. Many people skip over that first R.
Another reason why antibodies might not decrease may be other compromised areas have not been addressed. I mentioned earlier nutrient deficiencies. It gets complex. Even when working with a natural health care practitioner can be challenging, but it’s definitely more challenging trying to do this on your own.
Let’s summarize what I discussed in this episode. There are four main types of thyroid antibodies. It’s common to have multiple thyroid antibodies. Having negative thyroid antibodies doesn’t always rule out Graves’ and Hashimoto’s. It can be challenging to normalize the thyroid antibodies, which is why it’s a good idea to work with someone.
Of course, you could do things from a dietary standpoint on your own. You can change your lifestyle, like stress management techniques, on your own. Even though diet and lifestyle are a key piece of restoring one’s health, doing these alone, cleaning up one’s diet and managing stress, as important as these are, doing these alone usually won’t get the person into remission. That’s why we need to dig deeper. You need to detect and remove the environmental trigger. Healing the gut by following the 5R protocol.
That’s all I want to discuss when it comes to thyroid antibodies. I hope you learned a lot. I look forward to catching you in the next episode.