Attaining a healthy level of thyroid autoimmune antibodies
Attaining a healthy level of thyroid autoimmune antibodies
The thyroid is something that is often the source of many health problems. Hypothyroidism is the most common thyroid disorder in Australia, affecting around 1 in 33 Australians. It is more common in women than men, and in those aged more than 60 years.(1) Thyroid autoimmune antibodies develop when a person’s immune system mistakenly targets components of the thyroid gland or thyroid proteins, leading to chronic inflammation of the thyroid (thyroiditis), tissue damage and/or disruption of thyroid function.
Laboratory tests detect the presence and measure the quantity of specific thyroid autoantibodies in the blood. If elevated antibodies are found, this indicates the presence of a thyroid autoimmune disorder, usually Hashimoto’s Disease.
So, what is a healthy level of thyroid antibodies and if you have an elevated level of antibodies, how can you reduce them?
About the thyroid
The thyroid is a small, butterfly-shaped gland that lies flat against the windpipe in the throat. The primary hormones that it produces, thyroxine (T4) and triiodothyronine (T3), are vital in helping to regulate the rate at which the body uses energy. The body uses a feedback system in which thyroid stimulating hormone (TSH) stimulates the thyroid to produce T4 and T3 as needed. This system helps maintain a relatively stable amount of the thyroid hormones in the blood.
When thyroid antibodies interfere with this process, they can lead to chronic conditions and autoimmune disorders associated with hypothyroidism or hyperthyroidism, such as Graves disease or Hashimoto thyroiditis.
What are the most common thyroid antibodies?
- Anti-thyroperoxidase (TPO) antibodies
- Thyroid stimulating hormone (TSH) receptor (TSHR-Ab) antibodies
- Anti-thyroglobulin (anti-Tg) antibodies
Anti-thyroperoxidase (TPO) Antibodies
The most common thyroid antibodies attack thyroid peroxidase. Also called thyroperoxidase, this enzyme functions in the thyroid gland to help produce the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
Autoimmune antibodies can interfere with TPO’s ability to use iodine to produce these hormones, resulting in hypothyroidism. TPO antibodies cause inflammation, can eventually destroy all or part of your thyroid gland and can also cause your thyroid gland to form nodules or to become enlarged.
The presence of anti-TPO antibodies is associated with pre-term labour and with Hashimoto’s thyroiditis, an autoimmune thyroid condition.
It can take time for the destructive effect on your thyroid gland to be reflected in your thyroid-stimulating hormone (TSH) level. It’s not uncommon to have positive TPO antibodies for months or years before your TSH level rises to a point where you are diagnosed with hypothyroidism. It’s important to mention, as well, that some people never progress to being hypothyroid, despite having positive TPO antibodies.
Thyroid Stimulating Hormone (TSH) Receptor (TSHR-Ab) Antibodies
TSH, a hormone released by the pituitary gland in the brain, stimulates the thyroid gland to make thyroid hormone. TSH initiates this process by binding to TSH receptors on the thyroid gland. TSH receptor antibodies (TSHR-Ab) can imitate the action of TSH, causing excess thyroid hormone production. High TSHR-Ab levels are associated with Graves disease, an autoimmune condition that usually causes hyperthyroidism.
Anti-thyroglobulin (Anti-Tg) Antibodies
Thyroglobulin (Tg) is a protein that helps the thyroid gland function properly. Anti-Tg antibodies are associated with Hashimoto’s thyroiditis.
What is a healthy level of thyroid antibodies?
Not everyone who has thyroid antibodies is hypothyroid, but most people with elevated TPO or TG antibodies eventually become hypothyroid if the antibodies are left entirely unchecked.
The levels recognised as healthy are:
- TPO antibody: The measured serum level should be less than 30 IU/mL.
- Anti-Tg antibody: The measured serum level should be less than 4 IU/mL.
- Thyroid-stimulating immunoglobulin antibody (TSI): This value should be less than 1.75 IU/L. (2)
However, a 2016 study published in the Journal of Hormone and Metabolic Research found: (3)
- Those who had TPO antibodies below 500 IU/mL had a low risk of future progression to hypothyroidism.
- Those who were above 500 IU/mL still only had a moderate risk.
Which means that there is low risk of progressing to hypothyroidism if TPO antibodies are at or below 500 IU/mL. Those with elevated TPO antibodies have a 9-19 chance of becoming hypothyroid after six years of follow up so elevated thyroid antibodies are not as consequential as we may have thought. This study suggests that you don’t have to continuously pursue lower levels of antibodies with strict diets or supplements, especially if your thyroid is working well. (4)
So, what should you do be doing to keep your thyroid antibodies in check?
Patients with hypothyroidism are typically given a thyroid replacement hormone as medication although some people still experience low thyroid symptoms despite medication and “normal” lab results. The reason is that many thyroid problems are not actually problems of inadequate thyroid hormone.
How can you reduce your level of thyroid antibodies naturally?
Supplements to lower thyroid antibodies
There are a number of supplements that have been shown to be effective through various studies to lower thyroid antibodies. Be sure to check with your doctor that it is the right supplement and dosage for you, as some may cause the reverse of the intended effect.
There is a proven relationship between low vitamin D levels and the incidence of Hashimoto’s thyroiditis and Graves’ disease. More recently, however, researchers have shown that even eight weeks of vitamin D therapy can significantly reduce thyroid antibodies. (5)
The mineral selenium has been shown in numerous studies to reduce thyroid antibodies. In some cases, the impact on antibodies is significant enough to restore patients to the normal TSH reference range without prescription treatment. Selenium is not easy to get from the diet, (the richest source of selenium is Brazil nuts), so supplements may be necessary. A caution: You should not exceed 400 mcg of selenium per day from all sources, including food and supplements because higher levels can cause toxicity.
Melatonin, a hormone produced by the pineal gland, plays a key role in your immune system and has both anti-inflammatory and immunomodulatory effects. Some practitioners include melatonin in autoimmune disease treatment because of its adaptogenic abilities. Melatonin can stimulate your immune system when needed or calm an overactive immune system. Supporting the melatonin and serotonin pathway indirectly rather than supplementing melatonin is also a great way to prove the thyroid and body support.
CoQ10 & Magnesium
Some evidence suggests CoQ10 and Magnesium supplementation may reduce thyroid antibodies. CoQ10 has been shown to “improve thyroid vascularity,” and magnesium supports iodine uptake. One small study demonstrated supplementation with magnesium, CoQ10, and selenium along with additional supports reduced thyroid antibodies, while one additional study showed an association between low serum magnesium and thyroid antibodies.
Worldwide, iodine deficiency is the most common cause of hypothyroidism.(6) Optimizing your iodine levels may reduce thyroid antibodies but must be used cautiously. Supplemental dietary iodine has been shown in several population-based studies to increase the incidence of autoimmune thyroid diseases but too little iodine can also cause thyroid symptoms. Iodine should not be administered without strict supervision to those with autoimmune thyroid conditions, many studies show a worsening effect of the thyroid with iodine supplementation.
Improve your gut health with dietary changes
A number of dietary changes, with a focus on improving your gut health, can reduce thyroid antibodies. The challenge is determining which ones might work for you.
Start with four key steps:
- Identify your allergies and food sensitivities. This may involve blood tests, or a rotation diet to evaluate your sensitivity to common triggers such as dairy, wheat, sugar, soy, and sulphur in foods, among others. Specifically, you should be evaluated for gluten and wheat sensitivity, as this is a common trigger in people with autoimmune thyroid disease.
- Follow a diet that eliminates your triggers and incorporates anti-inflammatory foods. Even when specific triggers, allergies, and sensitivities have not been demonstrated, some autoimmune patients have lowered antibodies and resolved symptoms by following specific diet programs, including:
- A gluten-free diet
- A Low-FODMAP diet
- The Autoimmune Protocol (AIP) diet
- Treat gut infections such as H.pylori, SIBO (small intestinal bacterial overgrowth), and Blastocystis Hominis are associated with elevated thyroid antibodies. Treating these infections may reduce thyroid antibodies.
- Probiotics are the “good” bacteria found in a number of fermented foods like yogurt, sauerkraut, kimchi, miso, and kombucha, as well as in supplements. Numerous studies have found that increasing the intake of probiotics enhances the immune system and addressing gut inflammation and imbalances of bacteria may help reduce autoimmune activity.
Lifestyle changes to lower antibodies
According to research regarding stress and autoimmunity, stress reduction interventions can have a positive therapeutic effect in autoimmune disease patients, improving your quality of life, reducing symptoms, and in some cases, reducing antibodies. Stress reduction interventions are more than just “relaxing,” however. You need to develop strategies to reduce your overall load of stress, cope with the inevitable stress you face, eat and sleep well, and incorporate a daily activity that physiologically generates your relaxation response.(7)
There are some encouraging data showing that low-level laser therapy can improve thyroid function and decrease TPO antibodies. A randomized clinical trial was performed to evaluate the efficacy of low-level laser therapy for hypothyroidism induced by chronic autoimmune thyroiditis and found it to be safe for the treatment of hypothyroidism.(8)
How Functional Medicine can help you
At Advanced Functional Medicine, our functional approach is to address the underlying imbalances that can contribute to hypothyroidism and Hashimoto’s disease.
We will test your antibody, immune, gut and endocrine function to get a complete picture of your health. After these tests, we will formulate a comprehensive and customized treatment plan specifically tailored to you and your body’s needs.
We always aim to address the root cause of your health challenges. By addressing the primary cause of an imbalance, as well as providing alternative care to mitigate symptoms and additionally support you in your healing process, we bring your body into balance gradually. Autoimmune disease of the thyroid isn’t just about getting your TSH tested once a year and adjusting your thyroxine accordingly.
Autoimmunity is a whole body systemic dysfunction that needs to be treated as such to allow the body to heal. Removing triggers, pathogens and bacteria’s, correcting gut imbalances, nutrient deficiencies, methylation, diet and lifestyle, sleep and a range of other areas are the approach we take.