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The awareness of thyroid disease is at an all time high. Most people who see functional medicine practitioners are given full screens for thyroid disease and many of them end up with positive antibodies. These people are often not sure what these antibodies mean to their thyroid function or general health.
This is an important finding but one that leads to much confusion and uncertainty. This blog will cover the top 7 misconceptions and close with some effective action steps.
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Question #1 What are thyroid antibodies?
Thyroid antibodies are immune cells which bind to structures within or outside the thyroid. These cells can cause other immune cells to attack the thyroid structures leading to cell death or a change in thyroid function.
There are many ways the immune system can affect the thyroid, most of these reactions are not measurable in commercially available blood tests.
The most common two antibodies that are measured include antithyroglobulin (anti-Tg) and antithyroid peroxidase (anti-TPO).
Antithyroglobulin attacks thyroglobulin. It is the protein on which iodine attaches in order to make thyroid hormones.
Antithyroid peroxidase attacks thyroid peroxidase. This is the enzyme that oxidizes iodide into iodine so that iodine can attach to thyroglobulin.
Given the role of iodine in both of these reactions, it becomes clear how too much of it can cause and worsen thyroid autoimmunity.
Question #2 Do thyroid antibodies affect your health apart from your thyroid?
Here is an important distinction. Positive thyroid antibodies can lead to thyroid disease and thyroid disease can affect many facets of your health. Many people with positive antibodies have stable thyroid levels either because they are on thyroid medication or because their thyroid is still working fine.
Can thyroid antibodies affect you even if your thyroid is dialed in?
Yes. Even in those with good thyroid levels, thyroid antibodies can predict symptoms like fatigue and hair loss, infertility, and heart disease.
One study compared the symptoms of two groups of people who were on thyroid medication. Both groups had healthy thyroid levels, but one group had higher antibody levels than the other. Those with the high antibodies had higher rates of several troublesome symptoms including changes to hair and voice as well as fluid retention1.
Positive thyroid antibodies can lower fertility, even in women with normal thyroid levels2.
If thyroid medication did not help, would other treatments that lowered thyroid antibodies help fertility? It might. One study lowered thyroid antibodies in hopes of improving in vitro fertilization odds.
Those treated did have better chances of conception and successful pregnancies.
Thyroid disease relates to heart disease. It is well established that abnormal levels of thyroid hormones in either direction can be harmful to the heart and circulatory system.
A recent study looked to see if antithyroid peroxidase antibodies related to cardiovascular risk in those with normal thyroid function.
The results showed that:
“TPO-Ab range was found to be significantly positively associated with atherosclerosis in eu-thyroid participants and in those participants with normal TSH range3”
Those with high anti-TPO levels had more heart disease even after other factors were considered.
Question #3 Do positive thyroid antibodies mean you have thyroid disease?
The answer to this is a definitive maybe, maybe not.
When adults are given thyroid tests as a screen, as many as 27% will have positive thyroid antibodies.
For many, these antibodies precede the onset of low thyroid function (hypothyroidism) due to autoimmune thyroiditis (Hashiomto’s). Yet for many people, they do not. Some people are perfectly healthy and never develop thyroid disease despite having positive antibodies.
It turns out that a little autoimmunity may be normal.
Each part of the body has a process to get rid of old cells and encourage the growth of new cells. It was recently learned that part of the cell removal process can be done by the immune system. The body’s immunity can attack old and unhealthy cells as part of its systems to keep the population healthy. Sometimes this attack can show up as autoimmune antibodies. Just because antibodies show up in a blood test does not always mean something is wrong.
Question #4 Are high antibody levels more dangerous than lower levels?
Thyroid disease becomes more likely for those with high antibodies than for those with negative ones or with lower levels. But not by as much as you might guess.
The following table shows the likelihood of developing hypo or hyperthyroidism over a 9-year period with people of various antibody levels.
Those with only anti-TPO positive and at a low level (under 100) had a 15.3% risk of becoming hypothryoid over 9 years.
Those on the other end of the extreme had both anti-TPO and anti-Tg positive and over 500. People in this category had a 31.3% risk of becoming hypothroyid over 9 years.
In other words, the disease risk per year was 1.7% for those with the lowest positive antibodies and 3.4% for those with the worst.
It is true to say that high antibodies doubled their risk (from 1.7 to 3.4). But it is also true to say that 96.6% of people with high thyroid antibodies did not develop thyroid disease in any given year.
If your antibodies are positive, you still have options.
Question #5 Does it mean thyroid disease is reversed when antibodies become negative?
I frequently see people bragging on social media about how they did some diet or treatment and reversed their thyroid disease. When you get into the details, what they mean is that their antibody levels became negative.
From the question above you can see that thyroid antibodies don’t perfectly predict thyroid disease.
The opposite is also true. Studies on those with Hashimoto’s show that as many of half of people who have it, never develop positive thyroid antibodies.
The final factor to consider is that thyroid antibodies fluctuate.
Some tests are pretty stable and some can vary over time. Height is an example of a stable test. If I stand up straight I’m 5’11”. I would never expect to be 7’0” or 4’8”.
Some tests can fluctuate for predictable reasons. An example is whitecoat hypertension. Some people only have high blood pressure when they are in the doctors’ office.
Other labs fluctuate for reasons that are not always predictable. Thyroid antibodies are like this. People who test them often find that they can vary tremendously from one reading to the next. For some they can be totally negative on one test, and quite high on others without it being significant.
Having your antibodies become negative does not always mean that your body is in a better place. It can just be random. Sometimes other treatments like allergy medications or other immunosuppressants can cause them to be falsely negative.
If your tests are not done at the right time, your readings can also fluctuate.
It is essential to evaluate thyroid antibodies over several readings. Any one or two results could be a fluke.
Question #6 How should you test your thyroid antibodies?
Thyroid antibodies measurements can be skewed by many supplements including probiotics and supplements that contain biotin. Biotin can also cause abnormal levels of other thyroid blood tests.
It is best to avoid all supplements for 3 days prior to having thyroid blood tests.
Other thyroid levels can be skewed by additional factors including the time of day, a recent meal, prior thyroid medications, and the time of one’s menstrual cycle.
The most accurate way to do thyroid tests is to always do them:
- Before taking the day’s thyroid medication
- Before food
- Between 6-9 AM
- 3 days after taking any supplements
- Between days 1-9 or 21-28 of the menstrual cycle. Not between days 10-20.
Question #7 Can diet lower thyroid antibodies?
Several diets have anecdotal reports showing that they may improve antibody levels. Some of these diets have undergone clinical trials and some have not.
Diets considered include Autoimmune paleo, gluten-free, soy-free, dairy-free, vegan, and low iodine.
All of these approaches may have helped some individuals yet not all have been effective in controlled studies.
The one diet that has clinically proven to reverse thyroid disease is the low iodine diet as outlined in the Thyroid Reset Diet. Of those who follow it, 97% find improved thyroid function and 78.3% may have their disease reverse.
Take Good Care Today
Try the Thyroid Quiz today (Click Here: Take the quiz) to learn more about your thyroid and the impact it may be having on your overall health.
1 – Hu Y, Yao Z, Wang G. The Relationship Between the Impairment of Endothelial Function and Thyroid Antibodies in Hashimoto’s Thyroiditis Patients with Euthyroidism. Horm Metab Res. 2020 Sep;52(9):642-646. doi: 10.1055/a-1178-5882. Epub 2020 Jun 15. Erratum in: Horm Metab Res. 2020 Jun 30;: PMID: 32542626.
2 – Unuane D, Velkeniers B. Impact of thyroid disease on fertility and assisted conception. Best Pract Res Clin Endocrinol Metab. 2020 Jul;34(4):101378. doi: 10.1016/j.beem.2020.101378. Epub 2020 Jan 30. PMID: 32037280.
3 – Shimizu, Yuji MD, PhDa,b,∗; Kawashiri, Shin-Ya MD, PhDa; Noguchi, Yuko BAa; Nagata, Yasuhiro MD, PhDc; Maeda, Takahiro MD, PhDa,d; Hayashida, Naomi MD, PhDe Normal range of anti–thyroid peroxidase antibody (TPO-Ab) and atherosclerosis among eu-thyroid population, Medicine: September 18, 2020 – Volume 99 – Issue 38 – p e22214
P.S. Whenever you are ready, here is how I can help you now:
1. Schedule a Thyroid Second Opinion with me, Dr. C, Click Here for Details
2. Need A Thyroid Supplement Recommendation? Take My Thyroid Specific Formulations Quiz Now
3. Need a Personalized Supplement? Check out My Thyroid Specific Formulations
4. Download and use my Favorite Recipes Cookbook Here
5. Check out my podcast Medical Myths, Legends, and Fairytales Here
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet, The Metabolism Reset Diet and The Thyroid Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.