How do you lower Hashimotos antibodies?
Antithyroid Antibody
Antithyroid antibody studies are used to evaluate for autoimmune thyroid problems.
The reference ranges for antithyroid antibodies are as follows:
Thyroid peroxidase antibody (TPOAb): Titer less than 9 IU/mLco [1]
Thyroglobulin antibody (TgAb): Less than 116 IU/mL [1]
Thyroid-stimulating immunoglobulin antibody (TSI): Less than 130% of basal activity [1]
Thyroid-stimulating hormone (TSH) receptor binding inhibitor immunoglobulin (TBII)/TRAb: 1.75 IU/L or less [2]
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Interpretation
Antibodies directed against 3 major thyroid antigens are as follows:
Thyroglobulin: Antithyroglobulin antibody (TgAb)
Thyroid peroxidase (microsomal antigen): Antithyroid peroxidase antibody (TPOAb)
TSH receptor: Anti-TSH receptor antibody (TRAb)
The presence of serum thyroid antibodies usually indicates an autoimmune thyroid disorder, but elevated levels may also be detected in other conditions.
Conditions associated with elevated serum TPOAb levels include the following:
Hashimoto disease (90%-100%) [3, 4]
Graves disease (50%-80%) [5]
Other autoimmune diseases (eg, type 1 diabetes mellitus) (40%)
Sporadic multinodular goiter, isolated thyroid nodule, and thyroid cancer
Relatives of patients with an autoimmune thyroid disorder (40%-50%) may have elevated serum TPOAb levels.
Conditions associated with elevated serum TgAb levels include the following:
Hashimoto disease (80%-90%)
Graves disease (50%-70%) [5]
Other autoimmune diseases (eg, type 1 diabetes mellitus) (40%)
Pregnancy (14%)
Sporadic multinodular goiter, isolated thyroid nodule, and thyroid cancer
Relatives of patients with an autoimmune thyroid disorder (40%-50%) may have elevated serum TgAb levels.
Assays for TgAb and TPOAb are highly sensitive but less specific; therefore, the absolute concentration is very important in the interpretation of the test. Monitoring antibody titers is important to evaluate the disease progression/regression over time, as well as among different patients, but the same assay should be used for this purpose.
TRAb are classified as stimulating, blocking, and neutral antibodies in relation to thyroid function and can be measured with 2 techniques. The TSI bioassay is used to measure the net stimulatory activity of all TRAb, and the TBII assay is used to measure all 3 types of TRAb. In some laboratories, TRAb refers exclusively to the TBII assay.
Conditions associated with elevated serum TSI levels include the following:
Graves disease (80%-90% of untreated patients)
Toxic multinodular goiter (15%)
Conditions associated with elevated serum TBII levels include the following:
Graves disease (>90% of untreated patients)
Hashimoto disease (15%)
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Collection and Panels
Antithyroid peroxidase antibody
Specimen type: Blood serum; hemolyzed specimen not acceptable
Collection tube: Red-top tube or gel-barrier tube
Specimen preparation: Separate serum from cells and transfer to transport tube
Storage/transport temperature: Refrigerated
Stability: 7 days refrigerated, 1 month frozen
Patient instruction: No need for fasting
Thyroglobulin antibody
Specimen type: Blood serum; hemolyzed specimen not acceptable
Collection tube: Red-top tube or gel-barrier tube
Specimen preparation: Separate serum from cells and transfer to transport tube
Storage/transport temperature: Refrigerated
Stability: 7 days refrigerated, 1 month frozen
Patient instruction: No need for fasting
Thyroid-stimulating immunoglobulin antibody
Specimen type: Blood serum
Collection tube: Red-top tube or gel-barrier tube
Specimen preparation: Separate serum from cells and transfer to transport tube
Storage/transport temperature: Refrigerated or frozen
Stability: 7 days refrigerated, 3 months frozen
Patient instruction: No need for fasting
Thyroid-stimulating hormone receptor antibodies/thyroid-stimulating hormone receptor binding inhibitor immunoglobulin
Specimen type: Blood serum; hemolyzed specimen not acceptable
Collection tube: Red-top tube or gel-barrier tube
Specimen preparation: Separate serum from cells and transfer to transport tube
Storage/transport temperature: Frozen
Stability: 3 days refrigerated, 1 month frozen:
Patient instruction: No need for fasting
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Background
Description
Autoimmune thyroid disease, including Hashimoto disease and Graves disease, is characterized by lymphocytic infiltration. Animal studies have shown that B lymphocytes in the thyroid gland are the major source of antithyroid antibodies. As described above, 3 major thyroid antibodies exist: TPOAb, TgAb, and TRAb.
TPOAb and TgAb are polyclonal antibodies of the immunoglobulin G (IgG) class. They have a complement fixing and cytotoxic capacity, but their role in Hashimoto disease still is not clear and seems to be a response to thyroid injury.
TRAb are divided into 3 types: stimulating, blocking, and neutral antibody in relation to the thyroid function. The stimulating TRAb are oligoclonal antibodies of the immunoglobulin G1 (IgG1) subclass. TRAb bind to TSH receptors and activate the signaling pathway. They can induce thyroid growth, as well as thyroid hormone production and secretion; this finding suggests that TRAb are the primary cause of Graves disease.
It is now believed that Graves disease and Hashimoto disease are closely related. In Graves disease, the goiter can result from TSH receptor stimulation, whereas, in Hashimoto disease, it results from lymphocytic infiltration, causing follicular cell destruction.
Indications/Applications
Indications for TSI and TRAb/TBII measurements include the following:
For diagnostic purposes in euthyroid patients with exophthalmos or other extrathyroidal manifestation or when thyroid uptake and scan is contraindicated or nondiagnostic
In pregnant women with Graves disease to determine the likelihood of neonatal thyrotoxicosis (risk increases with antibody concentration)
To assess the degree of disease activity
To assess the risk of Graves disease relapse after treatment with antithyroid agents (risk increases with antibody concentration)
To differentiate between gestational thyrotoxicosis and Graves disease in the first trimester of pregnancy
TSI and TRAb/TBII measurements are not routinely indicated for the diagnosis of Graves disease.
Indications for TPOAb measurement include the following:
To help confirm the diagnosis of Hashimoto disease (in some cases)
To help with the treatment decision in the patient with subclinical hypothyroidism (in some cases)
Indications for TgAb measurement include the following:
In conjunction with other thyroid antibody tests for diagnosis of autoimmune thyroid disease
To monitor the disease status of thyroid canceraftertreatment
Considerations
Persistence of TgAb in patients with thyroid cancer for more than 1 year after therapy indicates the presence of residual thyroid tissue and perhaps an increased risk of recurrence.
High TPOAb levels in pregnant euthyroid women increases the risk of spontaneous miscarriage and preterm birth. Treatment with levothyroxine in these women seems to decrease the miscarriage rate, but it is not yet recommended to treat pregnant euthyroid women with positive antibody test results. [6, 7]
An elevated serum level of TPOAb and/or TgAb is essential for the diagnosis of the controversial disorder of Hashimoto encephalopathy.
A retrospective study by Muir et al indicated that in patients who have been newly diagnosed with Graves disease, those who are positive for TPOAbs have a reduced relapse risk subsequent to antithyroid drug treatment. The odds ratio for relapse in study patients who were not TPOAb-positive was 2.21. [8]
TBII assays are less expensive and more precise in detecting TRAb than the TSI bioassay.
TPO Antibodies
Thyroid peroxidase (TPO) antibodies are a type of thyroid antibody. Thyroid antibodies can form in autoimmune thyroid disease. The body wrongly identifies thyroid cells and tissues as non-self. This means that our body sees our own cells and tissues as foreign, and attacks them.
The two main autoimmune thyroid diseases are Grave’s disease and Hashimoto’s thyroiditis. 1 Thyroid peroxidase antibodies are also called anti-TPO antibodies or TPO antibodies. You can read more about thyroid peroxidase antibodies in this article and find more general information about the thyroid in Ada’s thyroid guide.
What are thyroid peroxidase antibodies?
Thyroid peroxidase (TPO) antibodies are a type of thyroid antibody. Thyroid peroxidase is an enzyme which helps to make thyroid hormones (T3, T4 and TSH). 2 The body’s immune system makes antibodies in response to non-self proteins. These non-self proteins are called antigens. Making antibodies is important to protect us from diseases. However sometimes the immune system identifies our own proteins as non-self, making autoantibodies.
The immune system then attacks our own body proteins in error. This is known as an autoimmune disease. Thyroid antibodies develop when the immune system identifies our own thyroid cells and tissues as non-self. This can cause inflammation and affect thyroid function. 1
What are thyroglobulin antibodies?
Thyroglobulin antibodies (Tg Ab) are another type of thyroid antibody. Thyroglobulin is a protein made by thyroid cells. It helps to make thyroid hormones. Thyroglobulin antibodies (Tg Ab) are made when the body attacks it’s own thyroglobulin. Thyroglobulin antibodies can be raised in Hashimoto’s thyroiditis (link to ada page on Hashimoto’s thyroiditis). They are also raised in 10-15% of the general population. 1
What is the thyroid peroxidase antibody normal range?
Normal TPO antibodies range is less than 30 international units per millimeter (IU/ml). 3 Thyroid peroxidase antibodies are considered high if above this. Note that the normal range used can differ in different laboratories. It is not possible for the thyroid peroxidase antibodies to be too low.
What causes high thyroid peroxidase antibodies?
Autoimmune thyroid disorders cause high thyroid peroxidase antibodies. 2 The two main autoimmune thyroid disorders are Grave’s disease (link to Ada page on Grave’s disease) and Hashimoto’s thyroiditis, (link to Ada page on Hashimoto’s thyroiditis )
Anti-TPO antibodies are present in:
- 80-95% of cases of Hashimoto’s thyroiditis
- 65-80% of cases of Grave’s disease
- 10-20% of cases of thyroid cancer. 123
10-15% of people who don’t have any thyroid disorder can have raised TPO antibodies. 1 3 High TPO antibodies may increase the risk of developing a thyroid disorder in the future. 2
What is the difference between thyroid peroxidase antibodies and thyroglobulin antibodies?
Thyroid peroxidase and thyroglobulin antibodies are two different types of thyroid antibodies. The body needs thyroglobulin and thyroid peroxidase to make thyroid hormones. Both types of thyroid antibodies are often raised in autoimmune thyroid disorders. Raised thyroid peroxidase antibodies are found in a higher percentage of people with autoimmune thyroid diseases. 1
Does high TPO antibodies mean cancer?
High TPO antibodies does not necessarily mean cancer. TPO antibodies are raised in 1-20% of people who have thyroid cancer and they can be raised in healthy people. 3 The main symptom of thyroid cancer is a painless neck lump. 4 It is important to speak to your doctor if you think you have thyroid cancer or any other thyroid disease.
You can read more about the symptoms of thyroiditis and hyperthyroidism on Ada’s website.
At a population level, having a raised TPO antibody level alone doesn’t increase your risk of developing thyroid cancer. 4 A raised TPO antibody level should be considered together with other blood tests and clinical assessment. The meaning of a raised TPO antibody test in isolation is difficult to interpret and additional investigations may be needed.
How to reduce TPO antibodies naturally?
There is some limited evidence that selenium supplementation can reduce anti-TPO antibodies. 2 More research in this area is needed. 5 The role of vitamin D supplementation in reducing TPO antibodies is being considered. Currently there is not enough evidence to support this claim. 6 7
- Fröhlich E, Wahl R. (2017).Thyroid Autoimmunity: Role of Anti-thyroid Antibodies in Thyroid and Extra-Thyroidal Diseases. Front Immunol.9;8:521. PMID: 28536577; PMCID: PMC5422478. Accessed 12th July, 2022.
- Godlewska M et al. (2019). Thyroid Peroxidase Revisited–Whatʼs New?. Hormone and Metabolic Research, 51(12), 765-769. Accessed 30th June, 2022.
- Rrupulli A et al. (2019). Significance of testing anti-thyroid peroxidase in euthyroid patients. In Endocrine Abstracts (Vol. 63). Bioscientifica. Accessed 30th June, 2022.
- Xiao Y et al. (2019). Positive thyroid antibodies and risk of thyroid cancer: A systematic review and meta-analysis. Molecular and clinical oncology, 11(3), 234–242. Accessed 30th June, 2022.
- Rayman, M. (2019). Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proceedings of the Nutrition Society, 78(1), 34-44. Accessed 30th June, 2022.
- Chahardoli R et al. (2019). [Can supplementation with vitamin D modify thyroid autoantibodies (Anti-TPO Ab, Anti-Tg Ab) and thyroid profile (T3, T4, TSH) in Hashimoto’s thyroiditis? A double blind, Randomized clinical trial. Hormone and Metabolic Research, 51(05), 296-301](https://doi.org/ 10.1055/a-0856-1044). Accessed 30th June, 2022.
- Zhang W et al. (2021) Immunomodulatory function of vitamin D and its role in autoimmune thyroid disease. Frontiers in immunology, 12, 574967. Accessed 12th July, 2022.
9 Functional Remedies To Get Thyroid Antibodies in Control
Two types of thyroid antibodies act in distinctive ways to damage the thyroid gland:
- Thyroid peroxidase antibodies (anti-TPO): Anti-TPO antibodies inhibit the enzyme thyroid peroxidase, which decreases thyroid hormone production. Chronic elevated anti-TPO can trigger hypothyroidism and lead to thyroid cell destruction.
- Thyroglobulin antibodies (anti-TG): Anti-thyroglobulin antibodies inhibit the enzyme thyroglobulin. Unlike anti-TPO antibodies, anti-TG does not appear to cause cell destruction.
Anti-TPO is the most reliable lab marker for autoimmune thyroid disease while anti-TG is less reliable as a disease marker.
What a Thyroid Panel Can Tell You About Thyroid Autoimmunity
Thyroid antibody tests are useful diagnostic tools for identifying autoimmune thyroid disease.
Doctors typically test for T4 and TSH levels to diagnose hypothyroidism, and this is a completely reliable method. However, a full thyroid panel, which includes blood tests for thyroid antibodies, can tell you if hypothyroidism is the result of an autoimmune condition.
The “normal” reference range for TPO antibodies is less than 35 IU/mL. If you are hypothyroid and have TPO antibodies above the reference range, you will likely be diagnosed with Hashimoto’s disease.
Should You Worry About Your Thyroid Antibody Levels?
Functional medicine approaches can help autoimmune thyroid patients to lower antibody levels. Lowering antibodies through dietary and lifestyle interventions is a smart choice for most thyroid patients, but sometimes a good idea can get carried too far.
It’s not unusual for patients to become hyper-focused on getting their antibody levels down to zero. This type of zealousness can be counterproductive as it leads to unnecessary stress. The notion that thyroid antibodies should be completely eradicated is not backed up by science.
Research suggests that moderately elevated TPO antibodies are not associated with thyroid damage. A 2016 study in the Journal of Hormone and Metabolic Research [6] discovered:
- Individuals with TPO antibodies below 500 IU/mL had a low likelihood of future hypothyroidism.
- Individuals with TPO antibodies above 500 IU/mL are only moderately at risk for hypothyroidism.
In addition, the Tehran Thyroid Study tracked the thyroid disease progress of a large cohort of participants over nine years. After six years of follow-up, the study found that only 9-19% of individuals with elevated TPO antibodies became hypothyroid [7, 8].
The bottom line is, elevated thyroid antibodies are not as consequential as the recommended reference range suggests. Not everyone with elevated thyroid antibodies will become hypothyroid.
A Rational Approach to Thyroid Antibodies Levels
If your thyroid symptoms are under control and your anti-TPO antibodies are below 500 IU/mL, there’s little need to try to lower antibody levels further with strict diets or supplements. Celebrate your good health and enjoy life!
If your anti-TPO levels are above 500, you should take steps to lower them.
9 Functional Remedies To Reduce Thyroid Antibodies
If your test results show that anti-TPO antibodies exceed 500 IU/mL, the following approaches can help decrease antibody levels, improve thyroid function, reduce thyroid symptoms, and prevent further thyroid damage.
Boost Gut Health
Gut and thyroid health are intricately connected [9], therefore improved gut health should be the main focus of your plan to decrease thyroid antibodies. There are several ways to do so:
1. Anti-Inflammatory Diets
A diet high in inflammatory foods undermines your immune system and thyroid function. Switch to an anti-inflammatory diet to lower your thyroid antibodies.
The Paleo diet is a good starting place to address thyroid health concerns, as it focuses on fresh, whole foods and reduces inflammatory, processed foods. It also removes dairy and gluten, which are common food sensitivities. Two studies have noted that gluten- or dairy-free diets may improve thyroid function [10, 11].
Many thyroid patients benefit from lowering carbs in their diet. One study showed that a low-carbohydrate diet significantly reduced thyroid antibodies by 44% in autoimmune thyroiditis patients [12]. The Paleo diet is lower in carbs and can help to achieve this.
Many practitioners recommend the Autoimmune Paleo diet (AIP) for those with autoimmune thyroid conditions. While research is limited, one small study showed that thyroid patients successfully managed thyroid symptoms and inflammation with the AIP diet [13].
The AIP diet is a more restrictive version of the Paleo diet and removes some of the less common trigger foods. We generally recommend that patients start with a basic Paleo diet and progress to the AIP diet if thyroid symptoms haven’t fully resolved after 30 days of following the Paleo diet.
2. Probiotics
Probiotics rebalance the gut microbiota, diminish gut inflammation, and help to heal the gut lining. Better gut health leads to a calmer immune system and may help to reduce thyroid autoimmunity.
While there is little direct research into the effects of probiotics on thyroid antibody levels, multiple studies show that an association between gut infections and thyroid autoimmunity. Probiotics improve gut infections that are associated with elevated thyroid antibodies, including H. pylori infection and SIBO [14, 15]. One study found that probiotics can reduce the need for thyroid medication and reduce fatigue in hypothyroid patients [16].
3. Digestive Support
Digestive issues, like food sensitivities and low stomach acid, are associated with thyroid disorders.
Up to 40% of hypothyroid individuals suffer from stomach autoimmunity [17, 18], which can lead to low levels of stomach acid. For these patients, stomach acid support in the form of HCI with betaine supplements may help boost their thyroid function [19].
For some patients with food sensitivities, digestive enzyme supplements can help to reduce immune responses to trigger foods, such as the lactose in dairy products.
4. Gut Infection Treatments
When patients are not able to fully reduce thyroid antibodies and resolve thyroid symptoms with diet and supplements alone, we typically suspect an underlying gut infection.
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 [20, 21, 22, 23, 24].
One small but remarkable study found that when thyroid patients were treated for H. pylori infection, patients had an average drop in TPO antibodies of 2029 [25].
Our clinical team can help to diagnose and treat hidden gut infections that may be contributing to poor thyroid health.
Try Dietary Supplements
Poor gut health may lead to nutritional deficiencies. Dietary supplements can help correct micronutrient deficiencies that impact thyroid function.
Dietary supplements should be taken as a complement to gut-directed therapies, not as a stand-alone treatment.
5. Selenium
Selenium is essential for the conversion of T4 to T3 [26]. Its deficiency is associated with thyroid dysfunction and thyroid disorders [27, 28]. While more research is needed, several studies (including a meta-analysis) noted lower thyroid antibody count in autoimmune thyroiditis patients after selenium supplementation [29, 30, 31].
6. Vitamin D
Vitamin D deficiency is associated with hypothyroidism, Hashimoto’s thyroiditis, and Graves’ disease [32, 33, 34]. Correcting this insufficiency with vitamin D supplements is a potential remedy for lowering TPO and TG antibodies [35, 36, 37].
7. Coenzyme Q10 and Magnesium
As essential micronutrients, coenzyme Q10 (CoQ10) and magnesium may decrease thyroid antibody levels. In fact, low serum magnesium was linked to an increased risk of elevated thyroid antibodies in one study [38]. A preliminary study also suggested that CoQ10, magnesium, and selenium reduce thyroid antibodies [39].
8. Consider Light Therapy
Low-level laser therapy may help with hypothyroidism. This treatment option improves thyroid function and lessens TPO antibodies [40, 41].
9. Optimize Iodine Levels
Iodine is a vital nutrient in the production of thyroid hormones. Iodine deficiency is associated with goiter and hyperthyroidism [42]. Unfortunately, iodine supplementation is a double-edged sword and can increase the prevalence of autoimmune thyroid disease in some individuals [43, 44]. It’s best to consult your functional medicine doctor to decide if iodine may be helpful for your symptoms.
Austin FH Helps You Get Your Thyroid Antibodies in Check
While TPO antibody levels above 35 IU/mL are considered elevated, research shows that levels below 500 IU/mL have a significantly lower risk for thyroid disease.
Simple yet effective lifestyle changes that can lower thyroid antibodies include anti-inflammatory food choices and probiotic supplements to balance the gut ecology. Hidden gut infections may be the root cause of elevated thyroid antibodies for a subset of thyroid patients.
Aim to get your anti-TPO levels below 500. Trying to lower thyroid antibodies to near-zero levels can do more harm than good, and is not recommended.
An experienced functional medicine doctor can help get your thyroid antibodies in check. At Austin Functional Medicine, Dr. Michael Ruscio and his team are available through in-house and telemedical appointments to provide you the relief you need.
