How Hashimoto's Antibodies Progress & Fluctuate Over Time

How Hashimoto’s Antibodies Progress & Fluctuate Over Time

What Thyroid Antibodies Mean for your Body and your Thyroid

Thyroid antibodies have become somewhat of the hallmark of the autoimmune thyroid condition known as Hashimoto's thyroiditis

While you can certainly have Hashimoto's even without having thyroid antibodies, most people still associate Hashimoto's with thyroid antibodies. 

What antibodies am I talking about?

I'm talking about thyroglobulin antibodies and thyroid peroxidase antibodies

If you are reading this then there is a good chance that you probably already understand at least the basics of Hashimoto's and understand the important role that these antibodies play in the progression of your disease.

Today I want to take a little bit of a deeper dive into Hashimoto's and discuss more about these thyroid antibodies and how they fluctuate over time. 

To do that, I will be referring to an image of a whiteboard that I created for the video above. 

If you prefer to watch the video then please check it out. If you prefer to read then you will get a slightly more in depth overview than what is presented in the video. 

hashimoto's antibodies over time

If the image looks a bit confusing, don't worry!

I will walk you through the graphs so you understand exactly what is being illustrated (rather poorly) on the whiteboard. 

Buckle up because today you will learn...

  • What happens to your thyroid antibodies if you do NOTHING
  • What you should expect your thyroid antibodies to do if you are trying to treat them
  •  What it looks like when you undergo a "flare" or an antibody "spike"
  • Why you should be as aggressive as possible to lower your antibodies

Let's jump in! 

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Thyroid Antibodies Fluctuate Over Time (This is NORMAL!)

The first thing you should understand is that it is perfectly normal for thyroid antibodies to fluctuate and change over time. 

I've had the advantage of testing for these antibodies hundreds of times over the last several years and I've been able to follow the results on countless patients. 

And I can tell you for sure that your antibody levels WILL fluctuate even with the most rigorous treatments. 

If you have Hashimoto's thyroiditis then it is a really good idea for you to keep track of these antibody levels over time and throughout the course of your disease. 

Do your best to ask your doctor to check your antibody levels every time that you get your other thyroid lab tests drawn

If you do this, you should have at least 2-4 results that you can plot each and every year. 

Why would you want to do this?

Because the information that it provides you is invaluable! 

Tracking your antibodies over time can help you understand IF your therapies are working, what sort of things may be exacerbating your thyroid condition, and much more. 

You might be thinking to yourself:

"I don't need to track my antibody levels because I know what therapies and treatments I've done". 

If you are thinking something like this allow me to ask you a question: 

What did you have for breakfast 5 days ago?

Most people have no idea what they ate for breakfast 5 days ago so don't feel bad if you don't know the answer. 

Let's relate this scenario to the thyroid for a second.

Do you remember what happened to you 5 years ago when your antibodies first spiked?

Do you remember what stressor you were under which caused you to feel worse for a period of 6 months?

Do you remember what you did to get out of that flare-up?

By keeping track of your antibodies over time you will have a much better picture of what works and what doesn't. 

Thyroid Antibody Levels if you do Nothing (No therapies or treatments)

As we talk about thyroid antibody levels I want you to remember one thing:

The graphs and instances we are going to be using are purely hypothetical and do not represent what will actually happen in your situation. 

They are used to illustrate the likely course of thyroid antibody progression but they will not map exactly with your experience. 

With that out of the way, I want to first start with the progression of thyroid antibodies over time for people who plan to do NOTHING in treating their Hashimoto's. 

The reason we care so much about this is because there are many people who fit into this category. 

In fact, if you are following the advice of your endocrinologist or primary care provider then there's a good chance you fit into this category. 


Because the therapies that actually work to prevent and reverse Hashimoto's include just about everything except the use of levothyroxine. 

In other words, levothyroxine does NOT treat the underlying cause of Hashimoto's

The way to see improvement in your thyroid antibody levels is to address your immune system

As you address your immune system you will see a decline in thyroid antibodies and a reduction in thyroid gland damage

hashimoto's antibodies without treatment

This image represents what you should expect to happen over time if you do nothing in terms of treatments (remember: levothyroxine doesn't count). 

The x-axis is a representation of time and the y axis is a representation of the level of your thyroid antibodies. 

The blue line walks you through the various ups and downs that you may expect from your thyroid antibodies as you progress over the course of your disease. 

The time length in this image is roughly 20-30 years. 

I've stopped it at around that point for one very important reason:

If you do nothing for that length of time then you will enter what is known as end-stage Hashimoto's thyroiditis and at that point, it is too late to salvage your thyroid. 

Let's walk through the progression of these antibodies:

In the beginning, your antibody levels will be virtually zero. 

This makes sense because they really shouldn't elevate until something triggers them to do so. 

In the beginning, your thyroid antibodies will rise rather rapidly. 

While you technically have Hashimoto's thyroiditis, you will most likely not be diagnosed for several years for reasons that I've explained in this blog post

After this initial rise, you can expect that your antibodies will hang out in this elevated state for some period of time (different for each person) and until you hit some trigger which causes what I refer to as a flare-up or a spike in your antibody levels. 

This flare-up or spike causes a rapid rise in antibodies which is higher than your regular elevated antibody levels and can be triggered by many different things. 

In my experience, most of these flare-ups are triggered by stressors to the body (1) and can occur due to the death of a loved one, not getting enough sleep, extra stress at work, stress from your kids or family life, and so on. 

But flare-ups and spikes can also be caused by a variety of other issues including new gut issues (2), new infections or recurring infections (3), exposure to heavy metals (4) or environmental toxins (5), the diagnosis of other chronic medical conditions, and so on. 

supplements designed for hashimoto's

Remember, we are talking about a timescale in the years here so the likelihood that something stressful will happen to you is VERY high. 

When you hit these flare-ups you will notice that you feel considerably worse. 

In addition, these flare-ups are likely to cause increased thyroid gland damage and rapidly bring you closer and closer to end-stage Hashimoto's. 

How many flare-ups or spikes that you have depends on your disease and your individual situation but you can expect to have 1 to 5 or more of these. 

Unfortunately, many people with Hashimoto's will have no idea that they are in a flare-up because it's not common for doctors to check or recheck thyroid antibodies!

This is obviously less than ideal because if you have no idea what is happening in your body then you will miss the opportunity to address the problem which spiked your antibodies. 

The good news is that this scenario does NOT have to be what happens to you. 

It is possible to have a MUCH better disease course, one that doesn't necessarily guarantee complete thyroid gland destruction and end-stage Hashimoto's. 

What Your Thyroid Antibodies Look Like if you Use Natural Therapies

Let's talk about a completely different disease course. 

One that occurs if you are aggressive in the sort of natural treatments and therapies that are available to you and one that occurs if you have a knowledgeable doctor working with you. 

I know it may be hard to believe but when I refer to a knowledgeable thyroid doctor I am NOT referring to your endocrinologist. 

You can expect something similar to this course if you are aggressive with the therapies that I will be discussing below: 

hashimoto's antibodies with therapies

The x and y-axis in this image are the same as in the previous image. 

The main difference here is the blue line which represents your antibody levels over time. 

You will notice that the beginning looks much the same. 

There will always be a rise in your antibody levels initially (this is unavoidable for most people) but where things differ from the first image is in what happens next. 

Once you officially have a diagnosis of Hashimoto's it is time for you to get aggressive with your therapies. 

If you start with these therapies EARLY (meaning as soon as possible) then you can actually help to drive your antibody levels DOWN from the level that they initially rose to. 

To put this into perspective, let's imagine this hypothetical scenario:

Imagine you were just diagnosed with Hashimoto's and your thyroid antibody levels are at 1,000. 

In the first situation, they will stay at that 1,000 level until you hit a flare at which point they may spike up to 2,000 for a short period of time before falling back to 1,000. 

In this scenario, it may be possible (and likely) that your antibody levels will FALL down to a lower base level of something like 200-300. 

This sort of response is definitely possible and happens to many people but it requires you to use certain therapies. 

Therapies that can help you do this include things like:

By targeting THESE areas you can help drive down inflammation and immune function which will be represented as a decline in your antibody level. 

What's interesting is that even though you can drive down your antibody level to a new low level you will STILL experience flares. 

But instead of your flares spiking up your antibody level to the 2,000 range, they will be a much more mild rise to something around the 1,000 level. 

In this scenario, your body spends less time with the extremely high antibody levels which reduce thyroid gland damage and preserve the function of your thyroid gland. 

Even if you aren't able to bring your antibodies down to 0 (which is ideal) you will still feel so much better by reducing them to a manageable level. 

Is Hashimoto's Completely Reversible? 

The answer is that it depends. 

When someone talks about reversing Hashimoto's what they are really asking is if they can completely eliminate or reduce their thyroid antibodies down to zero. 

If you can bring down your thyroid antibodies and reduce thyroid gland damage or destruction then you are said to be in remission. 

I wish I could tell you that ALL cases of Hashimoto's are reversible but that just isn't true

But I can give you some insight that will help you understand whether or not your specific case is more likely or less likely to respond to natural therapies. 

The first thing you need to know is how long you've had your disease

In general, the longer you've had Hashimoto's the more difficult it will be to treat it. 

The next thing you need to think about is the severity of your symptoms and illness

Are your antibodies clear over 2,000 or are there only slightly elevated at around 300 or 400? 

Are your symptoms crippling so that they prevent you from getting up and going to work or are they minor in that they impair your day-to-day life but do not prevent you from living? 

In general, the higher your antibodies and the more severe your symptoms the more difficult it will be to treat your disease. 

Another important factor has to do with what triggered your Hashimoto's. 

Was your Hashimoto's triggered due to a serious disease or illness or was it triggered by something reversible or treatable such as H. pylori?

In my experience, cases of Hashimoto's triggered by extreme stress tend to be more difficult to treat compared to cases caused by infections or viral illness. 

But remember:

This information merely reflected my own personal experience and should not be taken as gospel truth. 

I'm constantly surprised at how each person with thyroid disease reacts to different therapies/medications/supplements/hormones, etc.

You should not let someone tell you what you are or are not capable of. 

The goal for every patient with Hashimoto's should be to put it into remission and you should aim for that. 

If you miss you will still have done plenty of good along the way. 

Final Thoughts

You now have 2 different options and scenarios that can play out as it relates to thyroid antibody levels and their progression over time. 

In one scenario, you have the typical course which results in complete thyroid gland destruction and life-altering symptoms. 

In the other, you have the potential to restore thyroid function and delay the destruction of your gland with the use of natural therapies. 

I strongly suggest that you do everything your power to make sure you fit into the latter!

Now I want to hear from you:

How long have you had Hashimoto's thyroiditis and which category do you think you fit into?

Have you been able to reduce your thyroid antibodies with natural therapies? 

Are you keeping track of your antibodies over time? If so, how often are you testing them?

What level do your antibodies usually stay at when you are being healthy?

Share your questions or comments below! 

References (Click to Expand)

hashimoto's antibodies change and fluctuate over time

Dr. Westin Childs

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 45,000+ people have used them over the last 4.5 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

12 thoughts on “How Hashimoto’s Antibodies Progress & Fluctuate Over Time”

  1. I don’t know how long I’ve had it, but after having COVID 19 in June/July, I have been having constant inflammation/pain, so in November when I get my usual annual bloodwork done, my dr asked if I wanted to include “inflammation” tests. Of course I said yes, and she informed me of my Hashimoto’s. I just had my blood work done again at 3 months. In Nov, my Thyroid Perox was 438, now in Mar its 491. My doctor is not giving me any treatment towards it, and its frustrating. I just came upon your video so looking forward to seeing what I can do for myself to lower them! Thank you!

  2. I was told I have hashimotos but have never tested positive for antibodies. Mine was pregnancy/stress triggered and I had TSH of 11 when I was diagnosed. I’ve been told by my endo dr that I don’t have antibodies because I’m in end stage hashimotos (I was diagnosed in 2018). I remain symptomatic despite treatment with Levo (50mcg). Heavy hair loss, sluggishness, cold intolerance, and joint pain. How can I tell how I’m managing my disease if I don’t have antibodies as a marker?

  3. I’ve been on Levo for about 17 years and was just diagnosed with Hashimotos early 2020. My antibodies are only slightly elevated 70-80’s, but I’ve had fatigue, hair loss, and very difficult to lose weight. I have researched and researched over the years and came across your site last night! THANK YOU for your work, I believe this is going to help change my life!

    • Hi Angela,

      I’m glad you found it and thanks for sharing! I have tons of resources that should help you on your journey.

  4. Dr Childs,
    I’m 33 and I’ve had anti-tpo thyroid antibodies for the past 6 years, most recent number 450. What’s confusing is that, currently, I have low TSH, (.13) and I am not taking any thyroid medication. I’ve been on LDN (many thanks to your site) for the past 2 years. Anytime I take a break from the LDN (2 or more days), I can’t get out of bed because my body radiates pain. I’m always, ALWAYS tired. I have body/skin/muscle sensitivity to the point I can’t even rub or lean up against anything without pain. Exercise, even my daily walk, leaves me exhausted. I’m always exhausted. A few years ago, after I had lost 30 lbs and while still dieting, I suddenly gained 50 lbs in 6 months and while I’ve technically lost a little bit of it, I am still in the same size and I can’t seem to get the weight nor size to budge. For what it’s worth, my vitamin D levels are always on the bottom of “normal” 30-34, even with lots of sunshine and taking vitamin D, iron fluctuates between just under range to bottom normal range (recent iron 49, UTIBC 344). My doctor (PCP, DO) is baffled and wants to help but doesn’t know what to do and all the endocrinologists I’ve seen just want to do nothing and wait until the antibodies destroy my thyroid and then remove it. I don’t even know what to do anymore and I feel hopeless about the situation.
    Sincerely, tired, exhausted,

  5. I was diagnosed with hashimoto’s in 1998. I was 25. I was falling asleep at crosswalks in my car on the one hour drive to work. Fast forward. Now I am 48 and take 2hour naps each day after work. I just had my NP to check my Thyroid levels and she said all was good. I asked for a copy of report and the levels are as follows:
    TSH 2.740 0.450-4.500
    T4 5.9 4.5-12.0
    T3 uptake 24 24-39
    Free Thyroxine index 1.4 1.2-4.9
    Reverse T3 12.4 9.2-24.1
    Thyroid Peroxidase 123 0-34
    Thyroglobulin Antibody 268.0 0.0-0.9
    I’m just not sure everything is so good like she is saying. Can you please help? I currently take both Tirosint with Cytomel. I have put on over 15lbs since August. I can not lose this weight….. My voice is constantly hoarse, I just chalk it up to GERD???? It can all feel pretty hopeless.



  6. Thanks for the videos & blogs! How is Hashimoto’s late stage determined if antibodies are low as you mentioned in the video? Does it matter if a provider determines it to be Hashimoto’s?

    First thyroid tests ever last few years b/c years of symptoms & TPO & thyroglobulin Ab present repeatedly (once above the “normal” range) plus low normal range free T3/T4 & a higher “normal” RT3 now. This year no Ab show on the labwork, but T3 is sluggish and sudden weight gain & very difficult to lose. Just started 15 mg Armour.

  7. I was diagnosed with Hashimotos and had a partial thyroidectomy 27 years ago. I had been taking levo for most of that time and did pretty much OK. Fast forward to now, retired early, moved from the UK to Turkey and for the last 3 years my symptoms have been unbearable…..tingling, numbness, muscle weakness recurring UTI’s, no energy. The year before I moved to Turkey I had my gall bladder removed. I was pretty clueless in regards to Hashimotos until very recently when I started researching. I was really ill and admitted to hospital..kidney stones and an severe infection which went into my lungs. On discharge they sent me to an endocrinologist. By this time I was convinced the root cause of my symptoms were thyroid related. The endocrinologist did my bloods, sent me away as he didn’t believe I only had a partial thyroidectomy. He wanted me to try and obtain my medical records from the UK. I got confirmation that I had a partial thyroidectomy and on my return visit they only tested my TSH and glucose and did a blood count. They argued with me that T3, RT3, RT4 etc were not needed, advised me to reduce my Levo to 75mch from 5 days and 50mcg for 2 days. I knew nothing about thyroid atrophy until this time, again my own research led me to your site, (which is amazing). I just wish I was armed with the information I have now 20 years ago. I can only assume that my thyroid is completely destroyed. I’m currently trying to find a good doctor. The endo wants me to return in 6 weeks to check my TSH in the meantime I’m still symptomatic and researching. Any advice you have is much appreciated. Thank you so much for all your videos. I now have a good understanding of what has happened to me. I am struggling with these symptoms daily and it certainly impacts on my quality of life. I just don’t know what to expect in the future.


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