*This post was most recently updated on January 29th, 2019 with new information.*
Do you have Hashimoto's thyroiditis with elevated antibodies?
Would it surprise you to know that it may be possible to lower these antibody levels and reduce the damage done to your thyroid gland?
Many doctors seem to blow off the fact that you have elevated TPO or Thyroperoxidase antibodies by saying that it doesn't affect treatment or worse, they don't even test for them.
It turns out that having elevated antibodies is a big deal because it may affect your treatment.
Not only does having TPO antibodies present in your serum indicate you may have inflammation and autoimmunity present, but it also changes your management and treatment.
This article highlights several therapies that I've used successfully in patients to help them LOWER their TPO antibodies, inflammation, and reduce the autoimmune process.
These therapies may not work for everyone with Hashimoto's thyroiditis, but they should still be considered in most cases.
Why it's Important to Lower TPO Antibodies
In case you didn't already catch this:
Many patients with Hashimoto's are being mismanaged.
For the most part, doctors tend to ignore antibody levels by saying that it doesn't change how you are going to be treated.
If they find your TSH is greater than 5.0 they will slap you on some levothyroxine and call it a day.
If this approach doesn't sound appealing, you are not alone because there may be a better way.
While TPO antibody levels can be difficult to lower (and may not be possible in all situations), they should still be monitored every few months at a minimum.
Trending out your antibody levels over time and monitoring fluctuations can be helpful when assessing which treatment is working and which is not.
Having said that:
It's equally important that you don't hang all of your efforts or success on the absolute level of your antibodies.
Some people may notice a significant improvement in their symptoms as they follow these therapies while their antibody levels may paradoxically INCREASE.
This is not necessarily a problem, as anti-thyroid antibodies don't always track well with your disease state.
Like many things, they can't and shouldn't be evaluated in isolation, but when used with other tests and markers of hypothyroidism, they can provide valuable data.
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What is the Normal Range for TPO antibodies?
In general, you will want your TPO antibodies to be as LOW as possible.
That means nonexistent or < 30 U/mL.
The reason for this is simple:
If we know that the presence of antibodies indicates potential damage to your thyroid gland, then having those antibodies as low as possible will increase your chances that very little to no damage is taking place.
You can see an example of the thyroperoxidase antibody reference range below:
As you can see from the image above, the "standard reference range" provided by the lab is anything less than 60 U/mL.
But, when I look at it, I take it a step further by looking specifically for the "optimal reference range" which I define as anything less than 30 U/mL.
I get worried when antibody levels start to creep higher than 30, and ESPECIALLY if they are higher than 60.
Hashimoto's thyroiditis exists on a spectrum of disease severity.
Before you develop the full-blown symptoms of Hashimoto's you will first start to experience minor symptoms.
It's much better to catch your diagnosis EARLY so you can prevent the disease state from worsening.
That's why I prefer to 'tighten' up the reference range and why I consider anything less than 30 U/mL to be healthy.
And, by the way, this idea of looking at optimal reference ranges over the standard range also applies to all other thyroid lab tests.
If you fall into this category (slightly raised) or they are outside of the reference range AND you also have symptoms of hypothyroidism then it's definitely worth considering with the treatment below.
It might also be worthwhile for you to undergo a trial of thyroid hormone replacement medication as you might find significant benefit.
Therapies that May Help Lower Thyroperoxidase Antibodies
These are tips I've used and tested on many patients with Hashimoto's in my office and I'm going to go over which ones work best, how you should consider using them, and how they actually help.
Before we dive in, just be sure to remember that each person is different. These therapies may not necessarily work for you or you may need to make adjustments to them.
When in doubt, make sure to discuss these therapies with your current physician (and if you aren't seeing the right type of doctor make sure you check out my tips on how to find one here).
Some of the therapies listed below are medications, some are supplements, and others are related to lifestyle interventions but the point is this:
I've seen each one of them help lower thyroid antibody levels in the patients that I've treated.
#1. Get on the Right Diet for YOUR Body
The first, and perhaps most important step, is to take a long look at the foods that you are putting into your body.
And by that, I am referring to your diet.
Not the type of diet that you get on for a few weeks or days, but a lifestyle shift which helps you continuously and consistently put healthy food inside of your body.
Maybe you are already eating 'healthy' foods and you think this section doesn't apply to you.
This type of logic may not necessarily be true, especially considering that there are many types of 'healthy' diets and you need to spend time finding the one that works well for you.
If you are not already eating a healthy diet (whole 30, real whole foods, paleo, AIP, ketogenic, etc.) then you will probably find a big benefit to switching to any of the diets we are going to discuss.
If, however, you are already eating healthy but not feeling better, then you may want to consider making changes.
For a more detailed post on diet and how it impacts Hashimoto's, please see this post.
Below you will find information on 4 different types of diets that have worked well for many patients with Hashimoto's.
Spend some time looking at the pros and cons of each to help you determine which diet may be ideal for you.
Autoimmune Paleo Diet or AIP Diet
You can see a case study here, which also shows how it can help with weight loss.
The AIP diet has a lot of popularity on the internet because it can be so effective, but I definitely do not recommend it for EVERY patient.
It is a very restrictive diet (It's basically the paleo diet without nuts and nightshades) and can be difficult to follow and maintain over a long period of time.
One of the downsides to using this diet is that some people end up restricting their diet so much that they develop an intolerance to healthy foods and have trouble re-introducing them back into their diet.
Typically I recommend this diet for patients who have failed less restrictive diets or for those who have a history of multiple autoimmune diseases on top of their Hashimoto's thyroiditis.
One of the benefits of going on the AIP diet is the amazing online community, free recipes, and help that you can receive through online groups.
The elimination can be very powerful at reducing antibody levels as well.
In a nutshell, the elimination diet works by removing certain food groups that may be perpetuating inflammation in your body.
As you remove these foods, you will most likely start to feel much better.
You can do this diet 1 of 2 ways:
#1. Test yourself using delayed IgG food sensitivity testing and remove only food groups that you react to.
Food intolerance testing, while potentially helpful, is certainly not 100% reliable or accurate.
Often, people will find that they are 'reactive' to MANY different types of foods and food groups which don't necessarily reflect reality.
I rarely use these tests nowadays because I find that teaching patients how to monitor their body and how they are feeling to be much more effective.
#2. Remove the most common food allergies and monitor your symptoms upon reintroducing those food groups.
You probably have a good idea which foods you should or shouldn't be eating and if you remove these food groups for 6-8 weeks you'll probably be surprised how well you feel.
And you can always reintroduce them back into your diet to see how your body reacts.
From there, it's just a matter of trial and error until you figure out what your body does well on.
Gluten Free, Dairy Free, and Soy Free Diet
Perhaps one of the best shotgun approaches to changing your diet is by going gluten-free, dairy-free, and soy-free.
If you aren't sure where to start then you may want to start here.
While not everyone with Hashimoto's will need to stay off of these food groups long-term, it's still a great place to start.
I don't believe that everyone with Hashimoto's HAS to be gluten-free forever, but I do find that foods containing gluten can exacerbate and perpetuate inflammation in the gut and temporarily removing them for a short period usually helps most people.
SIBO and Low FODMAP's Diet
The last diet I want to mention is the low FODMAP's diet.
This diet is designed to be low in certain types of carbohydrates because these carbohydrates can accelerate the growth of potentially negative bacteria in your GI tract.
Many patients with Hashimoto's also suffer from gut related issues such as constipation, SIBO, fungal overgrowth, irritable bowel syndrome, and so on.
This diet can be very helpful for people with these conditions.
By improving your gut function you may be able to reduce inflammation and autoimmunity and ultimately help treat your thyroid as well.
Before you jump into this diet, however, you will probably want to confirm that you have some intestinal issues which warrant its use and you may need a doctor to help with that.
#2. Consider using Testosterone or DHEA
DHEA and/or Testosterone can be VERY helpful in reducing antibody levels.
If you notice the majority of patients who have Hashimoto's are women (1). This is actually true of almost ALL autoimmune disease (with few exceptions).
Part of the reason this is felt to occur has to do with how Testosterone, DHEA and androgen levels interact with your immune system.
It is currently felt that higher (or should I say 'normal') levels of testosterone may help prevent the onset of autoimmune disease and is protective against these diseases.
This also means that people with LOW testosterone may be at increased risk for developing Hashimoto's thyroiditis.
And this certainly holds true in my experience, as I often test each and every patient with Hashimoto's for both testosterone and DHEA.
My experience suggests that most women with Hashimoto's also tend to have lower than normal testosterone for their age.
If you are someone who has both Hashimoto's AND low testosterone, then you may benefit from the use of testosterone cream or gel.
The goal when using testosterone is only to help balance out your levels and get you back to 'normal', not to give you more than you need.
Using testosterone in this way makes it a very safe and effective treatment for both men and women.
Adding these androgens to your treatment regimen can help in the following ways:
With all of these benefits, you may be wondering if you need testosterone replacement therapy.
The way you find out is simply by testing both your testosterone and DHEA-S.
You can do this with a simple blood test:
Once you have your tests in hand, all you need to do is look at your result and compare it to the reference range.
I find that women with testosterone (free or total) in the bottom 1/3 of the reference range often benefit from taking testosterone.
As you take testosterone you may want to shoot for a serum total testosterone in the 200-300 ng/dL range.
As you take testosterone, make sure you monitor both your symptoms and your total and free testosterone levels.
Beware of using DHEA by itself if you have low testosterone!
DHEA can become converted to either androgens (testosterone) or estrogens based upon the preference of your body.
You may take DHEA to try and push your androgens up, but your body may take that DHEA and create more estrogens instead.
#3. Consider Using Vitamins & Minerals
The use of certain vitamins and nutrients may help improve your immune system and help reduce thyroid antibody levels.
It's always a good idea to ensure that you have an optimal level of ALL nutrients in your body at any given time, but there are certain nutrients which play an important role in both regulating your thyroid and your immune system.
Two of the most potent nutrients include Zinc and Selenium.
Many hypothyroid patients find that they are deficient (even just slightly) in either or both nutrients.
These nutrients work by helping your body in the following ways:
My experience suggests that most people who are deficient in one are also deficient in another.
And testing for deficiency with blood tests is not always accurate so the best way to approach supplementation is often to take both together.
I find that using them together tends to provide the best results.
My personal recommendation is to use both together (along with other nutrients designed to enhance thyroid function) found in this supplement.
Feel free to use other supplements if you prefer, I just recommend what I know works.
In addition to Zinc and Selenium, you'll also want to look at your Vitamin D status.
Vitamin D is another nutrient involved in regulating your immune system and it is well known that patients with Hashimoto's frequently suffer from Vitamin D deficiency.
How to fix this problem is not quite clear, however.
My personal recommendation is to use a low dose of Vitamin D and try to get the rest the "all natural" way through sunshine.
#4. Improve your Gut Function
I mentioned earlier that many patients with Hashimoto's also suffer from gut-related issues.
I want to take a second to expand on that here.
Your gut is the center of thyroid hormone conversion, neurotransmitter production, and immune system education.
Any problem in your gut may, therefore, affect and alter any of these systems.
There are many gut-related issues that you can suffer from, but I find that patients with Hashimoto's tend to experience two conditions which are often underdiagnosed:
- SIBO or Small Intestinal Bacterial Overgrowth
- Yeast Overgrowth
Studies have shown that up to 54% of hypothyroid patients suffer from SIBO (10).
Not only that but having SIBO can increase your risk of developing autoimmune disease and can potentiate inflammation if it's already present (11).
Now let me ask you this:
When was the last time your Doctor asked you about SIBO or mentioned it to you?
Do you see the problem now?
As many as 54% of you may have this condition and you probably don't even know it!
If you have any of these symptoms you will want to get evaluated:
- Gas or Bloating especially 30-60 minutes after a meal
- Chronic constipation
- History of vaginal yeast infections or Intestinal yeast overgrowth
- History of acid reflux
- History of Diabetes or concurrent peripheral neuropathy
- History of Vagal nerve dysfunction
If you are experiencing any of these symptoms I do recommend looking into further testing for SIBO or yeast overgrowth as most people experience a combination of these conditions.
SIBO and other gut issues may also cause food intolerances and other symptoms such as constipation.
I've found that these supplements tend to work the best for treating both SIBO and yeast overgrowth:
If you aren't sure where to start with your gut health then using a probiotic is always a safe bet.
Certain probiotics can help balance bacterial concentrations in your gut, can potentially help with weight loss, and may promote immune balance as well.
#5. Consider using LDN (Low Dose Naltrexone)
In this case, I saved the best for last.
I've found low dose naltrexone (or LDN for short) to be particularly helpful in lowering antibody levels, reducing inflammation and reducing chronic pain.
What is LDN?
LDN is an opiate blocker (meaning it sits on the receptor and blocks opiates from binding to your cells).
It is conventionally used to treat alcohol addiction, but in LOW doses it can help modulate the immune system and may treat certain autoimmune diseases.
It was first used to help patients with HIV back when there were very few treatments available, but it has since been tested in many other medical conditions and found to be quite effective.
The mechanism of action is not well understood but it probably works by temporarily increasing endorphin production.
LDN has been shown to be beneficial in the following ways:
How do you use LDN to lower TPO antibodies?
The dose ranges from 1.5mg to 4.5mg.
I typically recommend patients start with 1.5mg taken at night unless you find it stimulating.
Your dose can slowly be increased and most patients land somewhere between 3.0-4.5mg.
How do you know if it's working?
I've found that about 50% of patients find improvement when taking LDN.
Some, however, don't realize how much benefit they get from LDN until they stop taking it.
I had a patient the other day who stopped taking it after 4 months because she thought it wasn't helping and within 1 week she was suffering from worsening joint pain and inflammation which resolved once she resumed taking LDN.
If you've found that your TPO or thyroperoxidase antibody levels are increased then you will probably need to do some research on your own to find some treatment options.
Most Doctors will tend to ignore these antibody levels so you will likely have to request they order it each time they test your other thyroid numbers.
If you decide to try and treat your antibody levels I recommend using the 5 steps above (but please consult with your Doctor first).
Also, please realize that in order to have the greatest benefit possible you will need to do ALL of the above treatments in order to see a significant improvement.
These techniques have been used by me in the past on many patients to help lower antibody levels and I can vouch that they help (but not for everyone).
While antibody levels are important they are not EVERYTHING. Use these levels as a guide, not as a marker if treatment is working.
In some patients, antibody levels will remain high no matter what you do.
Now it's your turn:
Have you tried any of these treatments to help lower your TPO antibody levels?
What has worked for you, what hasn't?
Leave a comment or questions below!
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