How to Lower TPO Antibodies: 5 Tips I use in my Practice

How to Lower TPO Antibodies: 5 Tips I use in my Practice

Are you struggling to lower your TPO antibodies? 

Many Doctors seems to blow off the fact that you have elevated TPO or Thyroperoxidase antibodies by saying that it doesn't effect treatment...

It turns out that is definitely NOT true. 

Not only does having TPO antibodies present in your serum indicate you may have inflammation and autoimmunity present, it also changes management and treatment of the patient.

This article will highlight several therapies that I've used successfully in previous patients to help them LOWER their TPO antibodies, LOWER inflammation and reduce autoimmunity...​


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 > 5.0 they will slap on some levothyroxine and call it a day.

It turns out that there is definitely a better way...

While TPO antibody levels can be difficult to lower and you shouldn't base ALL of your efforts on lowering them, they should at minimum be followed. 

Trending out antibody levels and monitoring fluctuations can be helpful when assessing which treatment is working and which is not.

Having said that:

You can DEFINITELY still have improved symptoms and have your antibody levels spike up or stay the same. 

Like many things, they can't be used in isolation, but when used with other markers of Hypothyroidism they can provide valuable data. 

​What is the Normal Range for TPO antibodies?

In general you will want your TPO antibodies to be as LOW as possible.

That means non existent or < 30 (with the lab I use).

Please see this example for TPO antibody references ranges:

Slightly elevated thyroperoxidase antibodies

​As you can see in the image above the "optimal range" would be considered < 30, while the "normal range" would be considered less than 60. 

I get worried when antibody levels start to creep higher than 30, but ESPECIALLY if they are higher than 60. ​

A trend of continuing elevation of TPO or thyroperoxidase antibodies over time is also concerning (especially in the face of treatment).

​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 continuing with the treatment below. 

In these patients I also recommend a trial of thyroid hormone and evaluation because most do MUCH better after thyroid replacement hormone. ​

Tips to Treat and Lower your TPO or 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.

Remember that each patient is different, so don't just blindly try these therapies without consulting your physician.

Some are medications, some are supplements and others are related to lifestyle interventions but the point is this:

I've seen each one of them lower thyroid antibody levels in patients that I've treated...​

1. Get on the Right Diet for YOUR Body

​The FIRST step you should take when trying to lower or treat your elevated TPO antibodies is changing your diet. 

While diet is usually NOT enough to lower them all by itself (I have seen this a handful of times) it will ALWAYS help.

Likewise it's going to be impossible to change those levels without also addressing diet - so consider this the necessary first step.

For a more detailed post on diet and Hashimoto's please see this post. ​

When changing your diet it's always best to tailor your diet to your needs and medical conditions. 

I'm going to go over 4 diets below that I've seen work for many patients:

Autoimmune Paleo Diet to Reduce TPO antibodies​
AIP foods to avoid

The AIP diet is VERY effective at lowering TPO and thyroperoxidase antibody levels.

​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 ​(Basically paleo without nuts and nightshades) and can be difficult to follow and maintain. 

There are also several patients who feel good on the diet, but are unable to reintroduce foods after being on it for several months due to tolerance issues.

Typically I recommend this diet for patients who have failed less restrictive diets or for those who have a history of multiple autoimmune disease. ​

One of the benefits to going on the AIP diet is the amazing online community, free recipes and help that you can receive. ​

Elimination Diet to Reduce TPO antibodies​

The elimination ​can be very powerful at reducing antibody levels as well. 

You can do this diet 1 of 2 ways:

Test yourself using delayed IgG food sensitivity testing and remove only food groups that you react to.

Or remove the most common food allergies and monitor your symptoms upon reintroducing those food groups.

Typically I will recommend removing the most common food allergens and then move to testing if symptoms do not improve. ​

T3 conversion booster results
Gluten Free, Dairy Free and Soy Free Diet to Reduce TPO antibodies

​Going gluten free, dairy free and soy free should be the FIRST place you start (if you don't know where to start) in treating high TPO antibody levels. 

This by itself is enough for many patients to notice significant improvements. ​

SIBO and Low FODMAP's Diet to Reduce TPO antibodies​

SIBO and the Low FODMAP's diet can be particularly helpful in patients who ALSO have irritable bowel like symptoms in addition to elevated TPO antibodies.

In these instances treating the underlying cause is usually necessary to help reduce antibody levels. ​

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. 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 Testosterone, DHEA and androgen levels.

The less testosterone you have = the more likely you are to develop autoimmunity and Hashimoto's.

In my experience of testing MANY patients with Hashimoto's I can attest that the vast majority ALSO have low free and total testosterone in addition to low DHEA.

​Adding these androgens to your treatment regimen can help in the following ways:

How do you test for low Testosterone?

Check your Free and Total testosterone in addition to DHEA-S. 

Low normal testosterone levels

​If your ranges are in the lower 1/3 of the "reference range" I would consider adding either or both of these therapies. 

A goal to shoot for would be in the high normal range, or even as high as ​200-300 total testosterone in the serum for women. 

3. Consider the use of Zinc and/or Selenium

Some supplements can also have a very powerful impact on lowering TPO and thyroperoxidase antibody levels.

Two of the most potent nutrients include:

Zinc and Selenium. 

​Some hashimoto's patients will need supraphysiologic doses of these nutrients to suppress antibody levels so I don't always recommend basing treatment off of lab values alone. 

How are they helpful?

Zinc can help with the following:

Selenium can help with the following:

​Both of these nutrients can be used in combination to provide a nice, powerful BOOST to your immune system and can help to lower TPO antibody levels. 

I recommend using this type of Zinc and this type of Selenium.

4. Improve your Gut Function

​When you have hypothyroidism and gut issues I'm specifically referring to two very common and under diagnosed conditions:

  • SIBO or Small Intestinal Bacterial Overgrowth
  • Yeast Overgrowth

​I'm specifically referring to these conditions because they are often missed completely and they have a huge effect on the immune system and gut function. 

Another problem is that as much as 54% of hypothyroid patients have SIBO.

​Not only that but having SIBO can increase your risk of developing autoimmune disease and can potentiate inflammation if its already present

​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. 

In many of my patients who have ALL or MANY of the above symptoms AND a history of Hashimoto's or Hypothyroidism I will usually recommend TREATMENT first and then testing to confirm eradication.

I've found that these supplements tend to do the best for treating both SIBO and yeast overgrowth:

​In some cases you may require antibiotics like rifaximin or antifungals like diflucan

5. Consider using LDN (Low Dose Naltrexone)​

LDN anti inflammatory agent

In this case I saved the BEST for last.

I've found LDN or Low Dose Naltrexone to be particularly helpful in lowering antibody levels, reducing inflammation and lowering chronic pain.

​What is LDN?

LDN is an opiate blocker (meaning it sits on the receptor and blocks opiates from binding to cells). 

It is conventionally used as a rescue medication​ for patients who have overdosed on narcotics, but in LOW doses it can help modulate the immune system and reduce autoimmune diseases. 

It was first used to help patients with HIV back when there were very few treatments, but it has undergone significant research since that time and has shown benefit in many conditions.

​LDN helps with the following:

​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 patients find it stimulating.

The 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!

Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

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