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 blow off the fact that your thyroid antibodies are elevated because they believe that it won't affect treatment.
This is completely backwards:
The presence of high TPO antibodies indicate that you CAN and SHOULD do something.
The mere presence of TPO antibodies in your serum means that your body is attacking its own thyroid gland and with this attack comes inflammation and the autoimmune process.
But it doesn't have to be this way:
In this article, you will learn:
- Why it's so important to lower your TPO antibodies if you have Hashimoto's
- Normal reference ranges for TPO antibodies (and what you want your levels to be)
- Natural treatments that can help lower your antibody levels
- And some prescription medications that may help too!
Let's jump in...
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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 aren't alone.
It turns out there is a much better way to manage Hashimoto's.
This way includes keeping track of a combination of your thyroid function as well as the absolute value of your thyroid antibodies.
As you make changes, take supplements, alter your diet, take medications, you can track how you are feeling, what is happening to your antibody level in your blood, and how this impacts your thyroid function.
Doesn't this sound much better than the sit and wait approach that most doctors take when managing Hashimoto's?
This sort of treatment plan is helpful because it allows you to track your antibodies over time and, hopefully, reduce them.
While it isn't universally true for every patients with Hashimoto's, the higher your antibody levels the more likely you are to see damage and harm to your thyroid gland.
The longer your antibodies stay elevated and at higher threshholds, the faster you will progress to end-stage Hashimoto's and a lifelong requirement of prescription thyroid medication.
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.
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:
We know that the presence of antibodies indicates potential damage to the thyroid gland.
Getting your antibodies to as close to zero as possible ensures that these antibodies aren't floating around in your bloodstream capable of inducing damage.
The standard reference range for thyroidperoxidase antibodies is given as a value less than some number.
This may sound ambiguous, but it's just how it is.
In most cases, the "normal" range is given as less than 60 U/mL or even less than 30 U/mL.
If you pull out your own lab tests and compare you may find that your reference range is a little bit different and that's okay.
As long as you focus on getting your antibody levels to as close to zero as possible then you are on the right track.
More important than the absolute level of antibodies in your blood is the trend of those antibodies over time.
You can see an example of the thyroperoxidase antibody reference range below:
Treatments That Can Help Lower TPO Antibodies
It's tempting to think of Hashimoto's thyroiditis as a thyroid disease, right?
After all, Hashimoto's results in damage to your thyroid gland which results in low thyroid function and the need for thyroid hormone medication.
But this line of thinking misses the underlying cause of Hashimoto's:
Immune system disruption.
Hashimoto's is as much, or more, a disease of your immune system than a thyroid problem.
In fact, the therapies that we are going to discuss in detail below focus mostly on this aspect.
And that makes perfect sense:
If you can regulate or balance your immune system then you can help re-educate your body that your thyroid gland is your friend (and not your foe!).
As you do this, your antibodies level should decline, your body should stop attacking your thyroid gland, and your thyroid function should return to normal.
Let's talk about to how do it:
#1. Diet (The Foods you Put In Your Mouth)
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 not all of them are healthy or ideal for those with Hashimoto's.
In fact, there is wide dispute over what constitutes a health diet!
The good news is that we don't have to look far to figure out what works for Hashimoto's.
We have a bunch of information from patients with Hashimoto's to be our guide.
In fact, we have hundreds of case studies, and even medical research, to suggest which diets are best.
Based on this information, here are the top 3 best diets for those with Hashimoto's looking to reduce their TPO antibodies:
Autoimmune Paleo Diet or AIP Diet
The AIP diet stands for autoimmune protocol or the autoimmune paleo diet.
You can think of this type of diet as a paired down version of the paleo diet.
It takes the standard paleo diet, which is already fairly restrictive, and restricts down your food choices even further.
And it turns out that the AIP diet is actually quite effective at lowering TPO antibodies for most people who use it.
You can see a case study of a patient with Hashimoto's who used the AIP diet, in conjunction with other therapies, to lose 50 pounds and improve her thyroid status significantly.
This is just one example but there are many others.
There are also emerging studies (1) which show promise in using the AIP diet to treat all sorts of autoimmune conditions.
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.
Because of this, I tend to reserve the AIP diet for those who have failed less restrictive diets or in those who have a history of multiple autoimmune diseases on top of their diagnosis of Hashimoto's.
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.
#2. Increasing your Testosterone Levels
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. Optimizing your Vitamin D Level
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. Improving Gut Health
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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