Unraveling thyroid antibody tests

When it comes to thyroid antibodies, those definitive markers for Hashismoto’s, confusion sometimes arises. For instance, do your high antibody counts mean your Hashimoto’s is worse than your friend’s, whose counts are low? Or how come you first presented with negative antibodies, and now that you’re on your practitioner’s protocol and feeling significantly better your antibody counts are suddenly positive? And why is iodine producing negative antibody results? Does that mean it’s “curing” Hashimoto’s?

As you’ll learn, if your practitioner sees negative antibodies and proclaims you are “cured” of Hashimoto’s, he or she clearly does not understand some basic immune principles.

In this article I review thyroid antibody panels, what they really mean, how to accurately test the status of your autoimmune condition, and whether your protocol is working for you.

First of all, we all make antibodies against cell tissue. The presence of some antibodies is healthy and normal. As old tissue cells die to be replaced by new ones, the immune system tags these dead cells with antibodies, just as it would tag an invading virus or infection to destroy and remove. In the autoimmune process however, this highly organized and complex system runs awry, and antibodies tag healthy tissue. This is the case in Hashimoto’s, an autoimmune disease in which the body’s immune system tags healthy thyroid tissue for destruction and removal.

We identify Hashimoto’s by measuring thyroid peroxidase antibodies (TPO Ab) and thyroglobulin antibodies (TgAb). TPO is the most commonly elevated antibody in Hashimoto’s, however TgAb should always be checked too, even though it is not as common. To assess whether these antibodies are positive we use the lab ranges, which vary from lab to lab.

Why you can have negative antibody results and still have Hashimoto’s

Say all your symptoms point to Hashimoto’s but your antibody tests are negative. Does this mean you don’t have Hashimoto’s? Not necessarily. As you’ll learn, if your practitioner sees negative antibodies and proclaims you are “cured” of Hashimoto’s, he or she clearly does not understand some basic immune principles.

The waxing and waning immune system

When I have a patient who is struggling with symptoms of both hyperthyroidism and hypothyroidism, a strong indication of Hashimoto’s, and the antibody test comes back negative, I run a second panel. Because the autoimmune response waxes and wanes, the patient may test negative one week and positive the next.  Sometimes I may even ask the patient to enjoy extra sugar and gluten in their diet before the second test, as sugar will drive up inflammation and gluten will provoke the autoimmune response, both of which better the chances of producing a positive result on an antibody lab panel.

Many times these people will not test positive for Hashimoto’s or start to feel better until their compromised immune system improves in health.

Overall immune weakness

Some people with Hashimoto’s test negative because their overall immune health is weak and they do not produce enough antibodies. Their immune systems have been so stressed for so long that their total white blood cells and B-cells are too low to be able to make antibodies. You have to have some degree of immune fitness to produce antibodies. Many times these people will not test positive for Hashimoto’s or start to feel better until their compromised immune system improves in health.

These are the people who, after several weeks on a gluten-free diet or on a protocol from their practitioner start feeling great, yet are dismayed when a follow-up antibody panel shows antibodies are significantly higher, or are positive when they were initially negative. In some cases this is a sign that immune health has been restored to the point where antibody production kicks back into action.

TH-1 is higher than TH-2

A TH-1 dominance may be another reason for negative antibodies. As I explain in the book, we can roughly divide the immune system into two sides. TH-1 is the side that reacts immediately to an invader whereas TH-2 is the delayed response that produces antibodies. In a healthy immune system TH-1 and TH-2 are balanced, however in Hashimoto’s one of these becomes overly dominant. When TH-1 soars too high this suppresses TH-2 and hence antibody production. As a result antibody counts on a lab panel may show as low or negative. When you bring these two systems into balance, however, antibody counts on a panel may temporarily increase before balancing out.

This also explains why the use of iodine can produce a negative antibody panel in Hashimoto’s. Iodine has been shown to stimulate the autoimmune attack against the thyroid, which increases inflammation, a TH-1 response. In a TH-1 dominant person—statistically most people with Hashimoto’s—this further stimulates TH-1 while suppressing TH-2, again producing negative antibody results and giving many the impression the Hashimoto’s has been “cured.” Also, high doses of iodine can stimulate the production of TPO, the enzyme that is the target of autoimmune attack, to the point that it becomes inactive and the autoimmune attack ceases. However TPO is necessary for thyroid function and this is not a desirable approach when we have other methods that work better.

If either of these factors is a possibility, I tell people to check for inflammatory cytokine levels (the compounds that make up the TH-1 system), such as IL-2, IL-12, TNFa, and interferon. They should also check the CD4/CD8 ratio, which is the ratio between T-suppressor and T-helper immune cells. If inflammatory cytokines are high and the CD4/CD8 ratio is out of balance, this indicates an inflammatory condition that is suppressing TH-2 and perhaps artificially producing a negative result for Hashimoto’s. This is especially important to check in those using iodine to address Hashimoto’s.

(If all this immune terminology is confusing, please refer to the book, where it is explained in detail.)

Beyond thyroid antibodies to gluten

These reasons explain why Jane can have really low or even negative antibody counts and feel worse than her friend Mary, who also has Hashimoto’s but whose antibody counts are higher. Jane’s overall immune function is weaker or more out of balance. This is also why I caution people about the results from labs that test for intolerances to gluten, dairy, and other foods. A negative result does not necessarily mean you’re free to resume eating breads, pastas, and other gluten foods. In fact I heard of a woman with all the classic symptoms of Hashimoto’s, celiac disease, and rheumatoid arthritis (an autoimmune joint condition) who barely tested positive for a gluten intolerance. Unfortunately her doctor, who does not understand these immune basics, interpreted this as meaning she is only a little bit intolerant to gluten and can still eat it, just in smaller amounts, and she continues to suffer.

As I explain in the book, the Elimination/Provocation Diet is the best test for food intolerances.

Some people always test negative

Interestingly, studies also show some people always test negative for Hashimoto’s on antibody panels, while follow-up biopsies confirm that Hashimoto’s is present. That’s why it’s imperative to test other immune markers, remove gluten from the diet, and avoid iodine if Hashimoto’s is suspected.

Reacting to both TH-1 and TH-2 stimulators

In the book I explain how a challenge using designated herbal and nutritional compounds can determine a TH-1 or TH-2 dominance. One practitioner emailed with a question about a patient who reacted negatively to both TH-1 and TH-2 compounds. I have seen this before in those whose gut barrier is extremely compromised and who react to many things. In this case the focus would first be to first restore health to the gut and then try the challenge again some time later.

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