About 90 percent of hypothyroidism cases in the United States are due to Hashimoto’s, an autoimmune disease that attacks and destroys the thyroid gland. It’s important to identify Hashimoto’s because you then know it is the immune system you must address, although thyroid hormone medication may still be necessary.

How to test for Hashimoto’s hypothyroidism

In identifying Hashimoto’s, I test the blood for two antibodies that affect thyroid hormone production. These are:

If you test negative for Hashimoto’s but have symptoms

If the tests are negative but symptoms point to Hashimoto’s, I repeat the test since these antibodies are known to fluctuate. Also, results can be negative if the immune system is exhausted due to overwork and unable to produce enough antibodies for a positive result. Many times when people follow the autoimmune diet, antibody levels go up even though symptoms improve. This is because the immune system is able to recover enough to produce more antibodies. If you continue to follow the diet and autoimmune protocols, antibody levels should eventually drop as the immune system becomes more regulated.

Why antibody levels do not tell you the degree of autoimmunity

A mistake many people make is thinking low antibody levels mean their autoimmunity is not that bad, or that high antibody levels mean it is very bad. This can be true, but the opposite can be true as well. A person with low antibody levels can have terrible Hashimoto’s flare-ups while a person with higher antibody levels can be symptom-free and feel great. This is because the antibodies do not destroy the tissue themselves, they merely paint targets on it. It is up to the immune system to then decide whether it will attack the tissue with a knife or a blow torch. Of course, the most desirable outcome is to produce no antibodies to the tissue, which indicates the Hashimoto’s is in remission. But in the meantime, your symptoms will tell you more about the severity of your Hashimoto’s than your antibody panel.

The only exception to this is with antibodies to brain and nervous tissue–the higher they are the worse the autoimmune destruction.

Avoiding Hashimoto’s triggers: Understanding TH-1 and TH-2

It’s also important to know if you have Hashimoto’s so you can avoid immune triggers that will worsen your thyroid condition. One well-documented trigger is gluten, the protein found in wheat. You may also need to follow the autoimmune diet as many Hashimoto’s patients are sensitive to other foods that can trigger a flare-up.

Other triggers can be found in common supplements. In order to know which supplements are safe for you, it’s helpful to know whether your autoimmune Hashimoto’s is TH-1 dominant or TH-2 dominant. (TH stands for T-helper cells.)

This involves identifying which aspect of the immune system response is hyperactive–the side that  deploys immune cells to attack the intruder–or the side that deploys antibodies to tag the intruder so it’s easier to find next time.

If you are TH-1 dominant, you are producing too many natural killer and cytotoxic T-cells. These are the ones that immediately attack the intruder.

If you TH-2 dominant, you’re flooding your system with B-cells. These are the antibodies that tag the intruder so it can be more quickly identified next time.

Different herbs and supplements stimulate either TH-1 or TH-2. When this system is imbalanced, these supplements can either worsen your Hashimoto’s or make you feel better, depending on your TH dominance.

Compounds that stimulate TH-1

(These stimulate TH-1 and dampen TH-2. Avoid if you are TH-1 dominant. If you are TH-2 dominant they may make you feel better.)

  • Astragalus
  • Echinacea
  • Beta-glucan mushroom
  • Maitake mushroom
  • Glycyrrhiza (from licorice)
  • Lemon balm

Compounds that stimulate TH-2

(These stimulate TH-2 and dampen TH-1. Avoid if you are TH-2 dominant. If you are TH-1 dominant they may make you feel better.)

  • Caffeine
  • Green tea extract
  • Grape seed extract
  • Pine bark extract
  • White willow bark
  • Lycopene
  • Pycnogenol

Some people have clear reactions to these compounds. I have known TH-1 dominant people who ate the perfect diet and could not figure out why their autoimmune condition was out of control. Turns out they drank echninacea tea daily. The same goes for TH-2 dominant people and green tea.

On the other hand, a TH-1 dominant person may feel better using compounds that activate TH-2, and vice versa. Stimulating the weaker TH helps many people restore balance and improve symptoms.

Also, some people are so immune reactive they react to everything on both lists. Other people find compounds on both lists help them. Another group finds no reaction to the compounds on either list. Although we can identify some basic immune mechanisms, it’s important to remember not everyone’s body “follows the rules,” so pay attention to your symptoms. Your practitioner also may be able to run a lab panel to test for a TH dominance, which is explained more in the thyroid book.

If you read the thyroid book you may notice resveratrol is no longer on the TH-2 list. This is because we now work with another TH system called TH-17. TH-17 promotes inflammation and tissue destruction regardless of your TH dominance. I have found that emulsified resveratrol and curcumin, in high therapeutic doses, work well together to dampen TH-17 in most people. However, if you are a sensitive TH-2 dominant person, you may want to slowly dose up on resveratrol in case it makes you feel worse.

For more information about managing your autoimmunity and protecting your brain health, you can also read my new book Why Isn’t My Brain Working?



  • Natalie March 3, 2014 at 6:08 pm

    Thank you for this information Dr K!! I have been newly diagnosed with subclinical hypothyroidism and after doing some research and readings I have a few questions that even my doctor can’t answer (very concerning)!
    So the only reason I have been diagnosed is because I did fertility blood work that showed my TSH was slightly high (according to the doc) being 4.9 when the range was 0.40-3.5 and she explained that my t4/t3 were withing range but my TPO was very high (the pathology centre stops counting after 1000) soni was >1000. She subsequently put me in oroxine and my TSH is now at optimal levels, TPO still >1000. The reason for the meds is because I am trying to fall pregnant. And my doc explained optimal levels of TSH and thyroid in general to ensure baby is ok if and when I’m pregnant etc as well as helping me in my battle to overcome PCOS she placed me on metformin. My cycles are very irregular!

    So now you have a brief overview.. My questions are could my TpO impact my chances if falling pregnant and holding baby full term? (Apparently doc says yes somewhat but numbers are fine and not to worry) if so what can I do to fix this. And ensure a safe pregnancy and increase chances of Falling pregnant in the first place (it’s been very hard to date)
    Do I need to go in AIP or there like? My doc didn’t even know what this was!!
    And is there anything I can do to reverse or put my self into remission from PCOS and hypothyroidism? Keeping in mind I may have RA (Doppler u/sound showed signs -mildly in wrists)

    So I’m so confused and don’t know, apart from the oroxine, what I should do based in my situation? Everything I read is making sense but I don’t know if it truly relates to me considering I have no real symptoms of thyroid except coldness and that has been fixed from the meds?

    Praying you can help me because I feel I’m at a loss with the medical advice I’m receiving! I believe my conditions are Ll related and what to achieve a balance ASAP! So worried I’m missing out on healing myself!
    Thank you in advance and apologies for the long post !

  • Elaine March 12, 2014 at 1:12 pm

    Have you read the book? You will find quite a lot of answers to your questions in there, and in the brain book. It is vitally important you manage this first before getting pregnant. The risks between unmanaged autoimmunity and autism or other immune/brain development disorders in children is well established now.

  • Natalie June 29, 2014 at 10:41 pm

    Thanks for your reply Elaine. I haven’t got drK book I’m still trying to get through izabella wentz and Sarah ballyntynes book!

    My thyroid levels are all in range it’s now just the TPO that’s still sky high and I just checked my last scan for PCOS and it showed no cysts which was amazing! Hoping that lowers autoimmune attack overall somehow

    Still doesn’t explain the high TPO. I’m starting AIP adding selenium and cut out processed foods & gluten free – all early days so I hope to see results ASAP! I couldn’t bare another m/c

    Just found a functional doc so waiting for my appt on a month or so.
    Praying – that’s all I can do right now!

  • Carol September 15, 2014 at 5:07 pm

    how can you find out if you are th1 or th2 dominant? I drink green tea, and use tumeric, and I feel great. Does that mean that I am th1 dominant?

    • Samantha McRorie March 27, 2015 at 11:37 am

      I too would love to know how a person knows if they are TH1 or TH2 dominant :)

  • Laurel Kashinn October 1, 2014 at 4:16 pm

    I am searching for a functional medicine doctor in the Milwaukee area who is up on the latest research and protocols on managing Hashimoto’s. Would be great if it was someone who has insurance coverage; the costly tests are outside my budget at this time. Thanks!

  • Stacey October 30, 2014 at 6:42 pm

    I am searching to buy emulsified resveratrol and curcumin and can not find any supplier that sells the liquid form to get the high amount of daily intake as suggested. Can anyone help me out with an online source to buy these?? thanx!

    • Arrowyn November 19, 2014 at 7:34 pm

      I’m searching for exactly the same thing. RIght now I’m taking capsules from New Chapter, but I’m only getting 2500 mg per day and flying through them.

  • susan March 29, 2015 at 12:49 pm

    can you please comment further on Th17? if these levels are high, what does that mean? a high level of auto-immunity? i’m sure i deal with auto-immunity as i deal with CFS and am beyond exhausted. but all my tests come back normal. Would th17 also come back normal if my immune system was exhausted?

    i’m taking this test soon th1/th2/th17 (the advanced one). do i need to be off ALL supps prior for one week or just those that enhance one or the other? thanks


  • S April 3, 2015 at 1:07 pm

    Thank you for the article. How interesting, i have had Hashi’s from little up, it is my genetics, and i intuitively avoid coffee, strong green tea, alcohol, tomatoes (lycopene?), which, according to the article, are not good for TH2 dominates. On the other hand, i noticed i felt good after taking echinacea. I will try to take teas made of other herbs listed for ‘my’ type.

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