When it comes to thyroid antibodies, those definitive markers for Hashimoto’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.
Very interesting information. Thank you for this. I have Hashimoto’s (and was told I was “cured” as my last TPO antibodies were below mid range.) I will share this with my doctor.
Question: I had the cytokine testing and the results were negative. I am on 20mg of Cortef (taken in divided doses throughout the day – I’d love to be off of it and your protocol, btw!)… but I’m wondering if the Cortef can skew the results, creating a false negative. Thanks much.
What happens exactly to people with Hashi’s who take iodine? Thanks!
Datis,
Excellent information over here, – just added your book to my astore over at CorePsych Blog. Last time I checked the brain and the body are connected! We see so many who suffer with these issues in our offices, as so many who focus only on acuity miss the subtle chronic points you have so clearly described here. Thyroid challenges, gluten and other antigens, all effect bowel function – and yet go overlooked so often.
Well done, look forward to meeting one day.
cp
I was diagnosed with Hashimotos last year during a general checkup not suspecting anything was wrong with me. I had a slightly high TSH and followup anti-body tests were very high. No symptoms – and the ones that were linked like menstrual issues and reactive hypoglycemia had been eliminated with diet and supplements(I have been following the Zone diet with Paleo food choices, plus taking fish oil and Vit D).
I then added iodine thinking it might help – but everything turned to custard – my TSH shot up rapidly and my thyroid enlarged, I put on weight, and felt bad. Thank goodness your book was recommended! I immediately cut the iodine and went strictly gluten free (I was having a few cheats not realising the damage that could have happened) My TSH rapidly went down to from 13 to 6, and my thyroid shrank back to almost normal in weeks. My weight dropped back down and I feel normal again.
I am hoping to see a drop in thyroid anti-bodies, but early days yet. I am currently symptomless and hoping to stay that way.
What exactly would be considered high tpo?
Check the reference range on your labwork – every lab has a unique range, so it’s not possible here to give a specific number.
Hi, whats is your opinion on having a low or virtually no TSH reading due to taking Natural Whole Grain Thyroid. My t4 and t3 levels are within range but at the lower end? Does Tsh effect bone health and or other problems?
Many thanks
Paula
I have taken gluten out for 3 months – have been on HCL/Pepsin. The gut and puffy face has gone down alot and my new tests show no real gluten or wheat allergy. My hands can still flare up with joint discomfort and mild swelling – I will stay off anyway. It says yeast and aspergillus niger and yogurt are my big allergies. I paid $322 for this test thinking of course a test that is this much from Neuroscience would be accurate but somethings don’t add up with what i hear I should do for hashi and how I feel vs what it says I am and am not allergic too. Any others having this issue?
thanks
I got my test back and it is 37 for TPO ab. I have already been off gluten for 3 months though. Is 37 normal?
Less than 34 iis normal. Mine is 315
Just had my TPO drawn a few weeks ago and it was 2314! I’m definitely going to try going GF
Hi! I just had my thyroperoxidase abt drawn and it was 3,406. Were you able to lower yours? How?
Thanks so much for this information! My TPO tests are always normal but my TgAb tests are elevated. What does this mean exactly? Is this “less serious” than elevated TPO? In any case, I’ve stopped eating gluten and drinking alcohol, and feel much better.
Oh, now that I read futher. You are ssguegting that there could be more of an autoimmunity syndrome induced by all the cytokines. Is there a way to measure cytokines? Is there a way to find a balanced treatment using L-arginine especially for individuals with primary APS?
I’m like you. I just found out a few days ago I have Hashimotos however I’m 13 weeks pregnant. All my labs are within normal limits except the TgAB It’s 142.5 for reference my TPO is 13. My OB is gonna continue to monitor but she did not put me on medication yet. I’m just very worried for my baby obviously.
Hello JDH;
I saw your comment as I was reading through; though Dr. K doesn’t offer advice here for pregnant women with Hashi’s, I wanted to point you to some resources in case you are seeking them. Below are some links that you may find helpful:
http://www.phoenixhelix.com/2015/04/25/episode-17-an-autoimmune-paleo-pregnancy/
http://sweetpotatoesandsocialchange.com/aippaleo-pregnancy-1st-trimester/ (she has sequel posts for the rest of the trimesters)
http://www.grazedandenthused.com/single-post/2016/1/25/Paleo-Pregnant-Weeks-1-through-20
If you google “aip pregnancy” you will find more resources.
You might also check on Autoimmune Wellness website.
Good luck!
Was 13 tpo what got you diagnosed with hasimoto?
Thank you for this information! I have been on a VERY strict gluten free and pescatarian diet for about 3.5 years. In the past year all of my symptoms have returned and are getting worse; joint pain/swelling, muscle fatigue/pain, headaches, recurrent yeast infections (thrush, vaginal, skin), fatigue, depression, weight gain (20lbs in 3 months), foggy head/forgetfulness, inability to tolerate extreme temperatures, cold urticaria. I just had my thyroid checked, again, and my levels came back normal, again. On the most recent test my results were: TSH 1.9, T4/3 .97, total T4 7.4, T3 26.8%. My TSH has gone up from .5 two years ago. I’m at a loss for what to do next! I feel horrible and am unable to get any answers.
I’m in the exact same condition as Heather! My TPO = 11, which I’m told is normal, and Thyroglobulin was <20, but I have SO MANY symptoms of Hashimoto's! What is going on?! Any thoughts would help. I also have poly-cystic ovary syndrome, hypoglycemia, a gluten intolerance, asthma, allergies, gallbladder disease, etc.
I have chronic hives to and all the other symptoms I’ve had it for 14 months with no answers. Have you found anything out. Do yiu still have hives.
Keesha,
I had chronic hives as well and found out that I was suffering from leaky gut. You need to get checked for this and heal your gut/intestinal lining. It will distribute toxins all over your body giving you strange symptoms like this. I healed my gut and I don’t get the hives or rashes anymore.
Your Free T 3 is high!! Dont even need Total t3 the free is one that tells the unbound hormone. Your Ft4 is high also Reference range is 0.79-2.34 different ranges at different clinics or hospitals. Your test results indicate your are hypothyroid. You should follow up on this. High results mean your low on hormone. Low results mean your high. I have Graves Disease since 2009. I have learned the hard way how to manage it. Many doctors (even endos) dont know or understand the tests or how to treat!!!!! Research is the answer and hopefully find a good doctor that does not think the TSH is the gold standard to go by!!!
At 69 and male I have been diagonsed with Graves Disease which also effects my eyes–bulging and double vision. Would sure like to know what you did to manage your GD and if it helped your eyes, if you had that issue. Thanks.
Heather;
I know your original post was from 2012, but in case you saw Elly’s response to you above, it may be a bit confusing. The factor that she’s referring to where she says “High results mean your low on hormone. Low results mean your high” is referring to TSH, not Free T3 and Free T4. Free T3 and Free T4 are indeed important to track (total T4 doesn’t really tell you enough) but they are low when you are hypo, not high. Functional Medicine practitioners say they typically they need to be in the high end of the reference range for one to feel well. Surfing the low or middle range isn’t enough. Just wanted to make sure you were aware of all that 🙂 . Hopefully you have gotten things figured out in the meantime.
Where can I find a way to interpret my labs? My doctor does not seem to pay any attention to my symptoms and says I am just depressed and don’t sleep enough. I had to beg her to even order labs! I have a family history of hypo-thyroid and celiac.
TSH is 2.51 mclU/mL, Free T3 2.4 pg/mL, Free T4, .8 ng/dL, thyroglobulin Ab<20 IU/mL, Thyroperoxidase Ab 117 IU/mL, and my cholesterol is also high.
Gail: Your T3/T4 looks low. I used to be on Synthroid and felt like crap. Switched to Naturethroid with direct T3 and feel much better. My numbers before I switched looked like yours, except my TSH was like 5…really high. I would recommend switching to a Natural Path Doctor and getting on Naturethroid or Armour with direct T3. I felt better almost instantly in the switch due to the T3 which is the active form (not T4). Also, I have officially given up on conventional endo’s…they don’t care about us Hashi sufferers, I’d recommend doing the same.
I’m desperate for advice! I’m brand new to this and confused.
In 2010: due to fatigue I had an ultrasound and blood tests.
The ultrasound report: normal though it included a note asking my PCP if I had a history of Hashimoto’s and TSH test result was 3.267. Dr said I was fine and sent me on my way.
Early 2013: an enlarged lymph node in my neck, ultrasound #2
Ultrasound Dr said lymph node is fine but it “looks like I have the beginnings of Hashimoto’s, I should get my thyroid levels checked” and walked out. I was freaked out. I had never heard of Hashimoto’s before. I have my Dr (not the same as the 2010 one) check my thyroid.
TSH 1.894 (down from in 2010 but that doesn’t mean much).
TPO – 25.5
thyrogobulin 5.2.
Dr said I was at “risk” for Hashimoto’s because I had antibodies but my TSH #s are within range so I’m fine for now and we should just test it every year and she sent me on my way.
2014: yearly check up and my Dr ONLY tests my TSH and free T4 and tells me when I asked her why she didn’t recheck my antibodies to see if its changed that “it’s not necessary, once we know I’m at risk the antibodies don’t matter”. Great.
TPO 2.858
T4 Free 1.0
So my question is, do these results mean I do have Hashimoto’s? Should I be seeking treatment? I would rather not be on any medication if i can avoid it. Are my antibodies not high enough to be considered concerning? I do feel fatigued with low energy in the day and don’t sleep well at night. My hair has been thinning and falling out. I have tingling sensations throughout my body at different times of the day. Though, I have no weight issues. No bowel issues. I have a fast metabolism and have been naturally skinny my whole life. I know weight issues is usually a common sign of Hashi’s but I don’t have that. Ah I just need help from people who are going through it cuz clearly my Dr is useless. Thanks for your time.
Your numbers look good. Not concerning at all. I would agree with your doc. Meanwhile you can eat healthy and read up on things to do for thyroid health and so those things. Can’t hurt. But I’d kill for your test results. I know it’s a year since you posted so I hope you still have similar great numbers.
Hi There,
I was sent to an endo because I had a small lump on my thyroid (had ultra sound) about 3mm. Family history of both hypo and hyper thyroidism. Anyways..the endo I went to wasn’t very helpful. I received my blood work online, and pretty much had to decipher it myself because the only way my doctor believes in giving results is via follow up appointment, but I moved out of state and cannot return to his office. I am 22 years old and don’t really feel as if I have any Hashimotos symptoms. According to my results the doctor (briefly got him on the phone) says I have Hashimotos and a mildly underactive thyroid. He said my options are: Medicate then re check blood 6-8 weeks later. Or to just wait 6 months and re look at everything then. I didn’t care for these options. I don’t want to just jump to conclusions and medicate over a 60 second phone call. My Anti-Thyroglobulin Antibodies are 71 and my Thyroglobulin (Tg-Ria) is 8.7.
How bad is a 71? I know above 1 simply means the antibodies are present, but is this a number I should be super concerned about??? Now that I have moved I plan on getting a 2nd opinion elsewhere, but was wondering what to think in the mean time.
Note: I am on a pescetarian diet (no meat, seafood only) Could diet alter this???
Nicole,
What have you learned about your leveo Thyroglobulin ab? My daughter also tested at 70 and we trying to understand if that confirms hashimotos or what exactly it means. Any info would be greatly appreciated.
thanks!
“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”
Wondering what other immune markers should be checked? My TSH and ft3 ft4 were normal, and antibodies were negative- but I have A LOT of hypothyroid symptoms, as well as a very closely related autoimmune disease- vitiligo. I just recently tested a positive ANA, could this be from hashis?
Hello Jean. I’m feeling for you after reading your post. Hang in there! It’s a lot to take in at once. The best thing you can do for yourself is to learn as much as you can and commit to yourself to be your own advocate. Remember that the doctors work for you! Don’t let them waste any more of your life waiting for the damage to be done! Go in there knowing what you want and fight for it like your life is on the line, because it is! Check out the Facebook group hashimoto’s 411. It’s a great place to start. Good luck!
I recently went to see and endo and had some bloodwork done. I have hypothyroidism and have been on levothyroxine for a few years now. My TPO was 148. Could this mean I might have Hashi’s? My doc never mentioned it when she called me with my results,she was just concerned about my Vitamin D being extremely low. Doctors just dont seem concerned about me still having all these symptoms,they say my TSH tests normal. I am not feeling normal, and haven’t for years. I would really love some answers.
So… How do we get a Hashi’s DX? My new endo says I’m fine. I wish you could come to every one of our drs and dispute them. Wouldn’t it be great if drs were helping all these people instead of denying them treatment?!
My endo said to me…” I would never go to a naturopathic doctor and I would never send anyone I know to a naturopathic doctor I don’t know where they get their information but I got mine in medical school from a textbook.”.
I am just being diagnosed with this disease Dr. Says levels should be -9 mine is 76, not really sure what that means other than I know I am not functioning well daily but am improving from where I was at 3 weeks ago when I was probably at the worst I have been ever. I believe I have been misdiagnosed for yrs. Hoping to find answers and support! After reading lots of information the past couple days it makes sense and I have all of the symptoms.
I recently tested negative for hashimotos but i have so many of the symptoms. That specialist told me not to come back in since I tested negative.
I recently tested <1 on my TPO and <1 Tgab. However, my thyroid US 3 months ago says I still have nodules which were discovered 5 years ago. Therefore, I am still (and always will be) Hashimoto's. An US is what confirms Hashimoto's because – as in my case – you CAN test negative on both and still have Hashimoto's. I was diagnosed 18 years ago, but only tested for Hashi's 5 years ago with a result in the 300's! It's unfortunate, but I had to get really sick before someone thought to check my antibodies and do an US. After cleaning up my diet, I lost weight and my #'s are now <1. I'm not sure if that's good, or bad though… I'm in surgical menopause and so many of the symptoms mimic hypothyroid. ack! I wish there was someone who could explain this to me until I get it!
Kristi De; Sadly, you are not alone in having to get really sick before anyone tested you for autoimmunity. The fact that your antibody numbers dropped from 300 to below 0 when you cleaned up your diet is a good indication that it has been helping. The way I hear it, numbers aren’t something to track with great concern (unless you feel awful) but if they do come down in response to a protocol, you’re likely on the right track. And yes, once Hashi’s, always Hashi’s. It’s a lifelong matter of mediation and management. I am not versed in the effects of medically induced menopause, so I won’t comment much on that, but if you are having hypo symptoms even with the low antibody numbers, that’s your body telling you something is out of balance. Keep digging.
my antibodies were 70, suddenly went to 400, retest a month later, now 900!
Took the blood test for allergies awaiting results. I did take Armour for several yes, now on Naturethyoid.
Main symptoms, shedding hair, weak nails, can’t sleep.
I’ve been on nature thyroid for 3 months, my TSH, T3, and T4 are all within normal limits. But my thyroglobulin Antibody is 2620, and my Thyroid Peroxidase Antibody is 159.5. I’m now gluten free, even my cleaning product, and health and beauty aids. I’m scheduled for a thyroid ultrasound next week. I feel completely lousy, not sure what is going on with my body, or what else I should do to feel better. Any advice would be greatly appreciated. Thanks 🙂
Hi Noel; Here are some things to ask your doctor about:
1. What are the reference ranges for that TSH, Free T3 and Free T4?
Most traditionally trained doctors use the “pathological” (ie: includes sick people) reference range which is wider than a “functional” (ie: includes only well people) range. If you’re at the top or bottom of the pathological ranges, it would be no surprise you feel unwell. Functional ranges go roughly as follows: TSH between 1.8-3, Free T3 300- 450 pg/ mL, Free T4 1.0-1.5 ng/ dL.
2. Have you been tested for common micronutrient and mineral deficiencies such as Vit D and B12; iron and ferritin (storage iron, a very common form of anemia but not as commonly tested unless it’s a functional medicine doctor)?
3. Have you had your adrenal function tested with a 4 (or 6)-point 24 hour saliva cortisol test?
4. Is your diet and lifestyle supporting balanced blood sugar function? This is sidestepped by a lot of patients and it’s a deal-breaker for energy level, mood, and brain function. Also, just going gluten free is not enough for most thyroid patients. Check out Dr. K’s page on diet (https://drknews.com/autoimmune-gut-repair-diet/, as well as his links on diet resources. For those with autoimmunity, diet is KEY in managing symptoms and living well.
High antibodies don’t necessarily correspond to feeling awful. It’s important to make sure you are not dealing with other deficiencies before going the dramatic route of thyroid removal etc. (which is where a lot of traditional doctors want to go).
Have you read Dr. K’s thyroid book? It goes into detail about all this and more.
Thank you Susan
My latest TSH is 2.230, Free T4 1.0, Total Triiodothyronine 149, calcium is a little low at 8.2, vitamin d
D was very low and I’m now taking 5,000IU daily.
My diet is fairly strict, No food that comes in a can or have preservatives, no tomatoes, beets, corn, peas, or beans of any kind. Only fruits allowed are strawberry, grapefruit, or any melon. No pork, bacon, hot dogs, sausage, or lunch meat. But I can have fish, chicken turkey, eggs, and lean beef once a week. No dairy, no nuts or dried fruits, no soda, no candy, no sugar, no honey, no maple syrup, no ketchup. No starch, no rice or rice products, and no pasta of any kind. I must eat at least 3 times a day and drink half my body weight in water.
I have not had any adrenal function testing. I have not read Dr. K’s book but I’m going to, and I will check out the diet for sure 🙂
Thank you so much for your reply
Noel; For those of us with autoimmunity, it’s always a path of sleuthing out the underlying root causes for the symptoms. I wish there was a one-size-fits-all answer. Hopefully your healthcare practitioner is on board with functional ranges, as well as taking the steps to figure out what else lies below your symptoms (instead of giving you the oh-so-common line about a. see a psychiatrist or b. nothing to do, let’s just take your thyroid out).
If you are not happy with your doctor, there is an increasing number of practitioners who work under the umbrella of functional medicine, and some of them are listed on Dr. K’s practitioner finder page at http://thyroidbook.com/practitioner-locator/. On that page are practitioners highly trained in his protocols, and at the top of that page is a link to a thyroid doctor finder (on that page, the doctors report having knowledge of his work and protocols, but he is not personally familiar with them as he is with the ones on the first page).
I’d really dial in more on the diet, because even if there are indeed other things going on, that is key for autoimmunity. I’d eliminate the eggs, all seeds, all seed-based and processed oils (coconut, avocado, olive are considered fine, as well as lard and duck fat), and… this one may get a bad reaction – but, all grains. This is in line with Dr. K’s gut-healing diet, and there are specific reasons for all those eliminations.
On his Resources page, look for “Autoimmune Diet Research”, where you’ll see a link to Sarah Ballantyne’s book on the diet (she calls it something different, but the basis is the same). She does a great job of explaining the science behind the diet, how to reintroduce foods once you are ready, and lifestyle habits that support health while living with autoimmunity.
If you are having energy issues, you may need to eat every 2-3 hours until you get your adrenals and blood sugar balance back in a stable state. Many of us needed to do that for some months until things got stabilized.
I’d also get tested for MTHFR (simple blood test, many do it through 23andMe online). If you have methylation issues, which are VERY common in Hashimoto’s patients, treating it will be a deal breaker – and tx is over the counter, just needs to be dialed in by a healthcare practitioner who knows about it.
So: Those are some ideas. You’re on the right track with everything, just keep it up!
Hi. This is interesting. I spent more than a year with hypothyroid symptoms that would sometimes be debilitating. Shortly after I started investigating the cause of these symptoms (thyroid was ruled out because of normal TSH), a large nodule was found on the left lobe of my thyroid. I am in the midst of the journey to determine whether the nodule is malignant, but I haven’t let go of the possibility of Hashimoto’s, as well. My FNA biopsy showed follicular neoplasm and I am awaiting surgery for lobectomy and proper biopsy, but the FNA results also showed chronic thyroiditis.
My mother’s side of the family has Celiac disease and thyroid issues and I had done my research and taken myself off gluten shortly before my FNA. After three months gluten-free, I began to feel better than I had in a long time. I wanted to know, so I had my endo schedule blood tests and started eating gluten to see if there would be any antibodies. After two weeks back on gluten (I felt fine reintroducing it), I had the test, but the levels are all fine. He only tested TgAB, not TPO. When I asked for the blood tests I did not know the pathology from the FNA had said chronic thyroiditis and he didn’t tell me. His focus is on the priority of determining if cancer is present and I get that, but this is also a concern. What else could chronic thyroiditis be if not Hashimoto’s?
Karen; Many labs (thus doctors) still use a pathological (ie: includes sick people) reference range for TSH (0.5-5.5 mU/ L). The newer functional ranges (1.8-3.0 mU/ L) are based on a healthier cross section of people. If your doctor uses the old reference range for TSH, you may very well be told your labs are normal and you’re ‘fine’. Trust what your body tells you, and keep striving for answers.
Do get TPO done, at the same time as TgAb. And remember that antibodies can rise and drop, so it’s only a snapshot in time. Some with Hashi’s produce no measurable antibodies because their immune system is too worn out to even make enough to register. Regarding the diagnosis of “chronic thyroiditis” – only about 10% of those with hypo symptoms actually have true hypothyroid (“primary hypothyroidism”) – the other 90% have autoimmune thyroiditis. Sadly, many endos are reluctant to deal with the autoimmune aspect of thyroid, and many thyroid patients do better seeing a Functional MD or DC, a ND, an acupuncturist. Keep pushing for your answers.
Noel, I hope you check back and see this. Your calcium of 8.2 is way too low; it should be tightly controlled between 9 and 10. Hypocalcemia could be responsible for your symptoms– see hypopara.org for more information. Or read this: https://www.hypopara.org/wwwroot/userfiles/files/a_quick_guide_to_hypoparathyroidism.pdf
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 […]
This is very interesting! How long before the second antibodies blood test should I reintroduce gluten to try that?
I have been gluten free for 4 months now and know I am really sensitive to it, but I don’t have Celiac disease (blood test + biopsy done). I got a result of 35 at my TPO-Ab test last year (see more lab results below) and I’m pretty sure I am part of those with a poor immune system (eg: now having an Epipen for a pollen allergy).
My mother has Hashimoto and her grand-mother also had a thyroid problem. I have been feeling terrible since my daughter is 6 months (she is now almost two and a half) and I have a ton of symptoms that could be attributed to a thyroiditis. The only thing that the ultrasound of the thyroid showed was that the “gland has a slight heterogeneous echotexture”, but there is no nodule and the size of the gland is normal. My doctor said it is non specific as the blood tests are ok.
Milia; Depending on how your practitioner is testing you, you might need to eat gluten for anywhere from 2 to 6 weeks before your second test. It also depends on how reactive you are. Your best bet would be to call Cyrex and ask their recommendation.
Thanks for your answer. Unfortunately, eating gluten during 2 to 6 weeks would be a nightmare for me. I have digestive issues 30 min to 1 hour after I eat food that contain gluten (much worse when I eat wheat than for other gluten sources). Then the next day, I usually have skins problems, muscle and joint pain, numbness in hands, etc. So I might try to eat gluten 1 to 2 days before my next antibody test. We’ll see if it helps!
Some people must do a shorter time period for exactly that reason. It’s a total hassle to go through it, sorry to hear you react so severely. You might talk to your practitioner about any other options.
Also, this article may be interesting to you:
https://drknews.com/hashimotos-hypothyroidism-immune-basics/
Milia Your ferritin is low that will make you feel awful. Anything under 50 can feel terrible. A good GP or haematologist will agree
I’ve felt for the longest time that I had some sort of issue with thyroid, pointing towards Hashimoto’s.
Finally something has showed up through ultrasound: have a nodule lower right lobe, solid hypoechoic and echogenicity about both lobes is heterogeneously abnormal consistent with thyroiditis probably chronic.
Blood work shows cholesterol high and tpo at 68. In 2013 it was 95. Was diagnosed with fibromyalgia after 2013 bloodwork. Also trace of occult blood in urine and vit. D was low with recent blood and urine test. Going for a thyroid nuclear scan end of this week. Also made appts with ENT & endocrinologist. Let’s see what they say, what do you think diagnosis will be? Any guesses?
Sheryl; Sorry, but Dr. Kharrazian cannot give a diagnosis or treatment options without having someone as a patient, and at this point in time, he is not taking on any new patients or adding names to a waitlist.
Hi Susan,
My daughter at age of 7 had her adenoids removed after the surgery she drastically gained weight and had constipation for several months. We ran some tests and found out she has Hashimotos. She was on the hormon pill for a year then I took her off the meds because I wanted to try natural remedy treatment. I have tried the additional thyroid supplement from an organic store, Enema therapy for a week, acupuncture treatment, took her to see an irriologist and he gave her some supplements to take which she did, put her on gluten free diet, tested her for toxins/metals and results where negative, Got a third opinion and CHLA and fourth at UCLA ( no luck), got in touch with out of state homeopath who sold us minerals for her to take for a few months, tried the hair analysis and still nothing. Took her to an Easter Natural Homepath doctor who gave my daughter herbs to drink for a year who claims it’s not the real hashimoto that my daughter is having. About a month ago I took her for blood work and her TPO result were almost 1,000, TSH 12.1, T3 28.8, T4 total 7.2. We went back to a different pediatric endocrinology and he suggested I put my daughter back on her hormon pills. I agreed because what ever I have tried nothing forked for my daughter. my daughter is 11 now and she is on Tirosint Capsules ( new gel tabled hypothyroid hormones). Two week ago she was seen by an Immunologist who also ran some tests and results came in negative. All the specialist we have seen they said there is nothing we can do to help. They said they can not help me find the underlying cause. All I know is that she has an autoimmune disorder that’s attacking her healthy thyroid. Please note no one in my family going back to my parents and grandparents had this Hashimoto thing and neither of my husbands family members had it. I never heard of Hashimotos until my daughter was diagnosed. . I am not sure where to go and what to do at this point. I’s like to reach out to you and see what else can I try to help my daughter. As a mother it breaks my heart but I will not give up.
Marina; Sorry to hear of your daughter’s tough journey. I’d suggest contacting one of the practitioners on this page: (http://thyroidbook.com/practitioner-locator/). All of them are highly trained in the protocols Dr. Kharrazian uses, and some may even treat remotely if necessary. Good luck, and do contact them!
My TPO – Ab came back as 3100. My Dr does not seem to worry about it.
I feel dreadful, any advice?
Anne; There could be any number of reasons you don’t feel well. I’d try to find another practitioner; it might not be the antibodies but another issue associated with the autoimmunity. See the practitioner locator page – some of them will treat remotely: (http://thyroidbook.com/practitioner-locator/).
Hi … I’m a bit at sea re hypothyroidism which I’m sure I have. My new doctor didn’t even know what to put on the blood test … left out Free T-4 … Question: Do thyroid antibodies indicate hypothyroid or are they strictly a marker for Hashimotos??? The test did come back with High TSH (which I read IS an indication of not enough thyroid hormone in my body). Thanks so much.
Denise; Antibodies are an indicator of autoimmunity.
Ooops sorry – it was the Lab that left out Free T-4 … pending.
Thanks so much for providing this great forum!
Lab results – 3/29/16:
TSH 6.44 mIU/mL (norm: 0.40-4.50)
Free T-3: 2.5 pg/mL (norm: 2.3-4.2)
Free T-4 Pending (how weird)
Thyroid AB:
Thyroglobulin Antibodies: <1 IU/mL (norm: < or = 1)
Thyroid Peroxidase: < 1 IU/mL (norm: 24.0 ng/mL (norm: > 5.4)
High Total Cholesterol: 334 mg/dL (norm: 125-200) [has always been high]
High LDL Cholesterol: 230 mg/dL (norm: = 46)
Cholesterol/HDL Ratio 4.3 (norm: < = 5.0)
Triglycerides: 135mg/dL (norm: <150)
[Doctor didn't test for C-Reactive Protein)
Thanks so much.
Hello everyone im nee to the forum but i want help in understanding my new (told) issues my doctor called me and said i had hasimotos my test showed antibodies of 75 what does this mean doed it mean its low enough to regain its normal range.. As she stated shes seen ranged from 100-1000 i was to busy trying to figure out what hasimotos was to ask my PCP thankz guys
Lisa; you might check out Dr. Kharrazian’s book on Hashimoto’s: there is a link to it in the sidebar on this page.
Hi, I have been gluten free for a few months now, at first I felt better but then I started to feel worse again. The worsening of my symptoms seem to coincide with spring allergy season. Also, it may be related to coffee consumption. Could there be any connection between both? My antibody tests have gone up a bit in the last year.
Rositsa; It would be impossible to know without an exam. I’d suggest consulting with a functional medicine practitioner about it; they can do any tests and evaluation you might need.
HI,
Been on Gluten Free/ Soy free and dairy free for a year and half now.. my TPO in 2009 was 382 and after starting the new diet went down to 30.. which is great. Got tested again few days ago..after 7 month and my TPO went up to 36..which is concerning since I have not changed a thing with my diet. My thyroglobulin Ab is less than 1.0
T3=1.76 T4=1.0 TSH=1.4
What could’ve shot up my TPO again? any suggestions?
Monica; Antibodies will fluctuate over time depending on various factors. If your TPO went from 30 to 36 as you wrote above, it’s not really worth worrying over. You may also want to read this article:
https://drknews.com/hashimotos-hypothyroidism-immune-basics/
What does it mean if you have high tgab but normal tpo? Is that indicative of having Hashimoto’s?…
For example:
TgAb – 4.2 (range 0.0-0.9)
TPO Ab – 9 (range 0-34)
Laura; Having out of range thyroid antibodies is considered a marker for Hashimoto’s, but it doesn’t necessarily mean the autoimmunity is active. Be sure to read the article on this page, and also check out this article: https://drknews.com/hashimotos-hypothyroidism-immune-basics/
Hello,
Thanks for all the information on the website !
I have done thyroid hormones and antibodies tests recently.
Thankfully, I have no TpO or TGB antibodies ! Though I know I have to re-check later.
However, one thing puzzles me about the Free T3 levels. I can’t figure out it there are normals or not.
My lab test indicates 5,3 pmol/L and lab range is 2,8 to 5,7 so I’m fine.
However, when I convert it to pg/mL I get 3,45 pg/mL. In Dr Kharrazian’s book, functionnal range is 300 to 450.
So, am I having abnormaly low levels, or did I make a mistake somewhere ?
Thanks !
Also, my thyroglobuline came out at 9,5 ng/mL (lab reference is 3,5 to 77).
Hi there! So about a year ago I was diagnosed with Hashimotos. I was told I then had to go to a specialist to get further testing done as the doctor was having a hard time getting my system regulated. I had an appointment last week and now I tested negative for antibodies? Im confused. Am I crazy?
Lacey – thyroid antibody levels can fluctuate. It could be what you’ve been doing in the past year has allowed them to reduce, or, if your immune system happens to be really trashed, it could be it’s not strong enough to even produce antibodies right now. If it were me, I’d go back in for a retest in a few weeks to confirm. One does not have to have high levels to have Hashimoto’s. Also, check out this article: (https://drknews.com/hashimotos-hypothyroidism-immune-basics/).
Hey There! So my PCP ran my thyroid panels in June of this year as i have been having issues with fatigue, hair loss, depression and anxiety, cold hands and feet, ringing in my ears and brain fog. I also informed her that my aunt has Hashimotos and hypothyroidism runs strongly on both sides of my family. For the past 3 years, by FT4 has been around 0.56 but my TSH has fluctuated between 1.87 to 1.13 which of course they tell me its normal. However, my TGAB came back as a 4 and according to our labs, it should be <1. My TPO was at a 2 which our lab levels have it as <9. I was referred out to an Endo who told me that it was just a protein binding problem and to eat better and work out and that it was probably my birth control. Im still feeling horrible. Any suggestions on where to go from here?
Hello Heather;
From what you write here, it sounds like you need a new PCP and a different Endo (if you really need one at all). While we can’t diagnose on the blog, your symptoms do ring of hypothyroid, and if you can find a practitioner trained in functional medicine and autoimmunity, you’ll have much better treatment. Keep in mind that one does not have to have really high antibodies to have Hashimoto’s. Your TSH isn’t high, but how you feel is more important than the lab numbers. I’d recommend getting your Free T3 and Free T4 tested, as they are a more accurate indicator of what is actually going on with your thyroid function. Ideally they are in the high end of the reference range. TSH is only part of the picture. I hope you can find a new practitioner who understands how to put all the thyroid numbers together with your symptoms. The line your Endo gave you is clearly a dismissal of your obvious symptoms. Dr. K has a practitioner-finder page on his website at: http://thyroidbook.com/practitioner-locator/ – some of them will practice remotely. Good luck, and keep advocating for dealing with the signals your body gives you.
Hoping you can provide some answers because my quality of life is declining rapidly. I am a 57 year old female with a very stressful life for the past 20 years. For the past 4 years I have suffered from worsening symptoms in my mouth, extremely dry, inner upper lip burning, blistering and skin sloughing. The inside of my mouth feels like it’s literally disintegrating. The skin on my outer upper lip is bone dry, heavily cracked and wrinkled, moisturizing products make it worse. Went to several different MDs and was diagnosed with burning mouth syndrome which is not a helpful diagnosis at all. I have been on levothyroxine for 4 years, started at 25 mcg now at 88 mcg. Recent diagnosis of GERD, failed esophogeal motility testing and exacerbation of mouth issues launched me into numerous visits to more MDs to get some answers. Finally found a GI dr who did some in depth blood work and discovered my TPO is 1915 (range <9), Thyroglobulin antibody is 1990 (range <9), Thyroglobulin by LCMS is 0.2 (range 1.5 – 38.5) Homocysteine Plasma is 18.5 (range 0-15) and Vit B12 is 199 (range 211-946). He told me to stay on the levothyroxine, get B12 shots and see an endocrinologists. I feel awful, nausea most mornings, very low energy, my mouth feels terrible all the time, most foods irritate my mouth so I can't nor do I want to be very social. I work 10-11 hrs a day and then I go home and collapse. Please give me some useful advise. Thank you.
Hello Gayle;
Sorry to hear you are suffering so. While we can’t give medical advice here on the blog, I will say that you need to get in ASAP to see a practitioner trained in functional medicine. They will be best able to put all those pieces together. The high antibodies, low B12, high Homocysteine, are all common to Hashimoto’s. If you can go on the leaky gut diet, or AIP (autoimmune protocol), you may find it sets the stage very well for healing. I’d suggest reading Dr. K’s thyroid book, and if you can, his brain book as well. For in-depth resources on how to do the AIP, find phoenixhelix dot com.
On Dr. Kharrazian’s website is a practitioner locator page – I’d recommend contacting these. Some are willing to practice remotely, if none are near you. On that referral page is also a secondary link to a page of Drs. trained in thyroid by Dr. Kharrazian – keep in mind that list includes a lot of Drs who Dr. K has no ongoing contact with, so he cannot speak to how well or how much they integrate his protocols. Also, get on the Hashimoto’s 411 page on Facebook – thousands of members internationally, and you are likely to get a good referral to a local doc trained in functional medicine. Keep advocating for your health and recovery. Don’t give up hope!
Everyone seems to leave out Adrenal Fatigue. Get that test done (salivary). You could have normal blood TSH, etc. results but still have an abundant amount of stress that is affecting your thyroid! There is a very specific diet if you have Adrenal Fatigue & the first step is healing your gut (bone broth). Have hashimotos in the family and the only difference between me and the other family members- level of stress. Hope this helps!
Dear Dr, K
I was diagnosed with hypothyroid 20 years ago (I am 51 now). I had a throat surgery when I was 10 years old. No one knows what that surgery was done for as that Doctor is not alive and his office has been closed down; my dad and brothers have passed away and my mother doesn’t know what that surgery was for. I don’t know whether my thyroid was removed during that surgery or did my immune system attack and kill my thyroid gland in the last 40+ years. I test negative for TPO antibodies. During a previous thyroid ultrasound, it was found that there is only a tiny bit of my thyroid gland left. How can I find out whether I have Hashimotos or just hypothyroid. You mentioned about a biopsy in your article to find out the presence of Hashimotos. What is the biopsy called and how is it done? How can I ask my endocrinologist to do it for me, who refused to even test Free T3 and antibodies for me (I had to beg her for testing my TPO antibodies). I suspect I have it, because I have food sensitivities. However I didn’t have any major issues due to my thyroid all these years (except that my energy levels were lower than normal people), until a couple years ago when I reached menopause. Two weeks after menopause, I had severe shortness of breath and ended up in ER and was given anxiety meds and have been on them. Presently in the process of tapering off of them. I now think that shortness of breath could have been because I used to consume 1 tbsp of coconut oil daily (as it is good for hypothyroid and used to give me energy) and later I found I am highly allergic to coconut. I do not have any other issues related to menopause like night sweat, etc. Can you please guide me how to find out whether I have Hashimotos or not? Thanks a lot.
Hello Eager;
I’m not sure what you are referring to about mention of a biopsy in the article, as there is none. Some people in comments mentioned biopsies, but that is not suggested here. The lab test for Hashimoto’s is an antibody test. In the U.S. , typically one tests for TPO and TgAB antibodies – it’s done with a blood test.
Since not everyone with Hashimoto’s has high antibodies, a good practitioner will also diagnose based on symptomology. That isn’t something we can do here on the blog.
If your practitioner refuses to test you for Free T3 and Free T4, I’d suggest looking for a new practitioner. It’s your health, and you deserve a practitioner who is going to have a conversation with you and do the tests and treatment you need.
Sadly, many Endos are trained in old-school principles, which do not include testing for those factors, and also do not include incorporating autoimmunity into the treatment plan. If you can find a healthcare practitioner who practices Functional Medicine, you should be on the right track. I’d suggest looking first at Dr. Kharrazian’s practitioner locator page here:
http://thyroidbook.com/practitioner-locator/
and, you might also check here:
https://www.functionalmedicine.org/practitioner_search.aspx?id=117 — tho on that page I can’t attest to the training of those doctors.
This may also help:
http://hypothyroidmom.com/30-online-resources-to-find-a-good-thyroid-doctor/
Good luck, and keep advocating for your health!
Susan, Thank you so much for responding. I live on a Caribbean island, which do not have any functional medicine doctors. If I consult with such a doctor located in USA online, how will I get the tests done here?
I have another question: as I am allergic to coconut oil, which is the other oil that people with Hashimoto can use safely for cooking? Is Olive oil ok for high heat cooking? How about Red Palm Oil or any other suitable oil for people with Hashimotos?
Thanks
For lab testing: When you work with a practitioner remotely, they typically order tests via an online service associated with a network of labs; you go to the lab for the test, and the results are sent to them. Or, if it’s a test you can self-order online, you go to a local lab and you or the lab can send them the results.
Regarding oils:
Here are some helpful links:
http://autoimmunewellness.com/the-autoimmune-protocol-guide-to-fats/
An interesting take on olive oil:
https://www.thepaleomom.com/olive-oil-redemption-yes-its-a-great-cooking-oil/
I personally avoid palm oil due to the overwhelming destruction of Orangutan habitat associated with its cultivation.
ANTI MICROSOMAL ANTIBODY 57 REF RANGE ,<34
FREE TRIIODTHYRONINE FT3 2.6 REF RANGE 1.7-4.2
FREE THYROXINE FT4 0.9 REF RANGE 0.7-1.8
TOTAL TRIIODTHYRONINE T3 75 REF RANGE 60-200
TOTAL THROXINE T4 6.7 REF RANGE 4.5-12
TSH 0.05 REF RANGE 0.3 -5.5
PLZ CAN U TELL IF I HAVE HASHIMOTO OR NOT THIS IS CONDUCTED IN INDIA PLZ HELP ME AND ANSWER BACK I SHALL BE OBLIGED AND THANKFUL REGARDS
Hello Shubhashri;
I’m sorry, but Dr. Kharrazian is not able to make diagnoses on the blog or via email. However, I will say that antibodies are not the only factor in diagnosing Hashimoto’s, because in some people the immune system is too worn down to even make antibodies (ie: a low number doesn’t necessarily mean ‘no’). Most functional medicine practitioners look not only at antibodies, but also at symptomology. There really is no way for Dr. K to determine this for you here.
I’d suggest going over to some of the patient-run Hashimoto’s forums on Facebook and asking for a referral to practitioner who is either in India, or willing to treat remotely (some can do this by having your lab results sent, along with Skype consults). You might also contact the practitioners on Dr. K’s finder page here: http://thyroidbook.com/practitioner-locator/.
If your doctor runs a test for Anti-Microsomal Ab, is that the same as testing TPO Ab and TG Ab?
The reason I ask is in 2015, I went to see a doctor and TPO came back normal, but TG was at 368 (normal is supposed to be below 40).
I went to a different doctor last week, and he ordered Anti-Micorsomal Ab, which came back “normal”, and he said I do not have Hashimotos.
Do I, or do I NOT have Hashimotos? I have been following AIP for the last 2 years because the first doctor told me I have it, and now this 2nd doctor told me I do not. I am so confused!
Giselle;
Good question and sadly, one we hear a LOT in the Functional Medicine patient community.
Anti-microsomal Ab is the same as TPO Ab. In the U.S. it’s more common now to see the TPO moniker, but as seen with your doctor, some labs still use the other name. Dr. Marc Ryan spells it out in this article: https://hashimotoshealing.com/understanding-hashimotos-antibodies/.
Some people with Hashi’s have *either* high TPO or high TG Ab; some have both; some have neither. This article by Dr. K explains the conundrum of having Hahsi’s with low or no antibody counts: https://drknews.com/unraveling-thyroid-antibodies/.
Sadly the confusing answer you are getting from your doctor is really common. Conventionally trained doctors tend to see Hashimoto’s only if someone has high TPO antibodies, and they ignore the obvious symptoms that indicate the autoimmune disease. I’d recommend finding a Functional Medicine practitioner trained in autoimmune thyroid, who will talk with you about your health history, labs, and really hear what you are saying about your symptoms. Trust your body’s messages.
Dr. Kharrazian has a years-long waiting list of over 1500 names, and he’s not taking names to add to it at the moment. I’d suggest contacting the practitioners on his referral page here: (http://thyroidbook.com/practitioner-locator/); though the list is housed on his thyroid site, those practitioners are highly trained in all his protocols.
You might also try the practitioner locator on the IFM page (https://ifm.org/find-a-practitioner/) or the IAFNR page (https://iafnr.org/member-referral-directory/).
Good luck, and don’t give up – you’ll find a practitioner who can help you!
Hello
I live in Australia where I find endocrinologists know less than me about adrenal insufficiency and Hashimoto’s disease.
I understand the fluctuations of the autoimmune system and they did not make sense to me since I read the above article. You say that ‘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’. I am on a 100% gluten free diet. I only e at at the Wholefoods Cafe in my town where everything is gluten free. I’would eat sugar before a TgAb TPO Ab second test. Gluten, I read in my gluten free diet, if you break the diet, if you have say a croissant one day (my favorite pastry), it takes 6 months or something like that to go back to where you were before eating the croissant…
I was negative in both antibodies tests when I had them but I understand I will have to have them privately. (I do not understand very well why some doctors in the past in Australia gave me the those tests a couple of times if the word “Hashimoto’s” has never been mentioned in any medical practice I visited. . .!!!!
I am sicker everyday, and no amount of T3-T4 replacements seems to work with me
Hello Monsie;
It can seem counterintuitive to add gluten back in for a test, when you are already on a gluten-free (GF) diet. For some patients, it’s worth doing, despite the chance of having symptoms for some time (indeed up to 6 months, esp. for celiac patients).
In the article, Dr. Kharrazian mentions doing this in order to confirm reactivity to gluten; if someone has been GF for some time, and is then tested for gluten reactivity, it’s possible the results will come back negative despite the fact they are truly gluten sensitive. This is because the body isn’t currently producing enough gluten antibodies to even register on the test. For some patients, it’s worth going through the croissant-gobbling followed by crummy symptoms, to confirm reactivity for the long term.
This can be the case with any food proteins that you test for — if you haven’t recently been eating those foods, the body may not be producing enough antibodies to measure even though you are reactive to those proteins. Then you get a false negative, continue to eat those foods, and wonder why you still feel awful.
In the case of gluten testing, this ‘gluten challenge’ can be a thin line to walk; if you already know you are reactive to gluten, it may not be necessary to do the gluten challenge, and there are certainly patients who choose not to; for those who aren’t sure, it is helpful to get confirmation.
From what you describe about being gluten free and still feeling crummy, it sounds like you would benefit from finding a functional medicine practitioner who understands the varied underlying factors in autoimmunity that lead to symptoms. For many patients, going gluten free is critical but it’s not all that needs to be done. Dr. Kharrazian doesn’t have an international practitioner referral list, but if you go to this website http://www.joannafrankham.com/the-autoimmune-protocol-aip/australian-new-zealand-aip-medical-recommendations/, that AIP blogger has a page of AUS/NZ practitioners. Dr. Kharrazian can’t recommend any personally because he doesn’t know them, so it would of course be up to you to determine if they are right for your needs. They are reported to know about the autoimmune dietary protocol that Dr. Kharrazian uses, but beyond that, I have no idea of their training. It’s a place to start.
Pretty! This was an extremely wonderful post. Thanks for providing these
details.
I have been on levothyroxine for three years. I started to feel another symptoms besides my classic ones (tired, out of energy and cold). After that my symptoms have increased until I start to feel so dizzy and my doctor couldn’t figure out why because my TSH and T4 were within the normal range. He told me that you are fine and that I could have the low sugar problem. I started to eat sugar when ever I felt dizzy but my symptoms got worsened. I visited him rapidly complaining about the same symptoms until he decided to make the ultrasound for my thyriod and checked my TPO and it was 252! He didn’t care and he was like that is fine. The only thing that we can do is to give you hermonr replacement for your thyroid so it does not matter if you were to know that you have Hashimoto or not but I disagreed. In the end I reminded him to check my vitamin D snd I was right it was low. So I am taking 5000IU for vitamin D. He would’ve given me medicine to avoid stress instead of checking my vatmin D. I improved once starting taking Vd supplements but the symptoms came back one more time and now I can’t sleep. So my question is 252 TPO consider a dangerous level? Is it possible to bring it down by diet? Would Hashimoto be cured if I bring my TPO down.? At least for my case.
Kristen;
Sorry we missed your comment here. Dr. Kharrazian can’t give medical advice on the blog, but I’ll try to point you in the direction of some reading resources.
You mentioned low blood sugar. It’s too bad your doctor hadn’t mentioned this to you, but eating sugar is definitely NOT the right fix for low blood sugar. Just eating sugar will spike your blood sugar, then it will crash again, leaving you in worse shape (as you seem to have found out). What’s more important to do is to eat some protein and fat, perhaps with a bit of carbs, but not much. Most importantly, if you have chronic low blood sugar, you might look at changing both your dietary habits and your eating schedule to better support stable blood sugar all day. Here is an article that may help:
https://drknews.com/stabilizing-low-blood-sugar-key-many-autoimmune-inflammatory-brain-based-disorders/
Antibodies: For some people, those antibody numbers would be concerning, for others, they would not. It depends on what the messaging is in your immune system. Check out these articles for more info:
https://drknews.com/unraveling-thyroid-antibodies/
https://drknews.com/hashimotos-hypothyroidism-immune-basics/
An anti-inflammatory diet can assist with reducing the autoimmune reaction (thus antibody levels). Autoimmunity is not cured; one can go into remission from symptoms. It’s a matter of adopting the dietary, stress-management, lifestyle, and other factors that help to keep the autoimmune reaction quelled. It can come back when you disregard those things.
Good catch on the Vitamin D. Also, leaky gut can make absorption of D less effective (among other issues) so make sure you are attending to that: https://drknews.com/?s=leaky+gut
Your doctor is mistaken (and stuck in the past) about hormone replacement being the only thing you can do. In your shoes, I’d find a new doctor.
Dr. K’s thyroid book goes into depth on what to do when you have Hashimoto’s, from diet to reading blood labs. Since it was written, there is more information available, but it is still relevant and a must-have for any Hashi’s patient.
I hope that helps.
Thanks for giving complete information about thyroid antibody test. I saw so many peoples who are suffering from thyroid antibody issue. Some people with Hashimoto’s test negative because of their overall immune health is weak and they do not produce enough antibodies. I felt bad when I am reading your article about thyroid antibody test.
I have had hypothyroid symptoms my whole life but didn’t realize it. I’m about to do the everlywell thyroid test just to see. I have been eating a paleo diet for a couple of years. I want to make sure that if I have Hashimoto’s that the antibodies show up. In the article he mentions having his patients eat some gluten and sugar before they test. If I choose to do that, how long should I wait after the gluten and sugar before I do the test?
Kathy;
In the past, for someone already on a gluten-free diet whose antibody test came up negative, he used to recommend consuming wheat for two weeks and then repeat the test, *providing gluten doesn’t cause other severe symptoms* << that's key: the gluten challenge CAN make you very sick, even for months, depending on your sensitivities, and it can affect brain health and function negatively.
I hear he does not recommend doing the gluten challenge any more. Since the book was written, immune testing has improved greatly, and Cyrex Labs now offers accurate testing for gluten sensitivity (they test for multiple gluten proteins, whereas in the past no labs did so).
If your practitioner can access Cyrex Labs' tests, that would be your best bet because you can avoid the potential suffering — and cell damage, esp to the brain — caused by the gluten challenge.
In your shoes, I would go ahead and do the thyroid lab panel just as you are, without doing the gluten challenge first. See what the results are. If the antibodies (Ab) come up negative or very low, I'd retest after working on immune health for a while. A gluten challenge would be my last resort. There are various online sources with reasonably priced self-order thyroid tests, and it's worth the extra cash to have to retest if you want to double check the results later.
A note on antibodies – there are plenty of patients who have Hashi's but whose immune systems are so tired out from fighting for so long, they don't currently make enough for the lab test to show any. So, the gluten challenge may or may not even kick your antibodies into high gear. 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.
A good functional medicine practitioner should be able (and willing) to take into consideration not only your antibody tests, but your health history and symptoms to determine if Hashi's is present.
If a doctor sees low or negative Ab results yet you have obvious symptoms of hypothyroid, and they say you definitely do not have Hashi's…. get a new doctor.
The sugar reference is because it drives inflammation, and if you want to achieve an immune response, it will help build that fire.
I hope that helps!
Thank you so much for this helpful reply. I got my Everlywell lab tests back and my TPO was 12. So I don’t know what that means. Obviously it isn’t high, but there are antibodies present. I didn’t eat gluten first. I did find a practitioner that I think will be good. She describes herself as an integrative wellness practitioner. I got some lab testing done for her that hasn’t come back yet. I’ve been looking at different TPO ranges for Hashi’s but they are all different. But I have oodles of thyroid symptoms and low T3. My TSH was okay though, around 1.5 I think. So I don’t know if that is Hashi’s or not. I was hoping for a clear answer.
Some practitioners would not blink an eye at TPO of 12 (some folks have it in the hundreds or even thousands) and tell you to go home because they think you are fine, but other practitioners would note it and go more off of your symptoms – and if you feel unwell, then there’s some digging to do. And you’re right, the numbers really do depend on the patient (again, back to the tired immune system possibility). Patients want a clear-cut way to gauge it as in, “Your numbers are xyz which tells us pdq and there is no confusion or mystery”, but often it’s not that clear cut. I knew a woman who had TPO of 10,000 (I know, it sounds insane) and she felt fine. I on the other hand have never had TPO of higher than 37 and I was basically disabled by Hashi’s for years. While antibodies can be a clear diagnostic tool, they are not the only one a good practitioner will use.
Also, while the majority of Hashi’s patients have higher TPO antibodies than TgAB (thyroglobulin) antibodies, some have higher TgAB. So, next time you do labs, see if they can also measure TgAB. But don’t get blinded by the antibody question. Your symptoms matter.
Having that TSH at 1.5 is likely great news. Even if you do not feel your best, your body is not screaming loud for more (such as TSH in the teens). But also, pay attention to that low T3 and where it moves when you continue treatment. I hope your new doc tested you for Free T3, not just T3; Free T3 is the form of T3 that is needed to enter the cells of your body. If you have ‘normal’ TSH and even normal T4 but chronically low Free T3, it may mean your body is not properly converting T4 to T3. Then you need to look for a conversion problem.
If you continue with low Free T3, google up articles on “T3 conversion” – there are factors that make your conversion of T4 to T3 poor, and you can do a lot to support that in your body.
Good luck, and I hope you new practitioner can help you unravel your symptoms!
My tpo is 16 and my t3 is 2.7 is that normal?
Every lab has unique reference ranges – you should check the lab results and see where you stand.
I’m in the first 2 years of a Hashimoto’s diagnosis. Originally I was subclinically hypothyroid and had very low (but positive) antibody numbers. Important to point out that I was not feeling bad. I had some symptoms (weight gain, hair loss) but my energy was good, so the first year of treatment was hard to gauge progress, since I wasn’t feeling very different once I started taking medication. i’ve been on 15mcg of T3 and 100 mcg of T4 for almost a year and my thyroid levels are perfectly in range. But my antibodies continued to rise so I went gluten free back in January. I was hoping this would help the antibody levels come down. And it did! at least as far as my TPO was concerned. It went from 377 in January down to 123 last week. But my TGAB went up, from 103 to 406. I can’t understand why one antibody would go up like that when everything else is moving in the right direction. But two labs have come back with similar numbers. Does this make any sense to you? I’ve been trying to research this but haven’t come up with any explanations or similar cases. thank you!