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 hypothyroidism 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:
- thyroid peroxidase antibodies (TPO Ab), which indicates that the immune system is attacking the TPO enzyme in the thyroid gland
- thyroglobulin antibodies (TGB Ab), which indicates that the immune system is attacking the TGB protein in the thyroid gland
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.)
- 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.)
- Green tea extract
- Grape seed extract
- Pine bark extract
- White willow bark
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?
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 !
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.
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!
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?
I too would love to know how a person knows if they are TH1 or TH2 dominant 🙂
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!
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!
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.
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
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.
how does this apply to someone with out a thyroid
I saw a funct med doc a few years ago and he had me try particular supplements to see which I was (th1 or th2 dom). Basically, took one type for a few days and saw how I felt, then the other type a few days. I clearly felt like crap on one, so I knew. I am struggling to remember what they are called though! I will try to figure it out and post again.
I am curious if genetics alone in some cases can cause Hashimoto’s or if genetics are just a precursor and that other environmental triggers have to be introduced into the equation to cause Hashimoto’s.
My family has a history of Hypothyroidism and Hashimoto’s so I was not the least bit surprised when I was diagnosed with Hashi a year ago. My NPD told me it was caused by issues in my gut and that I needed to fix those by checking on any food allergens and other gut issues. He didn’t address the genetic aspect of it at all.
Our apologies that your question was missed back in January. The ‘jury’ is out on this, but the current word in the medical and research fields is that genetics are just a precursor and that other environmental and even viral triggers have to be introduced for gene to be activated. Your practitioner likely didn’t mention the genetic factor because there is nothing we are yet aware of that can change it. The path of addressing gut issues is at the foundation for reducing or eliminating the symptoms of Hashimoto’s (and many other autoimmune conditions). Repairing gut health may or may not be all that is necessary, depending on the individual. For many, there are other factors that must also be addressed, such as viral infections, systemic inflammation, etc.
Does that mean Curcumin is ok for those with either Th1 or Th2 dominance?
Thank you for asking. In some circles, curcumin is considered a TH2 stimulator (meaning that if you are TH2 dominant, it’s not a good idea to consume it). Some people feel its anti-inflammatory properties outweigh this factor and use it anyhow.
My adult daughter has congenital hypothyroidism (m/p ectopic thyroid-remnants on scan) diagnosed only at the age 3 years old and she is on thyroid medications since then.
She also was diagnosed with depression and later on bipolar disorder around age 13. She was on different antidepressants and antipsychotics without any improvement.
Recently her blood test showed hyperthyroidism. Is it possible she has Hashimoto even her thyroid antibodies test was negative?
To really know what’s going on with your daughter, Dr. Kharrazian would need to have her as a patient and do a full health history, exam, and labs. He’s not taking on new patients or adding to his years-long waitlist, so I’d recommend seeking a Functional Medicine practitioner who is trained in thyroid autoimmunity. Dr. Kharrazian has a practitioner-finder here: http://thyroidbook.com/practitioner-locator/. All those are highly trained in his protocols, and some are willing to practice remotely. 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/).
There are patients who are misdiagnosed with bipolar and find out the swings are actually due to Hashimoto’s-caused swings between a hyper- and a hypothyroid state: https://drknews.com/when-hashimotos-is-misdiagnosed-as-bipolar-disorder/
In addition, some with Hashi’s don’t show antibodies on a lab test:
Many with Hashi’s experience mood disorders, and practitioners believe this is based on brain inflammation that interferes with neurotransmitter function and brain signaling. An anti-inflammatory diet that helps to balance blood sugar can do wonders to help reduce this inflammatory process and bringing mental health back online. Dr. Kharrazian recommends this protocol (more details are available in his brain book): https://drknews.com/autoimmune-gut-repair-diet/
I encourage you to seek a practitioner who is trained to determine all this – sadly, the conventional healthcare community is still stuck on the outdated stance that no antibodies means one can’t have the autoimmune condition.
Good luck, and keep us posted.
Thank you for all the information! In Finland we have no such knowledge, nor well enough educated medical practitioners, sadly! We are struggling here without any effective treatment. Hopefully things will change soon. All the best for you!
My husband was recently diagnosed with Hashimoto’s, even got a second opinion, and everything is saying he has Hashimoto’s, yet he does not feel like he has the symptoms like everyone else does. He has been doing the AIP diet for about 1.5 months now, taking a thyroid medication, and taking supplements – but after researching, I do not think his supplements follow the strict AIP guidelines.
How can one determine whether your autoimmune Hashimoto’s is TH-1 dominant or TH-2 dominant?
You can determine if you have TH1 or TH 2 dominance with a lab test, or with a supplement challenge. Dr. Kharrazian writes about that in his thyroid book.
However, nowadays practitioners are paying more attention to TH17 and 3: (https://drknews.com/nitric-oxide-modulation-for-autoimmune-disease/).
What test do you recommend to check TH1 vs TH2 dominance?
To test for TH1 and 2 dominance, a practitioner would test cytokines. Most labs will have cytokine panels and individual cytokine tests. The actual name of available tests will depend on which labs your doctor uses. “TH1” or “TH2” may not be in the test panel name. For example, Diagnostic Solutions runs one called the Cytokine Response Profile:
Here is a link to their sample results pdf where you can see how that multiple immune factors relate to the TH1 and 2 pathways:
LabCorp runs cytokine panels, and also runs single cytokine tests.
Your practitioner would need to dial in on which ones to run.
Also, here’s more info on TH1&2: https://drknews.com/are-you-th-1-or-th-2-dominant