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?