Do low thyroid antibodies mean I don't have Hashimoto's?

Hi Stephanie,  

I am 55 years old and have been hypothyroid for many years. I just had bloodwork done (3 days ago) and my TSH is 1.0, my T3 is 3.9 and my T4 is 11. I have thyroid nodules and I was also told I had Hashimotos. My anti TG is currently 315 and my anti TPO is 11.  I just did 30 days of AIP diet and don’t feel any different but my anti TG has come down from 396 and anti TPO is down from 17 (blood test about 6 months ago) I have read that anti TPO is what determines hashimotos but have also read that either anti TG or TPO determines hashimotos.  With my TPO antibodies only 11 do I really have Hashimotos?  Also, since I do not feel any different how can I figure out what food is causing my anti TG to be so high?  

Thanks,

Tracey

Hi Tracey, 

Thanks for writing in. I’m going to break this down so everyone understands. Let’s start with the nodules. 

Nodules are often found via some kind of radiologic imaging- usually ultrasound but sometimes through a physical exam or even you might feel them yourself. Some studies show that anywhere from 20-75% of people have at least one nodule so it appears it could be quite common and doesn’t always mean there is something terrible on the horizon. Sometimes a needle aspiration biopsy will be done to determine if there is something serious going on. 

Things your doctor should be looking at is your history, in detail. Is there any pain on the front of your neck or are the nodules growing quickly. If the nodules are growing fast, there is concern for cancer. Do you have trouble breathing, feel like you are suffocating, have a hoarse voice and of course have symptoms of hypo or hyper thyroid. Your doctor should also be asking if you have had radiation over your whole body, did you have a nodule in childhood, anyone in your family have thyroid nodules? If you don’t have any symptoms they are usually benign.  

The problem I have with finding information in the scientific literature is that everything says that if TSH is normal then the free T3 and free T4 don’t need to be checked and that just isn’t true as far as those of us who are thyroid patients feel. What they do say is that Low TSH and high FT4 indicates hyperthyroidism, so for you Tracey with your TSH at 1.0 and T4 at 11- you might be feeling a little hyper. This could be due to the antibody levels being higher. 

When antibodies are high, the thyroid is probably being attacked which can kill off tissue and release T4 in to the system. I hope that makes sense to you. I think your T3 is in an okay place but again, I’m struggling to find anything in the literature. Having positive TPO Ab indicates Hashimoto’s. When I put anti thyroglobulin antibodies in to the search of the literature I actually found a paper talking about reducing test requests for antibodies by making it more difficult for the labs to be requested. The study discusses removing actual number values and putting either positive or negative since “TPO is not useful in monitoring autoimmune thyroid disease” and for Tg Ab it is only to be requested in the case of thyroid cancer and if there is a positive test on TPO they won’t even run TgAb. 

Another study confirms that both antibodies are found in Hashimoto’s with TPO being considered to THE test to confirm hashimoto’s and TgAb are also found in Lupus. So, as long as you have positive results for the antibodies tests, the science is saying that is hashimoto’s. I do not diagnose or treat anything because I am not a doctor- this is a disclaimer. If I had those labs I would consider myself to have hashimoto’s. 

Thyroid peroxidase is an enzyme that helps make thyroid hormones. It needs iodine to do its job which is to add iodine atoms to tyrosine on thyroglobulin so thyroxine (T4), triiodothyronine(T3) etc. can be produced. The enzyme needs peroxide as part of the process which is created by the body and neutralized by selenium. One study says that this is the major antigen in Hashimoto’s. This study was looking at how consuming certain polyphenols or plant compounds can also help in eliminating the damage caused by the creation of the hydrogen peroxide that isn’t otherwise neutralized naturally in the body. When you have antibodies to thyroid peroxidase you are impeding this whole reaction. 

Thyroglobulin antibodies are attacking the thyroglobulin protein that is made by the thyroid gland. Thyroglobulin is the most abundant protein in the thyroid gland. TSH from the pituitary tells the thyroid follicular cells to make thyroglobulin. 

So if you are making antibodies there is an immune system issue going on. 

After being on AIP for 30 days it looks like there was some change in antibodies but not much and you said you don’t feel any different. It is hard for me to comment here on why you don’t feel different when I don’t know how you felt before. So I would like to know more about that. Maybe 30 days was not long enough? Maybe it just isn’t helping. AIP will not work for everyone- it isn’t a be all end all diet and that is okay if it didn’t help you feel better. Unfortunately there are too many factors for me to consider to be able to say anything helpful right now. I just need to know more. Maybe you need to heal your gut.  What is your blood sugar like? How about your adrenals? What is the status of your fatty acids? Lots to consider here. 

As far as your labs- let me first say that some labs have different metrics and functional medicine lab values are different from conventional lab values.  

Your TSH is 1.0 - Depending on the lab and the practitioner an optimal range is anywhere from 1-3 mlU/L (milli international units per liter). So that looks okay. Personally, I feel great with a lower TSH. 

Your T3 which I am assuming is free T3 is 3.9 which also looks pretty good. FM values for that are 3.0-4.0 pg/mL (picograms/milliliter). 

Your T4 is 11 and again I am assuming that is free T4 and the optimal range for that is 1.0-1.5 ng/DL (nanograms/deciliter). So again, that is on the high side which indicates potential hyperthyroid. Do you have symptoms of hyperthyroid? 

TgAb is best between 18-27 ug/mL (micrograms/milliliter)(yours is 315)  and TPO antibodies are best below 15 (yours is 11). Ideally these should be zero and if not there is some kind of attack going on. 

I hope this helps. I would certainly consider lifelong gluten and dairy free for sure. It looks like a quick even one time consultation might be something that would help you figure out just where to start in feeling better. Or maybe you feel fine. I don’t know. When you have autoimmune disease you have to be sure you are managing diet and lifestyle for the rest of your life to avoid flare ups and have a good quality of life. It is unfortunate to be dealt those cards but it is the way it is. We have to make the best of it and move forward living our best life. 

Okay. That is it. I will be answering more questions in the coming weeks so if you have a question for me, please send it in either via helpforhashimotos@gmail.com or on my website outofthewoodsnutrition.com and fill out the contact form there and ask away. 

Someone did write in and ask for any and all advice on hashimoto’s which is great but if you can be more specific that is helpful to and for any and all advice I say, listen to the podcast and sign up for my newsletter on my website and that should be a great start. 

I thank you so much for writing in, keep sending those questions and if you can give me a rating and or review on apple podcasts I would greatly appreciate it! It helps make the podcast more visible so more people can be helped. 

If you are looking for someone to walk with you through your healing, I am taking on new clients. I am allowing about 2 new clients each month. I have lowered my rates by adding more time with me on to my packages so if you are already on a package you now get double the amount of time that you had before. I felt like it was necessary to spend more time each meeting to really make some progress. You can make an appointment for a 15 minute call to see if we are good fit by going to my website under make an appointment. I look forward to hearing from you. 

Until next week. 

AIP diet and vacation; feeling apathetic and tired all the time.

Hi, 

I am two weeks in to the AIP diet and am planning a vacation in December to an all inclusive resort. Will I undo all my hard work on this diet if I go off plan for a week? What if I have a glass of wine? How much damage will it do? 

Sarah,

Hi Sarah. Thanks for your question. You will be three months in to AIP which is a good amount of time on the diet. Some people only need that long to see a real benefit. The trick will be reintroducing foods while you are there. Your body will have had a good amount of time to heal which means your body will have the ability to give you a proper response to your reintroductions while on vacation. OR you could do a few reintro’s a week before you go in case you have some major digestive, skin or emotional reaction. This way you will be able to deal with it before your trip. Otherwise I would not really stress out too much about it because you want to enjoy your trip and sometimes stressing about what to eat is worse than eating the actual foods you want to. I would be mindful of not eating gluten and dairy since they are often a problem for autoimmune thyroid patients and if your symptoms before the diet change were not too terrible then you might be just fine. Just take it one meal at a time and play it by ear while on vacation. Make sure you are eating a lot of vegetables and fruits and enjoy an occasional glass of wine.  Have a great vacation. 

How do you know if your Hashimoto’s is the cause of your apathy (lack of interest, enthusiasm, or concern) and fatigue?  I know others who do not have any problem. My husbands wife has it as well and is thin, walks, does yoga, stays up past 10, etc. I am getting worse. I am tired and now apathetic about not getting anything done. I am eating anything because no matter what, I will gain weight. Is it hashimoto’s or something else? My doctor can't find any reason for me to be so tired. I just want to do nothing all day. I do work, so Monday-Friday I have to get up to the alarm, and then plant myself on the couch when I get home. This is existing, not a life.

I found a study linking major depressive disorder (depressed mood, low self esteem, loss of interest or pleasure in activities you used to find enjoyable) and the hypthalamic-pituitary-thyroid (HPT) axis. The amount of dysfunction in the HPT axis was related to how severe the depression was. Lower T3 and TSH was an indication of thyroid dysfunction in major depressive disorder. This study found a correlation, not causation but is still something to consider (1). 

Some other things to consider with apathy are your hormones. If you have an imbalance of estrogen, progesterone, or testosterone this can affect the neurotransmitters in your brain. Estrogen imbalances will have an effect on serotonin receptors in the brain. Serotonin is a neurotransmitter that gives you a feeling of well being and happiness as well as helping you learn, have memory and more. Estrogen imbalances will mess with dopamine too (a hormone and neurotransmitter related to motivation in reward-motivation behavior) and thyroid hormone is needed for all neurotransmitter receptors in the brain. 

Some questions you should be asking yourself and your doctor: 

• Is my medication doing it’s job?

• Do I need more T3, am I converting enough T3?

• What is my diet like?

  • Are you on a gluten free, dairy free diet?

  • Are you sensitive to any other foods?

• Is my cortisol high in the evening and low in the morning?

• How is my stress level?

• How is my sleep?

• Am I on a blood sugar roller coaster?

Something is not right, obviously you know that- the way you feel is no way to live and let me say to you that it is not your fault, you cannot just push through it and I hope you have some good support. You don’t deserve to feel this way. I have been there. My first inclination is to ask if you are on natural desiccated thyroid hormone like Armour or if it is a T4 only medication like levothyroxine because it sounds like you need T3 and if you are not eating a healthy diet, that needs to change. 

(1) Jia Y, Zhong S, Wang Y, Liu T, Liao X, Huang L. The correlation between biochemical abnormalities in frontal white matter, hippocampus and serum thyroid hormone levels in first-episode patients with major depressive disorder. Journal of Affective Disorders. 2015;180:162-169.