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. 

How to begin a detox program

You always start with food first. You need to remove all the offending foods and things in your environment that are suspected to be causing you a problem. You might start with an elimination diet which is meant to figure out which foods are an issue for you. Then you move on to the detoxification food plan which is just that- a plan for the rest of your life. That doesn’t mean that you never again can eat out or enjoy a treat or whatever- it means that for your health and longevity you will need to maintain a new, healthier lifestyle and way of eating. You do this by adding in nutrient dense foods that feed those detoxification pathways or phases that we talked about in the past few weeks. You literally want to eat a rainbow of colorful vegetables and fruits every day. 

How do you know if you are a candidate for needing detoxification? As I said before almost everyone needs to do it but here are some symptoms to look out for: 

• bloating, gas, GERD

• joint pain, muscle aches

• low energy

• immune system issues- sick a lot or autoimmune disease like hashimoto’s or Graves

• IBS

• leaky gut

• asthma

• skin rashes- this is a big sign your body is toxic

• fibromyalgia, arthritis

• mood disorders- anxiety, depression etc

• allergies

• weight gain

• food intolerances/sensitivity

• high liver enzymes

The detox food plan used by the Institute for Functional Medicine focuses on whole foods though a supplemental detox powder can be very helpful. It also focuses on organic foods for the big reason that most non organic or conventional foods are sprayed with more chemicals than organic. The ideal situation would be to get as much locally from growers who don’t spray at all. You do the best you can and at a minimum follow ewg.org list of dirty dozen and clean fifteen. 

You will want to also make sure you are getting enough protein balanced out with some healthy fats and lots and lots of a variety of vegetables and some fruits. Your everyday diet should be low in sugar and processed foods. If you are able to make this work for you, you should not have to “diet” or restrict calories in any way. It is gluten and dairy free which are best for those of us with Hashimoto’s or autoimmune disease. This will keep your gut bacteria in balance, reduce cravings and food addiction. You will get the antioxidants your body needs to repair and support itself as well. 

Fish is a big problem for heavy metal exposure. Mercury half life in fish is 2 years long which allows for greater accumulation of this heavy metal the bigger the ocean fish consumed. We have a 60 day half life for methylmercury so if you ate fish once a week, it can raise your own blood levels.  There are mercury advisories for many bodies of water around the country and  you can find out more about your local area at www.epa.gov . Fish from the great lakes will expose you to persistent organic pollutants but farmed salmon (restaurant) exposes us to 97% of all POPs in our diet. ⅔ of salmon eaten in the US is farmed and the POPs come from the food pellets fed to the salmon. Sardines are high in PCBs. 

A note on the organic aspect. This gets expensive. I do realize that and that it won’t be affordable for everyone to eat 100% organic. Make sure your protein choices are leaner cuts of meat or you are trimming the fat. Buy organic of whatever you eat the most of whenever possible. I have been using Imperfect Foods delivery of imperfect produce and you can get organic produce delivered to your door for cheaper than most grocery stores. Stick to real whole foods- they will keep you full and nourished. The cleaner the food, the better.  

Now you also need to look at what else in your life might be exposing you to toxins. 

Air pollution is a problem in urban areas, office buildings and your home. Things like air filtration systems or tightly sealed homes and buildings are all something to consider as well as smoking, exhaust, diesel fuel exhaust (ever been behind a school bus at a stop light or just behind a bus on the road?). What about air fresheners- those terrible chemical things you can plug in to your outlets- or just regular spray air fresheners. How about non stick cookware? That is one thing you should definitely get rid of. Carpeting emits semi-volatile organic compounds and collects all kinds of toxicants which includes things you bring in to your home on your shoes. 

Do you have vinyl shower curtains or live in a city that chlorinates their water so when you shower you are showering in chlorine? You can get a filter for your shower head and use a cloth shower curtain. 

To remove all these things from the air you can use air purifiers with HEPA filters and surprisingly house plants are good air filters. Or maybe not surprisingly to you. This was new to me until a couple of years ago. Spider plants, mother in laws tongue, Janet Craig, Sweet chico, peace lily are all great options for cleaning the air in your home. 

Next is looking at the plastic in your home. Do not cook food in plastic, do not store high fat foods in plastic or put warm liquids in plastics. Don’t use plastic microwave safe containers in the microwave. Use glass storage for foods. You can find inexpensive glass containers at stores like HomeGoods, Marshalls, and TJ Maxx. 

Clean up the water you drink. Get a reverse osmosis water system for your drinking water at a minimum. If you have a well, get the water tested. Your county often will do water testing but you have to check with them as to what exactly they are testing for. 

Personal care products and household cleaners are big ones too. This is one big way you can reduce your body’s toxic burden. 

• body lotion

• shampoo, conditioner

• body wash, soap

• deodorant

• cosmetics

• perfume

• skin creams, cleansers, serums

• lip balms

• nail polish

• hand soap

• laundry detergent

• household cleaners

This list can be overwhelming and I suggest just making one or two changes at a time so you are not burdened by this. I’ll share with you what I use and you can also check out ewg.org as they have some resources there for cleaning products and cosmetics. 

Here is my list: 

• Branch Basics for cleaning products and hand soap. It is a concentrated non toxic cleaner that really really works. I add Good Samaratin essential oil blend from Pranoram to the hand soap and to the general cleaning bottles. It smells good and has antiviral, antibacterial properties. You can also use this for laundry but I find it gets really expensive so I use Ecos or BioKleen. 

• Dr. Bronners liquid and bar soaps for cleaning. The bar soap is at our utility sink and I have used the liquid soap to clean really dirty dogs. 

• Ecos dish soap

• Seventh Generation dishwashing detergent and non chlorine bleach. I do keep chlorine bleach around for when someone has a stomach virus or for some special cleaning jobs but use it rarely. 

• Bar keepers friend and Bon Ami for cleaning tough spots on pots and pans and for cleaning my kitchen sink. 

• Beautycounter is mostly what I use for cosmetics but there are other brands such as Araza Beauty, W3LL People, RMS Beauty, 100% Pure, Crunchi, Mineral Fusion, Vapour, Lawless, Gabriel Cosmetics. I know nothing about these companies except Beautycounter which I used to sell to get the discount but am not selling anymore. They are not the cleanest but are better than many and I don’t wear a lot of make-up. I also like Celtic Complexion skin care and MeiZen skin care as well as Evan Healy and Intelligent Nutrients. 

• Hair products, I use are Intelligent Nutrients (they often have a 30% off sale) and I have started using HairStory which is not as clean. 

• I use Shea Butter or Jojoba oil for moisturizer or Allafia or Everyone lotion and body wash

• Allafia makes a non aluminum and non baking soda based deodorant which is nice. 

• I use a steam mop to clean my floors and I have microfiber cloths as well. 

• I use cast iron pans, stainless steel and enameled cast iron. We do have a non stick waffle maker and griddle but I just got a new stove with a cast iron griddle attachment so I am looking forward to using that. 

I think the other thing I would like to briefly mention is genetic testing. You may have a polymorphism in your genes- well we all have them it just depends on which ones you have and how many that determines if your body has some difficulty with detoxification. You can do genetic testing and work with someone who can create a nutrition plan for you based on your SNPs but you can do some general dietary recommendations like what I have talked about here. What you eat plays a role in turning on or off your genes that can create or keep disease at bay, especially chronic illnesses. Chronic illness like autoimmune disease is influenced by what we put in our body. 100 calories of cake is not the same as 100 calories of apples. It just isn’t. We also have to keep in mind epigenetics which is the role the environment plays in our overall health and what it is doing to our genes. So a clean diet that is full of plants of varying colors and quality proteins are your best bet for the beginnings of good health. 

Thanks so much for listening. Please head over to my website and sign up for my newsletter. It has been awhile since I sent a recipe out and I am due to get something together this weekend. If you could leave me a rating or review on apple podcasts I would really appreciate it. The goal is to educate as many people as possible to take control of their own health and I can’t do it without you. Share this with someone you know who might be struggling with autoimmune disease, especially hashimoto’s.