Understanding Hashimoto’s Antibodies

 

Some of the most common questions that I get from people who reach out to me are about antibodies.

There seems to be a good deal of confusion about them and also a good deal of emotion and expectation attached to these numbers going up or down.

In this post, we examine thyroid antibodies and, hopefully, dispel some of the myths around them.

What Are Antibodies?

First of all, what are antibodies, exactly? I like to use military analogies when describing the immune system. And antibodies are like military intelligence (hold the oxymoron jokes).

They are the part of the immune system that gathers information on the bad guys (bacteria, viruses, fungus, parasites, etc.) and then they label those bad guys. Kind of like putting a red flag on them.

The invader is called an antigen. Antibodies bind to these antigens like a lock and a key. Every cell has antigens and these are what the immune system recognizes. And every cell in our body has a self-antigen which are supposed to let the immune system know that our own tissue isn’t a bad guy.

Once the bad guys have been labeled, other parts of the immune system are signaled and they attack and, in most cases, kill the bad guys. In some cases these antibodies can neutralize the bad guys all by themselves and not have to wait for reinforcements.

With autoimmune disease these antigen signals get confused and the immune system ends up attacking our own tissue.

Over the last 50 years there has been a lot of research in this area.

HLA is the Place Where Bad Things Happen

There is a region on cells located on some of our genes called the HLA (or Human Leucocyte Antigen) System. Many of these are located on chromosome 6 (for those of you keeping count).

Mutations or defects of HLA has been linked to many different autoimmune diseases. Exactly what happens is not known, there are numerous theories, but the end result is that our own tissue gets attacked and destroyed by the immune system.

There is a specific class of HLA (class II) that has been linked to autoimmune thyroid diseases like Hashimoto’s and there are also specific antibodies that are important in the disease.

What Antibodies Are Linked to Hashimoto’s?

There are 2 autoantibodies that are important:

Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.

Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production.

TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.

In Hashimoto’s, TPOAbs are present in nearly all (>90 %) patients, while TgAbs can be seen in approximately 80%.

What Antigens Do These Antibodies Like?

Antibodies against TPO (TPOAbs) and Tg (TgAbs) are of immunoglobulin G class, (IgG) and both are really good buddies with their antigens.

For TPO, it is for the enzyme thyroid peroxidase, which frees iodine and helps in the production of T4 and T3.

And for TgAb it is for Thyroglobulin, which is also used by the thyroid to produce T3 and T4.

When these 2 things get destroyed, over time, the body can’t make enough thyroid hormone. 

This results in hypothyroidism and all the familiar problems of Hashimoto’s: fatigue, constipation, depression, hair loss, cold hands and feet, brain fog, memory issues and lots more.

Unlike TgAbs, TPOAbs can activate certain parts of the immune system (complement) and are able to cause damage to thyroid cells.

However, there isn’t much evidence that both antibodies have a major role in the formation of Hashimoto’s or in the destruction of thyroid cells.

It seems a lot more likely that other parts of the immune system are signaled and that they bring in the Navy Seals of the immune system which attack and kill thyroid cells.

Antibodies Are The Definitive Test for Hashimoto’s

TPO and TgAb antibodies, however, are considered the definitive test for whether or not you have Hashimoto’s. Basically, if either one or both of these are found to be above the lab range values, then you are positive for the disease.

Most labs have the high end at about 25 to 35. Numbers vary considerably, but it is not unusual for people who have been diagnosed to have antibodies above 1,000.

Antibodies Do Not Attack Thyroid Tissue

As I stated above, in most cases these antibodies, themselves, do not attack and kill thyroid cells.

What’s also important to understand is that there are various stages of autoimmune disease and depending on where you are in the progression, you will have different degrees of thyroid tissue destruction and, therefore, different symptoms.

According to Dr. Datis Kharrazian, there are 3 stages of autoimmune disease. While these stages are not recognized by conventional doctors, they are very useful in determining exactly where you are in the progression of the disease.

And realizing that there are stages and that the stages get worse and worse, is also helpful for motivating you to do as much as you can to stop the progression. (Hopefully!)

You can read more about these stages here.

Antibodies Unleash the Attack, But They Aren’t The Destroyers

The antibodies are really involved in signaling the immune system and in setting off a series of events that results in the attack and destruction of the thyroid.

I have written extensively about what happens in this previous post.

The important thing to understand here is that the amount of antibodies don’t necessarily directly correspond to how severe the Hashimoto’s is.

There are many reasons for this, but one simple way to look at it is this: The amount of destruction that is done by the army (the immune system) depends on the strength and number of the soldiers.

As I said earlier, the antibodies are really like the CIA or some intelligence gathering part of the army. The front line soldiers are the killers. If you have lots of soldiers and they are all revved up and ready to dance, then you get more destruction.

If your army is weak and there aren’t that many soldiers, then the CIA tells them to kill, kill, kill, but they can only do so much damage.

On the other hand, even if there are only a few CIA agents and there is a large, aggressive army, you will still have massive destruction (and loss of thyroid function).

Where am I going with all this? The amount of destruction, which really is the cause of how crappy you feel, depends on the strength and number of soldiers, not on the number of CIA agents in the field.

This is why antibodies are not a good measure of progress and often don’t correspond with how well people feel.

Antibody Levels Are Not A Good Measure of Progress (or Lack Thereof)

Antibody numbers don’t correspond, directly, with tissue destruction. As I mentioned above, in some cases TPO antibodies have been linked to tissue destruction, but more often, this is not the case.

Many patients and doctors or practitioners track these numbers and use them as a measure of whether or not what they are doing is working. And many times, they will find that there is no correspondence.

Obviously, getting antibody numbers to drop is not a bad thing. But it is also not necessarily such a good thing, because it may not be an indication that the destruction or the progression of the disease has slowed.

How Do You Measure The Severity of the Attack?

In conventional lab testing there really aren’t tests that are done to look at this. One theory with Hashimoto’s is that the ratio between the CIA and the soldiers is important.

The soldiers are also known as the TH-1 system, the cytokines or immune proteins associated with this part of the immune system are the killers.

The CIA is known as the TH-2 part of the immune system and you can test for ratios between TH-1 and TH-2 cytokines.

If there is a lot more of the soldiers than CIA agents, then the prognosis is not good and the disease tends to be more severe.

With Hashimoto’s there is a tendency towards more TH-1 than Th-2, but this is not always the case.

On the other hand if the CIA is more numerous or more balanced and the control and command part of the immune system (TH-3 or the regulatory part of the immune system- what we can call the General) is also strong, then, usually the prognosis is better and you can calm the attack and slow or stop the progression of the disease.

In reality, the immune system isn’t linear and this is an oversimplification. Testing is available to look at the cytokines that represent these different parts of the immune system, but there are many other factors that make current tests for this unreliable and not that helpful.

However, you can use these ideas to help figure out what you need to do in order to calm the attack, slow the progression of the disease and, most importantly, feel better.

What To Do About It

The major cause of thyroid tissue destruction is something called apoptosis. This is programmed cell death.

Lots of crazy things happen on a molecular level (like cytoskeletal disruption, cell shrinkage, chromatin condensation, nuclear fragmentation, membrane blebbing, and DNA fragmentation – membrane blebbing, people!) to make this happen, but the easiest way to grok the root of it is to understand that it is initiated by inflammation.

Inflammation Is the Root of All Evil

The best way to slow the progression and minimize destruction is to do everything you can to stop inflammation and to strengthen the regulatory part of the immune system.

2 important anti-inflammatory agents are: Vitamin D and glutathione. These supplements strengthen the regulatory part of the immune system (TH-3 or the General).

(One important thing to note is that some people with Hashimoto’s have a defect with vitamin D receptors and may need to take more than is usually required by normal individuals.)

These are important anti-inflammatories.

Another player in the complicated drama of Hashimoto’s is TH-17. This is like a rouge agent that when numerous and aggressive can do major damage. TH-17 is highly inflammatory.

Natural supplements that reduce TH-17 include Turmeric and Resveratrol. Some Chinese herbs that have been shown to reduce TH-17 are Chang Shan or dichroa root and Huang Lian and Huang Qin whose active compound is berberine.

Also, it is very important to reduce the causes of inflammation in your diet. The three most inflammatory foods in our diet are gluten, dairy and soy.

Gluten has been extensively hybridized and deamidated and has been linked to the initiation and progression of thyroid autoimmunity.

Dairy products when commercially produced are full of antibiotics, hormones and god knows what else. They have also been linked to the initiation of various autoimmune diseases.

Soy is one of the most heavily genetically modified foods in our diet and is also quite difficult to digest.

Things That Reduce Antibodies

Some research has indicated that thyroid replacement hormone can reduce TPO antibodies, though there is also some indication that natural desiccated hormone can raise antibodies in some individuals (it seems to be those who have a particularly severe immune reactivity – i.e., they have lots of inflammation).

Selenium has been found to reduce TPO antibodies in a number of studies.

Bottom Line

Thyroid antibodies are important for determining whether or not you have Hashimoto’s but are not always a good indicator of how well what you are doing is working.

Do not get too excited if antibody numbers go up or down. It’s not the antibodies that are the problem as much as the other parts of the immune system that are attacking and destroying the thyroid.

Get excited about reducing inflammation. That should be your daily obsession. Really, its that important.

Thyroid replacement hormone and selenium have been shown to reduce TPO antibodies, but this may not work for everyone.

Hashimoto’s is complicated. It is a multi-system disorder that requires a multi-system approach. That’s why created my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. Click here to learn more.

References:

http://en.wikipedia.org/wiki/Apoptosis

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC555850/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/

Hashimoto’s Thyroiditis

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/– Technichal, but great info on what happens in Hashimoto’s

http://www.ncbi.nlm.nih.gov/pubmed/15307940

http://www.ncbi.nlm.nih.gov/pubmed/7878464

http://www.ncbi.nlm.nih.gov/pubmed/20477110

http://www.medicalnewstoday.com/releases/241571.php

http://www.jimmunol.org/content/185/3/1855.full

http://www.cambridgemedicine.org/news/1299069648

http://jcem.endojournals.org/content/87/4/1687.long    

http://nuclmed.web.auth.gr/magazine/eng/jan07/8.pdf

http://www.ncbi.nlm.nih.gov/pubmed/16006728

About the Author Marc Ryan

Leave a Comment:

Nancy Fisher says

Thanks for the post, Marc. It gives me a new perspective on antibodies. As a Hashi’s ‘veteran’, I was diagnosed in 1990 and only had my antibodies measured upon diagnosis. However, that test result expresses them as “MAB” with no abbreviation. Can you tell me whether that is the same as the current-day TPO? Thanks much!

Reply
    Marc Ryan says

    Hi,

    Thanks for your comment. TPO antibodies were formerly known as microsomal antibodies. While I can’t say with absolute certainty, I suspect that that is wht this marker is referring to.

    Best,
    Marc

    Reply
Laura says

Good article. Thank you for the information.

Reply
Kara says

Trying to digest all this information. Our daughter is seeing an endocrine doctor for the first time tomorrow. So far she had just the basic thyroid test which the family doc said was, “the low end of normal” – BUT, she is feeling awful. The front of her neck is extremely painful to touch. Is this a sign of inflammation? She had an ultra sound of her neck (which was terribly painful and left her twitching for the rest of the day) and they said her thyroid looked normal. Is that a subjective call? Can they really tell from an ultra sound that it is NOT inflamed?

Reply
    Marc Ryan says

    Hi Kara,

    Thanks for reaching out! If her neck is painful to the touch it could certainly be inflammation, it could also be something neurological. Ultrasounds are generally good at finding obvious inflammation. It may miss others that are not so visible due to their position. I don’t think it really subjective, but as with any test there is room for error.

    Best, Marc

    Reply
Mandi says

My thyroid peroxidase number was in the 90’s

Reply
    Marc Ryan says

    Hi Mandi,

    Thanks for your comment. You compare that number to the lab range values. Normally these are around 30. If it is higher than the lab range then this is a positive marker.

    Best,
    Marc

    Reply
Andrea says

Great article! I was actually just discussing with my doctor about using my antibody levels as an indicator of whether or not what I was doing was working. My levels went down quite a bit after 4 months of gluten free, but I had no change in how I felt. :/
Also, a question on the antibody type. My Tgab levels were high (started at 122, then over 1000, then back down to around 500), but my Tpo levels have always been normal. My doc is pushing for a thyroid uptake scan to rule out cancer. I’m still on the fence on that one. Is it as likely to be hashimotos if only Tgab is elevated?

Reply
    Marc Ryan says

    Hi Andrea,

    Thank you for your kind words! It could be Hashimoto’s if only TgAb is elevated. Your doctor is concerned about ruling out cancer because this can also be elevated in thyroid cancer. The fact that it has gone up and down suggests to me that there is something driving this. Often with Hashimoto’s you will see these values ebb and flow with flare ups. The down side of the uptake scan is that they use radioactive iodine. Have they done an ultrasound? They could also do a biopsy if there were suspicious nodules.

    Please keep me posted.

    Best,
    Marc

    Reply
      Andrea says

      I’ve had many ultrasounds. I’ve had an enlarged thyroid for almost 10 years, so they’ve been keeping an eye on it. It is getting bigger, but slowly. I’ve had fine needle biopsies, and they’ve always been inconclusive. My labs are always in the normal range, so I’m not on any thyroid meds. Although I do have just about every hypo symptom there is. I’ve been to a few different specialists, and they all tell me that eventually my thyroid will tank and need to get taken out. Nobody really seems to know anything. I’ve been doing my own research for years now, and I still don’t understand, lol. I think I’ve learned more from reading your stuff in the past few months than I have from anything else in the last 10 years.
      I also had Hodgkin’ s lymphoma a couple years ago, so radiation to the neck area probably didn’t help…..

      Reply
ANA says

Hello marc

i was diagnosed 2 years ago and my antibodies where no enxintant until one test came tpo came out 110. I am on 50 a the moment i was 125 and suoer overmedicated . my lasts tpo and tga labs do not show any antibodies at all. Labs normal with t3 in med range. I still have to have antidpressants as i have terrible back and join paint and anxiety. i do not understand why i am not better without the antidepressants if i do not have antibodies so i tend to thing the autoantibody attack is in control. My body is very inflamed obviusly, my lovely endo has suspicion of allergy . i am seing an allergist and i have delayed igg for yeast wheat and corn and mushrooms. can they really make you feel that bad despite of you antibodies being non existant? does the level of inflamation have to do whether you have antibodies or no? sorry for long question

Reply
    Marc Ryan says

    Hi Ana,

    Thanks for sharing your story! The point I was trying to make in the article is that antibodies can be a smoke screen. You may be able to reduce them, and this is a good thing, but this does not eliminate the underlying problem which is systemic inflammation. I would encourage you to do allergy testing and to look at foods that may be driving this inflmmation, in particular.

    The reason you are not better without the antidepressants is because the thyroid has a major impact on neurotransmitters and neurotransmitter production. In the near future I will do a series on Hashimoto’s and the brain and it will help shed light on what is happening.

    Best,
    Marc

    Reply
Sissy Koleva says

Hi Marc! Thank you for the excellent article! It sheds new light on the antibodies and how they affect the overall symptoms. I’ve been digging into all possible info about this disease since I was diagnosed this summer. The endo and gp weren’t very helpful though. I was given L-Thyroxin to take till I die! lol! Strangely, I have been feeling worse since I started taking it and developed so much muscle pain in my arms.I had the joint stiffness before, but now together with the muscle pain, it’s so frustrating as I can’t do my daily routines. Apparently, I have lots of inflammation, despite going on GF, dairy free and soy free diet. My question is: Is it safe if I take NSAID like iboprofen or diclofenac. With them the pain goes away, but I don’t think they are good for the digestive system and can cause leaky guts. I also take turmeric, but don’t know how much I should take (just 2 a day as it is recommended on the bottle). Your article gave me very good advice on what I should target, but still don’t have an idea how to organise my supplementation. The endo prescribed me only selenium and vit D3.
Thank you in advance and looking forward to your next article!
Sissy

Reply
    Marc Ryan says

    Hi Sissy,

    Thanks for reaching out! You really have to be cautious about not overdoing NSAIDs for precisely the reasons that you mentioned: leaky gut and also they can be hard on the liver and the kidneys. For some people, a more restrictive diet is sometimes necessary (Check out the Autoimmune Paleo approach). Also, you have to look at the health impact of other things in your life. How stressful is your job or relationship, etc. because stressful life events can cause autoimmune flare ups, as well. It’s sometimes more about lifestyle modifications, like diet and stress than it is with supplements.

    Best,
    Marc

    Reply
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