Thyroid Antibodies: Measuring Autoimmunity

The thyroid gland is the master of our metabolism. It controls the production of ATP, our fuel source, and therefore impacts every system within the body if it is not functioning optimally.

In conditions of hypothyroidism, we see T4 and T3 hormones lower and TSH rise. In conditions of hyperthyroidism, we see T4 and T3 hormones rise and TSH lower. As you can imagine, being the master of energy production and metabolism, a significant change in the amount of thyroid hormone in circulation can lead to a large assortment of signs and symptoms.

What causes a change in thyroid hormone production can be unique from one individual to the next. Possible causes include; iodine excess, iodine deficiency, exposure to toxins such as perchlorate or mercury, and certain medications such as Amiodarone. However, the most common cause of both hypothyroidism and hyperthyroidism in North America is autoimmunity.

An autoimmune condition is one in which the body loses its ability to identify what is self and what is foreign. The body then creates antibodies to attack and destroy what it has flagged as foreign. This leads to tissue destruction and hormonal imbalance in the case of autoimmune thyroid disease.

If you are struggling with a thyroid hormone imbalance, it is important to know if you have an autoimmune thyroid condition. Having one autoimmune condition is associated with an increased likelihood of getting another autoimmune condition. If your thyroid condition is autoimmune, your treatment should also include management of the immune system dysfunction.

How do you know if your thyroid condition is autoimmune in nature?

There are simple blood tests that can be run to measure thyroid antibodies and determine if your thyroid condition is autoimmune in nature. These tests include:

Anti-Thyroid Peroxidase (Anti-TPO)

This is the most commonly elevated thyroid antibody seen in up to 80% of cases of both Hashimoto’s hypothyroidism and Graves hyperthyroidism1.

Thyroid peroxidase is an enzyme that moves iodine into the thyroid gland to build thyroid hormones. If Anti-TPO antibodies attack the thyroid peroxidase enzyme, the body no longer can move iodine into the cell and T4 and T3 cannot be made.

Anti-Thyroglobulin (Anti-TG)

This antibody is elevated in up to 50% of all cases of Hashimoto’s hypothyroidism and Graves hyperthyroidism1.

Thyroglobulin is a protein formed from the amino acid, tyrosine. Thyroglobulin is the backbone that iodine attaches to, to make thyroid hormones. If Anti-TG antibodies attack thyroglobulin, your body is missing the essential protein for T4 and T3 production.

Anti- Thyroid Stimulating Immunoglobulin (Anti-TSI)

This antibody is elevated in up to 90%  of Graves hyperthyroidism and up to 10% of Hashimoto’s hypothyroidism cases1.

Thyroid stimulating immunoglobulin looks identical to TSH to the thyroid gland. It binds to the TSH receptor on the thyroid gland and tells the body to produce more thyroid hormone leading to high levels of T4 and T3.

Can thyroid antibodies change with time?

Absolutely. Antibody levels are constantly changing and it is very common to see them go up and down with time.

In fact, in 25% of the cases of Hashimoto’s hypothyroidism the body will go into spontaneous remission with no identifiable cause!

Changes in antibody levels don’t always correlate with how someone is feeling and the most important marker in treatment should always be your own signs and symptoms.

Even when antibodies reduce in time the thyroid itself may not function optimally, and this can create further dysfunction of the immune system and the gland.

It is important then to focus not just on the antibodies but also on the overall function and structure of the thyroid gland, as well as to optimize thyroid function with medication if necessary.

Treatments that may reduce thyroid antibodies

There are a few treatments that have been shown to reduce thyroid antibodies. These include:

1)    Selenium

Research finds that 200mcg of selenium a day can reduce anti-TPO antibodies in Hashimoto’s hypothyroidism2.

Selenium is a trace mineral that is found in high doses in brazil nuts. The content of selenium in one brazil nut compared to another can vary significantly, so supplementation is recommended to ensure precise dosing.

2)    Myo-inositol

A combination of selenium and myoinositol has also been found to significantly reduce both Anti-TPO and Anti-TG in Hashimoto’s hypothyroidism3.

Myoinositol is an endogenous sugar, which acts as a messenger in regulating several hormones including TSH and insulin.

3)    Natural desiccated thyroid hormone (NDT)

There have been suggestions in the medical literature that natural desiccated thyroid supplementation can worsen thyroid autoimmunity. However, there are no studies to date that support this claim. The little information available on NDT and thyroid autoimmunity suggests it may actually reduce the autoimmune attack4.

4)   Vitamin D

A research study found that in women who had normal baseline Vitamin D status, supplementation with 2,000IU of vitamin D daily for 6 months in combination with levothyroxine reduced thyroid antibodies5.

Key Takeaways

  • Thyroid antibodies can be measured easily in the blood and are markers of autoimmune thyroid disease
  • Knowing if you have elevated thyroid antibodies is important because having one autoimmune disease is associated with an increased likelihood of getting a second autoimmune disease and treatment should include immune system support
  • Thyroid antibodies fluctuate constantly and up to 25% of the time a person can go into complete remission without a clear cause
  • Thyroid antibody levels are not always correlated with symptoms – how you feel is always the best marker of treatment
  • There is some research to support the use of selenium, myoinositol, NDT and vitamin D to reduce thyroid antibodies

References

  1.  Fröhlich, E., & Wahl, R. (2017). Thyroid Autoimmunity: Role of Anti-thyroid Antibodies in Thyroid and Extra-Thyroidal Diseases. Frontiers In Immunology8. doi: 10.3389/fimmu.2017.00521
  2. Duntas, L., Mantzou, E., & Koutras, D. (2003). Effects of a six month treatment with selenomethionine in patients with autoimmune thyroiditis. European Journal Of Endocrinology, 389-393. doi: 10.1530/eje.0.1480389
  3. Nordio, M., & Pajalich, R. (2013). Combined Treatment with Myo-Inositol and Selenium Ensures Euthyroidism in Subclinical Hypothyroidism Patients with Autoimmune Thyroiditis. Journal Of Thyroid Research2013, 1-5. doi: 10.1155/2013/424163
  4. LEE, S., SCHERBERG, N., & DeGROOT, L. (1998). Induction of Oral Tolerance in Human Autoimmune Thyroid Disease. Thyroid8(3), 229-234. doi: 10.1089/thy.1998.8.229
  5. Krysiak, R., Szkróbka, W., & Okopień, B. (2017). The Effect of Vitamin D on Thyroid Autoimmunity in Levothyroxine-Treated Women with Hashimoto’s Thyroiditis and Normal Vitamin D Status. Experimental And Clinical Endocrinology & Diabetes125(04), 229-233. doi: 10.1055/s-0042-123038

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