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UnderstandingHashimotosAntibodies

SomeofthemostcommonquestionsthatIgetfrompeoplewhoreachouttomeare
aboutantibodies.
Thereseemstobeagooddealofconfusionaboutthemandalsoagooddealof
emotionandexpectationattachedtothesenumbersgoingupordown.
Inthispost,weexaminethyroidantibodiesand,hopefully,dispelsomeofthemyths
aroundthem.
WhatAreAntibodies?
Firstofall,whatareantibodies,exactly?Iliketousemilitaryanalogieswhen
describingtheimmunesystem.Andantibodiesarelikemilitaryintelligence(holdthe
oxymoronjokes).
Theyarethepartoftheimmunesystemthatgathersinformationonthebadguys
(bacteria,viruses,fungus,parasites,etc.)andthentheylabelthosebadguys.Kindof
likeputtingaredflagonthem.
Theinvaderiscalledanantigen.Antibodiesbindtotheseantigenslikealockanda
key.Everycellhasantigensandthesearewhattheimmunesystemrecognizes.And

everycellinourbodyhasaselfantigenwhicharesupposedtolettheimmunesystem
knowthatourowntissueisntabadguy.
Oncethebadguyshavebeenlabeled,otherpartsoftheimmunesystemaresignaled
andtheyattackand,inmostcases,killthebadguys.Insomecasestheseantibodies
canneutralizethebadguysallbythemselvesandnothavetowaitforreinforcements.
Withautoimmunediseasetheseantigensignalsgetconfusedandtheimmunesystem
endsupattackingourowntissue.
Overthelast50yearstherehasbeenalotofresearchinthisarea.
HLAisthePlaceWhereBadThingsHappen
ThereisaregiononcellslocatedonsomeofourgenescalledtheHLA(orHuman
LeucocyteAntigen)System.Manyofthesearelocatedonchromosome6(forthoseof
youkeepingcount).
MutationsordefectsofHLAhasbeenlinkedtomanydifferentautoimmunediseases.
Exactlywhathappensisnotknown,therearenumeroustheories,buttheendresultis
thatourowntissuegetsattackedanddestroyedbytheimmunesystem.
ThereisaspecificclassofHLA(classII)thathasbeenlinkedtoautoimmunethyroid
diseaseslikeHashimotosandtherearealsospecificantibodiesthatareimportantin
thedisease.
WhatAntibodiesAreLinkedtoHashimotos?
Thereare2autoantibodiesthatareimportant:
ThyroidPeroxidaseAntibody(TPOAb):Thisantibodyistheonethatisusually
highinautoimmunethyroidconditionslikeHashimotos.Itisalsoknownas
microsomalantibody.
ThyroglobulinAntibodies(TgAb):ThesearentseenhighasoftenasTPOAb.
Theyareusuallyorderedwhenthyroidlabresultsseemstrangebecausethese
antibodiescaninterferewiththyroidhormoneproduction.
TgAbisalsousedtomonitorprogressaftersurgeryforremovingthethyroidin
thyroidcancer.

InHashimotos,TPOAbsarepresentinnearlyall(>90%)patients,whileTgAbscan
beseeninapproximately80%.
WhatAntigensDoTheseAntibodiesLike?
AntibodiesagainstTPO(TPOAbs)andTg(TgAbs)areofimmunoglobulinGclass,
(IgG)andbotharereallygoodbuddieswiththeirantigens.
ForTPO,itisfortheenzymethyroidperoxidase,whichfreesiodineandhelpsinthe
productionofT4andT3.
AndforTgAbitisforThyroglobulin,whichisalsousedbythethyroidto
produceT3andT4.
Whenthese2thingsgetdestroyed,overtime,thebodycantmake
enoughthyroidhormone.
Thisresultsinhypothyroidismandallthefamiliarproblemsof
Hashimotos:fatigue,constipation,depression,hairloss,coldhandsand
feet,brainfog,memoryissuesandlotsmore.
UnlikeTgAbs,TPOAbscanactivatecertainpartsoftheimmunesystem
(complement)andareabletocausedamagetothyroidcells.
However,thereisntmuchevidencethatbothantibodieshaveamajorroleinthe
formationofHashimotosorinthedestructionofthyroidcells.
Itseemsalotmorelikelythatotherpartsoftheimmunesystemaresignaledandthat
theybringintheNavySealsoftheimmunesystemwhichattackandkillthyroidcells.
AntibodiesAreTheDefinitiveTestforHashimotos
TPOandTgAbantibodies,however,areconsideredthedefinitivetestforwhetheror
notyouhaveHashimotos.Basically,ifeitheroneorbothofthesearefoundtobe
abovethelabrangevalues,thenyouarepositiveforthedisease.
Mostlabshavethehighendatabout25to35.Numbersvaryconsiderably,butitis
notunusualforpeoplewhohavebeendiagnosedtohaveantibodiesabove1,000.
AntibodiesDoNotAttackThyroidTissue

AsIstatedabove,inmostcasestheseantibodies,themselves,donotattackandkill
thyroidcells.
Whatsalsoimportanttounderstandisthattherearevariousstagesofautoimmune
diseaseanddependingonwhereyouareintheprogression,youwillhavedifferent
degreesofthyroidtissuedestructionand,therefore,differentsymptoms.
AccordingtoDr.DatisKharrazian,thereare3stagesofautoimmunedisease.While
thesestagesarenotrecognizedbyconventionaldoctors,theyareveryusefulin
determiningexactlywhereyouareintheprogressionofthedisease.
Andrealizingthattherearestagesandthatthestagesgetworseandworse,isalso
helpfulformotivatingyoutodoasmuchasyoucantostoptheprogression.
(Hopefully!)
Youcanreadmoreaboutthesestageshere.
AntibodiesUnleashtheAttack,ButTheyArentTheDestroyers
Theantibodiesarereallyinvolvedinsignalingtheimmunesystemandinsettingoffa
seriesofeventsthatresultsintheattackanddestructionofthethyroid.
Ihavewrittenextensivelyaboutwhathappensinthispreviouspost.
Theimportantthingtounderstandhereisthattheamountofantibodiesdont
necessarilydirectlycorrespondtohowseveretheHashimotosis.
Therearemanyreasonsforthis,butonesimplewaytolookatitisthis:Theamount
ofdestructionthatisdonebythearmy(theimmunesystem)dependsonthestrength
andnumberofthesoldiers.
AsIsaidearlier,theantibodiesarereallyliketheCIAorsomeintelligencegathering
partofthearmy.Thefrontlinesoldiersarethekillers.Ifyouhavelotsofsoldiersand
theyareallrevvedupandreadytodance,thenyougetmoredestruction.
Ifyourarmyisweakandtherearentthatmanysoldiers,thentheCIAtellsthemto
kill,kill,kill,buttheycanonlydosomuchdamage.

Ontheotherhand,evenifthereareonlyafewCIAagentsandthereisalarge,
aggressivearmy,youwillstillhavemassivedestruction(andlossofthyroidfunction).
WhereamIgoingwithallthis?Theamountofdestruction,whichreallyisthecause
ofhowcrappyyoufeel,dependsonthestrengthandnumberofsoldiers,notonthe
numberofCIAagentsinthefield.
Thisiswhyantibodiesarenotagoodmeasureofprogressandoftendontcorrespond
withhowwellpeoplefeel.
AntibodyLevelsAreNotAGoodMeasureofProgress(orLackThereof)
Antibodynumbersdontcorrespond,directly,withtissuedestruction.AsImentioned
above,insomecasesTPOantibodieshavebeenlinkedtotissuedestruction,butmore
often,thisisnotthecase.
Manypatientsanddoctorsorpractitionerstrackthesenumbersandusethemasa
measureofwhetherornotwhattheyaredoingisworking.Andmanytimes,theywill
findthatthereisnocorrespondence.
Obviously,gettingantibodynumberstodropisnotabadthing.Butitisalsonot
necessarilysuchagoodthing,becauseitmaynotbeanindicationthatthedestruction
ortheprogressionofthediseasehasslowed.
HowDoYouMeasureTheSeverityoftheAttack?
Inconventionallabtestingtherereallyarentteststhataredonetolookatthis.One
theorywithHashimotosisthattheratiobetweentheCIAandthesoldiersis
important.
ThesoldiersarealsoknownastheTH1system,thecytokinesorimmuneproteins
associatedwiththispartoftheimmunesystemarethekillers.
TheCIAisknownastheTH2partoftheimmunesystemandyoucantestforratios
betweenTH1andTH2cytokines.
IfthereisalotmoreofthesoldiersthanCIAagents,thentheprognosisisnotgood
andthediseasetendstobemoresevere.

WithHashimotosthereisatendencytowardsmoreTH1thanTh2,butthisisnot
alwaysthecase.
OntheotherhandiftheCIAismorenumerousormorebalancedandthecontroland
commandpartoftheimmunesystem(TH3ortheregulatorypartoftheimmune
systemwhatwecancalltheGeneral)isalsostrong,then,usuallytheprognosisis
betterandyoucancalmtheattackandsloworstoptheprogressionofthedisease.
Inreality,theimmunesystemisntlinearandthisisanoversimplification.Testingis
availabletolookatthecytokinesthatrepresentthesedifferentpartsoftheimmune
system,buttherearemanyotherfactorsthatmakecurrenttestsforthisunreliable
andnotthathelpful.
However,youcanusetheseideastohelpfigureoutwhatyouneedtodoinorderto
calmtheattack,slowtheprogressionofthediseaseand,mostimportantly,feelbetter.
WhatToDoAboutIt
Themajorcauseofthyroidtissuedestructionissomethingcalledapoptosis.Thisis
programmedcelldeath.
Lotsofcrazythingshappenonamolecularlevel(likecytoskeletaldisruption,cell
shrinkage,chromatincondensation,nuclearfragmentation,membraneblebbing,and
DNAfragmentationmembraneblebbing,people!)tomakethishappen,butthe
easiestwaytogroktherootofitistounderstandthatitisinitiatedbyinflammation.
InflammationIstheRootofAllEvil
Thebestwaytoslowtheprogressionandminimizedestructionistodoeverything
youcantostopinflammationandtostrengthentheregulatorypartoftheimmune
system.
2importantantiinflammatoryagentsare:VitaminDandglutathione.These
supplementsstrengthentheregulatorypartoftheimmunesystem(TH3orthe
General).
(OneimportantthingtonoteisthatsomepeoplewithHashimotoshaveadefectwith
vitaminDreceptorsandmayneedtotakemorethanisusuallyrequiredbynormal
individuals.)

Theseareimportantantiinflammatories.
AnotherplayerinthecomplicateddramaofHashimotosisTH17.Thisislikearouge
agentthatwhennumerousandaggressivecandomajordamage.TH17ishighly
inflammatory.
NaturalsupplementsthatreduceTH17includeTurmericandResveratrol.Some
ChineseherbsthathavebeenshowntoreduceTH17areChangShanordichroaroot
andHuangLianandHuangQinwhoseactivecompoundisberberine.
Also,itisveryimportanttoreducethecausesofinflammationinyourdiet.The
threemostinflammatoryfoodsinourdietaregluten,dairyandsoy.
Glutenhasbeenextensivelyhybridizedanddeamidatedandhasbeenlinkedtothe
initiationandprogressionofthyroidautoimmunity.
Dairyproductswhencommerciallyproducedarefullofantibiotics,hormonesand
godknowswhatelse.Theyhavealsobeenlinkedtotheinitiationofvarious
autoimmunediseases.
Soyisoneofthemostheavilygeneticallymodifiedfoodsinourdietandisalsoquite
difficulttodigest.
ThingsThatReduceAntibodies
SomeresearchhasindicatedthatthyroidreplacementhormonecanreduceTPO
antibodies,thoughthereisalsosomeindicationthatnaturaldesiccatedhormonecan
raiseantibodiesinsomeindividuals(itseemstobethosewhohaveaparticularly
severeimmunereactivityi.e.,theyhavelotsofinflammation).
SeleniumhasbeenfoundtoreduceTPOantibodiesinanumberofstudies.
BottomLine
Thyroidantibodiesareimportantfordeterminingwhetherornotyouhave
Hashimotosbutarenotalwaysagoodindicatorofhowwellwhatyouaredoingis
working.
Donotgettooexcitedifantibodynumbersgoupordown.Itsnottheantibodiesthat
aretheproblemasmuchastheotherpartsoftheimmunesystemthatareattacking

anddestroyingthethyroid.
Getexcitedaboutreducinginflammation.Thatshouldbeyourdailyobsession.
Really,itsthatimportant.
ThyroidreplacementhormoneandseleniumhavebeenshowntoreduceTPO
antibodies,butthismaynotworkforeveryone.
Hashimotosiscomplicated.Itisamultisystemdisorderthatrequiresamultisystem
approach.Thatswhycreatedmyprogram:HealingHashimotos:The5
ElementsofThyroidHealth.Clickheretolearnmore.
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/
http://www.thyroidmanager.org/chapter/hashimotosthyroiditis/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/Technichal,butgreat
infoonwhathappensinHashimotos
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

{17commentsaddone}
norskswede October30,2013,11:41am
Thanksforthepost,Marc.Itgivesmeanewperspectiveonantibodies.Asa
Hashisveteran,Iwasdiagnosedin1990andonlyhadmyantibodiesmeasured
upondiagnosis.However,thattestresultexpressesthemasMABwithno
abbreviation.CanyoutellmewhetherthatisthesameasthecurrentdayTPO?
Thanksmuch!
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MarcRyan October30,2013,11:56am
Hi,
Thanksforyourcomment.TPOantibodieswereformerlyknownasmicrosomal
antibodies.WhileIcantsaywithabsolutecertainty,Isuspectthatthatiswhtthis
markerisreferringto.
Best,
Marc
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Laura October30,2013,11:46am
Goodarticle.Thankyoufortheinformation.
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MarcRyan October30,2013,11:57am

Thanksforyourcomment!
Best,
Marc
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Kara October30,2013,12:38pm
Tryingtodigestallthisinformation.Ourdaughterisseeinganendocrine
doctorforthefirsttimetomorrow.Sofarshehadjustthebasicthyroidtestwhichthe
familydocsaidwas,thelowendofnormalBUT,sheisfeelingawful.Thefrontof
herneckisextremelypainfultotouch.Isthisasignofinflammation?Shehadan
ultrasoundofherneck(whichwasterriblypainfulandlefthertwitchingfortherest
oftheday)andtheysaidherthyroidlookednormal.Isthatasubjectivecall?Canthey
reallytellfromanultrasoundthatitisNOTinflamed?
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MarcRyan October30,2013,9:08pm
HiKara,
Thanksforreachingout!Ifherneckispainfultothetouchitcouldcertainlybe
inflammation,itcouldalsobesomethingneurological.Ultrasoundsaregenerally
goodatfindingobviousinflammation.Itmaymissothersthatarenotsovisible
duetotheirposition.Idontthinkitreallysubjective,butaswithanytestthereis
roomforerror.
Best,Marc
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Mandi October30,2013,7:07pm
Mythyroidperoxidasenumberwasinthe90s
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MarcRyan October30,2013,9:10pm
HiMandi,
Thanksforyourcomment.Youcomparethatnumbertothelabrangevalues.
Normallythesearearound30.Ifitishigherthanthelabrangethenthisisa
positivemarker.
Best,
Marc
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Andrea October30,2013,8:33pm
Greatarticle!Iwasactuallyjustdiscussingwithmydoctoraboutusingmy
antibodylevelsasanindicatorofwhetherornotwhatIwasdoingwasworking.My
levelswentdownquiteabitafter4monthsofglutenfree,butIhadnochangeinhow
Ifelt.:/
Also,aquestionontheantibodytype.MyTgablevelswerehigh(startedat122,then
over1000,thenbackdowntoaround500),butmyTpolevelshavealwaysbeen
normal.Mydocispushingforathyroiduptakescantoruleoutcancer.Imstillonthe
fenceonthatone.IsitaslikelytobehashimotosifonlyTgabiselevated?
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MarcRyan October30,2013,9:15pm
HiAndrea,
Thankyouforyourkindwords!ItcouldbeHashimotosifonlyTgAbiselevated.
Yourdoctorisconcernedaboutrulingoutcancerbecausethiscanalsobe
elevatedinthyroidcancer.Thefactthatithasgoneupanddownsuggeststome
thatthereissomethingdrivingthis.OftenwithHashimotosyouwillseethese
valuesebbandflowwithflareups.Thedownsideoftheuptakescanisthatthey
useradioactiveiodine.Havetheydoneanultrasound?Theycouldalsodoa
biopsyifthereweresuspiciousnodules.
Pleasekeepmeposted.

Best,
Marc
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Andrea October31,2013,8:15am
Ivehadmanyultrasounds.Ivehadanenlargedthyroidforalmost
10years,sotheyvebeenkeepinganeyeonit.Itisgettingbigger,butslowly.
Ivehadfineneedlebiopsies,andtheyvealwaysbeeninconclusive.Mylabs
arealwaysinthenormalrange,soImnotonanythyroidmeds.AlthoughIdo
havejustabouteveryhyposymptomthereis.Ivebeentoafewdifferent
specialists,andtheyalltellmethateventuallymythyroidwilltankandneed
togettakenout.Nobodyreallyseemstoknowanything.Ivebeendoingmy
ownresearchforyearsnow,andIstilldontunderstand,lol.IthinkIve
learnedmorefromreadingyourstuffinthepastfewmonthsthanIhavefrom
anythingelseinthelast10years.
IalsohadHodgkinslymphomaacoupleyearsago,soradiationtotheneck
areaprobablydidnthelp..
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ANA October31,2013,5:17am
Hellomarc
iwasdiagnosed2yearsagoandmyantibodieswherenoenxintantuntilonetest
cametpocameout110.Iamon50athemomentiwas125andsuoerovermedicated.
mylaststpoandtgalabsdonotshowanyantibodiesatall.Labsnormalwitht3in
medrange.Istillhavetohaveantidpressantsasihaveterriblebackandjoinpaint
andanxiety.idonotunderstandwhyiamnotbetterwithouttheantidepressantsifi
donothaveantibodiessoitendtothingtheautoantibodyattackisincontrol.My
bodyisveryinflamedobviusly,mylovelyendohassuspicionofallergy.iamseingan
allergistandihavedelayediggforyeastwheatandcornandmushrooms.canthey
reallymakeyoufeelthatbaddespiteofyouantibodiesbeingnonexistant?doesthe
levelofinflamationhavetodowhetheryouhaveantibodiesorno?sorryforlong
question
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MarcRyan October31,2013,8:40am
HiAna,
Thanksforsharingyourstory!ThepointIwastryingtomakeinthearticleisthat
antibodiescanbeasmokescreen.Youmaybeabletoreducethem,andthisisa
goodthing,butthisdoesnoteliminatetheunderlyingproblemwhichissystemic
inflammation.Iwouldencourageyoutodoallergytestingandtolookatfoods
thatmaybedrivingthisinflmmation,inparticular.
Thereasonyouarenotbetterwithouttheantidepressantsisbecausethethyroid
hasamajorimpactonneurotransmittersandneurotransmitterproduction.In
thenearfutureIwilldoaseriesonHashimotosandthebrainanditwillhelp
shedlightonwhatishappening.
Best,
Marc
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SissyKoleva November19,2013,4:10am
HiMarc!Thankyoufortheexcellentarticle!Itshedsnewlightonthe
antibodiesandhowtheyaffecttheoverallsymptoms.Ivebeendiggingintoall
possibleinfoaboutthisdiseasesinceIwasdiagnosedthissummer.Theendoandgp
werentveryhelpfulthough.IwasgivenLThyroxintotaketillIdie!lol!Strangely,I
havebeenfeelingworsesinceIstartedtakingitanddevelopedsomuchmusclepain
inmyarms.Ihadthejointstiffnessbefore,butnowtogetherwiththemusclepain,its
sofrustratingasIcantdomydailyroutines.Apparently,Ihavelotsofinflammation,
despitegoingonGF,dairyfreeandsoyfreediet.Myquestionis:IsitsafeifItake
NSAIDlikeiboprofenordiclofenac.Withthemthepaingoesaway,butIdontthink
theyaregoodforthedigestivesystemandcancauseleakyguts.Ialsotaketurmeric,
butdontknowhowmuchIshouldtake(just2adayasitisrecommendedonthe
bottle).YourarticlegavemeverygoodadviceonwhatIshouldtarget,butstilldont
haveanideahowtoorganisemysupplementation.Theendoprescribedmeonly
seleniumandvitD3.
Thankyouinadvanceandlookingforwardtoyournextarticle!
Sissy

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MarcRyan November30,2013,8:20am
HiSissy,
Thanksforreachingout!Youreallyhavetobecautiousaboutnotoverdoing
NSAIDsforpreciselythereasonsthatyoumentioned:leakygutandalsotheycan
behardontheliverandthekidneys.Forsomepeople,amorerestrictivedietis
sometimesnecessary(CheckouttheAutoimmunePaleoapproach).Also,you
havetolookatthehealthimpactofotherthingsinyourlife.Howstressfulisyour
joborrelationship,etc.becausestressfullifeeventscancauseautoimmuneflare
ups,aswell.Itssometimesmoreaboutlifestylemodifications,likedietandstress
thanitiswithsupplements.
Best,
Marc
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T ES TI MONI ALS
Myapproachtodealingwith
Hashimotosisunchangedsince
learninghowfromyou,andIamvery
grateful,indeed.Mydoctorhas
loweredmySynthroiddosageacouple
timesnow,andIvelostthirtypounds.
Ihavealotmoreenergyandam
enjoyingthediet.Therearequiteafew
otherimprovementsinmyoverall
health,aswell.
MarieGrimwood

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