Hashimoto’s Thyroiditis is the most common autoimmune condition and is responsible for over 80% of “low thyroid” even though most patients have never had their thyroid antibodies tested.
“More than 10% of all women will test positive for thyroid antibodies, even if the rest of their thyroid panel appears normal”1
Conventionally the way we treat low thyroid doesn’t really change whether the cause is autoimmune or something else, which means that we don’t often test antibodies to determine if a patient’s case is caused by their immune system. However, patients with autoimmune low thyroid may have symptoms even after they are treated, which can leave them searching for answers to their fatigue, mental fog and body aches when the cause is right in front of us.
Studies have confirmed multiple times that “just treating thyroid lab work” does not absolve patients with Hashimoto’s Thyroid from all of their symptoms. Even once we achieve normal thyroid lab work, a large percentage of patients still have symptoms, with fatigue being the most common.
The level of autoimmune activity in a Hashimoto’s patient may be responsible for how they feel. In a study where they compared medicating patients against removing the thyroid completely (and then medicating them to replace their thyroid hormones). The patients who had complete thyroid removal had a significant improvement in their symptoms, even though their lab work looked exactly the same as the patients who were only medicated. Their antibody levels fell dramatically after surgery and the authors concluded that the antibody activity was likely responsible for how the patients felt even though their lab work looked normal.2
Now, removing the thyroid is not a viable option for most patients (and is certainly not the first line therapy), but these findings point to an important point – we should be paying attention to thyroid antibodies, and working to lower them.
Patients with elevated antibodies may benefit from the addition of a complete health plan that addresses not only their thyroid, but also their immune system. Specific diet recommendations and supplements have been shown to lower thyroid antibodies and improve the thyroid function of patients even if their medication doesn’t change. These strategies are simple and complement your regular medical care. Each of the NDs in our office also hold a prescribing licence in Ontario to prescribe Thyroid Hormones where indicated.
1. Ralli, M. et al. Hashimoto’s thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun. Rev. 102649 (2020) doi:10.1016/j.autrev.2020.102649.
2. Guldvog, I. et al. Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial. Ann. Intern. Med. 170, 453–464 (2019).