The Real Reasons Why Your Thyroid Medications Aren’t Working
First of all, thyroid medication normally comes in the form of a synthetic T4 thyroid hormone. T4 is the main thyroid hormone that your body produces naturally, but it needs to be converted into T3 for it to be used actively in the body. I have found that the overwhelming majority of people struggling with low thyroid symptoms are having some sort of autoimmune response, in which the immune system mistakes the thyroid as a foreign body and attacks it, destroying it so it cannot produce the thyroid hormones your body needs.
This immune dysregulation can cause systemic inflammation in the body. Inflammation is a normal response to an injury, but when the source of the inflammation, in this case an autoimmune response, isnt addressed, the vicious cycle of systemic inflammation is never broken. Adding a synthetic hormone to replace what your thyroid isnt making is only a drop in the bucket in terms of addressing the symptoms that result from this cascade of dysfunction. Not only that, but your body may not be capable of using the hormone you are taking every day.
The only way to actually repair this problem is to address the underlying issues of an autoimmune pattern and inflammation. This is how to restore health. With that in mind, lets go over five reasons why your thyroid medication may not be working, based on the actual thyroid problem you might have:
1. Decreased thyroid receptor sensitivity
2. Decreased thyroid hormone conversion.
3. High reverse T3 levels.
Other Diseases Associated With Autoimmune Thyroiditis And Elevated Anti
Not only will high levels of anti-TPO antibodies damage your thyroid, but it also is important to identify because the presence of this autoimmune disease increases your risk of developing other autoimmune diseases.
Studies have shown that patients with Hashimoto’s and autoimmune thyroiditis conditions have a very large increase of developing other diseases like Celiac disease , type I diabetes mellitus, pernicious anemia and even adrenal insufficiency.
For this reason, the early detection of thyroidal antibodies becomes very important.
Treating and reducing the immune and inflammatory component to this disease can help reduce the risk of developing these other autoimmune diseases.
The presence of TPO antibodies in your blood should prompt your physician to order other tests to evaluate your autoimmune status.
This is particularly important in the case of Celiac disease which is so often undiagnosed and underappreciated .
Below I’ve included an example of a patient of mine who had elevated anti-TPO antibodies on initial testing and further evaluation of her antibodies to gluten revealed she also had antibodies to the gluten protein.
You can see above the high titers to tissue transglutaminase and gliadin antibody, both of which can be markers of the condition Celiac disease.
It’s always very important to identify the gluten sensitivity in patients because the removal of gluten can be curative in this autoimmune disease .
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Your complete thyroid blood panel should include TSH, free triiodothyronine , free thyroxine , and TPO antibodies. Having this information helps to determine the cause of your under- or over-active thyroid.
Lab results read as “positive” or “negative” concerning whether you have TPO antibodies present in your blood sample.
Suppose you show a negative result for TPO antibodies. In that case, it means that there were no TPO antibodies discovered in your blood. Therefore, if you have symptoms of a thyroid condition, it is unlikely that an autoimmune disorder causes them.
If you show a positive result for TPO antibodies, it may mean you have:
The diagnosis is made if you have high levels of TPO antibodies and high levels of thyroglobulin – a protein produced by the thyroid.
The diagnosis is made if you have high levels of TPO antibodies and high levels of thyroid-stimulating hormone receptor antibodies.
A TPOAb test is not the only indicator of Hashimoto’s. A study from California Northstate University suggests that 10% of patients with Hashimoto’s may have negative blood work for TPO antibodies.
While there is a low probability that you need other tests to confirm Hashimoto’s disease, a thyroid ultrasound can help diagnose, if necessary. The ultrasound assesses the size of the thyroid, the pattern and structure of tissue, and the presence of nodules.
Use the same laboratory
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Do Antibody Numbers Matter
Some clinicians will say that once you have thyroid antibodies, you will always have thyroid antibodies, so the actual number doesnt matter, as the antibodies can randomly fluctuate. I respectfully disagree. Antibodies fluctuate in response to triggers , and in my exhaustive experience, they can be an incredibly helpful marker for tracking disease progression. That said, they should not be the only marker. We also want to look at your overall health and the big picture are you feeling better or worse?
Recap + Final Thoughts
The presence of anti-TPO antibodies is never a normal sign.
The presence of these antibodies combined with hypothyroid symptoms may indicate autoimmune thyroiditis.
If you are experiencing hypothyroid like symptoms then you should have a complete thyroid lab panel checked which includes antithyroid antibodies.
Due to the various issues with diagnosing and managing thyroid abnormalities, it will be important for you to have a basic understanding of how to diagnose and manage your condition.
Because autoimmune thyroiditis indicates both an inflammatory and autoimmune condition, it is treated differently from hypothyroidism.
For best results, patients should focus on a combination of supplements, diet, stress reduction and hormone replacement to reduce this inflammatory state.
Doing this early may help to preserve thyroid function long term.
Now it’s your turn:
Are your TPO antibodies elevated?
Are experiencing any of the symptoms of hypothyroidism or hyperthyroidism?
Leave your comments below!
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Without verifying the presence of thyroid antibodies, these symptoms can lead to a missed diagnosis or misdiagnosis.
But My Doctor Said My Tsh Level Is Normal
My doctor said my TSH level is normal, so why should I worry about testing for thyroid antibodies?
I cant tell you how many times I hear this in my clinical practice and from readers. And I thought this myself many years ago. I spent almost a decade undiagnosed because I only had my TSH tested, and my thyroid diagnosis was completely missed. I had been told that my thyroid was normal even though my TSH was 4.5 IU/mL. That left me struggling with progressively worse symptoms for almost ten years symptoms like chronic fatigue, anxiety, depression, hair loss and many others.
This is why Im so passionate about advocating for you to get the proper tests and for you to understand your tests. Had I known then what was happening in my body, I could have taken on the lifestyle modifications and treatment steps necessary to not only alleviate my progressing symptoms but also prevent further damage to my thyroid.
Thyroid antibodies are going to be the first indication of a thyroid problem in many cases. They can be elevated for 5, 10, sometimes even 15 years before a change in TSH is even detected! Keep in mind that the presence of thyroid antibodies means that there is an active destruction going on against your thyroid.
Elevated thyroid antibodies, even in the presence of a normal TSH, means that its only a matter of time before your thyroid becomes destroyed to the point it can no longer produce sufficient amount of hormones.
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Ask A Laboratory Scientist
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What Abnormal Results Mean
A positive test may be due to:
- Granulomatous thyroiditis
- Hashimoto thyroiditis
High levels of these antibodies have also been linked with an increased risk of:
- Premature birth
- In vitro fertilization failure
Important: A positive result does not always mean that you have a thyroid condition or that you need treatment for your thyroid. A positive result may mean that you have a higher chance of developing thyroid disease in the future. This is often associated with a family history of thyroid disease.
Antithyroid microsomal antibodies may be seen in your blood if you have other autoimmune conditions, including:
- Autoimmune hemolytic anemia
- Systemic lupus erythematosus
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Risks And Side Effects
There are few risks or side effects associated with a blood test. Because veins vary in size, your healthcare provider may occasionally have difficulty obtaining the blood sample.
Any time your skin is broken, theres a slight risk of infection. You should notify your doctor right away if the area of the blood draw swells or starts to produce pus.
Other minimal risks include:
You Must Reduce Elevated Tpo Antibodies Down To The Normal Reference Range To Prevent Hypothyroidism
If a recent lab test has shown that you have elevated thyroid antibodies, your next question might be, How can I bring them down to normal levels?
When it comes to thyroid antibodies, striving for perfection may be overrated. Lets talk about what level of antibodies you should aim for and how to reduce them.
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Your Guide To Thyroid Medication
Optimizing your thyroid levels with thyroid hormone replacement medication is usually the first step in minimizing symptoms.
Nearly all hypothyroid patients can be treated as outpatients, not having to admit to the hospital.
Most patients with hypothyroidism will require lifelong treatment with thyroid hormone replacement medication. Finding the appropriate dose, particularly at the beginning, may require some trial-and-error. You should test thyroid levels every 6-8 weeks after any dose adjustment until achieving the correct dose. After that, testing your thyroid once a year is generally sufficient.
When on the appropriate dose of thyroid hormone replacement medication, it has no side effects. However, suppose your dose of medicine is too high or too low. In that case, serum TSH levels remain affected, and patients may have persistent symptoms.
So Whats Your Thea Score
Do you know what yours is? If not, do a quick calculation now by taking the assessment it is easy to do. Assign points as per the chart based on your TSH, TPO antibodies and family background. Again, low risk is considered in the 0-7 range. This means the Hashimotos is or would not be super aggressive. But, you are still at risk.
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Improve Your Gut Health
Preliminary evidence suggests that gut health is closely linked to thyroid health, and that improving gut health can decrease thyroid antibodies and balance your thyroid hormones. Here are several ways you can work on improving your gut health.
- Anti-Inflammatory Diet: A low-quality diet is typically the single biggest source of inflammation that can impair your thyroid and immune function. But encouragingly, early evidence shows that changing your diet can lower thyroid antibodies.A low-carbohydrate diet was shown in one study to reduce thyroid antibodies by 44% in people with Hashimotos thyroiditis, but not celiac disease , while a gluten-free diet was shown to reduce thyroid antibodies in a group of women with Hashimotos thyroiditis . Other studies have shown that eliminating dairy or gluten may help improve thyroid function [6
- For more on supplements to support thyroid function, see How Should I Use Thyroid Supplements?
What Is Thyroid Peroxidase Antibody
Thyroid peroxidase antibody is an antibody against thyroid peroxidase , an enzyme normally found in the thyroid gland that plays an important role in the production of thyroid hormones. Thyroid peroxidase antibody is most common test for autoimmune thyroid disease it can be detected in Graves disease or Hashimoto thyroiditis. In autoimmune disorders, your immune system makes antibodies that mistakenly attack normal tissue. Antibodies that attack the thyroid gland cause inflammation and impaired function of the thyroid.
The highest thyroid peroxidase antibody levels are observed in patients suffering from Hashimoto thyroiditis. In Hashimotos disease, the prevalence of thyroid peroxidase antibodies is about 90% of cases, confirming the autoimmune origin of the disease. These thyroid peroxidase antibodies also frequently occur in the course of Graves disease.
In patients with subclinical hypothyroidism , the presence of thyroid peroxidase antibodies is associated with an increased risk of developing overt hypothyroidism. Many clinical endocrinologists use the thyroid peroxidase antibody test as a diagnostic tool in deciding whether to treat a patient with subclinical hypothyroidism.
Your doctor may also order a thyroid peroxidase antibody test if you are pregnant and have an autoimmune disease, especially one that involves the thyroid, such as Hashimotos disease or Graves disease.
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Thyroid Antibodies An Early Warning For Hashimotos
In Hashimotos, we know there are 5 stages relating to the initial development and also worsening of the disease. A quick review of these stages is helpful in understanding the importance of knowing your thyroid lab results.
It also really demonstrates the importance of specifically knowing your results relating to the presence of elevated thyroid antibodies.
Causes Of Hashimotos Thyroiditis
Doctors aren’t entirely sure why the immune system, which is supposed to defend the body from harmful viruses and bacteria, sometimes turns against the body’s healthy tissues.
Some scientists think a virus or bacterium might trigger the response, while others believe it may involve a genetic flaw. A combination of factorsâincluding heredity, sex, and ageâmay determine your likelihood of developing the disorder.
Researchers estimate that 70%â80% of autoimmune thyroid disease susceptibility is from a family history of autoimmune disease.
Pregnancy puts metabolic stress on a woman. The thyroid undergoes noticeable modifications to cope. These changes are typically reversible after birth, though pregnancy can sometimes be a trigger for postpartum thyroiditis. Postpartum thyroiditis is a condition in which the thyroid becomes inflamed within the first year after birth. In most cases, postpartum thyroiditis is limiting to weeks or months after delivery but occasionally develops into Hashimoto’s disease.
Other hormonal events
Hashimoto’s is seven times more likely to occur in women than men. Hormonal events like puberty, pregnancy, or menopause may contribute to the development of Hashimoto’s.
It is not uncommon for someone with one autoimmune condition to have another like celiac disease, type one diabetes, rheumatoid arthritis, or lupus. This condition of have two or more autoimmune disorders is polyautoimmunity.
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Who Has Elevated Thyroid Antibodies
While high thyroid antibodies are one of the diagnostic criteria for Hashimotos disease surprisingly there are other health conditions associated with their presence. It means that there is a risk that eventually the person may develop Hashimotos and/or hypothyroidism later on.
1. Thyroid antibodies levels were found to be mild to moderately elevated in associated diseases such as systemic lupus erythematosus , thyroid cancer, thyrotoxicosis, rheumatoid arthritis, fibromyalgia, pernicious anemia, autoimmune collagen vascular disease and type 1 diabetes.
2. According to different studies, high thyroid antibodies were reported in a range of 1229% in patients with chronic hives . There is an increased prevalence of thyroid autoimmune disease such as positivity of thyroid antibodies, Hashimotos disease with or without hypothyroidism in people with chronic urticaria. However, there are no cases of Graves disease described among patients with chronic hives.
Test for thyroid antibodies and thyroid function are especially recommended for those patients who experience chronic hives that cannot be attributed to an allergen or any other obvious cause.These tests can rule out involvement of thyroid autoimmunity or help to confirm it as being the cause of this condition.
One study estimated that up to 12.5% of women can have elevated TPO thyroid antibodies during the first two trimesters of pregnancy and it can negatively affect development of the fetus and child.
Thea Score: Assessing Your Risk For Hypothyroidism
Once you have your lab results in hand, there is a great tool that your clinician can use to help determine the aggressiveness of your condition. The Thyroid Event Amsterdam Score is a score that can help assess your risk of progression into hypothyroidism.
The THEA score is used to help estimate the risk of developing hypothyroidism within five years in people who have TPO antibodies, and can also help estimate the risk for those who have relatives with thyroid diseases.
Please note that thyroid antibodies make a very big contribution to the total THEA score.
How does THEA work? It applies a certain amount of points towards different measures. These measures consist of genetic predisposition as well as lab test results. Ive included a chart that shows you how the scoring is made.
Genetic predisposition: We know there is a genetic component to developing Hashimotos, and it tends to run in families. So, if you have relatives with Hashimotos, that increases your risk. And if you have been diagnosed with thyroid disease, theres a greater chance that a loved one like your child, parent or sibling may be at risk as well.
Hashimotos can occur in two varieties: an organ wasting form associated with HLA-DR3 gene inheritance, and an enlarged thyroid form through HLA-DR5 inheritance.
People with these genes and who have a relative with Hashimotos would get points. Someone with multiple relatives with Hashimotos would get additional points.
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Very High Thyroid Antibodies
All that said, if your TPO antibodies are very high, reducing your antibody count is definitely a worthwhile goal. The higher the antibodies, the more likely you are to develop hypothyroidism.
The farther you reduce your antibodies, even if you cant get them down to 500 IU/mL, the less damage to your thyroid gland. Just dont feel discouraged by failing to get them down to the normal reference range.