The Link Between Hashimoto’s Antibodies and Symptoms

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If you’ve been diagnosed with Hashimoto’s thyroiditis, you know it’s more than just a thyroid problem. Hashimoto’s is an autoimmune disease where your body mistakenly goes on the attack against your thyroid gland. Over time, Hashimoto’s usually leads to hypothyroidism – an underactive thyroid – which is treated with thyroid hormone replacement medication.

One thing that Hashimoto’s patients know all too well, however, is that despite the treatment, they can experience symptoms long before they become hypothyroid. And many Hashimoto’s patients continue to experience a range of symptoms – even when medication returns their thyroid hormone levels to normal!

What’s going on? Let’s look at what we know about the connection between thyroid antibodies and symptoms and what you can do to optimize your health.

Elevated thyroid peroxidase (TPO) antibodies and/or thyroglobulin (TG) antibodies are hallmarks of Hashimoto’s thyroiditis. TPO is an enzyme involved in producing thyroid hormones, while TG is a protein essential for storing these hormones. When the immune system mistakenly attacks these crucial thyroid components, it triggers an inflammatory response that gradually damages the thyroid gland.

Research shows that TPO antibodies are present in 50 to 90% of Hashimoto’s patients, and TG antibodies are found in 30 to 50%. Elevated TPO – and sometimes TG – antibody levels are commonly used to diagnose Hashimoto’s.

Higher levels of these antibodies are associated with more severe thyroid dysfunction and a higher risk of progression to overt hypothyroidism. The research shows that 73% of subjects who later developed hypothyroidism had detectable TPO antibodies an average of 252 days before the onset of thyroid dysfunction4.

These findings suggest that the presence of thyroid autoantibodies in euthyroid patients may be an early marker of subclinical thyroid disease, potentially associated with subtle symptoms or increased risk of future overt thyroid dysfunction.

Many patients with Hashimoto’s thyroiditis maintain normal thyroid-stimulating hormone (TSH), free T4, and free T3 levels for years before progressing to hypothyroidism. Despite being considered euthyroid with “biochemically normal” thyroid function, these patients frequently experience symptoms. The persistence of symptoms in people with otherwise normal thyroid levels has led researchers to explore the role of autoimmune activity beyond thyroid hormone levels.

Studies have consistently shown a correlation between elevated thyroid antibodies and greater severity of thyroid disorders and symptoms. In autoimmune thyroid diseases like Hashimoto’s thyroiditis, the presence and concentration of specific antibodies are closely linked to disease manifestation and progression.

A study published in late 2024 in the journal Scientific Reports sheds light on why this might be happening. Researchers investigated the connection between thyroid antibodies and the various symptoms experienced by individuals with Hashimoto’s. Let’s break down what they found and what it could mean for you.

The study was designed to evaluate the relationship between thyroid antibodies and multiple symptoms, including quality of life. The study population included Hashimoto’s patients who had elevated antibodies but normal thyroid hormone levels and a group of controls with healthy thyroid function. Study participants were evaluated based on their symptoms and responses to specially designed quality-of-life questionnaires.

The study had an important finding: compared to the healthy control group, multiple symptoms were significantly more serious in Hashimoto’s patients – even though these patients had normal thyroid levels.

The study confirmed that even when Hashimoto’s patients are euthyroid – meaning that they have thyroid hormone levels that fall within the reference range – they often experience a variety of symptoms that significantly impact their quality of life.

The most commonly reported symptoms included:

• Digestive: bloating, abdominal distension, constipation, diarrhea, and irritable bowel
• Endocrine: feeling cold, cold intolerance, weight gain, and facial puffiness and swelling
• Neuropsychiatric: forgetfulness, difficulty concentrating, brain fog, anxiety, depression, fatigue, unrefreshing sleep, insomnia, irritability, and mood instability
• Mucocutaneous: Dry skin, itchy skin, and hair loss
• Musculoskeletal: muscle and joint aches, stiffness, and sensitivity to pain

The research found that higher antibody levels are associated with more of these symptoms and greater severity of those symptoms.

Higher levels of antibodies were also associated with reductions in quality of life, general health, and overall vitality.

Several mechanisms explain why high TPO and TG antibody levels contribute to worsening  symptoms:

1. Chronic inflammation: Autoimmune activity creates a systemic inflammatory response, increasing cytokines and oxidative stress, which can affect the brain, joints, and muscles.

2. Direct thyroid tissue damage: Even if thyroid hormone levels remain within range, the ongoing immune attack causes microdamage to thyroid cells, potentially impairing hormone production efficiency.

3. Impact on the brain: Thyroid antibodies may cross-react with brain tissue, particularly affecting mood-regulating areas, contributing to depression, anxiety, and cognitive dysfunction.

4. Dysregulation of immune function: A heightened autoimmune response can disrupt other systems, increasing the risk of autoimmune coexisting conditions such as celiac disease, rheumatoid arthritis, and lupus.

This research suggests that thyroid antibodies play a more significant role in the overall experience of Hashimoto’s than previously thought. While thyroid hormone replacement medication is a crucial part of managing hypothyroidism, symptoms persist even when blood tests show that thyroid levels are within range. Therefore, treatment should also focus on modulating the autoimmune response, reducing inflammation, and supporting overall well-being.

There are some things you can do to manage Hashimoto’s.

Work closely with your doctor

Effective management of thyroid antibodies requires a partnership with your health care provider. Be proactive in discussing your ongoing symptoms and any concerns you have about autoimmunity. Share research and ask about specific strategies tailored to your needs. Some key approaches for focus:

• Ensure that your thyroid testing is comprehensive and includes TSH, free T4, free T3, and thyroid antibodies

• Evaluate potential underlying triggers such as gut health issues, chronic infections, or environmental toxin exposure.

• Review and adjust your thyroid medication as needed to optimize thyroid hormone levels and reduce autoimmune activation.

• Discuss anti-inflammatory treatments and immune-modulating options tailored to your condition.

Get periodic antibody testing

Regular monitoring of thyroid antibodies can provide valuable insights into autoimmune activity and overall thyroid health. Many providers discontinue antibody testing for their patients with hypothyroidism who are on thyroid medication. However, it is crucial to periodically assess these markers to track progress and monitor for elevated thyroid antibodies.

• Ask your doctor to include thyroid antibodies in routine thyroid panels, even if they are not standard practice.

• Monitor changes in antibody levels over time, particularly when making dietary or lifestyle changes.

• Use antibody trends to indicate how well your immune system responds to interventions.

Consider medical interventions for autoimmunity

Some medical treatments may help regulate immune activity and reduce thyroid antibodies. These include:

• Low-dose naltrexone (LDN): LDN is a promising therapy for autoimmune diseases, as it helps modulate the immune system, reduce inflammation, reduce antibodies, and promote endorphin production, which can positively impact immune function.

• Immune-modulating therapies: Consider consulting a functional medicine practitioner to explore immunotherapy options. Potential treatments include intravenous immunoglobulin (IVIG) therapy or other targeted immune interventions.

Incorporate supplements

Certain supplements may play a role in reducing thyroid antibodies, supporting immune balance, or modulating stress responses. Key supplements include:

• Selenium: Research suggests that selenium supplementation can significantly lower TPO antibody levels and improve overall thyroid function. Brazil nuts are a natural source, but selenium supplements (typically 200 mcg/day) can be beneficial.

• Vitamin D: Vitamin D deficiency is common in autoimmune diseases. Maintaining optimal vitamin D levels (ideally 50-80 ng/mL) may help reduce antibody production and inflammation.

• Zinc: Zinc is crucial for immune function and thyroid hormone conversion. Supplementing with 15-30 mg per day may help modulate immune activity.

• Magnesium: Magnesium supports stress response, inflammation reduction, and thyroid function.

• Curcumin: Curcumin, a potent anti-inflammatory compound found in turmeric, may help regulate immune responses in autoimmune conditions.

• Adaptogenic Herbs: Ashwagandha, rhodiola, and holy basil may help modulate stress responses and support adrenal health.

Make dietary and nutritional changes

Diet plays a critical role in managing thyroid antibodies. Several dietary approaches have shown benefits for Hashimoto’s and autoimmune thyroiditis:

• Anti-inflammatory diet: A diet rich in whole, unprocessed foods, including leafy greens, healthy fats, and lean proteins, helps lower systemic inflammation. Avoiding refined sugars, processed foods, and unhealthy fats is crucial.

• Autoimmune Protocol (AIP) diet: This elimination diet removes inflammatory foods, processed foods, and potential triggers such as dairy, gluten, soy, and nightshades. It focuses on nutrient-dense whole foods to support healing.

• Gluten-free diet: Many individuals with Hashimoto’s have gluten sensitivity. Eliminating gluten may reduce cross-reactivity with thyroid tissue and lower inflammation.

• Gut health optimization: Since gut health is closely linked to immune function, incorporating probiotic-rich foods (such as fermented vegetables, kefir, or yogurt) and prebiotic fibers can support a balanced gut microbiome.

Manage stress

Chronic stress can significantly impact your immune function and worsen thyroid autoimmunity. Incorporating stress management techniques can help regulate the body’s immune response. Effective methods include:

• Meditation & mindfulness: Regular meditation helps reduce stress hormones and promote relaxation.

• Yoga & tai chi: These practices combine movement and mindfulness, lowering stress and inflammation.

• Deep breathing exercises: Techniques like diaphragmatic breathing, box breathing, or alternate nostril breathing can lower cortisol levels.

Get regular physical activity

Exercise helps regulate the immune system, reduce inflammation, and improve energy levels. The key is to find the right balance—too much intense exercise can be counterproductive for people with autoimmune thyroid disease. Beneficial activities include:

• Walking: A gentle but effective way to improve circulation and reduce inflammation.

• Strength training: Resistance exercises help build muscle and support metabolism without overstressing your body.

• Swimming & low-impact workouts: These are excellent options if you have joint pain or fatigue.

• Yoga and Pilates: These exercises improve your flexibility and reduce stress, benefiting thyroid health.

Optimize sleep

Good quality sleep is essential for reducing systemic inflammation and supporting immune balance. Prioritizing restorative sleep can make a significant impact on thyroid antibody levels. Key sleep optimization strategies include:

• Maintain a consistent sleep schedule: Aim for at least 7-9 hours of sleep per night, going to bed, and waking up at the same time daily.

• Create a sleep-friendly environment: Keep the bedroom dark, cool, and free from electronic distractions.

• Reduce blue light exposure: Limit screen time at least an hour before bed to enhance melatonin production.

• Practice relaxation before bed: Engage in activities like reading, gentle stretching, calming music, guided meditation, or ASMR videos to promote restful sleep.

• Address sleep disorders: If you experience frequent wake-ups, snoring, or restless sleep, consult a doctor to rule out conditions like sleep apnea or adrenal imbalances.

By implementing these comprehensive strategies, you can proactively manage thyroid antibodies and improve overall thyroid health.

The idea that normal thyroid hormone levels equate to a symptom-free experience in Hashimoto’s patients is a misconception. Mounting evidence shows that higher TPO and TG antibody levels are directly linked to more severe symptoms, even in people with normal thyroid function and test levels.

This knowledge has several important implications for thyroid care:

• Comprehensive thyroid function assessment –  including antibody testing – is essential, even if you have possible thyroid symptoms but normal thyroid function.
• It’s crucial to address the autoimmune component of Hashimoto’s thyroiditis rather than solely focusing on treating hypothyroidism with medication. Treatment success can’t be measured only by thyroid hormone levels and test results.

Only by recognizing and understanding the relationship between antibody levels and symptom severity can health care providers better predict disease progression, tailor treatment approaches, and potentially intervene earlier in the course of the disease.

Thyroid-savvy experts recommend a holistic approach that incorporates thyroid medication as treatment of hypothyroidism, along with nutritional strategies and lifestyle changes, to significantly improve your quality of life and manage your symptoms more effectively.

Paloma Health’s treatment philosophy incorporates this understanding, and the Paloma Complete Thyroid Test Kit includes a thyroid antibody test -- specifically, TPO antibodies -- as part of the core panel, along with TSH, free thyroxine (free T4), and free triiodothyronine (free T3.) In addition to optimizing thyroid function with prescription medication, Paloma’s Hashimoto’s treatment plans typically include recommendations for dietary changes, supplements, and lifestyle changes that will enhance your recovery and better relieve symptoms.

• Hashimoto’s thyroiditis is an autoimmune disease in which the immune system attacks the thyroid, often leading to hypothyroidism, but symptoms can persist even with normal thyroid hormone levels.
• Thyroid antibodies (TPO and TG) contribute to ongoing symptoms by triggering inflammation, immune dysfunction, and potential thyroid damage, even in euthyroid individuals.
• A recent study found that Hashimoto’s patients with normal thyroid levels still experience significant symptoms, including fatigue, brain fog, digestive issues, cold intolerance, and joint pain, with severity linked to antibody levels.
• Managing Hashimoto’s requires more than just thyroid hormone replacement; addressing immune activity, inflammation, and overall health is crucial for symptom relief.
• Comprehensive thyroid testing, including antibody levels, is essential, as higher antibodies are linked to more severe symptoms and greater risk of disease progression.
• Lifestyle and dietary changes, such as an anti-inflammatory diet, stress management, and targeted supplementation (selenium, vitamin D, zinc, etc.), can help reduce inflammation and support immune function.
• A holistic approach combining medication, lifestyle modifications, and immune-supportive strategies offers the best outcomes for managing symptoms and improving the quality of life in Hashimoto’s patients.