When it comes to hypothyroidism, or your thyroid not producing enough thyroid hormones it has been shown that nearly 90% of these cases are due to autoimmunity(1). Aka Hashimoto’s. Remember autoimmunity is when your immune system starts attacking your own healthy tissue. In this case, your thyroid. So how do we actually know whether your hypothyroidism is due to hashimotos or not? By looking for thyroid antibodies. This is important because the majority of primary care providers will not run this marker. At least not initially. These thyroid antibodies are called thyroglobulin antibodies or TGB and then thyroperoxidase or TPO. TGB and TPO. Why it’s important to measure antibodies is because the development of antibodies can precede clinical manifestation by 7 years(2). That means these antibodies may show up 7 years prior to you ever noticing any symptoms. And as you can imagine a lot of damage can occur in 7 years.
But before we get too deep into all of that let's first talk about how exactly the thyroid works. There are 3 major players involved. From the top you have the hypothalamus, the pituitary, and then of course the thyroid. The hypothalamus produces TRH, thyroid releasing hormone, the pituitary gland releases TSH, thyroid stimulating hormone, and lastly the thyroid produces T3 and T4. And this whole thing works off of a feedback loop. What I mean by that is if the thyroid starts producing less thyroid hormones that will signal back to the top, to the hypothalamus to say hey we need more thyroid hormone, can you tell the pituitary gland. The hypothalamus says sure, so in response the hypothalamus releases more TRH which then knocks on the door of the pituitary glad and in a way says hey you’ve gotta tell the thyroid to produce some more hormone. The pituitary says sure so he releases more TSH and when that reaches the thyroid it will make release more hormone. Then if the reverse of that were to happen as in hyperthyroidism, the thyroid is producing too much hormone so the hypothalamus and pituitary will release less of their hormones in an effort to say, hey we’ve got enough of this stuff, stop making so much of it. Think about it like talking to someone. If I were to scream at you I’ll probably get your attention, but if I whisper I might not. When the hypothalamus and pituitary release more of their hormones TRH and TSH they’re essentially screaming at the thyroid to produce more T3 and T4.
Since this is built off of a feedback loop lots of providers will only run a TSH marker when looking at a patient’s lab work because at least in theory if that number is really high that means your thyroid is not producing enough T3 and T4 and if its low that means your thyroid is working overtime, pumping out a lot of T3 and T4. One of the reasons for this is because at least in the traditional healthcare world they’re just want to know what the end product is. Do you have too much or too little hormone. And If you don’t have enough, then we can prescribe it to you. Makes sense right? Your levels are low, let's bring them back up. The problem with that is what we alluded to at the beginning of this video saying that 90% of hypothyroidism is due to Hashimoto’s. An autoimmune thyroid condition. Again most traditional healthcare providers are not going to run the antibodies to screen for this disease because whether they are present or not, the treatment is the same. They’re just going to give you thyroid hormones. I think we can do much better than this. Remember, on average it takes 7 years after a patient develops thyroid antibodies for them to have any TSH abnormalities. What that means is that you could very well have this disease brewing for nearly a decade before noticing any objective changes on your standard thyroid panel. Here’s why this is important: when you have Hashimoto’s your immune system starts destroying thyroid follicles and when they are destroyed those follicles have thyroid hormones within them. So now you get a dump of thyroid hormones into your system and even though you technically have a hypothyroid disease, as in your thyroid is not producing enough hormones but now hormones are just being dumped into your system. Do you see how that could lead to some false readings? Remember, most providers are only going to run a TSH so if your thyroid is producing low levels of thyroid hormone but then a follicle bursts and increases that supply, back to normal levels, your TSH will never be out of range and you never get diagnosed with a thyroid disease. At least not until you have killed off enough of your thyroid that you are no longer have any follicles that can burst and dump thyroid hormones into your system. This is why it can take 7 years after developing antibodies to your thyroid and why in this article they state that thyroid antibodies in apparently healthy individuals should not be neglected and may serve as a useful tool to screen for autoimmune thyroid disease. If you’re experiencing any of the typical thyroid symptoms like fatigue, trouble with your weight, bowel movement issues, trouble regulating your temperature or maybe you just want to screen for an autoimmune thyroid disease so you can be on top of things, tell your doctor to run the thyroid antibodies or give us a call. We’d be more than happy to help.
1) Amino N. Autoimmunity and hypothyroidism. Baillieres Clin Endocrinol Metab. 1988 Aug;2(3):591-617. doi: 10.1016/s0950-351x(88)80055-7. PMID: 3066320.
2) Hutfless S, Matos P, Talor MV, Caturegli P, Rose NR. Significance of prediagnostic thyroid antibodies in women with autoimmune thyroid disease. J Clin Endocrinol Metab. 2011 Sep;96(9):E1466-71. doi: 10.1210/jc.2011-0228. Epub 2011 Jun 29. PMID: 21715532; PMCID: PMC3167665.