Having Hashimoto’s Without Antibodies

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So we already know that in order to be diagnosed with Hashimoto’s (the leading cause of hypothyroidism at 90%), a positive antibody test is usually indicated. Testing for Thyroid Peroxidase Antibodies and Thyroglobulin Antibodies (TpoAB and TbAB) and them coming back with results above range is how we know if we have this autoimmune condition. 

But did you know that you can still have Hashimoto’s, without the positive antibodies?

Yes, negative antibodies doesn’t necessarily mean you don’t have the autoimmune condition and because we know that Hashimoto’s is responsible for 90% of us with hypothyroidism,  that leaves up to 10% of those with hypothyroidism, having Hashimoto’s but coming back negative on antibody tests.

Having Hashimoto’s without positive antibody tests is known as seronegative autoimmune thyroiditis, or serum negative Hashimoto’s.

People who do not have thyroid antibodies are more likely to have smaller thyroid glands and are less likely to have goitres.

Why?

Firstly, it’s important to be aware that your antibodies can move up and down and so testing them regularly or at least a couple of times a year is beneficial to keep an eye on things. Theoretically, you could test negative on antibodies one week and positive the next week.

This is because as the thyroid gland is being attacked and losing function (causing hypothyroidism), extra thyroid hormone contained in thyroid cells are released into the bloodstream in bursts, which can lead to hyperthyroid symptoms and Free T3 and Free T4 levels to go up (even above range), along with fluctuating antibody levels. Therefore, if you experience your results moving up and down, even without thyroid antibodies, you can probably safely assume that you have Hashimoto’s as it’s quite a common sign of the condition.

It’s also important to know that lifestyle changes and interventions such as a gluten free diet, dairy free diet, selenium supplementation (200mcg a day) and Vitamin D supplementation, can also reduce antibodies. I saw a dramatic reduction in my own antibodies from >1300 to 200, from implementing these four things alone. So if you’re already implementing things that can reduce thyroid antibodies, then when it comes to testing them, antibodies could come back as being quite low and even so low that it might appear you don’t have Hashimoto’s at all, even when they would be high if you weren’t implementing antibody reducing interventions.

This is where it could actually be beneficial to stop any supplement and diet changes,  for example resume eating gluten and dairy again and stopping the selenium and Vitamin D supplements, and then retesting a few weeks later to see if the amount of antibodies change and do indeed indicate Hashimoto’s.

However, some people may always test negative for Hashimoto’s on antibody panels, even when they’ve ran the tests numerous times, having not implemented any lifestyle changes than can bring the antibodies down, yet examinations and biopsies of the thyroid gland confirm that Hashimoto’s is present, due to the visible damage.

As Dr. Datis Kharrazian also explains:

Some people with Hashimoto’s test negative because their overall immune health is weak and they do not produce enough antibodies. Their immune systems have been so stressed for so long that their total white blood cells and B-cells are too low to be able to make antibodies. You have to have some degree of immune fitness to produce antibodies. Many times these people will not test positive for Hashimoto’s or start to feel better until their compromised immune system improves in health.

These are the people who, after several weeks on a gluten-free diet or on a protocol from their practitioner start feeling great, yet are dismayed when a follow-up antibody panel shows antibodies are significantly higher, or are positive when they were initially negative. In some cases this is a sign that immune health has been restored to the point where antibody production kicks back into action.

So, what’s the best thing to do?

Seeing as most of us with hypothyroidism will have Hashimoto’s anyway, it may be best to assume you do have the autoimmune conditon for at least a while, and implement things such as diet changes (gluten free especially), supplementation and other lifestyle changes, and see if they help you. If they do, it might be a sign that you do have the autoimmune condition as these interventions are so well reported to helping control it. Remembering that test results which move up and down can be a sign of Hashimoto’s and the on going destruction too, even with positive antibody tests.

You can click on the hyperlinks in the above post to learn more and see references to information given, but more reading and references can also be found at:

https://drknews.com/unraveling-thyroid-antibodies/ 

https://www.ncbi.nlm.nih.gov/pubmed/11932302

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Written by Rachel, The Invisible Hypothyroidism

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Rachel Hill, Thyroid Patient Advocate, blogger and author, has Six 2018 WEGO Health Award Nominations. She is a highly ranked writer appearing in the Top Hypothyroidism Websites and Top Thyroid Websites and has worked with The National Academy of Hypothyroidism, The BBC, The Mighty, Yahoo, MSN and ThyroidChange, to name just a few. She is well-recognised as a useful contributor to the thyroid community and also contributed the foreword to Emily Kyle’s The 30-Minute Thyroid Cookbook.

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