Note: The text below is a transcription from the video above. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
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today’s topic is going to be Follow TSH and TPO. This came up a couple of times in the past couple of weeks when I had patients that I reevaluated their thyroid hormones and they were a little upset because I didn’t rerun their thyroid antibodies. So I’m assuming if you’re looking at this, you have some idea what TSH and TPO is, but we’ll talk about it right now. So it’s not that you never look for thyroid antibodies. Obviously you have to look for them. I’ll assume that there’s maybe one person out there who, for some reason, tripped on this and doesn’t know what TSH and TPO is. So TPO is the thyroid peroxidase enzyme that is most, about 97% of the time, that’s what comes up positive when a person has autoimmune thyroid disease, or you might know it as Hashimoto’s. And a thyroid stimulating hormone is a hormone that everybody checks for your thyroid, all the endocrinologists check for the thyroid.
It’s the holy grail. That’s all they check. And if they just check that and they don’t do the antibodies, they’re not going to know that you have Hashimoto’s, which 90% of hypothyroid patients or more, actually have Hashimoto’s. So if they don’t look for it, they don’t know you have it, they’re just going with your TSH. And so TSH, when they just go after that and you have Hashimoto’s, a lot of you don’t do well. And so, TSH has gotten a bad name. I was probably part of that at one point in time, as was the group of doctors that I was involved with because at the time we didn’t know any better. And we were tracking thyroid peroxidase enzyme, TPO, to see if the patient was getting better. So, that was wrong. So here’s how it goes.
The thyroid peroxidase enzyme, and there’s another one called an antithyroglobulin enzyme. They’re antithyroglobulin tissue test. So these tests tell you whether you have an antibody that flares up that tells your immune system to attack your thyroid. So these are the tests that need to be run to figure out, do you have Hashimoto’s hypothyroidism? Once you figure that out, what someone figured out was that you really didn’t need to run those antibodies anymore, but because we have been trained throughout our life that if you have a high blood sugar marker, and you do a blood sugar diet, you want to see the marker go down. So we intuitively think that’s the same with the autoimmune thyroid disease markers, but it’s not, because they’re very erratic. They can go up and down for no reason at all. You can test them one day, they’ll be down. You can test them the next day, they’ll be high.
You can have, I have seen TPOs anyways, for those of you who know, or have had your own labs taken, and you have Hashimoto’s, I have seen them as high as 20 or 30,000, for those of you who have TPO of 30 and think it’s high or whatever. And I’ve had those people go, but I don’t feel bad. Then I’ve had other people and we used a range of zero to nine for this thyroid peroxidase antibody when we’re evaluating people for Hashimoto’s, I’ve had people at 12 and they have every single, they have all 20 symptoms of Hashimoto’s Thyroid Disease. So the point is, that the TPO doesn’t really tell you whether you’re better or not. If you’re doing something, if you’re taking a medication like a thyroid medication, or if you’re doing a program like we do, and we’re pulling all the triggers and doing all that type of stuff, it’s really not the thing you track.
I had these two patients and they were a little upset that I didn’t do them because they wanted to see if their thyroid peroxidase enzymes were better. And I tried to explain this to them, that the TSH is really, once you know that you have autoimmune thyroid disease, you don’t ever have to look at those antibodies again, ever. You have it. It’s not going away. The only reason you look at the antibodies is to know if you have it. But to find out if you’re getting better, you want to look at the thyroid stimulating hormone, the TSH, because here’s the deal. When the immune system attacks your thyroid, depending on the patient, depending on their immune system and their stress mechanisms and the plasticity of their microbiome and many other things, because all of you’re different.
The thyroid tissue gets damaged. And as a thyroid tissue gets damaged and cells, thyroid cells start to actually go into your bloodstream because they got damaged. Your thyroid’s getting damaged. Your brain is reading that. So basically your brain is going, let’s see, they got a lot of the thyroid hormone in their system, so I’m going to not stimulate the thyroid anymore. Thyroid stimulating hormone is a hormone that’s put out of the anterior pituitary gland and it goes to your thyroid. When your thyroid is low, when your thyroid is not producing enough thyroid hormone, it goes in and it stimulates it to make more, so it’s counterintuitive. When you have a bad thyroid, you’re going to have higher number, here’s another counterintuitive thing, right? You’re going to have a higher TSH. So a high TSH means you have low thyroid function and a low TSH, most of the time means you have hyper function.
So that’s what you’re looking for. So let’s say you start out with a TSH of regular, let’s say normal, it’s three. And then you start not feeling good. You go to the doctor and they go like, your TSH is 4.8. So you have hypothyroid. And maybe they haven’t even checked you for Hashimoto’s, but let’s say they did. You have hypothyroid and you have high antibodies, but most medical doctors are basically going to just give you thyroid medication. And then the next time you go in, your TSH is not 4.5 or 4.8, it’s six. So they increase your thyroid hormone. So let’s say the next year you go in and it’s seven and that means your thyroid tissue is getting damaged all that time. And nothing is being done to dampen that damaging effect.
So the thyroid stimulating hormone marker, the TSH, is really once you’ve established the diagnosis of autoimmune thyroid disease, the TSH is what you want to observe to determine how your thyroid is actually doing it. And a lot of you’re out there going, yeah well, I went to my doctor and he gave me the thyroid hormone and then it went up and then it went down and then it went up and then it went down and I’m driving them crazy. The TSH went up and down and they didn’t know how to dose me. If a person walks into me and they say that and they don’t know they have Hashimoto’s, I am like, you have Hashimoto’s, because that means that you’re not getting rid of all of the triggers that are causing attacks on your thyroid.
When the attack goes on your thyroid, you go into hyperthyroid and low TSH. And then after you get beat up, okay, then you go into hypothyroid and high TSH. So that’s really the basics, but the strong baseline basics of how to, there is a lot more to it. There’s like 21 different patterns to thyroid, but that’s really the core pattern right there. So when you want to figure out if you have Hashimoto’s, run the antibodies. You have the antibodies, tells you, you’ve got Hashimoto’s, you never have to run them again. You should really go by the TSH. And there’re other things, but that’s the big confusion. So I wanted to clear that up.