TPO antibodies dropped from 3484 IU/ml in Aug 2023 to 914 IU/ml in May 2024.

I want to be clear. This is only my second antibody test. First one was just before diagnosis. Neither my endocrinologist, nor me track my antibodies as a therapy target, nor is it advised by any endocrinology guidelines that I am aware of. I do not think it is healthy to obsess about thyroid antibody counts and make changes to diet and lifestyle for that purpose. Please read on, you will understand why. I also do not think it is healthy to judge people's lifestyle and diet choices based on antibody counts (this was done to me recently on this sub, and motivated this recent test and post).

How did I reduce my TPO antibodies by 75% in 9 months?

1. Ensured morning TSH was in range with the right levothyroxine dose, I check TSH every 45 days. in 2023, TSH was not under as good control.
2. I reduced my weight from 28 BMI to 25 via caloric deficit (weighing and logging food and exercise).
3. I reduced saturated fats in diet (am a long time vegetarian), thus reduced LDL cholesterol.
4. Added aerobic exercise (daily brisk walk/jog).
5. Reduced blood pressure and hs-CRP (inflammation marker) as a result of the above 3.
6. I DID NOT cut out gluten, dairy, cruciferous vegetables or soy. I consume a lot of these 4 foods.
7. I take vit D, B12, multivitamin and multimineral supplement with zinc, selenium; iodized salt in cooking to ensure all my vitamins and minerals are adequate (I do 6 monthly blood tests to confirm)
8. I have no idea if the above actually caused the antibody reduction, I suspect that they had only a little impact. But they were all healthful choices for reasons unrelated to Hashimoto's. I suspect that antibodies would have reduced regardless of the above 7 points.

Antibodies fall over time anyway for most treated Hashimoto's patients

Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto's thyroiditis) treated with levothyroxine

In the above linked study, 38 patients were followed up over 4-5 years on average.

In the 35 patients in whom there were decreasing TPO-Ab values, the mean of the first value was 4779 IU/mL with an SD of 4099 IU/mL. The mean decrease after 3 months was 8%, and after 1 year it was 45%. Five years after the first value, TPO-Ab levels were 1456 +- 1219 IU/mL, a decrease of 70%. TPO-Ab levels became negative, < 100 IU/mL, in only six patients, a normalization percentage of 16%.

Out of 38, 35 saw a mean decline of 70% in antibody count over 5 years from avg of 4779 to 1456. 6 patients saw their antibodies fall below <100 IU/ml. Antibodies did not change for 2/38 and rose for one. There was also a significant reduction in thyroid volume over time as the gland lost function.

Study Conclusion: Serum TPO-Ab levels decline in most patients with Hashimoto’s thyroiditis who are taking levothyroxine, but after a mean of 50 months, TPO-Ab became negative in only a minority of patients.

There are some weaknesses in this study because dietary changes, exercise changes or weight changes are not noted. But there are other studies which concur. This study which followed people for 1 year, then removed levothyroxine for 2 months in only 1 group out of two. They found that levothyroxine therapy lowered TPO antibody count.

PROBLEMS WITH GLUTEN-FREE DIET RECOMMENDATIONS ONLINE

Cardiovascular mortality attributable to dietary risk factors in 54 countries in the WHO European Region from 1990 to 2019: an updated systematic analysis of the Global Burden of Disease Study

This study, published just last month, showed that a diet low in whole grains was the number 1 cause of diet-related cardiovascular deaths in the European Region. Suboptimal-Diet related cardiovascular (CVD) deaths were 16.7% of total deaths and 36.7% of CVD deaths in 2019.

In rigorous double-blinded-placebo-controlled studies; only 14% of those who claimed non-celiac gluten sensitivity could identify gluten from gluten-free. 86% could not. In this study, only 20% of self reported gluten sensitive people were NCGS, the other 80% showed more symptoms on placebo than gluten.

Therefore, please think twice before willy-nilly recommending gluten-free diets to those who don't need it.

TAKEAWAYS

When some people on this subreddit claim that going gluten-free, dairy-free, soy-free etc. made their antibodies fall, know that in most cases antibodies fall with time regardless of any dietary or lifestyle changes. Unless there is diagnosis of Celiac disease, wheat allergy, lactose intolerance or proven non-celiac gluten sensitivity (NCGS); or if there are clear symptoms upon ingestion of some specific foods, there is no reason to adopt any dietary restriction for Hashimoto's without a qualified doctor's or registered dietician's prescription (woo-woo doctors don't count).