The Suspected Link Between Epstein-Barr Virus and Thyroid Health

In Some Cases Hashimoto’s May Be Linked to EBV Reactivation

• EBV Infection and Reactivation|
• EBV and Autoimmune Disease|
• Epstein-Barr Virus and Thyroid|
• Whole Body Approach for Hashiomoto’s|
• Treatments for Hypothyroidism|
• Treatments for EBV|
• EBV is Just One Factor in Thyroid Health|

Almost everyone gets infected with Epstein-Barr virus, part of the herpes family of viruses, at some point during their lifetime [1, 2]. 

The virus targets immune cells called B cells [1] and can cause mild to moderate symptoms such as fatigue, fever, sore throat, and body aches that last a few weeks. For most people, this is the end of the story.

However, for some, the virus may reactivate later in life, and may contribute to a higher likelihood of developing an autoimmune disease.

In this article, we’ll look at where the evidence lies on Epstein-Barr virus (EBV) and thyroid autoimmunity specifically. This is a matter of some debate in the functional health community, and the significance of EBV in thyroid disease may have been overestimated.

If you have Hashimoto’s, Graves’, or thyroid autoimmunity, let’s figure out whether the EBV virus could be a factor, and if so, what can you do about it.

EBV Infection and Reactivation

An initial Epstein-Barr virus infection may cause no symptoms at all, or it can cause the common illness “mono” or mononucleosis (sometimes known by the nickname “kissing disease” as it’s most common in teenagers and young adults). 

While kissing is certainly one way this viral infection can be passed on, it is also transmitted by sharing food, drinks, or toothbrushes, and forgetting to wash your hands after touching something with a small child’s saliva on it. EBV can also spread through uncovered coughs and sneezes, and unprotected sex [3].

Symptoms of infectious mononucleosis start 4 weeks after infection with EBV and can last 4 weeks, or longer. Typically young people with mono might get:

• Enlarged spleen or liver
• Extreme fatigue
• Fever
• Headaches
• Appetite loss
• Muscle aches or weakness
• Rash
• Sore throat
• Swollen lymph nodes in neck, armpits, and/or groin

Unfortunately for humans, EBV is peculiarly good at evading the immune system. This means that while our bodies will eventually quell an active infection after a few weeks, the virus is not cleared totally, but remains dormant (known as a latent infection) in the body.

In certain cases, sometimes years after the initial infection, the virus can reactivate and trigger autoimmune diseases [4, 5].

EBV and Autoimmune Disease

Though the science on EBV and autoimmune thyroid disorders specifically isn’t clear yet, there’s a proven association between EBV reactivation and higher susceptibility to a range of other autoimmune diseases, including [2]:

• Rheumatoid arthritis
• Sjogren’s syndrome
• Multiple sclerosis
• Systemic lupus erythematosus

Reactivation of the virus usually requires an immune system stressor, such as psychological stress, physical stress, another infection, or hormonal changes [3, 6]. Sometimes, reactivation may occur without any obvious stressful trigger [7]. 

We don’t yet know for sure how reactivated EBV might cause autoimmune disease, but these are some of the mechanisms that are suspected:

• Molecular mimicry: The Epstein-Barr Virus (EBV) produces proteins that resemble human proteins. The immune system then mistakenly attacks both the viral proteins and the similar human proteins, causing harm to the body’s own cells, including thyroid cells [2, 4, 8].
• Bystander activation: T cells ( a type of immune cell), become activated when other parts of the immune system respond to reactivated EBV, which is a legitimate threat. Some of these activated T cells don’t have a specific target and then mistakenly attack body cells [4, 9].
• Lymphocyte activation: Infections of specific immune cells (B cells) by EBV can cause them to multiply excessively and produce too many antibodies. This can result in immune reactions against the body’s cells [2, 4].
• Enhanced auto-antigen presentation: During inflammation (caused by EBV), immune cells at the site may present fragments of the body’s own cells as foreign. This prompts an immune response against these mistaken “foreign” cells [4].

Epstein-Barr Virus and Thyroid

Scientists are still figuring out if EBV is also related to thyroid autoimmunity and/or an underactive thyroid but there are some hints that they could be linked [4, 5, 10].

Given that Hashimoto’s disease (the number one cause of hypothyroidism in the US) is a thyroid autoimmune condition, this makes sense.

The following evidence supports the idea that EBV may contribute to autoimmune thyroid diseases [4]:

• People with autoimmune thyroid diseases commonly have human herpesvirus DNA in their bodies [11].
• Graves’ disease (an overactive thyroid also caused by autoimmunity) has been found to co-occur with EBV [12, 13].
• Some kids with mono have increased levels of antibodies that react against thyroid tissue [14].
• Reactivated EBV caused EBV-infected B cells to make thyroid antibodies in laboratory studies [15].
• Tiny pieces of genetic material known as EBV-encoded RNAs (EBERs) have been found in the bodies of people with Hashimoto’s or Graves’ [16].
• People with Hashimoto’s may also have a protein (latent membrane protein 1), made by EBV virus in their bodies [16].

However, none of this is anything more than theoretical, and the way EBV can wake up, how our immune system reacts, and how thyroid autoimmunity might be the result, is still controversial and requires more research.

In clinical practice, I’ve learned that while there is often a theoretical mechanism for a disease, it’s not helpful to get too hung up on it. Most of us probably have EBV in our body and we can’t change that, but only a small proportion of us will develop Hashimoto’s disease. Only 9–19% of these  will go on to develop clinical hypothyroidism, so it’s not something to stress over too much [17].

Interestingly, as I outlined in this short video, fewer hypothyroid patients test positive for EBV reactivation than you might expect.

Given there’s also no known guaranteed way of getting rid of EBV, and few effective methods, supplements and treatments aimed specifically at doing so are certainly not top of the list for dealing with hypothyroid symptoms.

In my experience, better results tend to come from treating the whole person — the immune system and symptoms of its dysregulation — rather than trying to aim at a slippery viral target.

Whole Body Approach for Hashiomoto’s

It’s understandable that you may worry if you are diagnosed with Hashionoto’s thyroiditis, but remember that only a small proportion go on to develop hypothyroidism, and you can significantly reduce the odds of this happening, whether EBV is a factor or not.

Before hurrying to any sort of treatment — whether thyroid hormone related or aimed at eradicating EBV — you may be able to make big improvements by paying attention to your gut health, diet, and stress levels.

Work on Healing Your Gut

Several studies have found that people with thyroid problems also often have poor gut health, including food sensitivities, gut inflammation, and microbial imbalances. This is an area that we’ve researched a lot and published research on at the Ruscio Institute, and I’m passionate about getting the message across.

For example, Hashimoto’s and hypothyroidism happen more often in people with conditions such as:

• Celiac disease 
• Sensitivity to gluten 
• H. pylori and other bacterial gut infections 
• Small intestine bacterial overgrowth (SIBO)

“Leaky gut,” where the gut barrier isn’t able to keep out toxins, allergens and incompletely digested food particles as it should, is also more common in those with poor thyroid function. These substances leaked into the bloodstream are recognized as foreign invaders which trigger inflammation and put undue stress on the immune system. Over a period of time, your overstressed immune system can begin attacking your own body tissue, including the thyroid, which is where autoimmune thyroid issues can begin.

Healing the gut with dietary changes and probiotics is therefore fundamental to treating or even reversing hypothyroid issues over the longer term.

There are many anti-inflammatory diets that could help you get started on your gut-healing journey, but it’s best to start simple, and for many people, that is the Paleo diet.

In particular, a Paleo diet that is gluten-free and dairy-free has a good chance of helping with thyroid issues like Hashimoto’s thyroiditis and hypothyroid as research shows that:

• A gluten-free diet reduced thyroid antibodies (a sign or thyroid autoimmune issues) in a group of women with Hashimoto’s disease [18].
• Eliminating dairy or gluten may help improve thyroid function [19, 20]
• Lactose restriction and a gluten-free diet led to significant improvements (i.e. reductions) in levels of thyroid stimulating hormone in hypothyroidism patients taking standard therapy [19, 20]. 

One additional study showed that women with Hashimoto’s who ate a low-carb diet (such as a Paleo diet) reduced their thyroid antibodies by 44% [21]. 

If you see little to no improvement in gut/thyroid symptoms such as fatigue, brain fog, and gut discomfort after a month or so on the Paleo diet, consider moving on to either the autoimmune Paleo diet or the low FODMAP diet. 

Not everyone with thyroid issues meeds to avoid gluten / dairy and be low carb for ever, but this strategy may help while your gut is healing and to reduce autoimmunity. Over time, your goal will be to gradually reintroduce foods as you become less sensitive and are able to tolerate them again. 

Take Probiotics

Thyroid health is closely linked to gut health, and probiotics have been shown to improve digestive symptoms and balance the gut microbiome [22, 23]. For example, probiotics were shown in one study to allow some patients to reduce their thyroid medication dosage [24]. 

Probiotics have also been shown to help resolve small intestinal bacterial overgrowth (SIBO) [24] , which has been closely associated with thyroid disease [25] , and to reduce inflammation [22]. 

Including a quality probiotic from each of the three main probiotic categories — Lactobacillus and Bifidobacteria blends, Saccharomyces boulardii, and soil-based probiotics — may help improve your constipation, brain fog, fatigue, and autoimmunity, and reduce your thyroid medication dosage. For more on how to use probiotics, see our Probiotics Starter Guide.

Reduce Stress Levels 

Stress seems to be a contributor to both [3, 6, 26]:

• The reactivation of EBV 
• Autoimmune problems in general

It therefore makes sense to try to keep your stress levels in check where you can if you are experiencing thyroid issues such as Hashimoto’s.

Some of the simplest ways to minimize the impact of stress include: 

• Doing regular exercise, such as zone 2 exercise 
• Immersing yourself in nature, including forests and other green spaces

Even just looking at pictures of flowers, green landscapes, and wooden materials has been shown to lower your stress response and decrease fatigue [27].

For more complicated cases of anxiety and stress (often in people with past trauma), some more in-depth techniques that can help re-program the way the brain deals with stressful situations are worth investigating. These include neuroplasticity training and EFT tapping.

If your thyroid condition is not better after addressing thyroid dysfunction with appropriate medication, improved gut health, exercise, and stress relief, then it’s reasonable to investigate EBV more fully as a possible contributor.

Treatments for Hypothyroidism

If your thyroid autoimmunity issues have already tipped over into clinical hypothyroidism, you can still make big improvements with all the gut health and lifestyle changes discussed above. However, getting your thyroid hormone levels back in range with medication will probably be a necessary additional step.

Use Conventional Medicine When Needed

Unfortunately, overprescribing of thyroid hormones for people who don’t actually have clinical hypothyroidism (but who maybe have subclinical hypothyroidism, sluggish thyroid, or Hashimoto’s without clinically low hormone levels) is quite common in the field of functional health. 

Functional therapists can also overcomplicate hypothyroid treatment and demonize standard pharmaceutical treatments. For example, prescribing combination T4/T3 combination therapy has become a “go-to” solution, but isn’t really supported by the totality of the evidence [28, 29, 30, 31, 32, 33].

That said, thyroid hormone medication is a really important treatment for patients with clinical hypothyroidism, and will usually bring quick relief. I generally recommend the use of standard medication (levothyroxine) combined with regular testing of thyroid hormone levels, with the aim of bringing thyroid hormone levels up to the normal range and keeping them at this level.

Treatments for EBV

If looking after your gut health, taking probiotics, and using thyroid medication still doesn’t bring sufficient relief, this is the point you could also consider treatments for EBV.

The closest we have in terms of pharmaceutical treatments for EBV are the anti-herpes virus drugs, few of which have shown much effect against EBV in human clinical trials. 

Those that have shown some effect include aciclovir (treats symptoms of herpes simplex and chickenpox), and ganciclovir (treats symptoms of cytomegalovirus) [34]. These antiviral medications appeared to reduce viral shedding, or the contagiousness of EBV [34].

On the more natural side of things, a few studies have shown that vitamin D might have promise to potentially support the immune system’s defenses against EBV [34]:

The evidence is lacking in hypothyroid patients, but some human clinical trials suggest vitamin D may support the immune system’s defenses against EBV in people with multiple sclerosis [35, 36, 37, 38, 39].

A whole host of other nutrients have also been linked in vitro studies (but not in humans or animals) to improved clearance of EBV.

These include: 

• Vitamin C
• Resveratrol (phenol common to grapes, blueberries, raspberries, and peanuts)
• Luteolin (flavone in celery, broccoli, green pepper, parsley, thyme, carrots, olive oil, oregano, etc)
• Apigenin (flavone common in parsley, celery, onions, oranges, chamomile, thyme, oregano, basil, tea, beer, and wine)
• Astragalus (Chinese herb extract)
• Epigallocatechin 3-gallate (EGCG, a polyphenol in green tea)
• L-arginine (amino acid)
• Sulforaphane (compound in cruciferous veggies, like broccoli and cabbage)
• Curcumin (extract of turmeric)

However researchers have a long way to go in terms of exploring the effects of these potential treatments on reactivated EBV in people with thyroid conditions.

EBV is Just One Factor in Thyroid Health

Reactivated EBV may be a factor in some cases of thyroid autoimmunity but is not something you need to be unduly worried about or go out of your way to address. The immune dysregulation that underlies Hashimoto’s and hypothyroid conditions is much more likely to be helped by a more general overhaul of gut health, including the use of an anti-inflammatory diet and probiotics, together with lifestyle changes that reduce the overall stress on your body

If you find it difficult to get started, my thyroid course, based on a combination of research and the results I obtain with patients offers a clear protocol for optimizing your thyroid function. You can also schedule a visit with us to get help finding your way back to health. 

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.