The Connection Between Epstein-Barr Virus (EBV) and Hashimoto's Thyroiditis
Updated: Aug 3
What is the Epstein-Barr Virus (EBV)?
The Epstein-Barr virus (EBV) is a type of herpes virus that causes mononucleosis or "mono." It's one that is more common among young adults and is also known as the "kissing disease" because it can be spread via saliva. Mono can cause extreme fatigue, enlarged lymph nodes in the neck, headache, joint pain, flu-like symptoms and an enlarged spleen. However, EBV can also not cause any symptoms at all and it's estimated that between 90-95% of adults have been exposed to the virus.
Once we have a virus it stays with us for our whole lives. Most of the time our immune system is able to keep the virus in dormancy and it doesn't cause any health problems. It's not until we encounter events that lower our immunity such as prolonged stress, illness, or use of steroids that the virus is able to overcome the immune defenses and become reactivated.
An example of this process is chicken pox and shingles, which are also in the herpes virus family. Before the chicken pox vaccine most of us had chicken pox as children and recovered from it after a short period of time. This virus can become reactivated as shingles in the elderly because their immune systems are not as robust as they were when they were younger. However, shingles can reactivate in young adults if their immune systems become impaired by the previously mentioned stressors.
How do I know if I have EBV?
Symptoms of reactivated EBV can include fatigue, weakness, depression or other mood disorders.
Blood tests can be used to find out if you've been exposed to EBV or have a reactivated infection. If you're testing for the first time an EBV panel is useful because it can help differentiate between a past and current infection, but after initial testing I usually test one marker that helps to determine if the infection is still active.
Tests in an EBV panel
Viral capsid antigen (VCA) IgM and IgG - IgM is an antibody that is produced early in an illness and means there is likely a current infection. IgG is an antibody that is produced about 1-2 weeks after an infection begins and can stay elevated for a while. Detection on a blood test means you have been exposed to EBV and had an infection in the past or could have a current infection.
Nuclear antigen (EBV-NA IgG) - this antibody rises months into an infection and can be present for a long time. Detecting this on a blood test usually means there was a past infection.
Early antigen (EA-D IgG) - this may mean you likely have a current or reactivated infection. This is the test I usually run if I'm checking to see if the infection is still going on after we've tried treatment because it can disappear once the infection has resolved.
If you'd like to know more about other tests for hypothyroidism take a look at my post here.
What is the connection between EBV and hypothyroidism?
Chronic viral infections can trigger autoimmune diseases in a few ways. EBV likes to "hide" from immune detection in the thyroid gland making it more likely that immune cells will mistake the viral cells for thyroid tissue. Immune cells like T cells and B cells can also become primed through the immune response to attack important thyroid related enzymes and hormonal receptors, resulting in less thyroid hormone and less hormonal activity. This process can lead to autoimmune thyroiditis or Hashimoto's thyroiditis and lowered thyroid function.
EBV has also been linked to other autoimmune diseases including lupus, rheumatoid arthritis, and multiple sclerosis (MS).
How does naturopathic medicine treat EBV?
Viruses can be difficult to fight because they have a protective shell around them. The goal of treatment is to weaken the virus and reduce viral duplication. Approaches include using diet, nutrients, botanicals and sometimes antiviral medication to make this process easier. It's important to know that treatment for EBV can take some time. You may need to continue treatment anywhere from 3 - 12 months.
Rest - EBV can make you feel worn out and exhausted! You may find you're sleeping more hours at night than you used to and needing a nap in the afternoon. Allow yourself to rest as much as you can and avoid strenuous exercise. Sleeping is one of the best ways to support your body and immune system while it's trying to fight off the virus.
Lysine and arginine - these amino acids are important for decreasing viral replication. The virus needs arginine to replicate but lysine can block this effect. You can reduce the amount of arginine in your diet and increase the antiviral action of lysine from supplementation and in the diet.
High lysine foods: eat more of these
Dairy (if not allergic) - yogurt, cheese, milk, cottage cheese, butter
Fish and seafood
High arginine foods: eat less of these or avoid
Peanuts and peanut butter
Nuts - almonds, cashews, pecans, walnuts
Chocolate, sugar, alcohol, caffeine
Herbal antivirals - these can be used as natural antivirals, adrenal support and for mood support.
St. John's Wort
Monolaurin - this comes from coconut and can be a potent antiviral that helps to break up the protective viral capsule. Using this in addition to the other therapies can make them more effective. Monolaurin can be found in capsule form.
Prescription antivirals - medications like acyclovir and valacyclovir can be used short term along with other treatment strategies to prevent viral replication and help the other treatments be more effective. This can be useful if you're having herpes outbreaks or symptoms are severe.
Epstein-Barr virus (EBV) is a virus in the herpes family that causes mononucleosis. Symptoms of an infection include fatigue, swollen lymph nodes, depression, joint pain and flu-like symptoms. Blood tests can be performed to determine if EBV infection is present and whether it's a past or reactivated infection. EBV is an important consideration when treating autoimmune hypothyroidism because it can contribute to autoimmunity. Natural treatments include resting, gentle exercise, high lysine and low arginine in the diet or from supplementation, monolaurin, herbal antivirals and prescription antivirals.
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Dittfeld, Anna, et al. “A Possible Link between the Epstein-Barr Virus Infection and Autoimmune Thyroid Disorders.” Central European Journal of Immunology, vol. 3, 2016, pp. 297–301., doi:10.5114/ceji.2016.63130.
Fujinami, R. S., et al. “Molecular Mimicry, Bystander Activation, or Viral Persistence: Infections and Autoimmune Disease.” Clinical Microbiology Reviews, vol. 19, no. 1, 2006, pp. 80–94., doi:10.1128/cmr.19.1.80-94.2006.
Wentz, Izabella, et al. “Epstein-Barr Virus and Hashimoto's - Dr. Izabella Wentz.” Dr. Izabella Wentz, Pharm.D, 5 Dec. 2018, thyroidpharmacist.com/articles/epstein-barr-virus-and-hashimotos/.
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