I have a 52-year-old male with Graves’ disease who we are tracking with thyroid labs. His TSH is consistently 5 and occasional palpitations despite being on LDN, autoimmune Paleo diet, and various supplements over the past few years, including bugleweed, L-carnitine, meriva, etc. We ran the Cyrex Array 2, which was normal, and the Array 10. He’s completely gluten, dairy, and grain-free, so we didn’t do Arrays 3 or 4. Array 10 showed to be positive to egg whites, some nuts, most fruits and vegetables across the board, but negative to white rice and black beans. I spoke with Dr. Alexander at Cyrex about the discrepancy between Array 2 being negative and Array 10 being very positive, and he felt that the negative Array 2 definitely means the patient does not have leaky gut and that Array 10 was still positive due to immune system reaction to the food antigens in the system. Do you have any recommendations either for this patient and/or how to explain the test discrepancies?

Chris Kresser: Interesting question. Going back to the case, you mentioned he has Graves’ disease, but his TSH is 5, so I’m wondering what is going there. As we’ll discuss in the thyroid unit in the hyperthyroidism section, some percentage of Graves’ disease patients spontaneously become hypothyroid even without thyroidectomy, radioactive ablation, or thyroid-suppressive drugs. It just evolves into a hypothyroid condition, so I’m wondering if that is what’s happening here, or if there is something else going on because, of course, with Graves in a true hyperthyroid state, we’d expect a low TSH rather than a high TSH. Nevertheless, it sounds like he is still having some symptoms despite LDN, autoimmune Paleo, and some of the other interventions that you’ve tried. It sounds like there is some different stuff going on with the Array 10 regarding food intolerances. I would probably have to disagree with Dr. Alexander in that Array 10 I don’t think can completely rule out intestinal permeability because it tests for antigenic intestinal permeability, and that’s autoimmune-mediated permeability. I think it still may be possible for this patient to have intestinal permeability. There are very few tests that are 100 percent sensitive or specific, and that’s even if we don’t consider the mechanism that Cyrex Array 2 is specifically looking at. I think it’s a great test, but I don’t think it can rule out permeability completely.

As for the Array 10 being positive, as I mentioned when we talked about this test, I think it’s a very useful test, but I still think you should be testing these foods with patients before telling them to remove them completely from the diet forever. We’ve definitely had situations where Array 10 has led to removal of some foods that have then subsequently led to clinical improvement, and we’ve had situations where removal of food hasn’t led to clinical improvement. Of course, if it does lead to clinical improvement, we want to figure out why he is reacting to so many different foods.

You haven’t mentioned whether you’ve done the testing for gut infections, you know, the stool testing, breath testing, and urine organic acids testing to see if he’s got anything going on that would be causing this kind of gut issue, or any of the other testing, the HPA axis assessment or some of the more advanced testing that we’re not covering in this course. We want to figure out what is provoking that kind of immune reaction in this patient. The food intolerances, I would look at that as a symptom of a deeper problem.