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What Does Elevated Thyroid Peroxidase Mean

What Is Thyroid Peroxidase

Thyroid Anti TPO test. THYROID peroxidase antibodies test: why it is important.

Thyroid peroxidase is an enzyme made in the thyroid gland that is important in the production of thyroid hormone. TPO is found in thyroid follicle cells where it converts the thyroid hormone T4 to T3.

The thyroid gland is located in the lower part of the neck, below the Adam’s apple, wrapped around the trachea .

What Do High Tpo Levels Indicate

;Answered by: ;Prof Dinesh Dhanwal;; |;Prof of Medicine and Head of Endocrinology, Maulana Azad Medical College, New Delhi

Q:;I have a slightly elevated level of TSH and normal T3 and T4 levels . The Anti TPO is very high and the doctor has suggested 50 mg of Eltroxin . Do I need to take the tablet on a life long basis? At present, I don’t have any clinical manifestations. What are the clinical manifestations of very high Anti TPO levels? What are the clinical implications of Hashimoto’s or AITD? Can we solve this problem by diet or physical exercise. I am 45 years and my BMI is 28.50. Please explain the significance of these and explain how I will get effected if medication is not taken.

Going by the details you have provided you have subclinical hypothyroidism, which means that you do not have symptoms but TSH is slightly high with normal T4/T3. The most common cause is autoimmune thyroid disease, which is confirmed by positive anti-TPO. Positive anti-TPO means you have these antibodies in your body which act against the thyroid cells leading to hypothyroidism. Most often this is a progressive disease.

Thyroiditis: An Integrated Approach

LORI B. SWEENEY, MD, Virginia Commonwealth University Health System, Richmond, Virginia

CHRISTOPHER STEWART, MD, Bayne-Jones Army Community Hospital, Fort Polk, Louisiana

DAVID Y. GAITONDE, MD, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia

Am Fam Physician.;2014;Sep;15;90:389-396.

;Patient information: A handout on this topic is available at .

Thyroiditis is a general term that refers to inflammation of the thyroid gland and encompasses several clinical disorders. The family physician will most commonly diagnose thyroiditis because of abnormal results on thyroid function testing in a patient with symptoms of thyroid dysfunction or anterior neck pain. The diagnosis of chronic autoimmune thyroiditis is usually straightforward. Patients typically present with a nontender goiter, symptoms of hypothyroidism, and elevated thyroid peroxidase antibody level. However, a diagnostic dilemma occurs when the patient presents with thyroid-stimulating hormone suppression. The natural history of postpartum, silent, or subacute thyroiditis may include a hyperthyroid or toxic phase of short duration, followed by transient or permanent hypothyroidism.


Patients with elevated thyroid peroxidase antibody levels and subclinical hypothyroidism should be monitored annually for the development of overt hypothyroidism.


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What Abnormal Results Mean

A positive test may be due to:

  • Granulomatous thyroiditis
  • Hashimoto thyroiditis

High levels of these antibodies have also been linked with an increased risk of:

  • Miscarriage
  • Premature birth
  • In vitro fertilization failure

Important: A positive result does not always mean that you have a thyroid condition or that you need treatment for your thyroid. A positive result may mean that you have a higher chance of developing thyroid disease in the future. This is often associated with a family history of thyroid disease.

Antithyroid microsomal antibodies may be seen in your blood if you have other autoimmune conditions, including:

  • Autoimmune hemolytic anemia
  • Systemic lupus erythematosus

There Is Low Risk Of Progressing To Hypothyroidism If Tpo Antibodies Are At Or Below 500 Iu/ml 1

The Great Thyroid Slowdown: Hypothyroidism  The Golden ...
  • Those who had TPO antibodies below 500 IU/mL had a low risk of future progression to hypothyroidism.;
  • Those who were above 500 IU/mL still only had a moderate risk.;

The Tehran Thyroid Study, which followed the course of thyroid disease in a large cohort of people over nine years, showed similar results: those with elevated TPO antibodies only had a 9-19% chance of becoming hypothyroid after 6 years of follow up .

If we consider this, elevated thyroid antibodies are not as consequential as many thyroid experts would suggest.;

Ive commonly seen people with Hashimotos disease or elevated thyroid antibodies become hyper focused on reducing their antibody test results to the normal reference range, and becoming unnecessarily stressed. The research suggests this isnt necessary.;

Instead, it implies that only a minority of patients with elevated TPO antibodies will progress to full hypothyroidism. What this means for you is that you dont have to continuously pursue lower and lower levels of antibodies with strict diets or supplements, especially if your thyroid symptoms are under control.

If youre a patient, or a doctor working with patients, its important to understand that reducing TPO antibodies to under 500 IU/mLor getting your thyroid symptoms under control through other meansis a clinical win.

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Stage : The Genetic Predisposition

The first stage is when the person does not have any manifestations of Hashimotos. So, they are going to have a normal TSH and will have normal thyroid function. They will not have any elevated thyroid antibodies. If you were to biopsy their thyroid gland, it would be perfectly normal. They just have the genes at this point. Again, there are 3 requirements for the disease to progress: genetics, intestinal permeability, and one or more triggers.

Do High Thyroid Antibodies Require Treatment

While up to 95% of hypothyroidism in industrialized countries occurs due to autoimmune Hashimotos disease, tests for thyroid antibodies combined with ultrasound imaging can give a definite diagnosis of this autoimmune condition even before onset of hypothyroidism.

High thyroid antibodies are a definitive marker for chronic thyroiditis even in asymptomatic individuals and represent a risk factor for development of Hashimotos with or without hypothyroidism and are indeed a marker of future thyroid failure.

One recent study found that

Increased odds for autoimmune thyroid disease are associated with positivity to TPO or Tb thyroid antibodies during the 27 years preceding diagnosis.

This fact makes early diagnosis of Hashimotos disease very important because it can change the course of the disease.

Some research studies showed that prescribing a low dose of thyroid medication can delay or even stop the progression of Hashimotos to hypothyroidism, reduce the inflammation of the thyroid gland and lower levels of thyroid antibodies.

Besides a trial of thyroid medication, conventional medicine does not offer any specific treatment for high thyroid antibodies in people with normal thyroid function and does not consider that a treatment is necessary. Thyroid antibodies remain ignored in the majority of cases and are not used for monitoring of the treatment progress and evaluation of the severity of the autoimmune process.

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What Your Tpo Antibodies Test Results Mean

The normal range for TPO Antibodies is less than 35 IU/mL.

A null to minimal TPO Antibody test means that your blood does not contain TPO antibodies. This normally insinuates that the causes of your thyroid symptoms are not due to an auto-immune disease. However, if these conditions are suspected; then, a recurring test may be recommended.

When the levels are mildly elevated, this can be caused by many thyroid conditions like thyroid cancer, type-1 diabetes, rheumatoid arthritis, as well as auto-immune collagen vascular disease.

High levels of TPO Antibodies are usually caused by an autoimmune disease like the Hashimoto Thyroiditis, Graves Disease, pernicious anemia, lupus and rheumatoid arthritis. It has been reported that almost 3% of people who have a positive TPO test result do not show any symptom.

If levels are high in a pregnant woman, this may lead to higher risks of developing hypothyroidism or hyperthyroidism in the newborn baby.

What Your Thyroglobulin Antibodies Results Mean

Why test for thyroid antibodies?

Thyroglobulin is a protein that is made by the cells of the thyroid gland. Thyroglobulin antibodies are proteins that are made by the immune system during an autoimmune attack from the body directed at the thyroid gland.

What does the presence of thyroglobulin antibodies mean?The presence of thyroglobulin antibodies in the blood may suggest that the cause of your thyroid disorder is autoimmune in nature.

If youre reading this article, you probably want to understand what your thyroid results mean. If you havent, maybe youre considering taking a thyroid test.

With LetsGetChecked, you can take a thyroid test from the comfort of home with online results available in just one week. Order today and receive complimentary clinical support as part of the service.

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Symptoms Of Hashimotos Thyroiditis

At the very beginning, patients may not notice any particular symptom. This autoimmune condition tends to progress slowly over the years and causes thyroid damage and a decline in hormone production.

In fact, Hashimoto’s thyroiditis is the most common cause of hypothyroidism, which is why signs and symptoms of this autoimmune disease are similar to the underactive thyroid. Some of them include:

  • Thick and red skin usually on top of feet or shins

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Elevated Thyroid Stimulating Immunoglobulins

If you have;elevated TSI antibodies, even if your TSH level is normal, you most likely have Graves disease, an autoimmune condition.;In Graves disease, the TSI antibodies cause your thyroid gland to make too much thyroid hormone. As TSI antibodies cause overproduction of thyroid hormone, a TSH in the reference range drops, and you can become hyperthyroid fairly quickly.

What should you do?

If you have thyroid symptoms, but your TSH test result falls within the reference range, an important next step is to request that your doctor order thyroid antibody tests. If your symptoms suggest hypothyroidismfatigue, weight gain, depression, hair lossyou should request a TPO antibody test. If your symptoms suggest hyperthyroidismanxiety, insomnia, weight loss, diarrhea, elevated heart rate/blood pressureyou should request a TSI antibody test.

Recap + Final Thoughts

What Does It Mean When Thyroid Peroxidase Antibodies Are ...

The presence of anti-TPO antibodies is never a normal sign.;

The presence of these antibodies combined with hypothyroid symptoms may indicate autoimmune thyroiditis.

If you are experiencing hypothyroid like symptoms then you should have a complete thyroid lab panel checked which includes antithyroid antibodies.;

Due to the various issues with diagnosing and managing thyroid abnormalities, it will be important for you to have a basic understanding of how to diagnose and manage your condition.;

Because autoimmune thyroiditis indicates both an inflammatory and autoimmune condition, it is treated differently from hypothyroidism.

For best results, patients should focus on a combination of supplements, diet, stress reduction and hormone replacement to reduce this inflammatory state.;

Doing this early may help to preserve thyroid function long term.

Now it’s your turn:

Are your TPO antibodies elevated?

Are experiencing any of the symptoms of hypothyroidism or hyperthyroidism?

Leave your comments below!

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What Are Thyroid Antibodies

Sometimes the immune system mistakenly attacks your thyroid gland with antibodies. This damages your thyroid and can lead to inflammation of the thyroid gland , symptoms of hypothyroidism or hyperthyroidism, and if left unchecked, autoimmune thyroid disease.

Hashimotos is diagnosed by blood tests looking for:

You have autoimmune hypothyroidism if you have elevated thyroid antibodies and also have:

  • Low T4
  • Elevated thyroid stimulating hormone levels.

Not everyone who has thyroid antibodies is hypothyroid, but some people with elevated TPO or TG antibodies will eventually become hypothyroid. The question is, how likely is it you will become hypothyroid if your antibodies are elevated?

What If You Dont Test Positive For Thyroid Antibodies Can You Still Have Hashimotos

Current medical reports state that 80-90 percent of people with Hashimotos will have TPO antibodies. That said, researchers at the University of Wisconsins Thyroid Multidisciplinary Clinic found that only half of the patients who tested positive for Hashimotos through cytology had TPO antibodies. This means that a person can have Hashimotos even if their thyroid antibody test is negative. This variant of Hashimotos is known as serum negative Hashimotos and is a less aggressive form of Hashimotos, so it will be slower developing.

Additionally, researchers have identified that the body may produce other thyroid antibodies, that are not yet available outside of research labs, but may also play a role in thyroid disease, including Sodium-iodine symporter and Pendrin . The clinical relevance of these antibodies is not yet understood, but as with all emerging research, we just want to be aware of it. NISAb is found in 17 percent of people with Hashimotos and Pendrin is found in 11 percent.

Ive included a chart from UpToDate that shows the estimated prevalence of these three antithyroid antibodies in various populations. Again, keep in mind that the more elevated these antibodies are, the more likely you are to progress to the stage that involves the destruction of your thyroid.

<35 IU/mL

<2 IU/mL

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How I Reduced My Thyroid Antibodies From Over 2000 To Zero

  • Pin

This is Part 5 of my Healing Hashimotos series which outlines my personal experience with Hashimotos Disease. The other posts in this series include:

Disclaimer: I am not a doctor or medical professional. This site is for informational purposes only and does not provide medical advice.

In 2010, I started on my personal roller coaster of recovery . And I mean roller coaster, just check out my thyroid antibody results

*FYI I was diagnosed in 2010, but at that time, my antibodies were just barely there. Then, I went a few years without further testing, and picked it back up in 2013. That is where we are going to start.

So, lets hop off this crazy coaster and look through the details of my thyroid antibodies journey since 2013.

Stage : Hashimotos Progresses And There Is A Progression To Other Immune Disorders

Thyroid Autoimmunity â What Are Healthy Levels for Thyroid Antibodies

In stage 5, as Hashimotos progresses, we unfortunately have a progression to other immune disorders as well. At this time, a person may get diagnosed with Rheumatoid Arthritis, Lupus or any of the other types of autoimmune conditions.

So as you look at the progression of disease, note that our earliest warning about Hashimotos, and our best opportunity for early intervention, is during Stage 2 when we initially find evidence of thyroid antibodies.

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How Is The Tpo Antibodies Test Performed

TPO antibodies test is, basically, a blood test. Your healthcare provider or a lab technician will take a sample of your blood in order to measure how many antibodies are in it.

The blood sample is collected by inserting a needle into a vein in the arm. You might feel a little sting when the needle goes in or out. The whole process lasts five minutes maximum. TPO antibodies test requires no special preparations.

However, you should inform the doctor if you’re taking some medications, supplements, or herbs. Some drugs and supplements may impair the results.

Based on the information you provide, the doctor will suggest whether you can continue taking the medication or supplement even on the day of the test or not.

Follow the doctors recommendations religiously in order to get accurate results and precise diagnosis or insight into your condition.

Other Diseases Associated With Autoimmune Thyroiditis And Elevated Anti

Not only will high levels of anti-TPO antibodies damage your thyroid, but it also is important to identify because the presence of this autoimmune disease increases your risk of developing other autoimmune diseases.

Studies have shown that patients with Hashimoto’s and autoimmune thyroiditis conditions have a very large increase of developing other diseases like Celiac disease , type I diabetes mellitus, pernicious anemia and even adrenal insufficiency.

For this reason, the early detection of thyroidal antibodies becomes very important.

Treating and reducing the immune and inflammatory component to this disease can help reduce the risk of developing these other autoimmune diseases.

The presence of TPO antibodies in your blood should prompt your physician to order other tests to evaluate your autoimmune status.

This is particularly important in the case of Celiac disease which is so often undiagnosed and underappreciated .

Below I’ve included an example of a patient of mine who had elevated anti-TPO antibodies on initial testing and further evaluation of her antibodies to gluten revealed she also had antibodies to the gluten protein.;

You can see above the high titers to tissue transglutaminase and gliadin antibody, both of which can be markers of the condition Celiac disease.;

It’s always very important to identify the gluten sensitivity in patients because the removal of gluten can be curative in this autoimmune disease .;

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What Does High Thyroid Peroxidase Mean

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Why Might Your Doctor Test Your Thyroglobulin Antibodies Levels

Maternal Thyroid Peroxidase Antibodies During Pregnancy ...

Your doctor may check your TgAB levels if they suspect you have an underlying autoimmune condition causing thyroid dysfunction. A doctor may want to see the results of a TGAb test if they see specific clinical findings on your lab work and physical exam, including:

  • A goiter
  • Inflammation of the thyroid
  • Abnormalities in other thyroid function tests like T4 and T3

While this may be a test occasionally used to detect autoimmune thyroiditis, it is more common to use this test to determine if treatment for thyroid cancer has been effective or not. Indeed, providers often use TgAB as a tumor marker because your body will only continue to produce TgAB’s if you still have thyroid tissue in your body. Thus, after thyroid cancer treatment, the goal is to have no TgAB’s in your lab work after your thyroid has been removed.

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