Thyroid Peroxidase Antibodies Test And Who Needs It
Thyroid peroxidase antibodies test measures the level of an antibody that is directed against TPO.
These antibodies are produced in the body by the immune system, as mentioned above.
The TPO antibodies test serves multiple purposes, such as:
- Helping doctors diagnose autoimmune thyroid disorders
- Aiding in differentiating autoimmune thyroid disorders from non-autoimmune hypothyroidism or goiter
- Serves as a diagnostic tool in deciding whether to treat a patient who has been diagnosed with subclinical hypothyroidism
Doctors may also order a TPO antibodies test if you are pregnant and have an autoimmune disease, particularly the condition that involves thyroid.
Thyroid peroxidase antibodies have been associated with reproductive difficulties such as miscarriage, preeclampsia, premature delivery, and in-vitro fertilization failure. In these instances, the doctor may also order TPOAbs test, but bear in mind its not a standard test for problems with fertility and pregnancy.
If a pregnant woman has an autoimmune thyroid condition or some other autoimmune disease with thyroid involvement, the doctor may order TPO antibodies test in order to determine whether the baby could be at risk of thyroid dysfunction.
Additionally, you might need a TPO antibodies test if other thyroid hormone levels are too low or too high. Your doctor will need results from TPO antibodies test to determine whether an autoimmune condition impaired the production and concentration of thyroid hormones.
Patients Who Have Symptoms But Normal Tsh
Falk: Lets come back to this TSH test. Lets say the patient is floridly symptomatic, comes right out of the textbook of hyper- or hypothyroidism, and the TSH is spot-on normal. Then what?
Kirk: In those cases, particularly if you are convinced that the patient has symptoms and signs consistent with underactive or overactive thyroid, well probably not stop at the TSH. You would go ahead and collect the actual thyroid hormones themselves which may be T4 or T3. Weve been talking about autoimmune thyroid disease affecting the thyroid gland itselfand that is absolutely true, that is what autoimmune thyroid disease affectsbut the thyroid can also be affected by non-autoimmune disease. So if that pituitary gland, the master gland, has stopped functioning for some reasonnow remember this is more rarebut if that happens, then the signals wont be sent to the thyroid. The TSH may actually look finea little low, a little high, normalbut you cant trust the TSH in that situation.
So if we think the thyroid is dysfunctional for some other reason besides autoimmunity or a direct attack, we may go on and measure the T3 and T4. Now the difficulty liesif the patient is having symptoms, and everything is normal, the TSH is fine, T4 and T3 are finesome practitioners are drawing another test called antibody testsTPO antibodies.
Falk: Anti-thyroid peroxidase antibodies.
What Do The Results Of Tpo Antibodies Test Mean
The TPO antibodies test results may show one of the following options:
- Negative as you can already conclude negative TPO antibodies test result indicates that no thyroid antibodies were found. This result also implies that thyroid problems and symptoms a patient experiences are not caused by an autoimmune condition
- Positive antibodies to TPO and/or Tg this result indicate a patient may have Hashimotos thyroiditis
- Positive antibodies to TPO and/or TSH may indicate the presence of Graves disease
The higher the level of antibodies, the more likely it is that a patient has an autoimmune disease of the thyroid e.g., Hashimotos or Graves disease. Blood test results for TPO antibodies are positive in 95% of patients with Hashimotos thyroiditis and in 50% to 80% of people with Graves disease.
When it comes to TPOAbs, the reference value is < 9.0 IU/ml . Values above 9.0 are typically associated with autoimmune thyroid disease, but elevations are also observed in some other autoimmune conditions. The most commonly mentioned TPOAb reference range is less than 35 IU/ml.
The presence of TPOAbs in patients with subclinical hypothyroidism predicts an elevated risk of overt hypothyroidism. Moreover, this also shows that those patients could be at a higher risk of developing other autoimmune conditions like type 1 diabetes.
As mentioned above in the article, some people may be positive to TPO antibodies, but they do not have a thyroid condition.
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Thyroid Function Blood Test
A GP may arrange for you to have a blood test to check your thyroid hormone levels. This is known as a thyroid function test.
The test checks the levels of:
- thyroid-stimulating hormone a hormone produced by the pituitary gland which controls the production of thyroid hormones
- triiodothyronine one of the main thyroid hormones
- thyroxine another of the main thyroid hormones
Your thyroid hormone levels will be compared to what’s normal for a healthy person of your age. A low level of TSH and high levels of T3 and/or T4 usually means you have an overactive thyroid.
Doctors may refer to these measurements as “free” T3 and T4 .
What’s considered normal varies depending on things such as your age and the exact testing technique used by the laboratory.
Is There Anything Else I Should Know
The sensitivity and specificity of thyroid antibody testing is improving but is still not as good as health practitioners would like it to be. All of the thyroid antibody tests have changed over time. This is part of the reason that the tests have historically acquired many different names. There are also many distinct methodologies and each has different reference ranges. If someone is having several tests done at regular intervals for monitoring purposes, it is best to have test done by the same laboratory each time, using the same methodology.
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How Is Hashimoto’s Disease Treated
Hashimotos disease is treated with a daily dose of . This is the same hormone that your thyroid gland makes. You will probably need to take thyroid hormone pills for the rest of your life. Talk to your doctor or nurse about any questions or concerns.
You may have to see your doctor or nurse a few times to test the level of thyroid stimulating hormone in your body. Thyroid hormone acts very slowly in the body, so it can take several months after the start of treatment for symptoms to go away. Once your TSH level is normal, your doctor or nurse will need to see you less often.
The same treatment dose usually works for many years. But your TSH levels may change sometimes, especially during pregnancy, if you have , or if you take . Your doctor or nurse may need to adjust your dose.
T3 And T4 Interpretations
- A normal TSH and normal T4 indicates a normally functioning thyroid gland.
- A low TSH and high T4 generally indicates hyperthyroidism.
- A high TSH and low T4 indicates primary hypothyroidism .
- A low TSH and low T4 suggest secondary hypothyroidism .
For diagnostic purposes, a low T3 value accompanied by a high TSH value is considered evidence of hypothyroidism. By contrast, a low TSH value accompanied by a high T3 value is considered evidence of hyperthyroidism.
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Causes Of Hashimotos Thyroiditis
Doctors aren’t entirely sure why the immune system, which is supposed to defend the body from harmful viruses and bacteria, sometimes turns against the body’s healthy tissues.
Some scientists think a virus or bacterium might trigger the response, while others believe it may involve a genetic flaw. A combination of factorsâincluding heredity, sex, and ageâmay determine your likelihood of developing the disorder.
Researchers estimate that 70%â80% of autoimmune thyroid disease susceptibility is from a family history of autoimmune disease.
Pregnancy puts metabolic stress on a woman. The thyroid undergoes noticeable modifications to cope. These changes are typically reversible after birth, though pregnancy can sometimes be a trigger for postpartum thyroiditis. Postpartum thyroiditis is a condition in which the thyroid becomes inflamed within the first year after birth. In most cases, postpartum thyroiditis is limiting to weeks or months after delivery but occasionally develops into Hashimoto’s disease.
Other hormonal events
Hashimoto’s is seven times more likely to occur in women than men. Hormonal events like puberty, pregnancy, or menopause may contribute to the development of Hashimoto’s.
It is not uncommon for someone with one autoimmune condition to have another like celiac disease, type one diabetes, rheumatoid arthritis, or lupus. This condition of have two or more autoimmune disorders is polyautoimmunity.
When Tsh Alone Is Not Enough
During diagnosis, most doctors use the TSH test to evaluate thyroid function and determine the optimal course of treatment. There are times, however, when knowing one’s TSH may be insufficient.
For instance, free T4 in addition to TSH is usually tested if a doctor suspects thyroid dysfunction due to disease of the pituitary gland or hypothalamus.
Likewise, if the TSH is normal, but a person still has symptoms of being hyperthyroid or hypothyroid, free T4 may be checked.
TSH is also not necessarily sufficient to monitor hypothyroidism during pregnancy T4 and free T4 are often recommended.
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Autoimmune Thyroid Disease With Deepa Kirk Md
This is Episode Ten of Autoimmune Disease: Pieces of the Picture. Dr. Deepa Kirk discusses autoimmune thyroid disease, how it is diagnosed, different types of hormone treatments, and questions patients often ask about lifestyle and diet. Dr. Kirk is an Associate Professor of Medicine in the Division of Endocrinology and Metabolism and is also the Medical Director of the UNC Hospitals Diabetes and Endocrinology Clinic.
The most common question I get is, Whats going to happen to me and how long will it take to get better? A related question is, Why did this happen to me? I think thats not an uncommon question for any autoimmune disease. We dont have great answers.
Deepa Kirk, MD
Ron Falk, MD: Hello, and welcome to the Chairs Corner from the Department of Medicine at the University of North Carolina. This is our series that explores topics related to autoimmune disease, to help patients and their loved ones understand and manage their condition. Todays episode will focus on autoimmune thyroid disease.We welcome Dr. Deepa Kirk who is an Associate Professor of Medicine in our Division of Endocrinology and Metabolism and is also the Medical Director of the UNC Hospitals Diabetes and Endocrinology Clinic. Dr. Kirk regularly sees patients at UNC who have thyroid disease, including autoimmune thyroid disease. Welcome, Deepa.
Deepa Kirk, MD: Thank you so much.
What Is Hashimoto Thyroiditis
Hashimoto thyroiditis also known as chronic lymphocytic thyroiditis, is a condition in which your immune system attacks your thyroid gland. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your bodyâs functions. Hashimoto thyroiditis is the most common form of thyroid gland inflammation and the most frequent cause of decreased thyroid hormone production and underactive thyroid gland .
Hashimoto thyroiditis is the most common cause of hypothyroidism in the United States. Hashimoto thyroiditis can affect anyone at any age but occurs most commonly in women who are between 30 and 50 years of age. Hashimoto thyroiditis can also occur in men and women of any age and in children. About 1 in 1,000 people are diagnosed annually with Hashimoto thyroiditis, and the number has been increasing over time due to improvements in diagnostic techniques. The ratio of women to men diagnosed with the disease is 20 to 1. People with a family history of thyroid diseases or with other autoimmune diseases, especially type 1 diabetes or adrenal insufficiency are at increased risk.
The thyroid gland is a butterfly-shaped organ that lies flat against the windpipe in the throat. It produces the hormones thyroxine and triiodothyronine and plays an important role in controlling the bodyâs metabolism.
Hashimoto thyroiditis symptoms
Signs and symptoms of hypothyroidism include:
- Fatigue and sluggishness
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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
But First Lets Discuss What Caused My Thyroid Antibodies To Go Up So High In The First Place
Between 2010 and 2013, I never had my antibodies tested. Within that time-frame, I was a pretty lost duck. There was just no consistency in my treatment plan.
I was uneducated. My doctors were uneducated. And there were two things that hurled me into the realm of intense inflammation poor diet and poor exercise choices.
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What Imaging Tests Do Doctors Use To Diagnose And Find The Cause Of Thyroid Disease
Your health care professional may order one or more imaging tests to diagnose and find the cause of thyroid disease. A trained technician usually does these tests in your doctors office, outpatient center, or hospital. A radiologist, a doctor who specializes in medical imaging, reviews the images and sends a report for your health care professional to discuss with you.
Hashimotos Thyroiditis: How Is Diagnosis Made
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What Number Is Considered Remission
Remission to me is a journey, not necessarily a destination. While researchers have labeled thyroid antibodies under 100 IU/mL as remission status, and thyroid antibodies above 500 IU/mL as aggressive, I would again caution to look at the big picture.
Remission is not the same as a cure, rather, remission is a respite from the disease, a reduction in the expression of the condition as well as a reduction in symptoms.
The definition for remission will thus vary with each person. Where were you when you got started on your journey?
If you started with thyroid antibodies in the 5000 IU/ml range and 10+ symptoms, improving your health to a point where your antibodies are 1000 IU/ml, and you only have 5 symptoms, may be your remission.
If, however, you started with antibodies in the 200 IU/ml range, and only had 3 symptoms to begin with, thyroid antibodies of 1000 IU/ml and 5 symptoms may be an exacerbation or worsening of the condition for you.
Thus, the goal of remission is for you to work on improving your health, and every small change that I recommend will hopefully result in an improvement for you. And yes, in some cases, a complete remission is possible, where you no longer test positive for any thyroid antibodies, dont have a single symptom, and there is no evidence of damage to your thyroid gland.
There Is Low Risk Of Progressing To Hypothyroidism If Tpo Antibodies Are At Or Below 500 Iu/ml 1
- 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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Why Are My Thyroid Antibodies Still High
For those people with Graves Disease and Hashimotos Thyroiditis who follow a natural treatment protocol, one of the primary goals should be to suppress the autoimmune response. As you probably know, most endocrinologists dont pay attention to the autoimmune component, as they just focus on getting the TSH and thyroid hormone levels within the normal lab reference range. But remember that Graves Disease and Hashimotos Thyroiditis are not thyroid conditions, but instead they are autoimmune conditions which affect the thyroid gland. Although not everyone with an autoimmune thyroid condition will test positive for thyroid antibodies, many people do have elevated levels. And its not uncommon for these antibodies to remain high even after following a natural treatment protocol for a prolonged period of time. Why is this the case?
Before I answer this question, lets briefly discuss the different types of thyroid autoantibodies. Hashimotos Thyroiditis is characterized by thyroid peroxidase antibodies and/or thyroglobulin antibodies. Graves Disease is characterized by TSH receptor antibodies, also known as TSI antibodies. There are a few other types of thyroid antibodies, but these are the most common ones associated with these conditions. Its also possible for people to have both types of antibodies, as Ill frequently see people have both TSI antibodies and TPO antibodies, and every now and then Ill see someone with all three of these antibodies.