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What Does Thyroid Peroxidase Antibodies Mean

Stage : The Breakdown Of The Immune Tolerance

Why test for thyroid antibodies?

In the second stage, you start seeing the breakdown of the thyroids immune tolerance, and the person will start to have a white blood cell infiltration into the thyroid gland. Some of these immune cells are going to start grouping there. This is when we will also start seeing elevated thyroid antibodies. This stage can go on for many years a decade or more before a person moves on to stage 3 or 4, when we start to actually see symptoms and changes in thyroid function.

What Does Your Thea Score Mean

Ideally, we want a THEA score of 0. That is only possible without any genetic predispositions. With a genetic predisposition, the lowest score will always be a 2.

Low risk is considered in the 0-7 range. This means they are at a low risk of developing Hashimotos, or that their Hashimotos is not super aggressive at this point. Nonetheless, they are at risk. For a person with a genetic predisposition, with no other points lets say they score a 2 they still have a 1.6 percent chance of being hypothyroid within 5 years. Keep in mind that if this same individual experiences more triggers, that will contribute to the disease progression.

The higher the score, the higher the aggressiveness rating, and the higher the chance of a person becoming hypothyroid within 5 years.

If we look at a score from 16-21, we know that the aggressiveness of the condition is very high and that they have about a 86 percent chance of becoming hypothyroid within 5 years. As we know that hypothyroidism is Stage 4 of Hashimotos, while other autoimmune conditions occur in Stage 5, higher thyroid antibodies may also predict a faster progression to other types of autoimmune conditions.

What I hope for with my clients is that they can reduce their risk and eliminate their symptoms. And the best way to reduce the THEA score early-on is to reduce thyroid antibodies.

When To Have A Thyroid Peroxidase Antibody Test

Antibodies that attack the thyroid gland cause swelling, rarely tenderness and reduced function of the thyroid. Your doctor may also order a TPO antibody test if you are pregnant and have an autoimmune disease that involves the thyroid, such as Hashimotos disease or Graves disease. Some people with TPO antibodies may not have thyroid disease.

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What Are Tpo Antibodies

Antibodies are proteins produced by the body to protect against infections. However, sometimes they mistakenly attack your tissues, causing illness.

Thyroid peroxidase is an enzyme found in the thyroid gland that plays a vital role in producing thyroid hormones. TPO converts iodide ions absorbed from food into an active form of iodine to be used by the body.

The body needs iodine to make thyroid hormones. Iodine connects with tyrosine for the production of the thyroid hormones: thyroxine and triiodothyronine . If dietary iodine is deficient, the thyroid cannot produce sufficient thyroid hormone.

This lack of thyroid hormone creates negative feedback with the pituitary gland, which produces and releases thyroid-stimulating hormone . An increase in TSH signals additional production of TPO.

If antibody levels in the blood are elevated, it suggests that your immune system is attacking normal, healthy tissue.

Typically, the immune system safeguards against germs like bacteria and viruses. It can generally distinguish between foreign cells and your cells.

However, autoimmunity is a condition in which your immune system mistakenly attacks your body. It mistakes your cells as foreign and releases antibodies that attack healthy cells.

Some autoimmune conditions target only one part of the body, like Hashimoto’s thyroiditis , which targets the thyroid gland.

Can I have thyroid antibodies without hypothyroidism?

What Does The Test Result Mean

Health Tips when you

Negative test results means that thyroid autoantibodies are not present in the blood at the time of testing and may indicate that symptoms are due to a cause other than autoimmune. However, a certain percentage of people who have autoimmune thyroid disease do not have autoantibodies. If it is suspected that the autoantibodies may develop over time, as may happen with some autoimmune disorders, then repeat testing may be done at a later date.

Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases.

Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.

In general, the presence of thyroid antibodies suggests the presence of an autoimmune thyroid disorder and the higher the level, the more likely that is. Levels of autoantibody that rise over time may be more significant than stable levels as they may indicate an increase in autoimmune disease activity. All of these antibodies, if present in a pregnant woman, can increase the risk of hypothyroidism or hyperthyroidism in the developing baby or newborn.

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When Is It Ordered

Testing may be ordered when an individual has abnormal TSH and/or free T4 test results or signs and symptoms of a low or high level of thyroid hormones or the presence of a goiter, especially if the cause is suspected to be an autoimmune disease.

A low level of thyroid hormones can cause symptoms, such as:

  • Weight gain
Graves diseaseWhen a person has symptoms of hyperthyroidism

If a pregnant woman has a known autoimmune thyroid disease or has another autoimmune disorder and thyroid involvement is suspected, then one or more of the thyroid antibodies may be ordered early in the pregnancy and then again near the end. These tests are used to help determine whether the baby may be at risk of thyroid dysfunction. Thyroid antibodies can cross the placenta and cause hypothyroidism or hyperthyroidism in the developing baby or newborn.

Thyroid antibody testing may also be ordered when a person with another autoimmune disorder has symptoms of thyroid dysfunction and/or when she has reproductive difficulties that a healthcare provider suspects may be associated with autoantibodies.

Tpo Blood Test Results Meaning

The TPO blood test is designed to help a medical provider determine whether or not there may be an autoimmune thyroid disease present. This test helps to distinguish the autoimmune disorder from other forms of dysfunction that may occur. When an individuals immune system targets the thyroid gland in some way mistakenly, antibodies that are specific to those components appear in the blood. This test will determine if they are present.

There are several blood tests that can be ordered to determine if there are thyroid-related autoimmune antibodies that are present in the blood. The TPO blood test is the most common of these tests as it can help to detect the presence of Hashimoto thyroiditis or Graves disease.

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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., Hashimoto’s 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.

Stage : The Genetic Predisposition

Hidden Cause #7 Why You STILL Have Low Thyroid Symptoms – TPO Antibodies

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.

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Do Antibody Numbers Matter

Some clinicians will say that once you have thyroid antibodies, you will always have thyroid antibodies, so the actual number doesnt matter, as the antibodies can randomly fluctuate. I respectfully disagree. Antibodies fluctuate in response to triggers , and in my exhaustive experience, they can be an incredibly helpful marker for tracking disease progression. That said, they should not be the only marker. We also want to look at your overall health and the big picture are you feeling better or worse?

When Will The Tpo Blood Test Be Ordered

The most common reason why the TPO blood test is ordered by a medical provider is because there is the presence of a goiter. This simply means that the thyroid has become enlarged in some way. There may also be the signs and symptoms of having too much or too little thyroid hormone present within the blood. This could be due to an inflammation or infection that has occurred near the thyroid or if an impact injury has damaged the tissues of the thyroid in some way.

If someone has too little thyroid hormone, then they may experience fatigue, hair loss, constipation, and weight gain. There may also be abnormal amounts of dry skin noticed and difficulty in dealing with cold temperatures. These symptoms may be chronic or acute and vary in severity.

If someone has too much thyroid hormone, then a rapid heartbeat and sweating are the most common symptoms noticed. There also tends to be an increased level of anxiety, muscle tremors, and problems sleeping. Some individuals may notice fatigue despite getting enough sleep every night and experience weight loss without dieting. Eyes that protrude is a common tell of having too much hormone present in the blood.

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Why Arent Thyroid Antibodies The Initial Screening Test Used For Thyroid Disease

You might wonder why TSH is still the standard screening test for thyroid disease given that thyroid antibodies can be elevated for decades before any change in TSH may even be seen.

Thats a good observation and an even better question. Unfortunately, many traditional doctors ONLY test for antibodies after they see an elevation in TSH. Its backwards from what it needs to be. That is why you need to be your own advocate and insist on thyroid antibodies testing. You can discuss this testing with your physician or you can also self-test, as the tests are not overly expensive. Ill talk more about that below.

At some point, the medical community will pick up on the importance of antibodies as an early warning for Hashimotos. I also believe labs will start to incorporate newer findings. For example, the reference range for TSH itself has already been redefined by the American College of Clinical Endocrinologists. The reference range was lowered , but most labs you get still use the old higher ranges as normal. That will hopefully change in the future.

On top of the reference ranges changing, we also know that a person with Hashimotos may fluctuate between high and low TSH readings. Reference ranges are also only average values, so even if your TSH reads as normal, you may not be. Remember, I was told my thyroid was normal when my TSH was 5.5 IU/mL, and I was sleeping for 12 hours each night! TSH is not the screening tool we should be solely using.

What Number Is Considered Remission

Hyperthyroidism During pregnancy

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.

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Everything To Know About Thyroid Peroxidase Antibodies

  • note:
  • This article was written by a Medical Doctor and reviewed by the thyroid health experts at ThyroMate.

    ThyroMate articles uses only proven, accurate, credible sources in order to provide accurate, fact-checked information about thyroid health that is helpful and objective. All references are linked throughout the article and sources for each are cited at the end. Visit these links to learn more about the research studies and conclusions drawn from the research methods.

    Information contained on this website is not a substitute for medical advice, diagnosis, or treatment. You should always consult your physician for questions related to your health.

You have probably heard or come across the term thyroid peroxidase antibodies, but may not be quite sure what it means.

Indeed, TPO antibodies are frequently mentioned in terms of thyroid health and diseases that affect it. Proper management of thyroid diseases and keeping the gland healthy require a thorough understanding of thyroid hormones, enzymes, tests, and other aspects that provide insight into the way the butterfly-shaped gland functions.

Thats why in this article we are going to talk about TPO antibodies.

Before we discuss TPO antibodies, it’s useful to give a brief introduction to thyroid peroxidase.

Thyroid peroxidase is defined as a key enzyme in the biosynthesis of thyroid hormones. The enzyme catalyzes iodide oxidation, thyroglobulin iodination, and coupling of iodothyronine.

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 dont have any clinical manifestations. What are the clinical manifestations of very high Anti TPO levels? What are the clinical implications of Hashimotos 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.

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Immunologic Processes In Aitd

Pathogenesis of Hashimotos disease and GD . Autoreactive CD4+ T cells in HT induce antibody production by B cells. The antibodies bind to the basal membrane of the thyroid follicle, activate complement, and induce necrosis of thyrocytes. The activation of cytotoxic CD8+ T cells leads to the induction of apoptosis by action of perforin. Finally, the expression of Fas and FasL by thyrocytes perpetuates HT. Autoreactive CD4+ T cells in GD induce only anti-thyroid-stimulating hormone receptor antibody-producing B cells. These antibodies act stimulatory by increasing I2 metabolism and promoting proliferation and survival of thyrocytes. Blocking antibodies are characterized by lack of effect , and neutral antibodies activate various pathways, such as PI3K/Akt, mTOR/p70S6K, and MAPK/ERK1/2 and induce thyrocyte apoptosis. Abbreviations: GD, Graves disease HT, Hashimotos thyroiditis ERK, extracellular signal-regulated kinase MAPK, mitogen-activated protein kinase p70S6K, ribosomal protein S6 kinase beta-1 PKC, protein kinase C PI3K, phosphatidylinositol 3,4,5, triphosphate kinase PKA, protein kinase mTOR, mammalian target of rapamycin.

A Note On Antibodies In Pregnancy

Thyroid Autoimmunity What Are Healthy Levels for Thyroid Antibodies

Thyroid disease is associated with poor outcomes in pregnancy, the risk of which is increased in the presence of antibodies. If you are pregnant or planning a pregnancy and are concerned about thyroid disease it is important to discuss this with your GP.

Note that the blood test ranges used in pregnancy are different and are trimester-specific.

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How Are Thyroid Peroxidase Antibodies Related To Graves Disease

However, thyroid peroxidase antibodies prevent it from doing so. The presence of TPO antibodies indicates that the cause of thyroid disease is an autoimmune disorder such as Hashimotos thyroiditis and Graves disease. Antibodies that attack thyroid gland induce inflammation and impair the function of this important gland.


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