Patients with Hashimoto’s thyroiditis and negative thyroid antibodies have a milder form of the disease

[helvella]

The American Thyroid Association isn't always in the front row of "friends" of thyroid sufferers, but sometimes it does publish things of interest. Among these is the summary below which suggests that you can indeed have Hashimoto's without elevated TPO antibodies.

Please note the emphasis by underlining - which I have added.

[B]HYPOTHYROIDISM[/B][I]

Patients with Hashimoto’s thyroiditis and negative thyroid antibodies have a milder form of the disease

[B]BACKGROUND[/B]

Hashimoto’s thyroiditis, also known as chronic autoimmune hypothyroidism, is the most common cause of hypothyroidism in the United States. It is caused by antibodies that attack the thyroid and destroy it. Most patients with Hashimoto’s thyroiditis have measurable antibodies in the blood, with ~90% of patients having positive TPO antibodies and ~50% of patients having positive thyroglobulin antibodies. About 5 % of patients with a diagnosis of Hashimoto’s thyroiditis based on clinical grounds or by ultrasound appearance have no measurable thyroid antibodies. This study was performed to note any differences between patients with Hashimoto’s thyroiditis with positive antibodies and those with Hashimoto’s thyroiditis but without any antibodies present.

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[B]WHAT ARE THE IMPLICATIONS OF THIS STUDY?[/B]

Patients with Hashimoto’s thyroiditis and positive thyroid antibodies were more likely present with overt hypothyroidism and a larger thyroid. Patients with antibody-negative Hashimoto’s thyroiditis had a milder form of hypothyroidism at the time of diagnosis. This could represent an earlier stage of the disease or simply a less aggressive form of Hashimoto’s thyroiditis. This study suggests that treating patients with subclinical hypothyroidism and positive thyroid antibodies is important to prevent the development of overt hypothyroidism.[/I]

thyroid.org/patient-thyroid...

Follow link to read more.

Rod

Image is Immunohistochemistry-Paraffin: Thyroid Peroxidase Antibody [NBP1-80670] - Immunohistochemical staining of human thyroid gland shows strong cytoplasmic positivity in glandular cells.

[Clutter]

Rod, Dr. Toft suggested treatment when antibodies were present to Pulse Magazine 4 years ago. You have to wonder how many times it has to be said before GPs and endocrinologists will act on it.

thyroiduk.org.uk/tuk/about_...

Next, they need to recognise and act upon the fact that clinical symptoms are presenting far earlier than blood tests demonstrate.

[gabkad in reply to Clutter]

Clutter, first they have to read the stuff. Good luck with that.

[PR4NOW in reply to Clutter]

Clutter, this is one of the primary weaknesses of the TFTs, they can lag clinical presentation of symptoms by years. For many people you have to reach an extreme state before it shows up in serum tests. Couple this with doctors not being trained in how to do a clinical differential diagnosis for thyroid matters and we have the mess we are in now. PR

[Angel_of_the_North]

How would you know you had Hashis is you have no antibodies?

[PR4NOW in reply to Angel_of_the_North]

At this point an ultra-sound is considered the most accurate test available. The antibody tests can get it wrong. Helvella just posted about an article that relates to the topic of low antibodies. PR

healthunlocked.com/thyroidu...

Although the link looks screwed up it seems to work.

[helvella in reply to Angel_of_the_North]

Thyroid tissue has a distinctive appearance when imaged by ultrasound. (At least, that is what the medical literature says.) Which is why the first paragraph includes:

About 5 % of patients with a diagnosis of Hashimoto’s thyroiditis based on clinical grounds or by ultrasound appearance have no measurable thyroid antibodies.

Rod

[Angel_of_the_North in reply to helvella]

I wondered how hashis differed from a n other hypo wihotu anti-bodies. Didn't know the tissue actually looked different

How likely are we to get an ultrasound with TSH less than 10 and no antibodies? Sorry, rhetorical question. And how likely is the NHS to notice tissue changes or do anything about them?

[helvella in reply to Angel_of_the_North]

I did. I asked. And was given.

My reason was not to find out about Hashimoto's but why I was feeling nauseous - and felt there might be some sort of lump.