What does high anti TPO value mean?

Hi, I am 24 year old female. I was diagonised with primary hypothyroidism (TSH 9.4)(range (0.1<4.3) in march this year and prescribed 50 mcg thyroxine every day. Subsequent tests have shown that my T3, T4 and TSH levels are in normal range but there is no relief in symptoms. Infact i am also having severe migraines these days which was not a problem before. Fatigue, slight weight gain, anxiety , leg pains, concentration lapses are other issues. I was also prescribed anti-depressants which I stopped taking after a while.

Recently i got an anti TPO test and the result is 409 (range <34). What does this mean? The other tests T3, T4 and TSH (3.43) (range 0.1 <4.3) are in normal range. My doctor has insisted that medication is working fine but I have felt no relief. I am yet to show him the Anti TPO results. Please share your expereinces and advice.

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27 Replies

  • Hello nilu197,

    Welcome to our forum and sorry to hear you are not feeling well.

    A high TBOAb indicates Hashimotos Thyroiditis which is an auto immune disease prevalent in suffers of hypothyroidism. As the thyroid gland gets attacked, the stored hormone is eventually depleted and in need of thyroid hormone replacement medication.

    A TSH of 3.45 is high and might account for your existing symptoms. Most people medicated on Levothyroxine would function better with a TSH of 1.0 or below and T4 & T3 in the upper quadrant of range.

    You need to ask your doctor for a dose increase and post future test results complete with ranges (numbers in brackets) for members to comment.

    Also ask for your Vit B12, Vit D, Folate and Ferritin to be tested as optimum levels are required for meds to be absorbed and converted in the body, and post these results too.

    Hope you feel better soon


  • Thanks for your reply. I did consult with my doctor but his response on the medication was same as before. Can't expect much considering i live in small town in India. I am thinking of consulting with another doctor in a big city. Maybe that will help, Thanks again for your advice.

  • Sometimes we have to shout loud and be very persistent in order to be heard nilu197.

    Your doctor won't increase your thyroxine but is willing to dose you up on antidepressants (which you thankfully declined.), and weight loss tablets!

    Show him lots of literature on hypothyroidism symptoms (you could start with ThyroidUK web site) and ask for a 3 month trial dose increase explaining you feel being so undermedicated accounts for most of your health problems.

    Don't give up easily as this is a life long condition and won't improve without adequate thyroid hormone replacement medication.

    Failing that you might be able to just buy some Levothyroxine in India. When I travelled, although didn't purchase Levothyroxine as didn't need it then, I did find medicines that were prescription only in UK, were freely available to buy over the counter.

    Good luck


  • Medicine is easily available over the counter in India. Prescription is not important here. My aunt who had a similar problem one year back had doubled the dosage on her own because she just wasnt feeling well. In 3 months she was back to her normal weight and felt so much better. She changed her doctor and met a specialist who was very understanding of her symptoms. Her old doctor had prescribed 50 mcg but she was having 100 mcg. The new doctor reduced it 75 mcg first and later to 62.5 mcg. He also made a lot of changes to her diet and lifestyle. She is much better and happier now,

  • If I was you I would ask your aunt for support and guidence in this matter then.

    I myself was given the chance to experiment with my doses of Levothyroxine so have known the side effects of having too much or too little.

    There is a magic dose for each of us and it is important you find yours. Just remember the body will only accept small increments (usually 25mcg) about every six weeks and symptoms may lag behind good biochemistry by upto 6 - 8 weeks so the trick is to go slowly.

    If I have too much Levothyroxine my main side effects are a racing heart and feeling too hot and too much energy to sleep.

    Good luck


  • thank you. this information was really helpful. I will probably increase 25msg myself after consultation with my aunt and her doctor.

  • A high TPO means you have an Autoimmune Thyroid Disease called Hashimotos.

    50mcg of levothyroxine from March is too low and should have been increased till your TSH is around 1 or lower. The treatment for Hashi's is the same as for hypothyroidism although you will have swings and roundabouts with your hormones and I'll give you a link.

    Unfortunately we have to read and learn ourselves if we want to recover. Email louise.warvill@thyroiduk.org and ask for a copy of the Pulse online by Dr Toft. He was President of the British Thyroid Association and read question 6 on his recommendation of the TSH. Many doctors wrongly believe that it has to be kept 'somewhere within range'.

    Some hints:

    Blood Test: Have the earliest possible appointment . Leave 24 hours since last dose of levo and test as it may skew results and fast. Take levo after test.

    Take thyroid hormones on wakening and wait approx 1 hour before eating. Some foods interfere with medication. I leave 4 hours between hormones and supplements which I have at lunchtime. Some prefer bedtime dosing, in that case you must leave 2 hours after eating before taking hormones. If you've had a fatty meal it should be longer. Food can interfere with the uptake.

    Ask for Vitamin B12, Vit D, iron, ferritin and folate to be tested. They should be towards the upper range.



    Ask for an increase in your levothyroxine and discuss the Pulse Online with him. Most don't like us getting information from internet but tell him it is an NHS Choices forum.

    I hope you feel better soon. The best thing is to have sufficient hormones to make us feel well, not stopped short of them.

  • Thanks a lot for your reply. The information you provided was really helpful and I will be reading more on the same.

    My doctor still insists that i am doing fine and has refused to increase the dosage of thyroxine. Although he has prescribed weight loss tablets (after my long rant on gaining weight) and calcium tablets.

  • Get a print-out of your latest blood test results with the ranges and post on a new question.

    Unexplained weight gain or when taking levothyroxine may only mean that you are either undiagnosed or not on sufficient thyroid hormones. There has been research done in several parts of the world of weight gain whilst on levothyroxine. No need for weight loss tablets when sufficient hormones should do the trick. They are apt to prescribe other medications for our symptoms instead of a proper, adequate dose of thyroid hormones.

    The main question, of course, is how do you feel. Do you feel well overall and back to normal health?

  • Kindly leave your complete Lipid Profile.

    There is only one problem for lots of these issues.

    By understanding the lipid profile, I am sure we can solve the problem.

    I doubt your HDL-C may be too low.

  • Also try to give your complete Food habits (from bed to bed). There is definitely link between diet, Lipid Profile and symptoms.

  • With respect, rsridhar, I can't see any indication that Nilu has any lipid problems at the moment - a complete day's diet seems a bit over the top as a request when she's not even asking about high cholesterol.

  • I had a Lipid test done some 6 months back and the results were normal. I dont remember the figures right now but I can look it up if it is important.

    I usually have a wholesome breakfast, a light lunch of fruits (can't work with full stomach) and a full dinner. I know dinner shouldn't be heavy but it is the only proper meal i have in the day so i cant compromise on it. In between i have 2 green teas (Tulsi Green Tea of Organic India) and 2 normal teas to get through my long working day (usually 9 am to 7 pm)

  • Reports older by 6 months will throw some light on the conditions for getting problems. I am repeating again to leave your Lipid profile, because it maps entire body, when read properly. I would like to have numbers rather a subjective self-comment.

    Looking at the diet I feel these are points I would like to add. I do not want people to jump on my observation; but I am only sharing out of my experiences.

    1) Always try to have balanced food for meals. Growth in body happens only when all nutrients are present together.

    2) please do not prioritize your (personal and taste) preferences over your (body and growth) requirements.

    3) Take enough water; kindly consume water as medicine, because we tend to give least preferences to water. Do not get confused with water in tea / coffee and taking water as such.

    4) Kindly avoid green tea as it interferes with Thyroid metabolism. (I may expect Diwali here, on this particular point), but it is TRUE. In stead of green tea you may take normal BLACK Tea.

    5) Please elaborate briefly your Break-fast.

    6) Avoid Oats, because it cause flatulence and indigestion. Please remember that our rate of digestion should be faster than rate of fermentation in the digestive system. (here again I expect Diwali).

    7) Consume limited amount of fruits. No doubt, "An Apple A Day Keeps A Doctor Away" but do not extrapolate this to "10 Apples a Day Keeps 10 Doctors away". We need only about 20 grams of fiber a day, which is just got with 100 grams of vegetables.

    May be able to add more on seeing your profile. There is clear relationship between your diet and your profile. Diet decides your health.

  • Thank you for the reply.

    1. I will look up the lipid test tonight and update it by tomorrow.

    2. As far as my diet is concerned, i do try to have a balanced meal. About the green tea bit, i have read reports on the internet that it interferes with thyroid functioning and showed them to my doctor but he insisted that having green tea is much better than my usual milk tea with sugar and there is no problem if i continue with my green tea. As far as the water is concerned, there is no issue at all. I live in a hot part of the country and drink lots of water. Infact if there is some problem that can he had with having excess of water then i will probably have it. My daily consumption is over 7-8 litres easily.

    Breakfast is usually a whole wheat sandwich with cucumber and cheese and a cup of chai. Sometimes i have 2 boiled eggs or an omelette for variety. My dinner is usually the heaviest meal with 2 rotis, lentils, rice (after removing starch), curd, vegetable (sometimes even junk food when i eat out)

    I would really appreciate some guidance on the diet. My email id is nilu197@gmail.com. If you could share some tips that would be really helpful.

  • I love rotis, lentils,rice, curd and vegetables.

    Your diet sounds fine to me.

    Don't eat junk as this may encourage further antibody activity.

  • Kindly define what is junk?

  • this question is for me or flower007?

  • flower007 to answer! All most, all are talking about junk!!! without knowing what is it actually?. It should be rightly wrong food and not junk food. Wrong food is the one which our body may not be able to identify it. Otherwise technically, non-bio-available.

  • I would really like some advice on exercising as well. Before I was diagonised with thyroid I was into gyming for over 9 months. Infact I had a personal trainer as well and was really pushing myself with a strenous routine of cardio and weights. There wasnt much weight loss but inch loss was great. Infact i had got the lipid test done to check why i wasnt losing as much weight as i expected from 6 day- a-week of strenous activity. But since the diagonisis my body is not able to handle gymming at all. My body would crash after 2-3 sessions and it was really difficult to get through the rest of the week so after consulting with my doctor i stopped gyming altogether. Any suggestions for physical activity?

  • Wait until you are feeling better.

    Dieting or gymming with a high TSH never works as the body can not sustain strong physical exercise. Adequate thyroid medication is required for muscle activity and good nutrient absorption.

    I practice yoga and Pilates.


  • Thanks, I will start with brisk walking for now and maybe yoga later on.

  • Hi from your first post it is clear that high tpo in this case is a hashimoto thyroiditis. Hence wheat gluten should be avoided at all cost in any form. Also try and avoid a lot of grains and concentrate on pro biotic foods as hypothyroidism can also be due to leaky gut syndrome. Take care of your gut, liver, and eat yogurt, carrots, oranges, olives, ginger, apple cider vinegar and only coconut oil everyday. To maintain t3, t4 and tsh take your usual minimum dose of levothyroxine...... Also meditate before sleep and don't take stress in life. Chill.....

  • I would try to practice yoga until you regain full health. Lots of exercise will deplete your T3 - the Active thyroid hormone - and I am suspecting yours is already low. Walking too is beneficial - I remember having to walk lots when I went to India for Ayeurvedic treatment - spelling ? One hour in the morning and one hour in the evening :-) Really felt well at the time considering my thyroid issue had not been diagnosed :-)

    Hope you soon feel well....

  • Thanks for the reply. I am planning to begin with walking for now. And yoga later on if i am able to find a good instructor.

  • Check out Yoga Journal on-line - they have some very good videos which may encourage you :-)

    Good luck !

  • Maybe GP could read this:


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