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Thyroid UK
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Borderline Tsh with high antibodies

I know what I think should happen in this situation, but what tends to happen according to nice?

An example: Tsh 3.5 TPOab 1200 or higher, goitre.

13 Replies

Haggisplant, I've not seen anything to suggest that NICE has a position when TPOab is elevated and goitre is present when thyroid levels are within normal range.



No, I couldn't find anything.

Tsh was around 5 a couple of weeks earlier (this isn't me). A second test found antibodies but Tsh had reduced. Obviously goitre trying to respond. Lots of symptoms.

Really it should be treated? There hasn't been a comment from GP on second test as yet and thyroxine was actually prescribed after first test.


Haggisplant, If thyroxine was prescribed after TSH was 5 that will be why TSH has reduced. Your friend/relative should ask for a dose increase because most people on Levothyroxine do well once TSH is 1 or lower.

Read Treatment Options in thyroiduk.org.uk/tuk/about_...


No, thyroxine wasn't taken. Sorry to miss that out.


Haggisplant, why wasn't the prescribed thyroxine taken?


I think a mix of shock and denial. But now there's the concern that second Tsh is 'in range' so will advice be not to take. I don't think there will be an issue though either GP or patient end. I just wondered what the guidelines actually were?!

Nice says if subclinical to test for antibodies, but obv ths was tested also- I guess it's unusual but in my opinion what hashimotos does at first. Up and down for a while ?


Yes, it does go up and down. And the way to stop it is to take the thyroid hormone replacement. A TSH of 3.5 is actually hypo, no matter what the unrealistic ranges might say. A person with absolutely no thyroid problems has a TSH of 0.85 - 1.25.


This is what I thought. Thank you!

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To update; Tsh came into range with high TPO antibodies and she was diagnosed with graves but clearly 'the tail end.' I'm not sure they're medicating at the moment as seems to be entering a thyroid storm. I didn't know that symptoms a while back had been over active. 


I don't understand this. "The tail end of Graves". I know that people can have Graves with TPO antibodies, but still... I can't see how a doctor has decided Graves is implicated with the info you have given. The more likely cause of problems is Hashimoto's Thyroiditis.


Having high levels of TPO antibodies can cause hypo/hyper swings as the levels of antibodies wax and wane. But that isn't the same as Graves.

Maybe someone who has Graves can explain?

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Totally agree, l don't understand that, either. Maybe the doctor concerned thinks that the terms 'Graves' and 'hyper' are inter-changable. But whilst all Graves people are hyper, not all hyper people have Graves. Sounds like this patient is just coming out of a Hashi's hyper swing, if the TPOab are high.


This is now my predicament TSH 3.47 T4 12.4 and antibodies of 129.4

Gp refusing to treat...but refferal to endo appoint not until end of april!!!

And im wondering if he wil actually help get rid of these unbearable symptoms??

So is the aim of the game to reduce the antibodies to 0?

Do the antibodies climb the longer you are untreated?

Is there a difference to how you would feel on say 100 antibodies and 1,000?

Im interested in learning how u actually get this auto immune throid disorder in the first place why???


Can I ask what symptoms the patient has? I am in exactly the same situation with borderline TSH and high antibodies


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