TPO antibodies

[JanD236]

I had Graves 13 years ago so have annual TSH/FT4 blood tests.

Over the last few years my TSH has been creeping up and my FT4 has been sitting low in the range.

In view of my history of Graves, the fact I have other autoimmune issues (pernicious anaemia and vitiligo) and because TSH was 4.3 six months ago I asked my GP to test my thyroid antibodies.

I’ve just had my results (which show that TSH is better than recent years) and these are

Thyroid peroxidase: TPO result is positive

263.8 (range 0-5.6)

TSH 3.05 (0.35-5.00)

Free T4 11.2 (9-22)

I do feel more tired than friends of a similar age but usually assume it’s a B12 issue (which I’m happy is being adequately treated). Otherwise apart from hair loss over the last 6-9 months I feel generally well and my weight is fine. (The test 6 months ago did show that Free T3 was near the top of the range despite T4 being near the bottom).

My GP has suggested that subject to the latest test results that it may be an idea to start me on 50mcg thyroxine and I’m seeing him soon to follow this up.

Do you think that starting on thyroxine is a good idea even though my TSH & T4 are in range?

Are there any questions I should ask my GP?

Incidentally I did have a test for coeliac a while back and this came back negative.

Thank you

[SlowDragon Administrator]

Testing for Coeliac is largely irrelevant with autoimmune thyroid. Most of us still find gluten free diet helps

Yes if you have no thyroid function, did you have RAI or thyroidectomy? Either way TSH is too high (should be around one) and FT4 too low, should be nearer top of range

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

Also ask GP to test vitamin D, folate, ferritin and B12

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

Low stomach acid can be an issue

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

[JanD236 in reply to SlowDragon]

Thank you SlowDragon. I didn’t have either RAI or thyroidectomy but was on carbimazole for 2 years and this seemed to sort out the overactive thyroid so I didn’t need further treatment. I’m not on thyroxine.

My latest blood test was at 8.30am and I hadn’t eaten or drunk anything beforehand.

My vitamin D levels were fine when last tested a year or so ago and the test last week showed folate and ferritin both in the top third of the ranges. (I refuse B12 tests as I have B12 injections so the result would be meaningless).

So.....should I take thyroxine if offered by the gp on the basis of raised antibodies, some tiredness and hair loss but no other symptoms?

Thanks

[SlowDragon Administrator in reply to JanD236]

Well I would. Your FT4 is almost rock bottom. Plus gluten free diet.

You could try gluten free diet first for 2-3 months first, if reluctant to start on Levothyroxine

[JanD236 in reply to SlowDragon]

Ok thank you. I’ll have a good look at all your links and think about the gluten free option too. I’m not against taking Levo either.

[JanD236]

Ps I take betaine HCL & pepsin already due to digestive issues related to PA as I definitely have low stomach acid.

[greygoose]

Did you actually have your antibodies tested for Grave's? Or did your doctor just assume that you had Grave's because your TSH was low and/or your Frees high? It could very well be that you've never had Grave's, but were on a Hashi's 'hyper' swing, which then went back to euthyroid, and now you're slowly going hypo.

If you're having symptoms, I would definitely start the levo, if I were you. Hashi's doesn't go away by itself, you just get more and more hypo.

[JanD236 in reply to greygoose]

Thanks greygoose. Yes I was tested for antibodies when I had the Graves diagnosis.

That’s a good point, it’s not going to go away by itself!

[greygoose in reply to JanD236]

So, you have Grave's and Hashi's? I think you need to ask your endo how he plans to handle that.

[JanD236 in reply to greygoose]

I thought the Graves was behind me as it was 13 years ago. But your comment has made me think maybe I should ask for an endo referral again. I had an endo managing my treatment of the Graves but since then blood tests (and PA) have been taken only at my GP practice.

[greygoose in reply to JanD236]

Grave's never goes away. Even after TT/RAI, the antibodies are still there - unlike Hashi's.

[JanD236]

How annoying!