Thyroid UK
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TPO antibodies positive

I have new results back and I have been told my TPO antibody results are positive and I need to be started on Levothyroxine immediately. Please see below new results.

Serum TSH - 33.8 (0.2 - 4.2)

Serum FT4 - 10.4 (12 - 22)

Serum FT3 - 3.2 (3.1 - 6.8)

TPO antibodies - 904.5 (<34)

Ferritin - 11 (30 - 400)

MCV - 76.2 (80 - 98)

MCHC - 387 (310 - 350)

Serum folate - 1.2 (2.5 - 19.5)

Vitamin B12 - 193 (190 - 900)

Serum calcium - 2.10 (2.20 - 2.60)

Serum calcium adjusted - 2.11 (2.20 - 2.60)

Any advice appreciated, thanks for reading

15 Replies
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It's good that your GP is starting you on levothyroxine. You should be started on 50mcg unless you have a heart condition, are very young, weak or frail. Then you need a blood test every 6 weeks and a dose increase and so on until your TSH is around 1 or a little lower which is where most people feel well.

Make sure you take levothyroxine on an empty stomach, for example, first thing in the morning with a whole glass of water and leave an hour before eating or drinking anything else (except for water). Leave 4 hours between levothyroxine and any other medicines or supplements.

Milk interferes with levothyrxoine absorption so ensure you don't have a cup of tea with milk in it until the hour's up.

If you haven't had your vitamin levels tested then ask GP to test B12, folate, ferritin and vitamin D as all are likely to be low due to thyroid antibodies and hypothyroidism. Sometimes beginning to take levothyrxoine can unmask nutritional deficiencies and you will feel unwell so best to get them checked.

It takes 6 weeks for thyroid hormone to circulate to all the cells so it will take a while until you begin to feel a little better and it can take 6 months to a year to find a dose that suits you. Stay on this forum and keep asking advice. There are lots of experienced people here who can help.

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Ferritin - 11 (30 - 400)

MCV - 76.2 (80 - 98)

MCHC - 387 (310 - 350)

Serum folate - 1.2 (2.5 - 19.5)

Vitamin B12 - 193 (190 - 900)

Serum calcium - 2.10 (2.20 - 2.60)

Serum calcium adjusted - 2.11 (2.20 - 2.60)

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Did your GP do these tests and what has your GP prescribed for these?

What about vitamin D? No result?

1 like
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Vitamin D 10.4 (<25 severe deficiency)

Nothing given

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MishaT,

Vitamin D is severely deficient. Your GP should refer to local guidelines or the cks.nice.org.uk/vitamin-d-d... Do NOT accept a prescription for 800iu which is a mainte-nance dose prescribed after vitD is replete >75. My GP prescribed 40,000iu daily x 14 followed by 2,000iu daily x 8 weeks which raised vitD from <10 to 107. Vitamin D should be taken 4 hours away from Levothyroxine.

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Yikes I have only ever been on 800 and was very low

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Sharcott,

Then you should retest and write a post with the results and members will advise how much to supplement.

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I will look to see if I have been and what the results are, thanks

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MishaT,

You are overtly hypothyroid. How much Levothyroxine has been prescribed? And what treatment have you been given for vitamin and mineral deficiencies?

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

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

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. Symptoms may lag behind good biochemistry by several months.

You should have a follow up thyroid test 6-8 weeks after starting Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

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

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I have been given 50mcg levothyroxine and nothing prescribed for low vitamins and minerals thanks

Reply

You need supplements for all of these and B12 needs further investigation. Although in range it's very low. Your GP needs to rule out instrinsic factor antibodies for pernicious anaemia before supplementing folic acid for low folate.

If nothing has been prescribed you need to make an urgent appointment with your GP or preferably a different one in the practice and ask to be treated according to guidelines. Your vitamin D is critically low and you must be feeling awful.

Once you get these sorted I would consider making a complaint to the practice manager because your vitamin deficiencies have been ignored as has your hypothyroid autoimmune condition.

Check out SeasideSusie advice on vitamins and what your GP should be providing. See this post here for typical advice:

healthunlocked.com/thyroidu...

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MishaT,

You need to get your GP or another GP to treat your vitamin and mineral deficiencies. Ask for vitamin D to be tested. Everything else is deficient so it's likely vitD will be too.

Severely deficient ferritin and low MCV indicate iron deficiency anaemia. Treatment is usually 3 x 210mg Ferrous Fumarate. Take each tablet with 1,000mg vitamin C to aid absorption and minimise constipation. Iron should be taken 4 hours away from Levothyroxine.

B12 and folate are deficient. GP should initiate B12 injections 48 hours prior to you being prescribed 5mg folic acid daily. Investigation should be done as to whether you have pernicious anaemia causing deficiencies. Symptoms are listed in b12deficiency.info/signs-an... healthunlocked.com/pasoc are the experts on PA, B12 and folate deficiencies if you need more advice.

Adjusted calcium is deficient and requires a calcium prescription.

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I was started on 200 to stop the attack on my thyroid, ask to see a consultant and really need B12 and D

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Make an urgent "on the day" appointment with any GP and ask that these vitamin deficiencies are treated

B12 needs full testing for Pernicious Anaemia before starting B12 injections

Folic acid supplements should be prescribed but not started until after first B12 injection

Ferritin, you need iron infusion to bring levels up fast, then prescribed ferrous fumerate 3 x daily as maintenance dose

Vitamin D - started on LOADING dose. Look up local CCG guidelines eg - Oxfordshire CCG

oxfordshireccg.nhs.uk/profe...

See this detailed reply by SeasideSusie on vitamin supplements

healthunlocked.com/thyroidu...

Hashimoto's affects the gut and leads to low vitamin levels

Low vitamin levels stop Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

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

chriskresser.com/the-gluten...

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

drknews.com/changing-your-d...

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription.

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You need B12 injections this low will be making your Hashi even worse, you must feel so ill

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