What to do about raised antibodies- advice please!

[Dlm3557]

Hi there,

I am a regular reader of this forum but this is my first post.

I was a recurring Graves sufferer on carbimazole for 3 years before finally having radioiodine treatment a year ago.

Just about Ok now on 75mg Levo but wanted to get a reading of blood levels other than TSH so had a private blood test through Medichecks.

Results are

T4 18.6 (9-22)

T3 3.71 (3.1-6.8)

TSH 0.61 (0.27-4.2)

Total thyroxine 103 (59-154)

Thyroglobulin antibodies 22.5 (0-115)

Thyroid Peroxidase antibodies 133 (0-34)

The levels seem Ok apart from thyroid peroxidase antibodies that are clearly raised.

What should I do about this?

Don’t know whether to go to the GP, back to my endocrinologist or do nothing!!

Never had this measured before so who knows how long it has been raised?

Is it Hashimotos or a remnant of the original Graves?

Any help or advice would be really appreciated.

By the way I feel Ok apart from being tired some days and I haven’t had any vitamins measured.

Many thanks.

[greygoose]

Can't be Hashi's, because Hashi's antibodies disappear when the thyroid is gone.

But, seems to me that your problem isn't so much high antibodies, as low FT3. You are not converting the T4 you're taking very well at all.

[Dlm3557 in reply to greygoose]

I was hoping you would reply because you are one of the experts in my view!!

Thank you for that and I did wonder if that was the case about the FT3.

I won’t get it from the GP so would you advise I go back to see the endo?

I know I could get it privately but wouldn’t know how much to take.

Thanks again

[greygoose in reply to Dlm3557]

Thank you for the compliment.

Going back to the endo should be the first step. But, even if you have to buy it privately, dosing is not a problem. You follow the rules for replacing hormones : start low and increase slowly. So, for T3, you would start on 1/4 pill - 6.25 mcg or 5 mcg, depending on the pill - and increase by 1/4 pill every two weeks until you arrive at one whole pill, then hold for six weeks and retest.

[Dlm3557 in reply to greygoose]

Thank you so much. I’ll make the appointment!!

[greygoose in reply to Dlm3557]

You're welcome.

[SlowDragon Administrator]

Many people do still have antibodies after RAI or thyroidectomy.

Trying strictly gluten free diet is something to consider.

Definitely get vitamins tested too

You could start with vitamin D via vitamindtest.org.uk £28 postal kit

If endo refuses to prescribe small dose of T3

You could try just increasing your Levothyroxine. TSH is not too low, there's room for small increase in FT4 and FT3 is definitely low

Perhaps try adding 12.5mcg Levothyroxine (25mcg on alternate days) and retest in 6 weeks preferably including B12, folate & ferritin and vitamin D if not tested separately

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

rcpe.ac.uk/sites/default/fi...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

[Dlm3557 in reply to SlowDragon]

Many thanks for the information