Falling Thyroid Peroxidase and Thyroglobulin antibodies - what does that mean?

[ds_charles]

Hi all,

I have been diagonosed with Hashimoto's since 2008. I recently got a comprehensive set of tests from Medichecks and was surprised to see antibodies falling. I'd love some help understanding what that might mean - if anything.

July 2017 (on 125mcg Levothyroxine/day):

Thyroglobulin: 66.9 kIU/L (normal <115)

Thyroid peroxidase: 121.1 kIU/L (normal <34)

February 2021 (on ~107mcg Levothyroxine/day):

Thyroglobulin: 21.8 kIU/L (normal <115)

Thyroid peroxidase: 49.4 kIU/L (normal <34)

So you can see they are falling, quite significantly too. I have two questions:

Firstly: is this a good thing? Or does it make no difference?

Secondly: why might they be falling?

My guesses:

1. Because of the slightly lower dose of Levothyroxine.

2. Because my thyroid is gradually dying off so the antibodies don't need to attack it so much anymore?!

3. Because I'm somehow managing the disease better now than I was in 2017? Perhaps through diet or better sleep or something.

4. Or it means nothing at all!

Thanks for your help!

David

[tattybogle]

Hi , in my opinion , the answer is a mix of 2,3 and 4, (and 1 is irrelevant)

my TPOab's were massively lower when retested in 2016 than they were at diagnosis in 2004, i've done nothing in particular diet lifestyle wise to 'try' and improve them.

(And my levo dose was the same) ...They were still 195 in 2016 though

But i don't assume that they wouldn't go back up again, and have no way of knowing what else they were up to for the years in between these tests.

But logically .. my understanding is that TPOab are 'clean this up' labels attached to protein from thyroid that's ended up in the blood. So less TPOantibodies simply means the thyroid has not been attacked by immune disease recently.

[SlowDragon Administrator]

Many people find TPO antibodies drop slowly if on strictly gluten free diet

TG antibodies seem to reduce as TSH lowers

Even if antibodies drop below top of range, you still have Hashimoto’s

What are your TSH, Ft4 and Ft3 results

Did you also test vitamin D, folate, ferritin and B12?

[ds_charles in reply to SlowDragon]

Thanks SlowDragon. I'm not on a strictly gluten free diet, but it's low gluten. Occasional non-GF bread, basically.

And yes - I tested everything If these results shed any further light, I'd be grateful for your interpretation:

TSH:

0.83 mIU/L (Range: 0.27 - 4.2)

Free T3:

4.61 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine:

20.400 pmol/L (Range: 12 - 22)

Ferritin:

76.50 ug/L (Range: 30 - 400)

Folate - Serum:

>19.8 ug/L (Range: > 3.89)

Vitamin D:

83.10 nmol/L (Range: 50 - 175)

Vitamin B12 - Active

60.000 pmol/L (Range: > 37.5)

Thanks again!

David

[SlowDragon Administrator in reply to ds_charles]

How do you feel?

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?

What vitamin supplements are you currently taking

Conversion is not very good

Ft4 is 84% through range

Ft3 only 41% through range

chorobytarczycy.eu/kalkulator

Helpful calculator for working out percentage through range

Most people when adequately treated will have Ft3 at least 60-70% through range

With Hashimoto’s we frequently have poor conversion

Vitamins levels

For a bloke your ferritin isn’t that high

Vitamin D might be better over 100

B12 is low at under 70

Roughly how old are you?

Common for B12 to drop as we age

Low B12 obviously common if vegetarian or vegan

But also common with Hashimoto’s

Are you on strictly gluten free diet?

[ds_charles in reply to SlowDragon]

Thanks for your advice!

I haven't felt great for a few months now. Today, for example: woke up with headache, which is still with me 7 hours later. Plus dry skin, scratchy throat and tiredness.

My recent blood tests showed that I had low neutrophils, a sign that I've been fighting something off, apparently.

Test was done in the AM, before eating/drinking. But not before I took levothyroxine - doh! My brain was on autopilot

I've been taking multivitamins, plus extra vitamin C+Zinc and vitamin D. Supplementing with B12 as well, as I'm vegan. I was told to stop taking the B12 in the week before the test.

I'm 38 years old.

Not strictly gluten free, but low gluten, I'd say. I have non-GF oats, but other than that I can't think of any regular sources of gluten in my diet. I might have the occasional piece of non-GF bread or something that sneaks in.

A few previous tests have shown my ferritin levels are usually around 55-75ug/L.

Current B12 is lower than previous tests - although hard to compare as I think previous tests were testing B12 serum rather than active B12.

I've never been tested for vitamin D before.

Thanks again

[SlowDragon Administrator in reply to ds_charles]

So you need to look at buying certified GF oats

Look at increasing iron rich foods in diet (obviously much more difficult on plant based diet)

Low B12

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B is another option that contain folate, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

With B12 result below 500, or Active B1# below 70 it’s recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

healthline.com/nutrition/me...

academic.oup.com/nutritionr...

The present review of the literature regarding B12 status among vegetarians shows that the rates of B12 depletion and deficiency are high. It is, therefore, recommended that health professionals alert vegetarians about the risk of developing subnormal B12 status. Vegetarians should also take preventive measures to ensure adequate intake of this vitamin, including the regular intake of B12 supplements to prevent deficiency. Considering the low absorption rate of B12 from supplements, a dose of at least 250 μg should be ingested for the best results.3

[ds_charles in reply to SlowDragon]

Hi SlowDragon!

I just wanted to follow up on your generous message to say: a) thank you! and b) I have taken your advice and been supplementing with B12 and B complex vitamins. My B12 is now Serum vitamin B12 level 744 ng/L [197.0 - 771.0]

So that looks like it worked! I guess that means I don't have pernicious anaemia or anything like that.

However, my symptoms of fatigue and general sickiness are unchanged. It seems to be worse the day after I have exercised. I used to run half marathons for fun and cycled long distances - but I've been exhausted today after a 6.5km slow run and a walk in the woods yesterday. I slept ~9.5 hours last night, had to nap this afternoon and I'm heading to bed once I've pressed send!

I wondered if that would have anything to do with conversion of Ft4 to Ft3? And, if so, how I might improve that? I have heard about getting a different pill to take, but that it seems hard to convince doctors.

Many thanks for your help!

David

[SlowDragon Administrator in reply to ds_charles]

As you are vegan low iron or ferritin is much more likely

When were iron levels last tested

TSH: 0.83 mIU/L (Range: 0.27 - 4.2)

Free T3: 4.61 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine: 20.400 pmol/L (Range: 12 - 22)

Ft4 is 84% through range

But Ft3 is only 41% through range

So poor conversion and likely to need addition of small doses of T3 prescribed alongside levothyroxine

Recommend getting TSH, Ft4 and Ft3 tested again .....particularly testing after a particularly active few days

Roughly where in the U.K. are you

Some CCG areas are worse than others at allowing prescription for T3 on NHS

You can search by CCG area

openprescribing.net/analyse...

Email Thyroid UK for list of recommend thyroid specialist endocrinologists who will prescribe T3

NHS and Private

[e-mail]

The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is under 2

When adequately treated, TSH will often be well under one.

Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

[ds_charles in reply to SlowDragon]

Thanks again SlowDragon!

I have emailed ThyroidUK about T3 specialists. Thanks for the tip.

My iron levels have been tested twice recently:

16 March:

Serum ferritin level 61.0 ug/L [30.0 - 400.0]

26 February:

Iron

12.83 umol/L (Range: 5.8 - 34.5)

TIBC

60.13 umol/L (Range: 45 - 72)

UIBC

47.30 umol/L (Range: 22.3 - 61.7)

Transferrin Saturation

21.34 % (Range: 20 - 50)

Ferritin

76.50 ug/L (Range: 30 - 400)

My Ferritin is historically this low:

01/11/16 Ferritin NHS 76 ug/L (Range: 30.00 - 400.00ug/L)

Thanks for your help!

d

[SlowDragon Administrator in reply to ds_charles]

humanbean may pop along

She's got fantastic knowledge on reading iron results

Recommend reading her many replies on iron and ferritin

Plant based diet is notoriously be hard to maintain good ferritin levels

Likely to need to supplement regularly

[ds_charles in reply to SlowDragon]

Thanks - I'll have a browse

Thanks for your time and energy - it means a lot!

[diogenes Remembering]

I guess, number 2 of your alternatives. If there isn't any thyroid to attack, the antibody stimulus has gone, so it would be logical for antibodies to drop to a low (watchful) level (ie baseline) just in case they might have another opportunity.