Hi, please review my bloods and advise. My TPA antibodies have increased since my last bloods in March. I am under an endocrinologist who said that there is nothing that can be done to reduce high antibodies. I am due to start IVF in four weeks and I am worried it will fail due to high antibodies. I am currently on 87.5mcg of Levothyroxine. I have had all my vitamin levels checked and my vitamin D and Vit 12 was low so taking supplements. All bloods taken first thing in the morning before eating and Levo tablet. I am due to see my endocrinologist next week. My Gp also rang today to say he want to speak to me about high antibodies, so I have an appointment tomorrow with the GP to discuss this
Blood results 11th March
TSH 0.66 (0.27-4.2)
Free T3 4.34 (3.1-6.8)
Free Thyroxine 21 (12-22)
Thyroglobulin Antibodies 209 (<115)
TPA 184 148 (<34)
(Bloods taken by medichecks)
Latest results 26/4
TSH 0.9 (0.2-5)
Free Thyroxine 17.5 (10-24)
TPA 258 (<34)
Thyroglobulin (not recorded even though it was requested)
I’m going to assume you did these tests as suggested here, so first thing in the morning, fasted, and 24 hours after last dose of Levothyroxine.
Okay, so first off let’s look at your FT4 and FT3. The first of these is nice and high in range at 90%. However your FT3 is only 33%. Here’s a useful calculator:
Often, we need both to be in the upper part of range to be and feel well. It looks like you might have a conversion problem. To help this, you definitely need Vitamin B12 and Vitamin D to be optimal and clearly they’re not. Have you been checked for pernicious anaemia?
Do you have recent results for ferritin and folate at all? If not, these are also worth checking as they too support thyroid function.
Other than this, I’m surprised at your endo’s comment about “nothing that can be done if you have high antibodies”. Sure, if you have Thyroid disease caused by high antibodies (which you do) there’s no cure. However you can do a lot to stabilise the effect of the antibodies on your health. Cutting out gluten is one.
I find Isabella Wentz’s site really useful on all of the nutritional and lifestyle issues relevant to thyroid health.
Hi, thanks for the reply. I always test 24hr before last dose of Levo without eating. My vit D and B12 was last tested in March 21 and since then I have been supplementing with B12 spray 1200 per dose daily and I take four sprays. I am also taking Vit D+K2 3000 spray daily and have 3 sprays.
I’ve not been checked for pernicious anaemia but I will look into having this checked. The most recent results for Folate and Ferritin are in my post and these were last checked in March 21. Before I saw the endocrinologist I was already on a strict gluten free diet, however I’ve not been as strict with a gluten free diet for the last couple of weeks, i will of course go back to a strict diet. I’ve seen a lot of Isabella Wentz articles and found some of the advice helpful. My main concern is wether or not to delay IVF until my antibodies are lower, however time isn’t on my side I’m afraid..
There's no real proof that antibodies can be lowered, because they fluctuate all the time. You'd have to test every day to have absolute proof.
Antibodies tend to be highest just after an immune system attack on the thyroid, when they come in to clean up the traces of thyroid peroxidas and thyroidglobulin that have leaked into the blood. They do not do the attacking themselves. So, is it even desirable to reduce them? They have a job to do. I've never seen absolute proof that they do any harm, ony opinions.
I really don't know. I wish I did. But, it could be, I suppose. Given how difficult it is to reduce them - impossible even - the body obviously wants them there. lol
Thanks for replying. This is good to know that there is any proof that antibodies do not do any harm. After two failed IVF cycles in which my thyroid has been uncontrolled I have been trying to find out ways to reduce thyroid antibodies including a gluten free healthy diet and supplements. I have read articles on IVF and high antibodies and how it can affect embryo implantation. With two failed IVF cycles despite top grade embryos, I am starting to think this is the reason why I’ve not yet had any success with IVF.
I'm no expert, but I think that thyroid hormone levels are far more important that antibodies. After all, many, many women with Hashi's do conceieve. I did three times.
This is good to know. At least my thyroid hormones are in range and have been since last year. I’ll probably go ahead next month then as I could be waiting for a long time for antibodies to reduce lol..
Well my recent results from yesterday is TSH 0.9, Free Thyroxine 17.5 and T3 4.34. The results have fluctuated since my last blood test in March but the results are still in range..
It would help if you gave us those ranges, though. Because ranges vary from lab to lab, so we cannot guess. But, that FT3 looks a bit low - far from optimal. If the ranges are those we usually see, then FT4 is only about mid-range, which is unlikely to be optimal, either.
So they are. But those are from two different blood draws, aren't they. The FT4 of 17.5 is after a reduction in dose.
So, as your FT3 was far from optimal at 4.34, it's going to be even less so now that you've had a reduction in dose. If the FT4 goes down, so does the FT3.
Well, you need an increase in dose. Either an increase in your levo, or some T3 added to your levo.
87.5 mcg of levo is only a very small dose. You're in the US, aren't you? I know they like to keep hypos under-medicated there, so you're probably going to have to insist.
Oh, I'm so sorry! No offense intended. We just don't normally see people in the UK with such strange doses. They usually go up in 25s, so 50/75/100/etc.
No, your GP cannot prescribe T3. But he can refer you to an endo who can prescribe it.
No worries, no offence taken at all. I am under an Endo and he prescribed the 87.5mcg, he also said he can’t prescribe T3. I had an appointment this week but it now been cancelled the 25th June. Thanks for your advice, I’ll see if my GP will change the dose.
Studies on the effect of elevated thyroid antibodies in pregnancy all appear to be fairly old, probably because not a lot outside of functional medicine has evolved in the management of autoimmune disease. Thyroid hormone levels will influence pregnancy hormones and vice versa but the response can be altered in women with elevated TPOAb.
If you read books such as "Your Healthy Pregnancy With Thyroid Disease" by Dana Trentini and Mary Shomon, and view websites such as ‘hypothyroidmom's' the general consensus appears to be to keep antibodies as low as possible through means such as eliminating cross-reactive foods, avoiding sugar spikes, supplementing selenium, fish oils, Vit D, etc. This helps calm an over active immune response and reduces the risk of further self-attacks on thyroid peroxidase which is an enzyme found in the thyroid gland (TPO), & a key protein called thyroglobulin (TG). It is these self-attacks that will keep thyroid antibodies TPOAb & TGAb raised.
Many immune changes take place in the body to accommodate acceptance of the foetus. The immune system having many parts & subdivisions is immensely complicated and way beyond my comprehension but I read the two most relevant in Hashi sufferers are T-Helpers;
- (TH-1) Non -specific immunity macrophages & Killer T cells is our immediate attack response to kill pathogens, subdivided into messenger proteins each having their own job, such as the Interleukin groups.
- (TH-2) Specific Immunity - slowly produces antibodies & identifies invaders so killer cells can attach to prevent them from entering our cells, also broken down into interleukins.
We are usually slightly dominant in one or the other although a balance is required for good immunity. Over activity of TH-1 will suppress activity of TH-2 & vice versa. This can be problematic in autoimmune disease as can further self-attacks on healthy tissue, worsening the condition. Pregnancy can shift the immune system temporarily to TH-2, which is why a lot of women find out they have Hashimoto’s after they give birth and their immune system returns to TH-1 dominance.
Thyroid antibodies aren’t unusual and many people live healthily with raised levels but in those whose antibodies have caused autoimmune conditions it is thought that raised levels can either risk further disruption of thyroid hormone levels through ongoing small self-attacks or encourage other autoimmune conditions to develop.
Keeping TSH low discourages thyroid activity and lessens the chance of an attack and thyroid meds are usually increased fairly quickly after conception (if not before in preparation) as baby will need the exact right amount of thyroid hormone for healthy development. However, if Hashi swings were to occur a chance of inadequate T4 risks increases foetal loss, or psychomotor/IQ deficits for baby, whilst too much T3 may put strain on baby’s heart.
There is also research into thyroid antibodies crossing the placenta and the origin of the TPOAb in those babies born is thought to be from the mother.
All this sounds scary but remember many Hashi sufferers including myself have produced wonderful, healthy, bouncing babies. Your thyroid antibodies may be elevated but not into the thousands as some other Hashi people have suffered.
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