What is treatment for high thyroid antibodies?

[weekitty]

Hi I'm having a blood test today to get thyroid peroxidase antibodies checked. If this result comes back as high, what would be the treatment? I thought it was steroids, prednisone or prednisolone?

Also the gp doesn't do the blood test for thyroglobulin antibody. Is it important to get this checked as well. My TSH has already been checked came back as high.

Can anyone please help.

Thank you

[tattybogle]

There is no treatment for TPOab... (certainly NOT steroids, you may be thinking of some other autoimmune disease rather than thyroid)

Only the resulting low thyroid levels are treated, by replacing low T4 with Levothyroxine (synthetic T4)..... this will then reduce TSH , although TSH itself is not the problem , low fT4 /3 is

NHS use raised TPOab to confirm the cause of hypothyroidism as being Autoimmune hypothyroidism (sometimes called 'hashimoto's disease', but usually NHS just say 'autoimmune hypothyroidism', or sometimes just 'hypothyroidism' )

If TPOab are raised they consider it shows an increased risk of person eventually going on to have fT4 below range as well as TSH above range. So raised TPOab (if very high) will sometimes persuade them to start Levo treatment if they were otherwise unsure whether to to so.

TGab .. can have many other causes not just thyroid... ( i don't think NHS use them much for diagnosing thyroid , but i could be wrong about this)

[weekitty in reply to tattybogle]

Thank you for your reply. That's put my mind a bit a ease.

[SlowDragon Administrator]

About 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies.

Significant minority of Hashimoto’s patients only have high TG antibodies (NHS won’t test)

Essential to test vitamin D, folate, ferritin and B12 too

Ultrasound scan of thyroid can be helpful

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Before even considering TTC thyroid levels need to be stable

TSH must be under 2 maximum

verywellhealth.com/infertil...

.

Pregnancy guidelines

thyroiduk.org/having-a-baby-2/

gp-update.co.uk/files/docs/...

See pages 7&8

btf-thyroid.org/Handlers/Do...

thyroidpharmacist.com/artic...

[weekitty in reply to SlowDragon]

Hi thanks for your reply. Always very helpful. I've started on the levothroxine 50micrograms. 1 tablet per day. I'm hoping in 6 weeks time that the fsh level lowers from 6.6 to at least 2. I will need to get a blood test done again 4 weeks from now to get levels checked.

[SlowDragon Administrator in reply to weekitty]

Bloods should be retested minimum 6-8 weeks after each dose change or brand change in levothyroxine

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

Likely to need further increase in levothyroxine after next test

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Guidelines are just that ....guidelines.

Some people need more .......some less

healthunlocked.com/thyroidu...

[weekitty in reply to SlowDragon]

Thanks for this information. Also I take liquid iron. Do I need to take levothroxine about 2 hours after I've had my liquid iron. Does levothroxine interfere with any vitamins. For example would I have to space out the time I'm taking levothroxine with certain vitamins?

[SlowDragon Administrator in reply to weekitty]

Sorry only just seen this question

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, magnesium or vitamin D should be minimum four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex