What antibody test is this (NHS)?

[melissa-b]

I asked the GP to check my antibodies for Hashimoto's (I have subclinical hypothyroidism, which I'm on a trial of levothyroxine for), and they requested two types of antibodies (Thyroid Peroxidase Antibodies (TPO) (Requested), Thyroid Antibodies(TPO)).

However, I've only had one test result back, which reads "Thyroid autoantibody level (XE257) 13 iu/mL [< 100]". Which one does this relate to? Is this the one that checks for Hashimoto's? Thanks!

I've also booked in to have the Advanced Thyroid Function Blood Test (Medichecks one) next week.

[SlowDragon Administrator]

they requested two types of antibodies (Thyroid Peroxidase Antibodies (TPO) (Requested), Thyroid Antibodies(TPO)).

That’s the same antibodies listed twice

NHS won’t test Thyroglobulin antibodies unless TPO antibodies are high (positive)

Thyroid autoantibody level (XE257) 13 iu/mL [< 100]".

It’s not clear what antibodies this is …..assume it’s TPO antibodies …..and result is low (negative)

Come back with new post once you get results back from Medichecks

How much levothyroxine are you currently taking

How long have you been on this dose?

Test thyroid levels early Monday or Tuesday morning and last dose levothyroxine 24 hours before test

Only do private testing early Monday or Tuesday morning. Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

[melissa-b in reply to SlowDragon]

Hi again! Hope you've been well. Thank you so much for your reply. I didn't realise they requested the same one twice (no wonder I was confused).

I'm taking 50mcg of Levothyroxine and it's been about 6-7 weeks now. Still having the same symptoms so maybe my thyroid isn't the issue (although I do feel less tired, all my other symptoms are still there). My last bloods in June showed "Serum TSH level (XaELV) 4.93 miu/L [0.3 - 5]" after taking 25mcg, so I wanted to see if taking 50mcg took it down more. Also interested to see my T3 and T4 levels since the GP doesn't test those! Also had COVID in July so interested to see if that had an effect.

I'm glad you said that as I'm booked in (private blood test) on Thursday at 8am! I've asked if I can be seen on Monday but it seems unlikely. I didn't know there were any strikes so that's really helpful - it does say 'We will deliver as many Special Delivery and Tracked24 parcels as possible' so I'm hoping if I got 24 hrs delivery I'd be okay (Thursday seems to be the only appointment!).

[SlowDragon Administrator in reply to melissa-b]

The problem with testing Thursday is its close to weekend

I think Medichecks do process kits on Saturday…..but not sure and probably not Sundays

You could email and ask them

50mcg is only the standard starter dose levothyroxine

Levothyroxine doesn’t top up failing thyroid, it replaces it. So dose is typically increased slowly upwards in 25mcg steps over several months. Eventual dose likely to be around 1.6mcg levothyroxine per kilo of your weight per day

Approx how much do you weigh in kilo

ESSENTIAL all four vitamins are at good levels too

Have you had vitamin D, folate, ferritin and B12 levels tested

What vitamin supplements are you currently taking

If taking any supplements that contain biotin, remember to stop these 5-7 days before test as biotin can falsely affect test results

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[melissa-b in reply to SlowDragon]

Thank you I'll email and ask! I weigh about 63kg. I think I've had those tested in the past with a routine blood test, but hopefully the Medichecks test will show some vitamins/minerals too! Thank you

[SlowDragon Administrator in reply to melissa-b]

63kg x 1.6mcg = 100.8mcg per day

Some people need less than guidelines, some need higher dose

So you can expect to likely eventually be on 100mcg levothyroxine per day

Dose levothyroxine is increased SLOWLY upwards in 25mcg steps

Retesting at least 6-8 weeks after each dose increase

Come back with new post once you get results

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

[melissa-b in reply to SlowDragon]

Hi,

I booked my medichecks blood test for next Wednesday but if I think I’m overmedicated should I come down on my meds immediately or wait for a blood test?

This past week I’ve had really heightened anxiety, sleeplessness, sweating, chills and feeling hot (at the same time), not being able to concentrate, no appetite, stomach cramps, and shaking hands.

should I try to stay on this dose and tolerate these symptoms until Wednesday (in case it isn’t my thyroid meds causing them) or just come down to 25mcg and not go for the blood test? What would you do? Thank you

[SlowDragon Administrator in reply to melissa-b]

more likely anxiety is because you’re under medicated

50mcg is only the standard starter dose

How long have you been on 50mcg levothyroxine now?

Definitely stay on current dose until Wednesday

Is test booked for early morning?

Do you normally take your levothyroxine waking or bedtime?

Last dose levothyroxine should be 24 hours before test

Are you also testing vitamin levels?

What vitamin supplements are you currently taking

[melissa-b in reply to SlowDragon]

I've been on 50mcg for over 6 weeks now! It's booked for 8am. I take it in the morning, and the Medichecks test i think tests some vitamin levels - I'm not taking any atm. I just feel absolutely terrible this week! Yesterday I just took 25mcg and felt better and calmer in the evening but I'm not sure if that was a placebo effect... I had COVID 10 weeks ago too so idk if that's affecting me still. My last bloods were when I was on 25mcg which was on the 6th June, and the results were: Serum TSH level 4.93 mIU/L [0.3 - 5.0]

[SlowDragon Administrator in reply to melissa-b]

Try to hang on taking the 50mcg dose until you get tested

You could try splitting your dose …..take half dose waking and half at bedtime …..can make it easier to tolerate

Do you always get same brand levothyroxine at each prescription?

It definitely does matter when thyroid levels are tested…..but GP’s rarely aware

Highest TSH is early morning

[melissa-b in reply to SlowDragon]

Thank you so much, i'll try splitting it (I'm on 25mcg x 2 tablets as I can only take mercury brand so that's easy to do!) My GP did say she thinks I'm having both hypo and hyper symptoms at the same time, and it needs investigating, so at least that's good. I'll call reception and try to get an early morning appointment (i'll say I'm busy in the afternoons and evenings lol)

[SlowDragon Administrator in reply to melissa-b]

👍👏

[melissa-b in reply to SlowDragon]

sorry to bug you again! I’ve booked in my medichecks blood test for this Wednesday at long last, but today I’ve woken up sick with a cold (sore throat, running nose, sneezing etc but no temp). I’ve struggled to book in my blood test for such a long time, is it okay to still go ahead for Wednesday’s test even if I’m sick?

[SlowDragon Administrator in reply to melissa-b]

not ideal…..but yes carry on

[melissa-b in reply to SlowDragon]

Hi again! I had the flu so postponed my bloods - I have an 8:30am appointment tomorrow for my thyroid Medichecks blood test. I was just wondering though, as you seem knowledgable about these things, do you know what a lab requisition form is? The message from the GP said "We will also need to include a lab requisition form that you will have to have ready for sending off in the kit." but I don't understand what it means. Do you know if there is a form within the Medichecks kit? I've asked the GP but she always replies weeks later for some reason! I don't have a lab requisition form otherwise, which I'm very worried about...

[SlowDragon Administrator in reply to melissa-b]

yes …in kit ..there’s test tube for blood….a pre printed sticker with your details to attach to test tube after filled it up

And a form for you to fill in….stating time and date of test

[melissa-b in reply to SlowDragon]

Oh amazing, thank you so much for your help again!! Excited to finally get some results 🤞

[melissa-b in reply to SlowDragon]

Just phoned my GP and they said to stay on it, earliest blood test they can give me is the 13th of October at 3pm... I asked for a morning one and they said it's not necessary and I need to just take that appointment 😪

[jimh111]

You don't have autoimmune hypothyroidism but you could still have a failing thyroid. If you don't improve on a higher dose of hormone you probably don't have hypothyroidism. It would be useful to test TSH, fT3, fT4 privately but I would avoid endless testing.

[melissa-b in reply to jimh111]

Higher than 50mcg? My TSH has been over 12, doesn't that mean overt hypothyroidism? I've only had like two blood tests I don't think I'll be testing too much! I have so many unexplained symptoms I need to figure out what's wrong with me

[Jazzw in reply to melissa-b]

It does, Melissa. A TSH of over 10 definitely shows a problem with your thyroid function.

And I’m not sure we can yet say that it isn’t autoimmune—antibodies don’t always show up (they do most of the time if it’s autoimmune thyroiditis but sometimes the only way to tell is through an ultrasound scan). Maybe don’t get hung up on the why though—it will need to be treated the same way whether or not it’s autoimmune-caused.

I think you’ve got a one or two raises of levothyroxine to go before you start to feel lots better—50mcg is only a starter dosage. Most end up on at least 75mcg, some more than 100mcg.

Hang in there. x

[melissa-b in reply to Jazzw]

thank you so much - that's true, I am pretty focused on what's causing it which probably isn't that helpful! it'll be interesting to see how my TSH is after 50mcg - hopefully if it isn't optimal the GP will increase the medication (fingers crossed). Thank you for your help x

[jimh111 in reply to melissa-b]

Yes higher than 50 mcg. You probably have hypothyroidism but not autoimmune, not that it matters. So see if you improve on a higher dose and post your results here.