Negative antibodies

[Blaziken]

I got my second TFT result today which was worse than my first (TSH 16, FT4 10.4 and now below range). I also for my TPO antibody result:

Thyroid peroxidase antibody <28 iu/ml

(range 0 - 60 iu/ml)

What is going on here? I guess it isn't autoimmune?

[tattybogle]

not necessarily....

there is another thyroid antibody .. TGab (thyroglobulin antibodies) some with autoimmune hypo have TGab , but not TPOab ,, but NHS rarely bother to test for TGab . they aren't very interested in cause of hypothyroidism because it makes no difference to treatment offered.

also it is possible to have definite autoimmune hypothyroidism without any raised antibodies being found (the characteristic damage to thyroid can be seen on thyroid scans, if it is bad enough)

also ...antibodies fluctuate .. so not finding any today doesn't mean you didn't have them last year ..and doesn't mean you wont have then next year.

[SlowDragon Administrator]

So with test with TSH over 10 and below range Ft4 you MUST be started on levothyroxine

Standard starter dose of levothyroxine is 50mcg

GP may consider starting at higher dose

Approx how old are you

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

There are two thyroid antibodies implicated in autoimmune thyroid disease

TPO and Thyroglobulin antibodies

NHS currently only tests TG antibodies if TPO antibodies are over range

Significant minority of Hashimoto’s patients only have high TG antibodies and struggle to get diagnosed on NHS testing

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.

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)

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

If not ……request these are tested now

Are you currently taking any vitamin supplements

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

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

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)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

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

Medichecks Thyroid plus BOTH antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

[Blaziken in reply to SlowDragon]

Thanks. I'm 41. I should hear from the GP again today and will raise getting the other levels tested. If I can't get it, I have the option through my work health insurance I think.

[SlowDragon Administrator in reply to Blaziken]

GP should test vitamin levels and (ideally) cortisol

Probably can’t test TG antibodies….usually endocrinologist test only

[knitwitty]

When I was diagnosed I did private testing as the NHS refused to test any antibodies . My TPO was about 30 ( the over range reading was 34+ if I remember correctly ) but my Tgab antibodies were around 450 ( anything above 115 was considered above range ) so I was suffering from autoimmune thyroid disease. My antibodies have stayed under range ( in the 20's ) since I went completely Gluten free, so I am assuming that being gluten free has stopped the attacks on my thyroid .

[Blaziken in reply to knitwitty]

That's interesting. My daughter is coeliac so I mostly eat gluten free. I wonder if that's why those antibodies were low.

[knitwitty in reply to Blaziken]

It's always a possibility, but I couldn't say definitively. Interestingly my son is also a coeliac, he was diagnosed when he was in his early 20's , it was missed for a long time ( about 3 years ) and it blighted his first couple of years living a away from home . I had many family members on both sides of my family with underactive thyroid disease though I doubt it was ever established as autoimmune. As coeliac disease is also autoimmune it doesn't take a genius to work out that thyroid problems are part of the same spectrum of diseases. I also have a cousin who was diagnosed with coeliac disease in his 40's.

Good luck finding the answers you are looking for.

I also get my adult son to check his thyroid with a Medichecks blood test once a year , just to ensure that if he starts to become unwell he will have a raft of blood tests to show a doctor if there is a significant deterioration in his blood test results over time. Not knowing how old your daughter is I don't know if this is something you may wish to pursue .