High TPO but normal TSH?

[pancake1971]

Hi there, I am a normally fit and healthy 51 year old female but have been feeling quite unwell over the last 2 years with intermittent spells of fatigue, frequent headaches, facial pain/sinus issues, lowness in mood. I am on HRT but this has made no difference. I have a history of 'borderline' thyroid results and my most recent test shows my TSH to be ok at 2.94 but my TPO antibodies are 408 (normal range less than 35). The other antibody test was fine. Could my symptoms be anything to do with my thyroid or am I clutching at straws? I am desperate to feel better and be able to live my life again!

[PurpleNails Administrator]

Was FT4 (free Thyroxine) tested? 

Do you remember the time of the blood test draw? The TSH  (Thyroid stimulating hormone) is a pituitary hormone which signal the thyroid to work.  It’s not a reliable measure of thyroid function because it can appear in range but your thyroid levels may not be.

Having positive TPO antibodies shows evidence of your immune system attacking your thyroid (autoimmune thyroiditis) so if thyroid levels are in range now it means over time function will likely reduce & it’s better to commence treatment before becoming overtly hypothyroid.  

if GP or lab can’t or won’t test free thyroxine FT3 -(Free Triiodothyronine) because your TSH is in range you might have to test privately.  

[tattybogle]

Hi pancake , (you've made me want pancakes for tea now )

Do you have the numbers for those previous ' borderline ' tests .. ?

Have you ever had more than just TSH tested eg fT4 ?

if you do, post the results and [lab ranges] like this

Date

TSH 0.00 [0.0 - 0.0]

fT4 0.00 [0.0 - 0.0]

400 is a significant 'positive' for TPOab and means that Autoimmune Thyroid Disease is definitely present and has already done 'some' damage to the thyroid . Whether it's done 'enough' damage yet to cause symptoms of hypothyroidism is not so clear .

Symptoms of hypothyroidism are certainly possible long before the damage gets so bad that the T4 level goes under range .

And the usual TSH level for the vast majority healthy people (who don't have any thyroid problem) is about 1-2 ish .

The TSH (Thyroid Stimulating Hormone ) is not a thyroid hormone , it's a message from the pituitary to the thyroid asking for more /or less thyroid hormones (T4/T3) to be made When T4 is low TSH level goes up to ask for more ..... so a TSH of nearly 3 does not look entirely 'happy' to most of us here ,

Most doctors will say it's fine, and will not believe you could possibly have symptoms at that level . But that doesn't mean you aren't . ( i was really struggling all day every day when my TSH was 'only' 5.7 /6.8 ... some doctors have difficult believing anything under 10 is a problem .. but they are not walking in our shoes .. and their training on thyroid disease and treatment is frankly ... 'not much use',

So no ..... i don't think you are clutching at straws at all ~ but a diagnosis of hypothyroid (and a prescription for thyroid hormone replacement) is usually not possible until TSH has gone over the lab [reference range] and stayed there for 3 months .

But if we can see the numbers, members can help more ,

[SlowDragon Administrator]

You need FULL thyroid and vitamin testing

High TPO antibodies confirms autoimmune thyroid disease also called Hashimoto’s

For full Thyroid evaluation you need TSH, FT4 and FT3

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

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)

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

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...

cheapest including both antibodies

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

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

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning. 

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

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...

GP should also do coeliac blood test at diagnosis of autoimmune thyroid disease