advice please thyroid peroxidase antibody results

[Wilma76]

hi can anyone help with these results please? Says no further action but I don’t want to assume that’s accurate:

Thyroid Peroxidase Antibody

54iu/ml (0.00-60.0)

thanks

☺️

[Jaydee1507 Administrator]

So your TPO antibodies are negative but the NHS only test that one type of antibody. Privately you can also test Thyroglobulin (Tg) antibodies.

Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/testing/priva...

There is also a new company offering walk in& mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

Only do private tests on a Monday or Tuesday to avoid postal delays.

Have you started supplementing your vitamin levels with the suggestions made in this reply to you? healthunlocked.com/thyroidu...

Have you retested your thyroid lvels since your increase to 75mcgs Levo?

[Wilma76 in reply to Jaydee1507]

hi thanks for replying.

Yes I started a superdose of vit D for 7 weeks, now I take a maintenance dose plus vit b complex and separate b12

I was also retested following my increase of Levo (Teva) and my results are now:

TSH 1.73mU/L (0.35-5.5)

T4 15.0 pmol/L (10.5-21.0)

Decembers results prior to increase was

TSH 2.91 mu/L (0.35-5.5)

T4 was 13.9 pmol/L (10.5-21.0)

Thanks

[Jaydee1507 Administrator in reply to Wilma76]

Well done on starting the vitamins, they will help you feel a little better.

Which vit D3 are you taking, what dose is it?

You dont have a full thyroid panel there as the NHS rarely test FT3. To make a full assessment you need TSH, FT4 & FT3.

Free T4 (fT4) 15 pmol/L (10.5 - 21) 42.9%

Presumably you left the full 24 hours between last dose of Levo & blood test.

How do you feel?

I would expect your FT4 to be much higher when you are optimally replaced, more like in the 80 - 90% range.

Your TSH is still on the high side despite being within the normal range.

Suggest you push GP for a trial increase of 25mcgs.

Do remind them of the NICE guidelines and dose by weight calculation of 1.6 x weight in kilos = approx final Levo dose.

nice.org.uk/guidance/ng145

[Wilma76 in reply to Jaydee1507]

Hi I’m taking Natures Bounty 1000iu but I’m taking two a day. When I had my super dose all my dry skin cleared and came back immediately when I stopped.

I do feel better but then I suppose I would with the slight increase and vitamins. I was thinking I might ask for a trial increase again. It was hard work getting the first one.

I requested all my thyroid test results since I was first diagnosed in 2014 and there is quite a fluctuation year by year in my results is that normal?

Thank you

[Jaydee1507 Administrator in reply to Wilma76]

2,000iu is a low dose of vit D. Its quite possible that you need a bit more, maybe 3-4,000iu but retest vit D in 3 months. Does your supplement also have vitK2 in it? K2 helps the vit D go to your bones where its needed.

It definitely can be hard work getting dose i ncreases but keep trying and asking different doctors if necessary. You're not asking for too much, just the right amount to make you feel well.

Particularly when under replaced fluctuations can happen, also in the early days of autoimmune hypo. TSH varies throughout the day so if your tests were taken under slightly different conditions and times then thats also a factor.

[Obsdian in reply to Jaydee1507]

Is this another postcode lottery testing thing? My gp did thyroglobulin as well.

[Jaydee1507 Administrator in reply to Obsdian]

I was under the impression that the NHS only tested TPO and doesn't believe in Tg antibodies but perhaps you're in an area thats a bit different?

[Obsdian in reply to Jaydee1507]

I don't know. They just ran it in March.

[PurpleNails Administrator]

Is this the first time your TPO antibodies been tested ?

Most hypothyroidism is due to Hashimoto’s (autoimmune thyroiditis) which is shown by positive TPO antibodies or positive TG antibodies.

Doctors don’t know how to treat the autoimmune aspect, the treatment is to replace to the low levels.

Antibodies can fluctuate so it’s currently negative but it might have been over range in past.

If it was positive your doctor might have advised your hypothyroidism is due to autoimmune but other that that there wouldn’t be anything further to do.

[Wilma76 in reply to PurpleNails]

Thank you yes first time

[Wilma76 in reply to Wilma76]

To say the doctor says mine is caused by a prolactinoma I had.

[SlowDragon Administrator]

Looking at previous post

healthunlocked.com/thyroidu...

You were only on 50mcg Levo

Dose increased to 75mcg

Free T4 (fT4) 15 pmol/L (10.5 - 21) 

Ft4 (levothyroxine) only 42.9% through range

New test results show you are now ready for next increase to 100mcg levothyroxine

When adequately treated most people will have Ft4 at least 70% through range

Typically eventual daily dose is approximately 1.6mcg per kilo of your weight per day

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.

Some people need a bit less than guidelines, some a bit more

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...

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

[SlowDragon Administrator]

Are you lactose intolerant

Do you always get Teva brand levothyroxine

Teva is only brand that makes 75mcg tablets

Vitamin levels low because you were/are on inadequate dose levothyroxine

Vitamin D - 34.9 nmo/l- range under 30 is deficient. 30-50 may be inadequate.

Vitamin D needs retesting

Test twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

aiming for vitamin D at least over 80nmol minimum

B12 - 344ng/l (211-911)

Folate - 7.30 ug/l (>4.12) 6.13 is replete.

Both far too low

Exactly what B vitamins are you taking

Have you retested

[Wilma76 in reply to SlowDragon]

Thank you for coming back to me. I’ve managed to get a telephone appointment for the end of May to request an increase.

I’m not lactose intolerant.

Sometimes the pharmacy give me a different brand for the 25mcg but always Teva for 50mcg. I’ve been using a pill splitter so I can keep consistency whilst I’ve been introducing vitamins and getting used to my increase.

I’ve not retested my vitamins yet.

I’ve been using Nature Provides liquid drops B12.

Natures Bounty Vitamin D 1000iu but I’m taking two.

Holland and Barratt Vitamin B complex with Vitamin C

Thanks for all the links

[SlowDragon Administrator in reply to Wilma76]

Holland and Barratt Vitamin B complex with Vitamin C

Suggest you get a better quality vitamin B complex next time

Difference between folate and folic acid

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[Wilma76 in reply to SlowDragon]

Hi, I had my GP appointment today, via telephone, different GP again. She is very reluctant to increase my medication as I’m in range and she’s worried I’ll become hyper and the increase risk to my heart. She says I need to list my symptoms and she will write and ask an endocrinologist for their advice. I quoted the NICE guidelines but she said it’s 1-1.5mcg per kg and they can’t just use those as a blanket for everyone anyway.

I’d printed off every test since I was diagnosed and pointed out the fluctuations year by year meaning I wasn’t correctly dosed. She said I was in range in every one.

She said my symptoms could be menopausal.

She also suggested I see a private endocrinologist and to be honest, I think that’s my next route.

Feels like that was a waste of time!

[SlowDragon Administrator in reply to Wilma76]

How much do you weigh in kilo

Unless extremely petite you will need to be on at least 100mcg per day

retest FULL thyroid and vitamins 6-8 weeks after working on improving very low vitamin levels

Then take these results to endocrinologist

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

[Wilma76 in reply to SlowDragon]

Thank you. ☺️ i weigh 85kg

[SlowDragon Administrator in reply to Wilma76]

Even if we frequently start on only 50mcg, 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

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.

Some people need a bit less than guidelines, some a bit more

85 kilo x 1.6mcg - suggests eventually may need to be on approximately 136mcg Levo per day

[Wilma76 in reply to SlowDragon]

Thank you I’ve now got an appointment with a private endocrinologist