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Avatar universal

Anyone familiar with Anti TPO results in kE/L instead of ui/ml?

I recently had my Anti TPO antibodies tested along with other thyroid labs and this was done by a lab in Belgium which uses what seems to be a different unit for the Anti TPO. The results are as follows:

++ >1300 kE/L    (reference value <60Neg)

Previously, on another lab, it was around 400 ui/ml, and had been going down from over 600.

I contacted the lab and they say it is ui/mL are equivalent to kE/L which I assume they mean its the same as ui/L, not ui/ml because it doesn't make sense for something /ml and /l to be the same. Also, it would be unlikely for the anti TPO to be over 1300 ui/ml when it had been going down. At least I hope that is not the case.

If I take it to mean that kE/L is the same as ui/L and convert it to ui/ml using an online calculator, this lab will only show Anti TPO levels up to 1.3ui/ml. This can't be right, can it? That's too low to be useful in telling if your antibodies are going up or down so I'm sure I'm either doing something wrong or misunderstanding.

Is there anyone familiar with this who could help me?
Best Answer
1756321 tn?1547095325
Belgium uses SI (international) units.  Eenheden means units in dutch.  I found a dutch lab on TPOAb which states "Thyroïdperoxidase As [eenheden/volume] in serum of plasma" with normal lab range listed under 60 kE/L.  As the conversion factor for TPOAb is 1.0 the result is the same in both conventional and SI units.

Quest Diagnostics - International System of Units (SI Units)...

"Thyroid Peroxidase Antibody (Anti-TPO)
Gravimetric [conventional] Unit: IU/mL
Conversion Factor: 1.0
International Unit: kIU/L"

***

On Biostatistics - Laboratory Tests: U.S. Conventional units versus SI units and Their Conversion Factors...

"In pretty much all clinical trials, laboratory tests are performed as a tool for diagnosing the disease, assessing the safety / tolerability, assessing the pharmacokinetics / pharmacodynamics and so on. A very common issue is the reporting units for laboratory tests. There are two different unit systems: conventional units and SI units.

U.S. Conventional Units (may also be referred as United States customary units): In the United States, most people express distances in inches, feet, yards, or miles. Those units, along with the units we use for speed, volume, and other quantities, are known as the U.S. Conventional System.

SI Units or Système Internationale: The International System of Units (abbreviated SI from French: Le Système international d'unités) is the modern form of the metric system and is the world's most widely used system of measurement, used in both everyday commerce and science. Most scientists and most countries now use SI units. SI units use the meter, the kilogram, the second, and the kelvin. Each base unit measures a different quantity. For example, the meter measures length, and the kilogram measures mass.

The units of these two systems are different, but the quantities they represent do not change. The units have a fixed relationship to each other. The laboratory results reported in U.S. Conventional Units can be converted into the results in SI Units or vice versa. The relationship to convert a value from one system to the other is called conversion factor."

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Avatar universal
You probably just got lucky with your genes on the weight issue...I'm jealous!  LOL

Your FT3:RT3 ratio is quite low.  It's 11.7, and it should be very close to 20.0 or over.  There are good thyroid doctors who believe that FT3:RT3 ratio is the best measure we have of tissue thyroid levels.  There is no way to measure tissue levels directly.  You might do some research on RT3 dominance (also called Wilson's syndrome or Wilson's temperature syndrome in older literature) to see if your symptoms seem to fit.

I agree with you; your vitamins and minerals look good.  It looks like you're absorbing things just fine.

Multivitamins are pretty useless.  They tend not to use the most bio-available forms of the vitamins and minerals.  For example, most multis use magnesium oxide as their source of mag, and mag oxide can actually deplete serum mag levels because so little of it is absorbed (and it becomes a laxative once it his the intestine).

Do some research on RT3 dominance.  I think you'll find it interesting.  If any questions are generated, feel free to ask.  
Helpful - 0
Avatar universal
Thank you for all this information.

As for being underweight, I have always been according to the BMI which is not the most accurate thing. I have really small bones so maybe that is part of the reason because I do eat enough and I'm not just skin and bones, I do have fat on my body, I'm just small.

As for reverse T3, I did have it tested as well, I don't know why I didn't include it. It is 0.30 (range 0.14 - 0.54) . Also had Anti thyroglobuline tested, 124ke/l, should have been less than 60.

As for being unable to absorb nutrients, I actually suspected that but I also had some vitamins and minerals tested which make me think that it is not an issue for me, specially since my vitamin b12 levels are very good and that's something that people with malabsorption are usually low on, from what I read. But I'm no expert, so if you would like to give your opinion on the results below, it will be certainly welcome.

Vitamin B12 788ng/l (range 300-835)
Selenium  156ug/L (range 90-143)
Zinc           141ug/L (84-135)
Folic Acid 1266 nmol/l (range >285)
Vitamin A 1,49 umol/l (range 1,13 - 2,72)
Vitamin D 116,8 nmol/l (range > 50)

3 months ago I also had Iron and ferritin levels tested and they were within range, though on the low end.

I'm not taking any medication at all, except now the LDN which I started 4 days ago. All I have been taking since January are vitamins and supplements. Previously I have taken birth control, but stopped over 2 years ago.

I'm also eating healthier now than I was before. I'm actually tracking what I eat to make sure I'm not eating too little with the paleo thing and I'm eating all the calories I need to maintain my current weight. Before I was also eating enough calories, sometimes more than enough but a lot of it was carbs and sugar, which is not very healthy. But I was taking a multivitamin to make sure I didn't become deficient on anything since I was trying to conceive.

I have not discussed getting my T3 up because up until I saw this doctor, who prefers a more natural approach to things when possible and seems to be more thorough, no other doctor even tried to test anything besides TSH, anti tpo and T4. I didn't even know that medication was an option for me.

Basically, if I hadn't gone to this new doctor, and following the advice of the other doctors I've been to, I would be doing nothing at all and waiting until my TSH went above 6. At that point I would be given thyroid hormones to lower my TSH. They didn't care that I was extremely tired, that I could sleep 10+ hours each night and still be sleepy and willing and able to sleep more, they think if the TSH is in range, iron is range, there's no reason to be tired and I must be stressed and it must be just a phase in life where I feel more tired.
Helpful - 0
Avatar universal
Many years ago, AACE recommended that TSH range be changed to 0.3-3.0, which is much more reasonable than the old ranges most labs and doctors still use.  3.0 is still too high for many people.

I agree with your doctor.  Your FT4 should be around 50% of range, and it's way up at 95% of range.  On the other hand, FT3 should be above 50%, and yours is 8%.  FT3 should also be higher as a percentage of its range than FT4 is of its.  Your FT3 is much lower than FT4, which does indicate a conversion issue.  Have you ever discussed trying to get your FT3 up by starting some T3 meds (Cytomel and generics)?  Your FT3 and FT4 are way out of balance.

FT3 is the test that correlates best with symptoms, so it's logical that most of your symptoms are hypo.

Chances of miscarriage are increased by low FT3 and/or FT4 levels.

Antibodies are very specific.  They're programmed to attack one, and only one, protein.  So, thyroid antibodies are not going to attack an embryo.  Even the two thyroid antibodies, TPOab and TGab, only attack one substance and one cannot cross over and attack the other.

A number of factors can impact conversion and how efficiently thyroid hormones transport into cells.  Vitamin D must be present in sufficient quantity in cells (not just on the bottom of the range) or thyroid hormones can't get in.  Ferritin also figures into that.  The enzyme that catalyzes the conversion of T4 to T3 is a selenium-based enzyme, so low levels of selenium can diminish conversion.  

Have you ever had RT3 tested?  There are only two ways your body can get rid of excess T4.  It can convert it to T3, which is the form your cells can use, or it can convert it to RT3, which is inert.  With all that T4 floating around in your blood, we'd expect your FT3 to be much higher than it is.  All that FT4 has to be going somewhere, and that would make RT3 a likely suspect.  If you have RT3 tested, you have to test FT3 on the same draw because it's the ratio of the two that's important, not the raw numbers.

I think you'd be much better off forgetting about the antibodies and concentrating on why your FT3 and FT4 are so far out of balance.  

You're not on any other meds that could be impacting conversion, are you?  Do you know why you're underweight?  Starvation, including starvation dieting, and malnutrition are both factors that can diminish conversion to FT3 and increase conversion to RT3.  Malnutrition can be related to inability to absorb nutrients, not just to poor diet.          
Helpful - 0
Avatar universal
FT3 is 3.5 pmol/l (range 3.23-6.47)
FT4 is 22.44 pmol/l (range 9.03-23.22)
TSH is 2.1 (0.3 - 4.5)

My TSH goes up and down. On this latest test it was 2. Previous one about 3 months ago was 4.2. I had three other tests over a one year period where it was between 2.2 and 2.6, which is acceptable. Before then it was above 4 most of the time, for three consecutive years, but I was only testing once a year back then. The highest it has ever been is 6.5.

According to the ranges of the labs I used, I'm fine and have always been except for the one time where it was 6.5.

It's really just the antibodies that are completely crazy. Although my current doctor said my FT4 is high and he thinks I have trouble converting T4 to T3 or something along those lines. I'm not on any medication because he said it might make my hyper instead of hypo or whatever it is I am now.

As for symptoms, I have mostly hypo ones. Hair loss, dry skin, extreme fatigue. I am underweight however, which is not a typical hypo symptom.

I have read about many women with TSH levels sky high who were able to conceive and some with high antibodies too. But I have also read that the high antibodies could be making my body attack the embryo before it even has a chance to implant. I have also read that it could increase the chances of having a miscarriage if I ever do get pregnant so I figured I would try to lower it. It's all I can do at the moment because the other doctor I go to will not run any fertility related tests before december because she claims I have to be trying for 12 months straight before they'll investigate, and I made the mistake of telling her I tried for 13 cycles but with a 6 month break in between. However, the only other things that could be wrong is either DH or blocked fallopian tubes from what I read, because I have been charting and using OPKs and it seems that I have been ovulation every cycle, with an long enough luteal phase.
Helpful - 0
Avatar universal
Many women who have Hashi's have successful pregnancies.  We've talked a lot about antibodies, but where are your FT3 and FT4 at?  Please include reference ranges which vary lab to lab.

I don't think lowering your thyroid antibodies (if that's even possible for you) is going to make you less susceptible to another autoimmune.  Autoimmune diseases run in families, so there's probably a genetic element to it (too late for you to do anything about that now).  Often, the same family will have different autoimmunes, so it seems it's the tendency of the immune system to attack parts of the body as if they were foreign proteins that's inherited, not the specific autoimmune.  There's not a lot known about how the mechanism works exactly.

What are you on for meds?

Do you have any thyroid symptoms, hypo or hyper?  
Helpful - 0
Avatar universal
Thank you again for the information! You seem to know a lot about this.

I tried the Brazil nuts and then just switched to 200mg of selenium and that's what lowered my antibodies from over 600 (off the charts for that lab, not sure how high it was) to a little over 400. And it happened in less than two months. I kept up with the selenium, added vitamin D and a bunch of other supplements that supposedly help, went gluten free and no sugar and dairy for 10 days and then tested again which is when I got those very disappointing results.

It was very discouraging, but I'll keep trying. It would be a lot easier if I knew what to do and exactly what to avoid.

As for the exercise suggestion, I will try to do that as well. I'm not a big fan of exercise but often walk a lot (and bike sometimes) because I don't have (or need) a car. It's not regular though, it's whenever I have to run errands or go out in the weekends or sometimes for work. But I will try to do something everyday, I'm sure it will be good for my health regardless.

At this point I'm willing to try anything, because I'm in my 30s already and I really want to have kids, and I'm not having any success with that for over a year. The only thing that I can think of that could be preventing me from conceiving is the Hashimoto's because everything else seems to be in order.

Helpful - 0
Avatar universal
This is actually something I am considering, because this diet is really bad. For someone who likes meat, I'm sure it's easier, but for me it's a nightmare as I hate red meat and only tolerate small amounts of other meats. I also do not seem to have any adverse reactions to any food, nothing noticeable at least. But we'll see how long I can do this.

The reason I am giving this a shot is that I am having trouble conceiving and have read and and also heard from the doctor that the anti bodies might have something to do with it. And also that I might be able to actually heal the hashimoto's with a combination of diet and LDN so I decided to give it a try. Specially since I also read that when you have one auto immune disease, it's likely that you could could have others, which I would like to avoid.



Helpful - 0
1756321 tn?1547095325
I've found since starting exercise I need to keep stopping and starting thyroxine to stop hyperthyroid symptoms. Exercise boosts endorphins but so does LDN (stronger than exercise).

LOW-DOSE NALTREXONE (LDN) FACT SHEET...

"Once LDN is metabolized by the liver and eliminated from the body (after 3-4 hours), the elevated levels of endorphins produced, as a result of the rebound effect, can now interact and bind with the more sensitive and more plentiful opioid receptors. These opioid receptors, are found throughout the body, including virtually every cell of the body’s immune system.

The elevated levels of endorphins will usually last around 18-20 hours.
During this time the elevated endorphins act by up-regulating vital elements of the body’s immune cells. By doing so clinical trials has been shown that elevated levels of

• Down regulating inflammatory cytokines
• Reducing inflammation and oxidative stress
• Facilitating tissue repair and wound healing
• Restoring T-helper/CD4 levels
• Restoring the balance between Th1 & Th2 lymphocytes
• Increasing cytotoxic T cells and natural killer (NK) cells
• Regulating cell growth & inhibiting tumor growth
• Reducing excitotoxicity and microglial activation
• Reducing apoptosis of the myelin-producing oligodendrocytes
• Stimulating mucosal healing (lining of bowel)”"
Helpful - 0
1756321 tn?1547095325
No problem. :)  My TPOAb went from 550 to 470 eating about 3 to 4 brazil nuts daily (took 6 months).  When I was chronically hyperthyroid my TPOAb rose from 470 to 1900. I don't know what my levels are currently. I can't do strict paleo as my favourite food is cheese LOL.

Nivedita Nanda, Zachariah Bobby and Abdoul Hamide, 2012. Oxidative Stress In Anti Thyroperoxidase Antibody Positive Hypothyroid Patients. Asian Journal of Biochemistry, 7: 54-58....

"We recruited untreated hypothyroid patients consecutively from the out patient department. We analyzed their TPO Ab titer, various biochemical and oxidative stress parameters and ultra-sensitive C reactive protein. The thiobarbituric acid reactive substances, an indicator of oxidative stress was significantly higher in TPO Ab positive hypothyroid patients compared to TPO Ab negative cases. TPO Ab titer positively correlated with the OS parameters and extent of low grade inflammation in TPO Ab positive hypothyroid patients."

***

Excerpt from What thyroid patients should know about Oxidative Stress...

"Some Causes of oxidative stress

There are quite a few situations mentioned in articles and studies which can cause your body to be overly stressed from the results of oxidation and all the reactive oxygen species. They include, but are not limited to:

excess endurance exercising
excess weight lifting
lack of key antioxidant nutrients like Vitamin C, Vitamin E, Selenium, Magnesium and other minerals
excess radiation or sunlight
smoking (huge cause of oxidative stress)
excessive drinking or drug use
over-exposure to toxins in our air, water and foods like pesticides, chemicals, heavy metals and more
prescription medications
processed foods with all their artificial dyes, additives or flavorings
excess physical trauma
Graves disease aka hyperthyroidism
excess copper levels from the MTHFR defect"
Helpful - 0
Avatar universal
I think this begs the question, "How many antibodies does it take to destroy the thyroid?"  What are you really accomplishing by lowering your antibodies a hundred or so?  Are the antibodies that remain ample to destroy your thyroid?  Hashi's gets much more stable and easier to treat once the thyroid is dead.  All you are doing is prolonging its dying.  The outcome is inevitable at this time.    
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Avatar universal
Thank you everyone for helping, and specially Red_Star for such a thorough explanation.

I wish I knew what made my antibodies go up so much. I was not expecting that at all as I have been taking a lot of supplements that are supposed to help bring them down and it had been working up to this point.

I'm hoping the LDN that the doctor prescribed will help (and the horrid paleo diet I restarted today), but I'm not too optimistic after seeing that the other things I tried were possibly in vain.



Helpful - 0
Avatar universal
I can't find anything on "kE/L", either, but from a mathematical standpoint, I tend to think the two are the same.  "k" in the metric system stands for 1,000.  So, it would appear that "kE" is probably 1,000 IU.  One L is 1,000 ml.  So, kE/L would be the same as IU/ml.

If the units on both sides of the slash are multiplied by the same factor (1,000 in this case), then the two are directly comparable.  

Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Different labs use different measurements and different countries may be even more different than we are in the U.S., so it doesn't matter what units are used to measure with, you have to compare your results with the units used by the lab that did the actual test.  I've searched online and can't find anything that compares kE/L to either iu/L or iu/ml, so you'll have to take the lab's word for it that kE/L is equivalent to iu/ml, which is quite possible. Perhaps someone else on the forum will be more familiar with units of measure in Belgium...  

Antibody counts can fluctuate, so it's possible that yours might have increased, in spite of the fact that they may have been shown a decrease previously.
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