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Help understanding antibodies
Hello
Hope someone can help me understand this. Does everyone have tpo antibodies or do only people that have hashi or graves have them? My guess is that because of there being a normal range everyone must have some. My result came close to the top end of normal.It was 92iu/mL(0.0-100.0). So I'm wondering if the borderline number is cause for concern or not. Should I be rechecking it? If so, how long should I wait?
Hope someone can help me understand this. Does everyone have tpo antibodies or do only people that have hashi or graves have them? My guess is that because of there being a normal range everyone must have some. My result came close to the top end of normal.It was 92iu/mL(0.0-100.0). So I'm wondering if the borderline number is cause for concern or not. Should I be rechecking it? If so, how long should I wait?
COMMUNITY LEADER
Well, at least you're going to be getting the B12 injections... that should help, as should the vitamin D and iron.
At least your doctor has acknowledged that TPOab is close to the top and will recheck. When she rechecks in 3 months, insist on the TgAB, as well.
If you have to do private blood work, there are sites from which you can order online and they will send you a lab order and tell you which lab to go to in your area - usually Lab Corp. Last time I looked, you could get FT3, FT4, and TSH for $105 (they do need to be done from the same blood draw). I haven't looked at the cost of the antibodies for a long time.
At least your doctor has acknowledged that TPOab is close to the top and will recheck. When she rechecks in 3 months, insist on the TgAB, as well.
If you have to do private blood work, there are sites from which you can order online and they will send you a lab order and tell you which lab to go to in your area - usually Lab Corp. Last time I looked, you could get FT3, FT4, and TSH for $105 (they do need to be done from the same blood draw). I haven't looked at the cost of the antibodies for a long time.
Update: starting b12 injections and advised by doctor to get vit D supplements as well as iron. Couldn't get her to agree to look into thyroid more but has noticed that the tpo ab are close to the top so will recheck them in 3 months time along with the above to make sure they are improving. I am going to start taking all of this and see if it makes me feel better, If it doesn't I might have to look into doing some private blood tests to check FT3 and the other antibodies.
COMMUNITY LEADER
You should have enough ammunition, now to face your doctor... Good luck and be sure to let us know how it all turns out...
Thank you so much Barb...I agree with all your points. It all needs looking into more. We shall have to wait and see what she says.
COMMUNITY LEADER
Your antibody tests are positive for Hashimoto's. Is the T4, total or free? If it doesn't say "Free" on the lab report, it's total, which is considered obsolete and of little value.
That said, your T4 level is over the range and your TSH is suppressed... In my opinion, you appear to be over medicated with the 150 mcg thyroxine. Do you have symptoms of over medication, such as sudden weight loss, nervousness, diarrhea, heart palpitations, rapid heart rate, etc?
I don't understand the need for surgery; why not simply reduce the thyroxine dose, so your thyroid levels can come down? The antibodies are in the process of destroying your thyroid, which is what happens with Hashimoto's. My thyroid has already been destroyed by them - no surgery necessary...
Yes, thyroid issues can affect fertility, but it wouldn't be the antibodies doing that; it would be inadequate or too much of the thyroid hormones (FT3 and FT4). I don't see an FT3, you should ask your doctor to order one, so we can get a better picture of your situation. FT3 is the active hormone, that's used by the individual cells.
That said, your T4 level is over the range and your TSH is suppressed... In my opinion, you appear to be over medicated with the 150 mcg thyroxine. Do you have symptoms of over medication, such as sudden weight loss, nervousness, diarrhea, heart palpitations, rapid heart rate, etc?
I don't understand the need for surgery; why not simply reduce the thyroxine dose, so your thyroid levels can come down? The antibodies are in the process of destroying your thyroid, which is what happens with Hashimoto's. My thyroid has already been destroyed by them - no surgery necessary...
Yes, thyroid issues can affect fertility, but it wouldn't be the antibodies doing that; it would be inadequate or too much of the thyroid hormones (FT3 and FT4). I don't see an FT3, you should ask your doctor to order one, so we can get a better picture of your situation. FT3 is the active hormone, that's used by the individual cells.
COMMUNITY LEADER
Your ferritin is way too low in the range. Ferritin should be at least around 50. Vitamin D should also be in the 50-80 range.
While your vitamin B12 is "in range" it's also way too low. I have to keep my B12 at/near the very top of its range in order to feel well.
You should talk to your doctor about supplementing all of these. Also, because your ferritin is so low, you should ask for a complete iron panel, which includes iron, Total Iron Binding Capacity, % saturation and another ferritin.
Last, but not least, don't forget to insist on the FT3 and FT4, along with the TgAB... You really need that TgAB in order to make sure you're being diagnosed properly.
While your vitamin B12 is "in range" it's also way too low. I have to keep my B12 at/near the very top of its range in order to feel well.
You should talk to your doctor about supplementing all of these. Also, because your ferritin is so low, you should ask for a complete iron panel, which includes iron, Total Iron Binding Capacity, % saturation and another ferritin.
Last, but not least, don't forget to insist on the FT3 and FT4, along with the TgAB... You really need that TgAB in order to make sure you're being diagnosed properly.
anti thyroglobulin > 3000 IU/mL (<40)
Antithyroid peroxidase 148 IU/mL (<35)
serum T4 11.20 ug/dl (5.5 - 11)
serum TSH 0.03 uiU/ml (0.4 - 4.2)
these are the readings i got after taking hydrocartisone 30mg daily, 150mg thyroxin and Surbex Z 1tab daily. for 2.5 months.
Now my doctor suggested me surgery as the results are very high in case of antiTG and anti tpo. what should i do.? surgery was never in my plans.
I am married for 9 years and no kids yet.is this related to infertility as well?
Antithyroid peroxidase 148 IU/mL (<35)
serum T4 11.20 ug/dl (5.5 - 11)
serum TSH 0.03 uiU/ml (0.4 - 4.2)
these are the readings i got after taking hydrocartisone 30mg daily, 150mg thyroxin and Surbex Z 1tab daily. for 2.5 months.
Now my doctor suggested me surgery as the results are very high in case of antiTG and anti tpo. what should i do.? surgery was never in my plans.
I am married for 9 years and no kids yet.is this related to infertility as well?
Hi Barb
Here are the full results I got 3 weeks ago
Total white blood count 4.3 10*9/L (4.0-11.0)
Red blood cell count 4.05 10*12/L (3.8-5.3)
Haemoglobin concentration: 124g/L (115.0-160.0)
Haematocrit 0.363 1/1 (0.35-0.46)
Mean cell volume : 89.6 fL( 80.0-100.0)
Mean cell haemoglobin level: 30.6 pg(27.0-32.0)
Red blood cell distr. width : 14.2 (11-16)
Platelet count - 159 10*9/L (150.0-400.0)
Meal platelet volume : 8.7 fL
Neutrophil count: 2.56 10*9/L (2.0-8.0)
Lymphocyte count 1.37 10*9/L(1.0-4.5)
Monocyte count : 0.34 10*9/L(0.1-0.8)
Eosinophil count : <0.01 10*9/L(0.0-0.4)
Basophil count 0.01 10*9/L (0.0- 0.3)
TSH 1.40 mu/L ( 0.35-5.5)
FT4 16.4 pmol/L (10.0-19.8)
LH 13.2 (1.3-8.4)
FSH: 11 (2.9-8.4) this turned out to be 16 days before my period so around ovulation
I insisted that I wasn't "just depressed" and listed all the symptoms that to me didn't go with depression (ie: hair loss) and managed to convince her to do some for tests. So from a week ago:
Vitamin B12 362 ng/L (211-911)
Folate 6.19 ug/L (greater than 5.38)
Ferritin 12 ug/L (10 - 291)
Anti TTG(igA) 0.2 u/mL(0.0-6.0) this result makes coeliac unlikely but doesn't exclude it
IgA Coeliac 1.6g/L(0.8-3.7)
Thyroid peroxidase antibody 92 iu/mL (0.0-100.0)
Serum albumin level 41 g/L (30-51)
Serum calcium level 2.28 mmol/L
Corrected serum calcium level 2.22mmol (2.1-2.5)
serum inorganic phosphate level 1.37 mmol/L (0.8-1.4)
serum alkaline phosphatase 70u/L (30-135)
serum C reactive protein level 2 mg/L (0.0-6.0)
serum prolactin level 146mu/L (59-619)
25Oh vitamin D
serum 25-Hydroxy vitamin D3 level 24.3 nmol/L
serum vitamin d2 level 5.0 nmol/L
I am seeing her in two days to discuss these results. I was told over the phone by the receptionist that my results were all fine but I insisted on getting a copy of these results and eventhough I am not a doctor I can tell that some of these are not fine at all. They might not be out of range but they are quite low. I do agree that I should see a different doctor but I will give her one last try to see if she will acknowledge what everyone keeps pointing out (low ferritin, low vitamin D etc).
Starting to wonder about pernicious anemia and the tpo ab so close to the top of the range. Then again my b12 isn't that low so maybe not...
Here are the full results I got 3 weeks ago
Total white blood count 4.3 10*9/L (4.0-11.0)
Red blood cell count 4.05 10*12/L (3.8-5.3)
Haemoglobin concentration: 124g/L (115.0-160.0)
Haematocrit 0.363 1/1 (0.35-0.46)
Mean cell volume : 89.6 fL( 80.0-100.0)
Mean cell haemoglobin level: 30.6 pg(27.0-32.0)
Red blood cell distr. width : 14.2 (11-16)
Platelet count - 159 10*9/L (150.0-400.0)
Meal platelet volume : 8.7 fL
Neutrophil count: 2.56 10*9/L (2.0-8.0)
Lymphocyte count 1.37 10*9/L(1.0-4.5)
Monocyte count : 0.34 10*9/L(0.1-0.8)
Eosinophil count : <0.01 10*9/L(0.0-0.4)
Basophil count 0.01 10*9/L (0.0- 0.3)
TSH 1.40 mu/L ( 0.35-5.5)
FT4 16.4 pmol/L (10.0-19.8)
LH 13.2 (1.3-8.4)
FSH: 11 (2.9-8.4) this turned out to be 16 days before my period so around ovulation
I insisted that I wasn't "just depressed" and listed all the symptoms that to me didn't go with depression (ie: hair loss) and managed to convince her to do some for tests. So from a week ago:
Vitamin B12 362 ng/L (211-911)
Folate 6.19 ug/L (greater than 5.38)
Ferritin 12 ug/L (10 - 291)
Anti TTG(igA) 0.2 u/mL(0.0-6.0) this result makes coeliac unlikely but doesn't exclude it
IgA Coeliac 1.6g/L(0.8-3.7)
Thyroid peroxidase antibody 92 iu/mL (0.0-100.0)
Serum albumin level 41 g/L (30-51)
Serum calcium level 2.28 mmol/L
Corrected serum calcium level 2.22mmol (2.1-2.5)
serum inorganic phosphate level 1.37 mmol/L (0.8-1.4)
serum alkaline phosphatase 70u/L (30-135)
serum C reactive protein level 2 mg/L (0.0-6.0)
serum prolactin level 146mu/L (59-619)
25Oh vitamin D
serum 25-Hydroxy vitamin D3 level 24.3 nmol/L
serum vitamin d2 level 5.0 nmol/L
I am seeing her in two days to discuss these results. I was told over the phone by the receptionist that my results were all fine but I insisted on getting a copy of these results and eventhough I am not a doctor I can tell that some of these are not fine at all. They might not be out of range but they are quite low. I do agree that I should see a different doctor but I will give her one last try to see if she will acknowledge what everyone keeps pointing out (low ferritin, low vitamin D etc).
Starting to wonder about pernicious anemia and the tpo ab so close to the top of the range. Then again my b12 isn't that low so maybe not...
COMMUNITY LEADER
If your lab report specifies free, then it is. It's a good idea to list your tests as Free T4 or FT4, so we don't have to question it, because if we see just a T4 or T3, we assume it to be total.
I'm not really confused by the reference range, because we know that different labs have different ranges, depending on the equipment, methodology and tolerances used to run the test; it's just that that one is a bit odd.
If our doctor truly believes that "depression stands alone", I strongly suggest that you find another doctor, as this one will keep you ill.
Please post some of your "hardly normal" results, with reference ranges. Your ferritin result is way too low in the range. Did your doctor suggest supplementing or did she think that result of 12 was "fine"? What about B-12 and vitamin D? Deficiency in some vitamins can mimic hypo symptoms; deficiency in others comes with their own set of symptoms. Please post results with reference ranges.
I think a couple months would be about right to retest the TPOab and don't forget to insist on the TgAB, I mentioned above, as well. Because you haven't had that, you may already have been misdiagnosed.
I'm not really confused by the reference range, because we know that different labs have different ranges, depending on the equipment, methodology and tolerances used to run the test; it's just that that one is a bit odd.
If our doctor truly believes that "depression stands alone", I strongly suggest that you find another doctor, as this one will keep you ill.
Please post some of your "hardly normal" results, with reference ranges. Your ferritin result is way too low in the range. Did your doctor suggest supplementing or did she think that result of 12 was "fine"? What about B-12 and vitamin D? Deficiency in some vitamins can mimic hypo symptoms; deficiency in others comes with their own set of symptoms. Please post results with reference ranges.
I think a couple months would be about right to retest the TPOab and don't forget to insist on the TgAB, I mentioned above, as well. Because you haven't had that, you may already have been misdiagnosed.
It definitely has the word free in there so it must be free T4.
I was also confused by the range on tpo ab as most results I have seen posted tend to be 0-35 not 0-100.
How long would you think I should wait to re-test the antibodies? Couple of months?
I wish my doctor would humor me...she's the most unhumoring person I've ever met! According to her ""depression stands alone"....as in depression can't be the symptom of something else it is only the cause of feeling low/depressed.
I agree with the normal levels.Some of mine are really hardly normal. For example ferratin is 12 (10-291).
I was also confused by the range on tpo ab as most results I have seen posted tend to be 0-35 not 0-100.
How long would you think I should wait to re-test the antibodies? Couple of months?
I wish my doctor would humor me...she's the most unhumoring person I've ever met! According to her ""depression stands alone"....as in depression can't be the symptom of something else it is only the cause of feeling low/depressed.
I agree with the normal levels.Some of mine are really hardly normal. For example ferratin is 12 (10-291).
COMMUNITY LEADER
Does the lab report specify FREE T4? Your result looks like it could be Total T4, which is considered obsolete and of little value. If the lab report doesn't specify "Free", then the result is total.
Yes, by all means, you need to have FT3 tested, as well, since that's the actual hormone that's used by individual cells, while T4 is a storage hormone and must be converted to the usable FT3.
When it comes to ferritin, vitamin B12, D, etc, I don't put a lot of stock in "normal" results, because they can be within the normal range and still not be normal for you.
Yes, one week is too soon to recheck the TPOab, as I'm sure not much will have changed that quickly.
As I noted before, TPOab can be present at lower levels with other autoimmune diseases, as well as Hashimoto's. Yes, 92 is considered negative, because it's less than 100, but 101 would be considered positive, because it's more than 100. I will say that's a pretty high range; most we see are < 35, but as I said before, ranges vary lab to lab, which is why they have to come from your own report.
My recommendation would be to get TSH, FT3 and FT4 tested again, so you can see where the FT3 falls in its range. Do make sure the test is for FREE T3 and FREE T4, not totals.
Is there any way you could get your doctor to humor you by prescribing a trial dose of thyroid replacement hormone, just to see if it helps your symptoms? Depression is a major symptom of hypothyroidism.
Yes, by all means, you need to have FT3 tested, as well, since that's the actual hormone that's used by individual cells, while T4 is a storage hormone and must be converted to the usable FT3.
When it comes to ferritin, vitamin B12, D, etc, I don't put a lot of stock in "normal" results, because they can be within the normal range and still not be normal for you.
Yes, one week is too soon to recheck the TPOab, as I'm sure not much will have changed that quickly.
As I noted before, TPOab can be present at lower levels with other autoimmune diseases, as well as Hashimoto's. Yes, 92 is considered negative, because it's less than 100, but 101 would be considered positive, because it's more than 100. I will say that's a pretty high range; most we see are < 35, but as I said before, ranges vary lab to lab, which is why they have to come from your own report.
My recommendation would be to get TSH, FT3 and FT4 tested again, so you can see where the FT3 falls in its range. Do make sure the test is for FREE T3 and FREE T4, not totals.
Is there any way you could get your doctor to humor you by prescribing a trial dose of thyroid replacement hormone, just to see if it helps your symptoms? Depression is a major symptom of hypothyroidism.
"MPJ Vanderpump, WMG Tunbridge et al, “The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey” Clinical Endocrinology, 1995, 43:55-68
“A logit model [logarithmic probability model] indicated that increasing values of serum TSH above 2 mU/L at first survey increased the probability of developing hypothyroidism which was further increased in the presence of anti-thyroid antibodies.”
“The current study has demonstrated that the presence of anti-thyroid antibodies or raised serum TSH alone was associated with a highly significant raised risk of developing hypothyroidism at twenty years. It has also demonstrated that, independent of age, the higher the serum TSH above 2 mU/L, the greater is the prognostic significance for the development of overt hypothyroidism in subjects with or without anti-thyroid antibodies.”"
Excerpt from Thyroid Australia - Thyroid Function Tests And Hypothyroidism.
“A logit model [logarithmic probability model] indicated that increasing values of serum TSH above 2 mU/L at first survey increased the probability of developing hypothyroidism which was further increased in the presence of anti-thyroid antibodies.”
“The current study has demonstrated that the presence of anti-thyroid antibodies or raised serum TSH alone was associated with a highly significant raised risk of developing hypothyroidism at twenty years. It has also demonstrated that, independent of age, the higher the serum TSH above 2 mU/L, the greater is the prognostic significance for the development of overt hypothyroidism in subjects with or without anti-thyroid antibodies.”"
Excerpt from Thyroid Australia - Thyroid Function Tests And Hypothyroidism.
And another question I I have is this...92 is negative but 101 would be considered positive? Is that correct? Seems so odd when it's so close.
Hi Barb
thank you for your reply. I was curious to know if a result so close to the top of what is considered normal means that something is going on with the thyroid.
No diagnosis so far. Went to doctor a few weeks ago because I had enough of feeling so rubbish. I was suspecting perhaps a hormonal imbalance of some sort but gp didn't take me seriously and just decided that I have depression.To shut me up the gp ordered some basic tests like full blood count ,tsh and ft4 and lh and fsh. Those all came back normal.
I managed to convince the gp to do more tests because I didn't agree they could all be down to depression. Some of the symptoms are fatigue,depression that comes and goes,joint pain,hair loss,cold hands and feet even in the middle of summer, feeling the cold more than normal etc.
Results I had were:
TSH 1.40 mu/L ( 0.35-5.5)
T4 16.4 pmol/L (10.0-19.8)
Other than the tpo antibodies we tested ferritin,b12,folate and vitamin d amongst other things. D and ferritin are both down at the bottom of the normal range so can possibly explain some of the symptoms but the tpo antibodies is what has thrown me through a loop. Going to discuss these latest results at the end of the week (tpo, ferritin etc) so not on any treatment yet. Someone suggested asking to check ft3 as well. Would it be too soon to recheck the tpo antibodies? These were tested a week ago.
Sorry if this is all a bit of jumbled mess of a reply. Finding it hard to focus at the moment.
thank you for your reply. I was curious to know if a result so close to the top of what is considered normal means that something is going on with the thyroid.
No diagnosis so far. Went to doctor a few weeks ago because I had enough of feeling so rubbish. I was suspecting perhaps a hormonal imbalance of some sort but gp didn't take me seriously and just decided that I have depression.To shut me up the gp ordered some basic tests like full blood count ,tsh and ft4 and lh and fsh. Those all came back normal.
I managed to convince the gp to do more tests because I didn't agree they could all be down to depression. Some of the symptoms are fatigue,depression that comes and goes,joint pain,hair loss,cold hands and feet even in the middle of summer, feeling the cold more than normal etc.
Results I had were:
TSH 1.40 mu/L ( 0.35-5.5)
T4 16.4 pmol/L (10.0-19.8)
Other than the tpo antibodies we tested ferritin,b12,folate and vitamin d amongst other things. D and ferritin are both down at the bottom of the normal range so can possibly explain some of the symptoms but the tpo antibodies is what has thrown me through a loop. Going to discuss these latest results at the end of the week (tpo, ferritin etc) so not on any treatment yet. Someone suggested asking to check ft3 as well. Would it be too soon to recheck the tpo antibodies? These were tested a week ago.
Sorry if this is all a bit of jumbled mess of a reply. Finding it hard to focus at the moment.
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Your result at 92 would, typically, be considered negative for Hashimoto's; however, if I were you, I'd want to keep an eye on them to see if the level rises.
Do you have a diagnosed thyroid condition? What prompted the TPOab test? Did you also have a Thyroglobulin Antibody (TgAB) test? TgAB is another marker for Hashimoto's, so if you haven't had that test, you need to ask for it. If your doctor says you don't have Hashi's based on the TPOab, s/he could be misdiagnosing you. Some of us only have TPOab, while others only have TgAB and still others have both.
Do you have symptoms of a thyroid condition? Have you been tested for the actual thyroid hormones, Free T3 and Free T4? If so, please post the results, here so we can better understand your situation. Be sure to include reference ranges, as ranges vary lab to lab and have to come from your own report.