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Thyroid Peroxidase and thyroglobulin antibodies
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Thyroid Peroxidase and thyroglobulin antibodies

My husband has been feeling horrible, tired, miserable, and has hives all over his body for 9 months. He is unable to sleep due to itching and has red welts all over his body. Was seen by 8 Dr's and found nothing except a thyroid nodule that has to be checked.  He is taking Prednisone.  Finally an allergist did blood work and found his Thyroid Peroxidase was 80 and thyroglobulin antibodies were 411.  Dr told him to follow up with more blood work in 1 week.  He's in agony, he doesn't want to wait another week.  I have some questions:

1)  what do these results mean?
2)  why is the Dr waiting?
3)  what can be done to get these number down?
4)  could these results be what is causing his symptoms?
5)  Is it serious?
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Avatar_m_tn
Hives may be associated with autoimmune thyroid disease.   The TPO ab and TG ab tests indicate an autoimmune thyroid disease called Hashimoto's Thyroiditis.  With Hashi's, the autoimmune system mistakenly identifies the thyroid glands as foreign to the body and produces the antibodies to attack the glands.   Over an extended period, the glands are destroyed.  Along the way, the loss of natural thyroid hormone production has to be compensated by taking gradually increasing amounts of thyroid medication, adequate to relieve hypo symptoms.

Instead of waiting for a week, maybe the doctor will agree for your husband to come in now and have blood drawn for testing.  Then the results would be available for discussion at the appointment.   When your husband does go in for blood work, he should request testing for the biologically active thyroid hormones, Free T3 and Free T4 (not the same as Total T3 and Total T4), along with the TSH they always test for.  If the doctor resists, then insist on it and don't take no for an answer.  Free T3 is the most important thyroid hormone test because FT3 largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  

Since hypo patients frequently have deficiencies in other areas, I would suggest additional testing for Vitamin A, D, B12, zinc, selenium, and RBC magnesium.  

With Hashi's there seems to be two approaches used by doctors.  One is to start medication fairly early, to prevent the worst of hypo symptoms.  Others like to wait until hypo symptoms become overt.   You can read about the preventive approach at this link.

http://thyroid.about.com/od/hypothyroidismhashimotos/a/preventative.htm

Regardless of the treatment approach, Hashi's does not go away, but the resultant symptoms can be minimized by taking adequate doses of the proper medication.   It will become very important to him to find a good thyroid doctor that will treat him clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  This is a link to a letter written by a good thyroid doctor.  Note the clinical approach to treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf


If your husband will get that testing done and get the lab report and post results and reference ranges, then members will be glad to help interpret and advise further.   In the interim, there are a couple of thing that he can do that have been reported to help.  One is to take 100 mg of selenium daily.  Some members have found this to dampen the level of the antibodies.  I also remember some member reporting on using a lotion of some kind that helped the rash a lot.  I will do some searching and see if I can locate that info.  
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Avatar_m_tn
Hives may be associated with autoimmune thyroid disease.   The TPO ab and TG ab tests indicate an autoimmune thyroid disease called Hashimoto's Thyroiditis.  With Hashi's, the autoimmune system mistakenly identifies the thyroid glands as foreign to the body and produces the antibodies to attack the glands.   Over an extended period, the glands are destroyed.  Along the way, the loss of natural thyroid hormone production has to be compensated by taking gradually increasing amounts of thyroid medication, adequate to relieve hypo symptoms.

Instead of waiting for a week, maybe the doctor will agree for your husband to come in now and have blood drawn for testing.  Then the results would be available for discussion at the appointment.   When your husband does go in for blood work, he should request testing for the biologically active thyroid hormones, Free T3 and Free T4 (not the same as Total T3 and Total T4), along with the TSH they always test for.  If the doctor resists, then insist on it and don't take no for an answer.  Free T3 is the most important thyroid hormone test because FT3 largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  

Since hypo patients frequently have deficiencies in other areas, I would suggest additional testing for Vitamin A, D, B12, zinc, selenium, and RBC magnesium.  

With Hashi's there seems to be two approaches used by doctors.  One is to start medication fairly early, to prevent the worst of hypo symptoms.  Others like to wait until hypo symptoms become overt.   You can read about the preventive approach at this link.

http://thyroid.about.com/od/hypothyroidismhashimotos/a/preventative.htm

Regardless of the treatment approach, Hashi's does not go away, but the resultant symptoms can be minimized by taking adequate doses of the proper medication.   It will become very important to him to find a good thyroid doctor that will treat him clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  This is a link to a letter written by a good thyroid doctor.  Note the clinical approach to treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf


If your husband will get that testing done and get the lab report and post results and reference ranges, then members will be glad to help interpret and advise further.   In the interim, there are a couple of thing that he can do that have been reported to help.  One is to take 100 mg of selenium daily.  Some members have found this to dampen the level of the antibodies.  I also remember some member reporting on using a lotion of some kind that helped the rash a lot.  I will do some searching and see if I can locate that info.  
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1756321_tn?1377771734
1) Hashimoto thyroiditis (autoimmune hypothyroidism) - antibodies to various thyroid antigens, the most frequently detected of which include anti-thyroid peroxidase (anti-TPO), antithyroglobulin (anti-Tg), and to a lesser extent, TSH receptor-blocking antibodies.

***

2) Some doctors don't like to rush into treatment for any number of reasons such as symptoms resolving without further treatment needed, unnecessary side effects etc.

***

3) Yes. There is a lot of information online and published (based on clinical trials, ancedotal evidence, and clinical practice) showing thyroid antibodies can be lowered. Just to note, not all thyroid sufferers will show the same results so take that into account. This is just a small sample...

Clinical practice -

From the book called Your Thyroid Problems Solved by Dr Sandra Cabot. This is what she noted in her practice with one of her patients. Dr Cabot is a famous naturopath (is also an MD) here in Australia. I've edited this information:  

Patient with Hashimoto's Thyroiditis:

The level of her T3 hormone is very low, whilst her T4 level is quite high; the high T4 is coming from her thyroxine medication. The body is not converting thyroxine (T4) into T3.

Free T3 = 1.1 pmol/L (2.5 - 6.0)
Free T4 = 23 pmol/L (8.0 - 22.0)
TSH = 2.0 mIU/L
Anti thyroglobulin antibodies = 80
Anti microsomal antibodies = 1200 (thyroid peroxidase antibodies)

New treatment: Patient prescribed T3 (brand name tertroxin) 20mcg three times a day, T4 100mcg a day, selenium (Dr Cabot recommends 200mcg daily), gluten and dairy free diet, bowel and liver detox.

Three months later:

Free T3 = 5.0 pmol/L (2.5 - 6.0)
Free T4 = 16 pmol/L (8.0 - 22.0)
TSH = 1.9mIU/L
Anti thyroglobulin antibodies = 40
Anti microsomal antibodies = 350

Clinical trials -

I've just added two but there are many more:

Turkey -  2006 Journal of Endocrinology.  This study showed a 30% decrease in anti-thyroid antibodies after 3 months of 200mcg per day of L-selenomethionine supplementation for in women with Hashimotos Thyroiditis. The starting average TPOAb was 803 and after 3 months the average was 572.  

"In the study of 21 patients with euthyroid Hashimoto's Thyroiditis (normal range TSH, but elevated antibodies), half of the patients were treated with levothyroxine for a year, the other half were not treated. After 1 year of therapy with levothyroxine, the antibody levels and lymphocytes (evidence of inflammation) decreased significantly only in the group receiving the medication. Among the untreated group, the antibody levels rose or remained the same."  

Ancedotal evidence -

Gluten free diet lowers TgAb antibodies.

http://www.medhelp.org/posts/Thyroid-Disorders/Gluten-Free-Diet-Lowers-TgAb-but-not-TPOab/show/1003484

***

4) Yes.  "Elevated thyroid antibodies are often associated with chronic urticaria, also called hives. Studies report that as many as 57.4% of patients with hives have the presence of anti-thyroid antibodies. An August 2010 paper suggests that treatment with T4 improves the itching associated with urticaria, but did not advise treatment with T4 unless the patient was hypothyroid." - excerpt from Life Extention - Thyroid Regulation

From what i've read, vitamin D deficiency is common in 98% of patients suffering with autoimmune thyroid due to defects in the receptor site for vitamin D.  

The University of Nebraska Medical Center research study has determined that patients with chronic hives may benefit by supplementing with vitamin D.  The researchers found patients with chronic hives had significantly reduced levels of vitamin D, with nearly half of them considered to be vitamin D deficient.  Try 1,000 to 2,000 international units (IUs) daily.  The vitamin D council state optimal vitamin D levels - 80ng/mL or 200nmol/L.

***

5) As thyroid disease progresses, the worse the symptoms may grow in severity.  In some rare emergency cases, untreated hypothyroidism may lead to seizures, coma, heart failure. Death related to Hashimoto thyroiditis typically results from failure to make the diagnosis of hypothyroidism or to start thyroid replacement therapy in adequate doses, or from failure on the part of the patient to take the replacement medication.
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Avatar_m_tn
Still searching, but found this post that was interesting.




1457077_tn?1297225907
cjbethell

Oct 02, 2010
To: flyboy786786
I wrote about my condition on 9.26.10, so please read my previous post.  Today is 10.2.10 and there have been new developments.  On 9.25.10 I discontinued using Tirosint and have been taking no thyroid medication.  I had always suspected that the thyroid med was the cause of the hives, however today I tried something new.  Since d/c'ing the Tirosint 175mg, my hives have worsened daily.  Last night was the last straw.  This morning I took my antihistamines (Allegra 180mg, Singulaire 10mg, Ranitidine 150 mg, Atarax 50mg), waited one hour and took my Tirosint.  This past week the antihistamines haven't even touched my hives, they've just been spreading and getting worse all week.  Within 2 hours, the itching stopped and it appears the hives are going away.  The mistake I made previously when I started Tirosint was d/c'ing all my antihistamines.  I'm staying on them this time (at night I take Allegra 180mg, Atarax 50mg, Doxepin 20mg, Xyzal 5mg, Ranitidine 150mg.)  Yes, that is a ton of antihistamines, but my allergist discovered that if I take a antihistamine cocktail every day, I stop breaking out.  I will post the progress I make this week in solving this mystery that has been going on for 7 years.  I definitely cannot live without taking thyroid, as I have always been hypothyroid and have never experienced Hashimoto symptoms previously.  Stay tuned...
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Avatar_m_tn
One more bit of info I found in an old post.

.

Hello. I posted on the websire in July. I have done alot of research and went to my doctor. I have been diagnosed with Hashimoto's and have had hives pretty bad since Febuary. One of the this I had found while researching the relation between hives and Hashimoto's was a trial study. I tried and and have not had any hives. What a difference in my life with out them. I was miserable.
Medications like benadryl or atarax are labled a H1 histamine blockers. Meds like zantac, pepcid or tagament are H2 histamin blockers. I take 25 mg of atarax in the am along with a pepcid. In the pm, I take another pepcid. Coincidence or not since I have been doing this combination my hives have gone away. Just thougt I would share this.





If you want to do some more looking just enter the search items in the Search blank at top of page and you will find lots of info.
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Avatar_f_tn
Thank you so much for all of the wonderful information that you have given me.  I will post the results of the next labs.  You have helped me so much.  Of course, the Dr still thinks the hives are NOT related to Hashi.  I now know different.  Thank you again, I truly appreciate it!!!
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Avatar_f_tn
Thank you so much for the information on the gluten free diet and how it lowers the antibodies.  He will start on this diet today.  After seeing your information on the hives, I now know that the Dr is incorrect thinking the hives are NOT related to Hashi.  Thank you again, I truly appreciate it!!!
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107693_tn?1252868043
thank you for the information....
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