Avatar universal

Does high TGAb always mean Hashimoto's?

Over the past few years, I started to wonder if something is off with my thyroid (or something).  My TSH has always been in normal range, but about 10 years ago I began to acquire a mild case of vitiligo (~age 40), and about 7 years ago discovered my Vit D was insufficient, almost deficient.  Now I have other mild things going on that line up with being hypothyroid, but also could just be age or something else.  I’m now 50.

The Dr. didn’t think additional tests were necessary after seeing my TSH, so I ordered my own lab work.  This is what I received:
TSH       3.32 (0.4-4.37)
Free T3    2.7 (2.3-4.2)
FreeT4    1.0 (.8-1.8)
Reverse T3  12 (8-25)
TGAb     2 (<1)  - High
TPOAb     5 (<9) - Normal
Vitamin B12    839 pg/mL (180‐914) – I'm taking 50 mcg/day.
25(OH) Vitamin D    63 ng/mL (30‐100) – I'm taking 3800 IU/day.
Cholesterol and Triglycerides are high, too, though the Dr. doesn't think I need to be on a statin.

All thyroid tests are within normal range except TGAb.  I cannot find much about this type of situation.  Is this TGAb result only mildly high? Or significantly high?
I read that with Hashimoto’s, practically no one has high TGAb without also having high TPOAb, but my TPOAb is within range.

Other info.:
I’m slightly overweight, maybe 10 pounds. Previous experience is that if I lose that much, my cholesterol drops a lot.  But, it’s not easy to lose.  My diet is pretty decent as it is, and I jog 14 miles/week.
I would appreciate any input about the TGAb and whether this is indeed indicative of Hashimoto’s, even without the TPO antibodies.

6 Responses
1756321 tn?1547095325
Excerpt from Life Extension - Thyroid Regulation...

"There is evidence that the standard blood TSH test reference range may cause many cases of hypothyroidism to be missed. Most physicians accept a reference range for TSH between 0.45 and 4.5 µIU/mL to indicate normal thyroid function. In reality, though, a TSH reading of more than 2.0 may indicate lower-than-optimal thyroid hormone levels.34

According to a report in Lancet, various TSH levels that fall within normal range are associated with adverse health outcomes.31

TSH greater than 2.0: increased 20-year risk of hypothyroidism and increased risk of thyroid autoimmune disease

TSH between 2.0 and 4.0: hypercholesterolemia and cholesterol levels decline in response to T4 therapy

TSH greater than 4.0: greater risk of heart disease"


Excerpt from the book "Differential Diagnosis by Laboratory Medicine: A Quick Reference for Physicians" edited by Vincent Marks, Dusan Mesko...

"Anti-Thyroglobulin Antibodies.

Thyroglobulin is quite a strong autoantigen.  In healthy blood there are many B-lymphocytes with membrane-bounded IgM type thyroglobulin antibodies. IgG antibodies against thyroglobulin are Hashimoto's thyroiditis markers. The presence of autoantibodies to thyroglobulin can lead to the functional destruction of the thyroid gland.

Test Purpose. To detect and confirm autoimmune thyroiditis, Hashimoto's thyroiditis.

Increased Values - positive. anaemia (pernicious a., autoimmune hemolytic a.), rheumatoid arthritis, autoimmune disorders, granulomatosis, hyperthyroidism, hypothyroidism, systemic lupus erythematosus, Graves' disease, myasthenia gravis, idiopathic myxedema, myxedema coma, myxedema heart disease, thyroid tumours, syndrome - (Down sy, Sjogren's sy, Turner's sy), thyroiditis - (Hashimoto's t., de Quervain's subacute t.), thyrotoxicosis, rheumatoid - collagen disease, non-toxic nodular goiter

Interfering Factors: healthy people, medicaments - (amiodarone)."


Excerpt from the book "The Everything Guide To Thyroid Disease" by Theodore C. Friedman, MD, PhD and Winnie Yu Scherer:

"Although the majority of people with Hashimoto's will not develop any other disorders, it's important to know what some of these autoimmune conditions are in case you do start to experience symptoms. Keep in mind, too, that you may be more likely to develop Hashimoto's if you have one of these other conditions.

Type 1 diabetes
Pernicious Anaemia
Addison's Disease
Celiac Disease
Alopecia Areta
Systematic Lupus Erthematosus (SLE)
Rheumatoid Arthritis
Sjogren's Syndrome
Inflammatory Bowel Disease
Multiple Sclerosis (MS)"
Thank you, Red_Star.
Avatar universal
Red_Star gave you lots of good info on the fallacy of reliance on TSH as the sole diagnostic.  TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  Your FT4 and FT3 are only about 20% of their ranges, which is far too low for many people. Due to the erroneous assumptions used to establish reference ranges for FT4 and FT3, the ranges are far too broad toward the low end.  If you will read the following quote from an excellent thyroid doctor, you can see that your FT4 and FT3 are far too low in the range.  

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."
649848 tn?1534633700
SklyerO...What other symptoms or things do you have going on that could indicate hypothyroidism?  

The reason I ask is because looking at your Free T4 and Free T3, I see that they are considerably lower than is, typically, recommended or where most of us feel the best.  Most of us find that we feel best with Free T4 about mid range; yours is only at 20% of range.  Also, most of us feel best with Free T3 in the upper half to upper third of its range and yours is only at 21% of the range.  

Since Free T3 is the hormone actually used by individual cells throughout the body, if we don't have enough, we aren't going to feel well.

TSH should never be used as the sole diagnostic so if your doctor is doing that, it's time for a different doctor.  You need one who will look at actual thyroid hormones (Free T4 and Free T3), along with symptoms, not just TSH.  

While TgAb can be present/elevated with other autoimmunes, the most likely, with your labs is Hashimoto's... It's not uncommon to someone with Hashimoto's to have only TgAb - some of have one or the other, TgAb or TPOab and have both. It's very possible that your levels simply haven't ramped yet and if you check them again a few months down the road, they may be higher...

I'm not a doctor, but if I were, I'd start you on a small dose of replacement thyroid hormone medication to see if it helps alleviate your symptoms.
Avatar universal
Thanks, Gimel and Barb135.  To answer the question about other symptoms....
- Vitamin D would be quite low without supplements even though I am out in the sun a few hours a week.
- High cholesterol and triglycerides (both just over 200).  Even my ob/gyn thinks it's strange because my diet is good, I exercise regularly, and I'm not very overweight. But, she thinks my family doctor should treat it, not her.
- Vitiligo has appeared in the past 10 years, mainly on my hands.  It happens to coincide with the low Vit D, and seems unusual that I didn't have it before age 40.  
- dry skin
- gradually gaining weight (ok, that could be age)
- recurrent corneal erosions...not sure if that could be thyroid related. I've had these for 15+ years. Eye Dr. thinks they are due to a corneal dystrophy, but not specific.
- swollen hands and feet, and sometimes even my tongue
- eyebrows are thinner.  My hair seems fine now that I take Vit D. It was definitely falling out before, which is how I discovered the Vit D problem.
- increased anxiety
- I've had both plantar fasciitis and frozen shoulder in recent years, but managed to get over both. Took a long time.
- In the past 6 months, I suddenly have arthritis in my fingers and maybe my knee.  My mother has OE - her fingers are knobby, but she says it's not rheumatoid. Looks like I'm on the same path :-(

Despite all this, I feel pretty good.  I'm not one to get overly worried about health issues, but it just seems like an odd collection of things.  My family Dr. seems unconcerned.  Ob/gyn wants to check my TSH again in 12 weeks.  I don't think it will be any different over a short period.  It was about 2 in 2011, and it's been over 3 for several years, so it looks like a slow rise.

I am also beginning to wonder if autoimmune issues may run in my family, though it's hard to tell because my extended family is small.  My grandfather became diabetic in his 30s or 40s, most likely Type 1 late onset.  My mother has the OE and gout, and she's Type 2 diabetic (supposedly not autoimmune).  My sister gets hives for no known reason.

Final note...my 20-year-old son recently had a checkup, too, and his TSH is 3.5, Vitamin D is low, and his cholesterol is high.  Sounds familiar.  He is very thin and gets enough sun.
649848 tn?1534633700
Some of your symptoms definitely go with hypothyroidism, but it's not unusual for doctors to go funky and tell us those symptoms can apply to a dozen other things, too, when thyroid levels are in the normal ranges... I've been hearing it for years and I'm on replacement medication, but nobody wants to give me an increase in med, because of the "almighty" TSH...   :-(  

Don't ever let anyone convince you that weight gain is "age" related - it doesn't have to be.  I never had a weight problem in my life, but when I suddenly gained 30 lbs in < 2 months my doctor tried to tell me it was because I was getting older... give me a break; even age doesn't play that trick on us!!  

Go ahead and let your ob/gyn test your TSH in 12 weeks, but make sure they do Free T4 and Free T3 along with it, because TSH is a very minute piece of the puzzle.  You'd be surprised how quickly it can change... mine was perfectly normal one day, at 1.52, and just a few months later, it was 55.5 - when the thyroid fails it can do it quickly.

Since cholesterol is affected so strongly by thyroid hormone levels, it's not always necessary to "treat" it in any other way than treating the thyroid.  I've refused to take statin drugs because of all the side effects they cause and it's been proven that simply lowering cholesterol doesn't reduce heart attack anyway.

Type II diabetes is, basically, a condition caused by lifestyle - too much of the wrong foods (sugar/carbs) and not enough exercise that starts out with insulin resistance in which the body produces insulin, but the cells don't use it properly, so we have to keep producing more and more.  Eventually, we can't produce enough.  Type II diabetes can be prevented in most cases and with early intervention can even be reversed in many cases.

Type I diabetes is autoimmine and happens when the immune cells attack insulin producing beta cells in the pancreas.

Your grandfather could have been either one.  You might have been able to tell by his weight and overall health, but that's not always sure fire, either.

You might want to have your son ask to get his Free T4 and Free T3 tested "every" time he gets a TSH.  I can't stress enough, how important that is, especially, since he's so young and already has high cholesterol.  It might be good to make sure his blood glucose levels are tested on a regular basis as well.  Is he supplementing vitamin D?
1756321 tn?1547095325
No problem. :) Also to add, studies report that as many as 57.4% of patients with hives (urticaria) have the presence of thyroid antibodies.
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Queensland, Australia
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