Does high TGB-ab but normal TPO-ab still mean Hashimoto's?

[Ponchik]

Hello, I have normal TSH level (1.44 mlU/L), normal anti-TPO antibodies (5 U/ml) but high anti-thyroglobulin Abs. (333 U/ml). Do these test results imply Hashimoto's or could this be something else? If this is Hashimoto's as my doctor believes, why my anti-TPO results are normal? Thank you.

[gimel]

Please post all those results and reference ranges shown on your lab report.  Also tell us about any symptoms you are having.  

[jramosvi]

My TSH and Free T4 were normal.  TPO results were normal.  Tg was 182 mg/dl (normal) but my Tg ab was high (5 IU).  Is this also indication of Hashimoto's or is this more indicative of thyroid cancer?

[gimel]

Doctors like to believe that TSH accurately reflects thyroid status; however, TSH cannot be shown to correlate well with either of the biologically active thyroid hormones, Free T3 or Free T4, much less correlate well with symptoms, which should be the number one concern.  So, if you are experiencing symptoms of being hypothyroid, I would ask for more extensive testing.  Specifically I recommend tests for Free T3 and Free T4, along with the TSH they always insist on running.  Also, would be good to test for Vitamin D, B12 and ferritin (iron).  

When TG ab or TPO ab results are high, it is indicative of Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously determines the thyroid gland to be "foreign" to the body and produces antibodies to attack and eventually destroy the gland.  As the output of thyroid hormone diminishes, the patient has to replace with thyroid med.  

You can try to get the above testing done by your regular doctor, but you need to have a good thyroid doctor, to assure adequate testing and treatment.  That does not automatically mean an Endo.    A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

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

[myragp]

My TSH is normal, but my thyroglobulin Ab is abnormal (4).
My regular doctor said that we should watch it because I might develop hypothyroidism. Should I do anything about this, see specialist, etc.?

[Red_Star]

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

"Test purpose - To detect circulating antithyroglobulin antibodies when clinical evidence indicates Hashimoto's thyroiditis, Graves disease or other thyroid diseases.

Increased Values - positive
anaemia (autoimmune hemolytic a., pernicious a.), rheumatoid arthritis, hypothyroidism, active autoimmune disease of the thyroid, systematic lupus erythematosus, Graves' disease, myxedema, thyroid tumours, goiter - (adenomatous g., diffuse g., lymphadenoid g., nodular g.), Sjögren's sy, thyroiditis - (granulomatous t., Hashimoto's t.), thyrotoxicosis

Interfering Factors: healthy individuals, elderly women"

[gimel]

After having been tested and confirmed with Hashi's, further testing for TPO ab and TG ab really is not necessary.  More important is to check for Free T3 and Free T4 each time you go in for tests.  Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

A good thyroid doctor will test and adjust 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 and especially not TSH.  Regarding all those supplements you mention to aid you, I don't know about you, but I could never even keep up with such a schedule.  With Hashi's the thyroid gland is being gradually destroyed.  As that proceeds, you will need to take increasing amounts of thyroid meds to offset the loss of natural thyroid.  I fully support this as the best approach for preventing symptoms caused by diminishing levels of thyroid hormone.  

So, you need to get your doctor to test for Free T3 and Free T4.  It would also be a good idea to test for Vitamin D, B12 and ferritin, since hypo patients are frequently too low in the ranges for those as well.  You also need to find out if the doctor is going to be willing to treat clinically as described above.  If not, then you will ultimately need to find a good thyroid doctor that will do so.

For some further insight, I think you will find this very interesting.

http://hormonerestoration.com/Thyroid.html

[Ponchik]

Thanks for your reply. Over the past 4 years I have experienced some growth/sallowness in the thyroid area of my neck which sometimes makes me feel uncomfortable pressure in that area. Not much other symptoms. I was diagnosed with Hashimoto's 3 years ago and back then my T3 and T4 levels were normal. Now my new doctor for some reason only tested me for the antibodies and TSH level and no T3 and T4. I am taking Vitamin D supplement as I indeed was too low on it when I was first diagnosed. Have been searching for supplement ideas for my condition and found the following in Aristo Vojdani's book about Hashi's:

Tyroid tissue disorder related to thyroglobulin (TGB)
autoimmune response. It is also a common site
for autoimmune attacks. A positive TGB antibody tests suggests
Hashimoto’s.
Nutritional support:
Regulatory T-cell Support:
Emulsified vitamin D and liposomal glutathione and superoxide
dismutase cream.
Nutrients that support TH-1 response or TH-2 response:
Nutritional compounds to support the TH-1 response: Key
ingredients include astragalus root extract, Echinacea purpurea
root, licorice root extract, porcine thymus gland, lemon balm,
maitake mushroom, and pomegranate.
Nutritional compounds to support the TH-2 response.: Key
ingredients include pine bark extract, grape seed extract, green
tea extract, resveratrol, and pycnogenol.

Would appreciate any thoughts and suggestions on supplements that I could also continue taking if I am planning a pregnancy. Thanks

[gimel]

Hashi's can be diagnosed by having either or both of the two tests show as above range.  So, your doctor is correct.  

Have you been tested for the biologically active thyroid hormones, Free T3 and Free T4?  If not you should make sure those are tested each time you go in for tests.  Also, since hypo patients are frequently too low in the ranges for Vitamin D. B12 and ferritin, you should get those tested as well.  If you were tested for Free T3 and Free T4, please post those results and their ranges.

What, if any, symptoms are you having?