What Is Thyroglobulin Antibody
In order to understand what thyroglobulin antibodies are, we first have to talk about thyroglobulin itself.
Thyroglobulin is a protein the thyroid gland uses to create T3 and T4 or thyroid hormones. Doctors often check thyroglobulin levels in people who received thyroid cancer treatment .
The immune system may mistakenly identify thyroglobulin as a harmful substance. In turn, it produces antibodies to attack thyroglobulin, otherwise known as TgAb .
According to some estimates, about 10% of the general population produces at least some TgAb. This rate goes up to 80% in those with thyroid disorders, such as in Hashimotos or Graves disease. Thats why TgAb are used as a marker of autoimmune thyroid problems .
Thyroglobulin antibodies can bind to thyroid cells, but its not entirely clear if they cause damage. These antibodies mostly become a problem when trying to measure thyroglobulin, as they skew thyroglobulin test results .
I Found Out My Thyroglobulin Antibody Is High Now What
Despite thyroglobulin antibody levels showing a correlation with thyroid health, research supports that they are not a strong predictor of thyroid disease. There are much more reliable tests for diagnosing Hashimotos thyroiditis, such as TPO-antibodies, TSH levels, and thyroxine levels.
Hashimotos thyroiditis is a common autoimmune condition that causes the immune system to attack the thyroid gland. In some cases, this leads to hypothyroidism, however this is much less common than many people assume .
Hashimotos is diagnosed by several thyroid function tests, such as [1
- Low thyroid hormone levels, reported as free or total T3 and T4
- Elevated thyroid peroxidase antibodies
- Elevated thyroglobulin antibodies
- Elevated TSH antibodies
While TPO-antibodies are more indicative of Hashimotos thyroiditis, elevated anti-TG antibodies are often reported on lab results, creating concern for patients.
A 2019 study found that anti-TG antibodies are elevated in 60-80% of patients with Hashimotos thyroiditis and in 40-60% of those with Graves disease. However, the presence of thyroglobulin antibodies showed only a low-to-moderate sensitivity in diagnosing autoimmune thyroiditis. Additionally, they were not useful in identifying when a patient has transitioned from subclinical to overt hypothyroidism .
It is no wonder that these elusive antibodies cause so much confusion to health care providers and patients.
Thea Score: Assessing Your Risk For Hypothyroidism
Once you have your lab results in hand, there is a great tool that your clinician can use to help determine the aggressiveness of your condition. The Thyroid Event Amsterdam Score is a score that can help assess your risk of progression into hypothyroidism.
The THEA score is used to help estimate the risk of developing hypothyroidism within five years in people who have TPO antibodies, and can also help estimate the risk for those who have relatives with thyroid diseases.
Please note that thyroid antibodies make a very big contribution to the total THEA score.
How does THEA work? It applies a certain amount of points towards different measures. These measures consist of genetic predisposition as well as lab test results. Ive included a chart that shows you how the scoring is made.
Genetic predisposition: We know there is a genetic component to developing Hashimotos, and it tends to run in families. So, if you have relatives with Hashimotos, that increases your risk. And if you have been diagnosed with thyroid disease, theres a greater chance that a loved one like your child, parent or sibling may be at risk as well.
Hashimotos can occur in two varieties: an organ wasting form associated with HLA-DR3 gene inheritance, and an enlarged thyroid form through HLA-DR5 inheritance.
People with these genes and who have a relative with Hashimotos would get points. Someone with multiple relatives with Hashimotos would get additional points.
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What To Do If Your Antibodies Are Elevated
Like Anna, perhaps you have been struggling with possible thyroid-related symptoms: anxiety, fatigue, brain fog, digestive issues, insomnia, weight gain, hormone imbalances, fertility challenges, miscarriages and youre pretty sure its your thyroid. You go to your wonderful doctor who gladly orders a complete set of thyroid labs. When you get your test results, you learn that your thyroid labs show that you have Hashimotos your TSH is high, your Free T3 or Free T4 could be low, and your thyroid antibodies are positive. And whoa if these tests are all sounding like Greek to you dont worry. . The presence of thyroid auto-antiantibodies in the blood, in conjunction with high TSH, or low FT4 or FT4 is indicative of Hashimotos versus non-autoimmune hypothyroidism. Hashimotos is the most common form of thyroid disease in the Western world, and it almost exclusively affects women.
Another scenario could be that your other thyroid labs are within normal ranges, and just your thyroid antibodies are high. In this case many doctors have been taught to dismiss this as no big deal but in fact, elevated antibodies gives you an elevated risk for developing Hashimotos later on.
Youre determined to bring those thyroid antibodies down! But is that possible? Perhaps your doctor said its just something you have to live with nothing can be done.
What Is The Takeaway
One potential flaw in the study is the fact that hypothyroidism was defined as a TSH > 4.6. There are some clinicians who believe that the range for TSH is far to broad and that TSH should be within a tighter window such as 1.5, 2.0, or 2.5 as the upper cut-off point. There is little evidence to support this claim for every single human being who has Hashimotoâs or hypothyroidism.
Sure, some people just feel better with a TSH that is in these lower ranges but some people also feel great with higher TSH levels. As with everything in functional medicine, this is an individualized question which shouldnât be set in stone.
Additionally, as pointed out above, the patients who did have TSH levels above 4.6 after the 6 year follow-up had normal thyroid function despite the higher TSH levels.
Once weâve dealt with the most significant causes of Hashimotoâs thyroiditis including gut health, infections such as Epstein-Barr Virus, food sensitivities like gluten, vitamin D deficiency, selenium deficiency, stress, and childhood adversity, you can be confident that your immune system will continue to heal and stay in balance.
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What If You Dont Test Positive For Thyroid Antibodies Can You Still Have Hashimotos
Current medical reports state that 80-90 percent of people with Hashimotos will have TPO antibodies. That said, researchers at the University of Wisconsins Thyroid Multidisciplinary Clinic found that only half of the patients who tested positive for Hashimotos through cytology had TPO antibodies. This means that a person can have Hashimotos even if their thyroid antibody test is negative. This variant of Hashimotos is known as serum negative Hashimotos and is a less aggressive form of Hashimotos, so it will be slower developing.
Additionally, researchers have identified that the body may produce other thyroid antibodies, that are not yet available outside of research labs, but may also play a role in thyroid disease, including Sodium-iodine symporter and Pendrin . The clinical relevance of these antibodies is not yet understood, but as with all emerging research, we just want to be aware of it. NISAb is found in 17 percent of people with Hashimotos and Pendrin is found in 11 percent.
Ive included a chart from UpToDate that shows the estimated prevalence of these three antithyroid antibodies in various populations. Again, keep in mind that the more elevated these antibodies are, the more likely you are to progress to the stage that involves the destruction of your thyroid.
|< 35 IU/mL||
< 2 IU/mL
Stage : The Genetic Predisposition
The first stage is when the person does not have any manifestations of Hashimotos. So, they are going to have a normal TSH and will have normal thyroid function. They will not have any elevated thyroid antibodies. If you were to biopsy their thyroid gland, it would be perfectly normal. They just have the genes at this point. Again, there are 3 requirements for the disease to progress: genetics, intestinal permeability, and one or more triggers.
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Thyroid Stimulating Hormone Receptor Antibodies
TSH starts the hormone-making process by binding to structures on the thyroid gland called TSH receptors. TSH receptor antibodies can imitate the action of TSH. This causes hyperthyroidism, when the thyroid makes too much hormone.
TSHR antibodies are also called thyroid-stimulating immunoglobulins . High levels are associated with an autoimmune condition called Graves’ disease.
Thyroglobulin Antibody Normal Range + High Levels
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Why Its Important To Lower Tpo Antibodies
In case you didnt already catch this:
Many patients with Hashimotos are being mismanaged.
For the most part, doctors tend to ignore thyroid antibody levels because they believe it doesnt change how they would treat you.
In other words, why care about something that doesnt impact management?
I dont agree with this logic, obviously, but this is exactly what they are thinking.
Instead of looking at your thyroid antibodies, they will measure your TSH.
If your TSH is greater than 5.0 then they will slap you on some levothyroxine and call it a day.
Meanwhile, as you are taking your thyroid medication, your immune system remains active and continues to damage your thyroid gland slowly day by day.
Ultimately, this process will result in the complete destruction of your thyroid gland if it is left unchecked.
If this approach doesnt sound appealing, you arent alone.
It turns out there is a much better way to manage Hashimotos.
The better way includes keeping track of both your thyroid function and thyroid antibodies.
It turns out you can walk and chew gum at the same time!
Theres no need to hyper-focus on just thyroid function while excluding the important role that your immune system plays in the Hashimotos disease state.
Your doctor wont recommend this method, though, because they dont believe medical treatments exist for balancing the immune system .
But thats not the case.
Did your antibodies go down? Did they go up?
Having said that:
Conflict Of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The reviewer JC and handling Editor declared their shared affiliation, and the handling Editor states that the process nevertheless met the standards of a fair and objective review.
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Elisa For Tpo Antibody Binding
mAb47 was used to capture recombinant TPO from CHO-TPO cell extracts. Binding of Fabs and patient sera to captured TPO was studied in different MMI conditions, with MMI added after Fab or serum binding. Sera that were positive for TPO antibodies on a conventional chemiluminescent assay from 36 patients with AITD were studied including 30 with Graves disease, and six with autoimmune hypothyroidism . All sera were collected with the approval of the Northumberland Tyne and Wear local research ethics committee . Ninety-six well ELISA plates were coated with 3 g mAb47 in carbonate coating buffer per well, overnight. After 3× 5 min PBS 0.1% Tween washes, wells were blocked with 2% BSA in PBST for 1 h and incubated overnight with CHO-TPO cell extracts in 2 mg/ml BSA in PBS. Wells were again washed and incubated overnight with either Fabs or Graves patient sera, individually diluted to 1/500 in 2 mg/ml BSA in PBST. To study the effect of MMI, wells were incubated with MMI for 30 min at 37°C. Fab or serum Ig binding was detected with antihuman IgG, Fab-specific Alk-Phos Conjugate raised in goat . Absorbance was measured after 1 h incubation pNPP ELISA substrate , using a 96-well-plate spectrophotometer .
Positive Antithyroid Antibodies And Nonsuppressed Tsh Are Associated With Thyroid Cancer: A Retrospective Cross
The relationship between Hashimotos thyroiditis and thyroid cancer is a controversial topic it remains unclear if HT acts as a risk factor of TC. The aim of our study was to compare the presence of HT and thyroid function in patients with TC and benign nodules. We analyzed 2571 patients after fine needle aspiration biopsy of thyroid nodule. Totally, 91 patients with primary TC and 182 sex- and age-matched controls were included. Positive antithyroid peroxidase and antithyroglobulin antibodies were associated with TC , and the TC group had significantly higher TSH . Using multiple logistic regression, positive anti-TPO was identified as an independent risk factor , while spontaneously suppressed was a protective factor against TC. In conclusion, nodules in subjects with positive antithyroid antibodies could be considered to have a higher risk of malignancy. However, based on our results, it is not possible to declare that TC is triggered by HT.
The aim of this study was to compare the prevalence of antithyroid antibodies, thyroid dysfunction, and thyroid texture and volume measured by ultrasound in patients with TC and benign nodules recruited from subjects undergoing fine needle aspiration biopsy of thyroid nodules in our outpatient departments. We also analyzed available data for thyroid cancer-specific mortality and recurrence of TC.
2.2. FNAB and Thyroid Ultrasound
2.3. Statistical Analysis
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How Often Should You Test Your Thyroid Antibodies
I often hear from readers who say that their doctors refuse to retest their thyroid antibodies, stating that once a person is thyroid antibody positive, they will always be positive, so retesting the antibodies is useless. I disagree. Tracking your thyroid antibodies can give you an idea of how aggressive the attack is on your thyroid gland. While other lab markers and symptoms should be considered, generally, a lower thyroid antibody number indicates that your condition is improving, while a higher antibody number may indicate that you are having a flare-up or that your condition is worsening.
Tracking antibodies can give you an idea of whether the interventions youre utilizing are working, i.e. is your change in diet leading to an improvement in your condition?
When implementing active interventions, you can check antibody levels every 1-3 months to see a trend however, it will take anywhere from 3 months to 2 years to see the full impact of an intervention.
But My Doctor Said My Tsh Level Is Normal
My doctor said my TSH level is normal, so why should I worry about testing for thyroid antibodies?
I cant tell you how many times I hear this in my clinical practice and from readers. And I thought this myself many years ago. I spent almost a decade undiagnosed because I only had my TSH tested, and my thyroid diagnosis was completely missed. I had been told that my thyroid was normal even though my TSH was 4.5 IU/mL. That left me struggling with progressively worse symptoms for almost ten years symptoms like chronic fatigue, anxiety, depression, hair loss and many others.
This is why Im so passionate about advocating for you to get the proper tests and for you to understand your tests. Had I known then what was happening in my body, I could have taken on the lifestyle modifications and treatment steps necessary to not only alleviate my progressing symptoms but also prevent further damage to my thyroid.
Thyroid antibodies are going to be the first indication of a thyroid problem in many cases. They can be elevated for 5, 10, sometimes even 15 years before a change in TSH is even detected! Keep in mind that the presence of thyroid antibodies means that there is an active destruction going on against your thyroid.
Elevated thyroid antibodies, even in the presence of a normal TSH, means that its only a matter of time before your thyroid becomes destroyed to the point it can no longer produce sufficient amount of hormones.
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What Are The Thyroid Antibodies That Need To Be Tested
There are three main types of antibodies in Hashimotos that are potentially going to be present. Two of them are created by the immune system to target the thyroid gland as if it were a foreign invader like a pathogen, and those are Thyroid Peroxidase and Thyroglobulin antibodies.
80-90 percent of people with Hashimotos will haveeitherTPO or TG antibodies, or both. The more elevated the thyroid antibodies are, the greater the likelihood of developing overt hypothyroidism as well as possibly additional autoimmune conditions.
Where do these antibodies come from? The current scientific thinking is that activated B-cells in the thyroid gland and lymph nodes secrete these antibodies, and that they react solely as markers but dont necessary attack the thyroid gland themselves. They likely activate T-cells, which then do the actual damage on the thyroid gland.
The third type of thyroid antibodies is TSH-Receptor antibodies, including thyroid-stimulating immunoglobulin . This particular marker is elevated in more than 90 percent of people with Graves disease. TSH-R antibodies are also more common in people who have thyroid cancer.
Another TSH-R antibody is known as TSH-binding inhibiting immunoglobulin . This is elevated in > 50 percent of people with Graves disease.