How Does Each Thyroid Antibody Affect Your Body
The presence of each antibody affects your thyroid gland in sightly different ways:
Anti-thyroid peroxidase antibodies
The presence of TPOAb is associated with Hashimotos disease.
TPOAbs attack the healthy tissue of the thyroid gland and stop it from producing thyroid hormones. This is also known as having an underactive thyroid .
Up to 95% of people with Hashimotos will have TPO antibodies in their blood, making them the most obvious sign that you might have or will develop Hashimotos.
Anti-thyroglobulin antibodies
Thyroglobulin antibodies are another type of antibody associated with thyroid disease.
Like TPO antibodies, TgAb is also found in people with Hashimotos disease, but to a lesser extent.
Thyroid receptor antibodies
This group of antibodies target the Thyroid Stimulating Hormone receptors in the Thyroid gland. This can cause the gland to overproduce thyroid hormones, resulting in an overactive thyroid .
Hyperthyroidism can lead to Graves disease, and the TRAb are the root cause.
Key Thyroid Enzymes And Hormones
Before we discuss thyroid antibodies, lets look at the specific roles of thyroid hormones and enzymes in the human body:
- TSH : TSH regulates thyroid function by controlling the amount of T4 and T3 hormones produced in the thyroid gland .
- T4 : T4 is a thyroid hormone produced in the thyroid gland. It is converted to the active T3 when it enters the bloodstream .
- T3 : T3 is the thyroid hormone most actively involved in regulating body functions. It is both produced in the thyroid gland and converted from T4 in the bloodstream. .
- TPO : TPO is the main enzyme involved in producing T4 and T3 .
- TG : TG is a protein involved in producing T4 and T3 .
When Should I Get Testing For Thyroid Antibodies
It is not always necessary to test for thyroid antibodies to establish a diagnosis of an autoimmune disorder affecting the thyroid. However, doctors may find thyroid antibody testing helpful in the following situations:
- Subclinical hypothyroidism: In patients with a high TSH and a normal T4, testing for TPO antibodies may help predict whether the hypothyroidism will progress from being subclinical, in which it may not be causing significant or observable symptoms, to more severe and permanent dysfunction.
- Goiter: A goiter describes the abnormal enlargement of the thyroid gland. Some experts recommend testing for TPOAb in patients with a goiter, even if their thyroid hormone levels are normal.
- Hyperthyroidism, if the cause is not obvious: When patients have an overactive thyroid, sometimes it is clear from their physical examination and thyroid hormone tests that they have Graves disease. In less obvious cases, TRAb testing or imaging tests may be helpful in diagnosing or ruling out Graves disease.
- Monitoring after thyroid cancer treatment: Patients who are monitored with thyroglobulin testing after treatment may also have their TgAb levels tested as elevated TgAb can interfere with some thyroglobulin tests.
Although thyroglobulin antibodies may be elevated in both Hashimotos and Graves disease, it is not typically tested during diagnosis.
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How To Interpret Your Thyroid Antibody Test Results
There are a number of possible results from your thyroid antibody test, including:
- Negative for all antibodies you likely do not have an autoimmune thyroid disease
- Positive for TPOAb and/or TgAb you may have Hashimotos disease or Graves disease, depending on whether you’re producing too little or too much thyroid hormone
- Positive for TPOAb and TRAb this pattern is commonly seen in people with Graves disease. Hashimotos patients rarely test positive for TRAb.
The higher the number of antibodies you have, the more likely it is that you have an AITD. However, Dr. Mira says that some patients may have subclinical disease.
This means that antibodies are present but the symptoms are not yet full-blown. Patients with the condition are closely monitored by their doctors, she adds.
Doctors can also use antibody levels as a measure of how a patient with autoimmune disease is progressing during treatment.
The Importance Of Thyroid Antibodies Even In The Absence Of Hypothyroidism
Thyroid antibodies have been connected to many symptoms even in the absence of hypothyroidism. When people are in stage 2 and they have thyroid antibodies, they may start to exhibit a whole bunch of different non-specific symptoms like fatigue, anxiety, stress, miscarriages, weight gain, and just feeling unwell.
Without verifying the presence of thyroid antibodies, these types of symptoms may not be associated with developing thyroid disease, and they may end up being misdiagnosed as other things such as anxiety, fatigue , depression, menopause, or even hypochondria. I have personally seen a number of clients who were diagnosed with depression and even bipolar disease as a result of being in stage 2 and already having elevated thyroid antibodies for years.
Remember, if these antibodies go unchecked, we are going to potentially start seeing a progression into stage 3, where we see subclinical hypothyroidism, stage 4 where we start seeing changes in TSH, and stage 5 which may include the progression of other autoimmune conditions.
Note that a small number of antibodies may be present in normal individuals without thyroid disease. According to UpToDate, roughly 5-27 percent of the general population will test for extremely low levels of antibodies . But, when you find elevated thyroid antibodies outside of this range, that is an indicator that the immune system is targeting the thyroid gland for destruction.
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What Do The Results Of Tpo Antibodies Test Mean
The TPO antibodies test results may show one of the following options:
- Negative as you can already conclude negative TPO antibodies test result indicates that no thyroid antibodies were found. This result also implies that thyroid problems and symptoms a patient experiences are not caused by an autoimmune condition
- Positive antibodies to TPO and/or Tg this result indicate a patient may have Hashimotos thyroiditis
- Positive antibodies to TPO and/or TSH may indicate the presence of Graves disease
The higher the level of antibodies, the more likely it is that a patient has an autoimmune disease of the thyroid e.g., Hashimoto’s or Graves’ disease. Blood test results for TPO antibodies are positive in 95% of patients with Hashimotos thyroiditis and in 50% to 80% of people with Graves disease.
When it comes to TPOAbs, the reference value is < 9.0 IU/ml . Values above 9.0 are typically associated with autoimmune thyroid disease, but elevations are also observed in some other autoimmune conditions. The most commonly mentioned TPOAb reference range is less than 35 IU/ml.
The presence of TPOAbs in patients with subclinical hypothyroidism predicts an elevated risk of overt hypothyroidism. Moreover, this also shows that those patients could be at a higher risk of developing other autoimmune conditions like type 1 diabetes.
As mentioned above in the article, some people may be positive to TPO antibodies, but they do not have a thyroid condition.
Why Take A Thyroid Antibodies Test
Your doctor will usually order the test to see if your symptoms are caused by autoimmune thyroid diseases , such as Hashimotos disease and Graves disease.1
These diseases are usually caused by hypothyroidism or hyperthyroidism .
Besides helping diagnose your condition, a thyroid antibody test can also be used to:
- Monitor the progression of an AITD
- Determine if a person is at risk for AITD
- Monitor a patient after they have received treatment for thyroid cancer
- Determine if thyroid hormone treatment is needed in pregnant women with AITD
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Why Arent Thyroid Antibodies The Initial Screening Test Used For Thyroid Disease
You might wonder why TSH is still the standard screening test for thyroid disease given that thyroid antibodies can be elevated for decades before any change in TSH may even be seen.
Thats a good observation and an even better question. Unfortunately, many traditional doctors ONLY test for antibodies after they see an elevation in TSH. Its backwards from what it needs to be. That is why you need to be your own advocate and insist on thyroid antibodies testing. You can discuss this testing with your physician or you can also self-test, as the tests are not overly expensive. Ill talk more about that below.
At some point, the medical community will pick up on the importance of antibodies as an early warning for Hashimotos. I also believe labs will start to incorporate newer findings. For example, the reference range for TSH itself has already been redefined by the American College of Clinical Endocrinologists. The reference range was lowered , but most labs you get still use the old higher ranges as normal. That will hopefully change in the future.
On top of the reference ranges changing, we also know that a person with Hashimotos may fluctuate between high and low TSH readings. Reference ranges are also only average values, so even if your TSH reads as normal, you may not be. Remember, I was told my thyroid was normal when my TSH was 5.5 IU/mL, and I was sleeping for 12 hours each night! TSH is not the screening tool we should be solely using.
After You Take The Test
After your blood is drawn, a cotton swab and bandage will be placed on the arm to prevent bleeding. You should leave bandages on for a couple of hours. But you may still continue with your day-to-day activities.
For at-home tests, a band-aid will be provided. You will need to package and send off your blood sample to a lab for testing.
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What Are Thyroid Antibodies
Before we look at the different types of thyroid antibodies, lets first understand what an antibody is.
Antibodies are a type of protein that your body produces to help you get rid of unwelcome visitors, like bacteria, viruses, and other foreign substances. They do this by signalling your immune system to attack and destroy any foreign particles that could be harmful.
This system isnt foolproof though. In some people, their immune system is hypersensitive they end up producing antibodies that attack healthy parts of the body, like the thyroid. This is known as an autoimmune disease.
Conditions Associated With High Thyroid Peroxidase Antibodies
What does it mean if you have thyroid peroxidase antibodies floating around in your blood?
Well, it can mean several things:
- It may be a marker for the autoimmune disease known as Hashimotos thyroiditis.
- It may also be a marker for another autoimmune disease of the thyroid gland known as Graves disease .
- It may be a transient thing that may eventually go away on its own ).
The presence of thyroid peroxidase antibodies is never normal but it doesnt always guarantee a poor outcome.
For instance, as I mentioned above, some people see elevated antibodies during pregnancy which then fall after birth.
The significance of thyroid peroxidase in this exact setting is not well understood but it does give some hope that not every situation of elevated antibodies points to autoimmune disease.
Why would you want to check your thyroid peroxidase antibodies?
Your doctor can use this test in a number of useful ways:
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Thyroid Antibody Test Results
Antibody levels can be tested with a blood sample. The antibody test measures the amount of antibody per milliliter or liter of blood in “international units.”
Normal values are:
- TPO antibody: Less than 9 IU/mL
- Thyroid-stimulating immunoglobulin antibody : Less than 1.75 IU/L
- Anti-Tg antibody: Less than 4 IU/mL
Note that different laboratories may have different normal range values.
How Is Hashimoto’s Thyroiditis Treated
Your healthcare provider will figure out the best treatment for you based on:
- Your age, overall health, and medical history
- How sick you are
- How well you handle certain medicines, treatments, or therapies
- If your condition is expected to get worse
- Your opinion or preference
You will not need treatment if your thyroid hormone levels are normal. But Hashimoto’s thyroiditis often looks like an underactive thyroid gland. If so, it can be treated with medicine. The medicine replaces lost thyroid hormone. That should stop your symptoms. It can also ease a goiter if you have one. A goiter can cause problems like pain or trouble swallowing, breathing, or speaking. If these symptoms don’t get better, you may need surgery to remove the goiter.
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Who Is At Risk For Hashimotos Thyroiditis
Things that may make it more likely to you for to get Hashimotos thyroiditis are:
- Being a woman. Women are about 7 times more likely to have the disease. Hashimoto’s thyroiditis sometimes begins during pregnancy.
- Middle age. Most cases happen between 40 to 60 years of age. But it has been seen in younger people.
- Heredity. The disease tends to run in families. But no gene has been found that carries it.
- Autoimmune diseases. These health problems raise a persons risk. Some examples are rheumatoid arthritis and type 1 diabetes. Having this type of thyroiditis puts you at higher risk for other autoimmune illnesses.
Why Are Thyroid Antibodies Important
Keeping track of your antibody levels helps you understand if youre at risk of thyroid disease.
Also, autoimmune conditions are associated with one another. If you have a diagnosis of Hashimotos you might also be at risk of developing diseases including type 1 diabetes, Addisons, coeliac disease and pernicious anaemia.
The presence of antibodies to the thyroid might prompt your clinician to screen for these other diseases depending on your symptoms.
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Symptoms Of Hashimotos Thyroiditis
At the very beginning, patients may not notice any particular symptom. This autoimmune condition tends to progress slowly over the years and causes thyroid damage and a decline in hormone production.
In fact, Hashimoto’s thyroiditis is the most common cause of hypothyroidism, which is why signs and symptoms of this autoimmune disease are similar to the underactive thyroid. Some of them include:
- Thick and red skin usually on top of feet or shins
Thyroid Antibodies An Early Warning For Hashimotos
In Hashimotos, we know there are 5 stages relating to the initial development and also worsening of the disease. A quick review of these stages is helpful in understanding the importance of knowing your thyroid lab results.
It also really demonstrates the importance of specifically knowing your results relating to the presence of elevated thyroid antibodies.
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Are There Any Risks Of Tpo Antibodies Test
Generally speaking, the TPO antibodies test is safe and is not associated with some severe risks.
However, some patients may experience bleeding, bruising, feeling of lightheadedness, and infection. The likelihood of these minor risks is small, and it doesn’t mean that all patients will experience them.
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.
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Certain Conditions Can Make Your Thyroglobulin Antibody High
Even though antithyroglobulin antibodies are not the best predictor of thyroid disorders, they should not necessarily be ignored. Unlike TPO antibodies, thyroglobulin antibodies are not able to stimulate an immune response in the thyroid, but they may be useful in diagnosing certain thyroid conditions .
Anti-TG antibody levels may show importance in the following:
- Patients diagnosed with thyroid carcinoma who have elevated TG antibodies may be at a higher risk of the cancer spreading to lymph nodes or surrounding organs. Elevated levels may also indicate a high risk of thyroid cancer recurrence after treatment [4
- Trusted SourcePubMedGo to source].
One study found that after successfully treating thyroid disease, thyroglobulin levels dropped back down into normal reference ranges . It is important to point out that this study tested the actual levels of thyroglobulin protein, not the TG-antibody levels.
However, this finding is consistent with another study that found elevated anti-TG antibodies to correlate with the severity of hypothyroid symptoms, including fragile hair, swelling of the face and eyes, and vocal hoarseness [3
Thyroglobulin autoantibodies may not be the best indicator of thyroid disease, but likely will continue to be useful in the screening and monitoring of select conditions.
Functional Remedies To Get Thyroid Antibodies In Control
For some individuals, worrying about elevated thyroid antibodies may be an unfounded concern. Indeed, elevated thyroid antibodies are one of the markers of autoimmune thyroid diseases like Hashimotos thyroiditis. However, research shows that moderately elevated thyroid antibodies do not necessarily bring about thyroid disorders.
In this article, we will explain what thyroid antibodies are and their roles in the human body. We will also share the optimal reference range for thyroid antibodies and what to do if your antibodies are high.
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A Note On Antibodies In Pregnancy
Thyroid disease is associated with poor outcomes in pregnancy, the risk of which is increased in the presence of antibodies. If you are pregnant or planning a pregnancy and are concerned about thyroid disease it’s important to discuss this with your GP.
Note that the blood test ranges used in pregnancy are different and are trimester-specific.
Key Points About Hashimotos Thyroiditis
- Hashimoto’s thyroiditis can cause your thyroid to not make enough thyroid hormone.
- It is an autoimmune disease. It occurs when your body makes antibodies that attack the cells in your thyroid.
- Symptoms may include an enlarged thyroid gland , tiredness, weight gain, and muscle weakness.
- You dont need treatment if your thyroid hormone levels are normal. If you have an underactive thyroid, medicine can help.
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