I'm trying to get to the bottom of my thyroid issues. Recent blood work showed my TPO antibodies at 11. The lab reference range is 34+ for a diagnosis of Hashimoto's but I read in an online forum that any level of antibodies can be a cause for concern and possible indication of autoimmunity.
I know my antibody level is relatively low, but could it still be a problem?
(I also have almost every symptom of low thyroid, with bordlerline elevated TSH and low ferritin. My doctor thinks I'm fine but I disagree, just not sure what is causing this yet)
My lab results...
Anti TPO: 11 IU/mL (ref <34)
TSH: 4.11 mU/L (ref 0.4-4.2)
FT4: 15.7 pmol/L (ref 9.7-25.7)
Ferritin: 23 ug/L (ref 20-200)
I haven't received the results of my FT3 yet.
Your TPO antibodies look good to me (low), but i am no expert. So hopefully someone with expertise will comment.
You should probably put up the test units as well (they vary, ie. U/ml or IU/ml); just edit your question.
Also put up your TSH for reference, some people say optimal is below 2.5, others go further, saying anything over 1.0 is sub-optimal.
& put up your ferritin result (with units) as well.
From your name, i am guessing you are female, y/n?
Its probably better to treat the symptoms anyway, rather than rely solely on test results.
btw, there is another common (i think it's common) thyroid autoantibodies test; Thyroglobulin antibody (TGAb)
yep, many would consider a TSH of 4.11 to be an indication of hypothyroidism.
some labs have dropped their upper limits to 4.0, others 3.0. I think this was following some studies done a few years back. more info here.
Also, the time of the day your blood is drawn will effect the TSH result (refs below), normally it will be highest first thing, so if your 4.11 was taken in the afternoon, it could be worth testing as early as possible in the morning which may bump it over 4.5 if you want your doctor to buy in.
You are right, your ferritin is on the low side, which is usually a sign of iron deficiency, which may be linked to your hypothyroid symptoms. You really need some more blood tests, ie. Complete Blood Count, Full Iron Studies, TSH again, Ferritin again (should be included in iron studies test) and D3 (always worth getting D3 done).
If you are Iron deficient, then getting your iron & ferritin levels up & having a good D3 level, should go a long way to sorting you out. (& do not donate blood if you are iron deficient or you will never raise it).
ie. D3; say a 25ohD in the 60-70 ng/ml range. & ferritin probably at least 35, 40 or 50 may be better (& preferably under 75). google for more info/refs.
Serum TSH, T3 and FT3 follow a diurnal rhythm (T4 & FT4 has a similar rhythm but it is not statistical significance).
Serum TSH, T3 and FT3 values in the early morning were significantly higher than during the daytime, but such change was not observed in serum T4 and FT4. http://sciencelinks.jp/j-east/display.php?id=000020021002A0288084
A practical consequence is that blood samples for TSH measurements in patients with moderately elevated TSH levels are best taken after 1100 h, when the low day levels are reached. http://www.ncbi.nlm.nih.gov/pubmed/985825
Ten normal young males were investigated in order to examine diurnal and short-term variations in serum TSH and serum thyroid hormones. In five subjects blood samples were obtained every 30 min during a 24 h period of daily life. A synchronous diurnal rhythm was found for free T3 and serum TSH with low levels in the day-time and higher levels at night. The mean increase from day to night was 15 and 140 per cent, respectively. There was a tendency to a similar rhythm in free T4, but the increase of 7 per cent fell short of statistical significance.
In the other five men blood samples were obtained every 5 min in a 6 to 7 h period starting within the interval from 19.15 to 22.00 h. A significant regular variation with a cycle-length of half an hour was found in TSH, free T3 and free T4. This rhythm accounted for a significant part of the total variation in the levels of TSH, free T3 and free T4. The mean amplitude of the short-term variation is 13, 15 and 11 per cent of the mean level of the respective hormones. The data suggest a pulsatile release of hormones from the thyroid gland governed by a pulsatile TSH secretion. http://www.eje-online.org/content/89/3/659
It is normal to have some antibodies floating around - that result is fine.
HOWEVER, your thyroid is almost certainly struggling with a tsh that high! Did you get the other antibodies tested too? (there's two for hashi's, and often only one is elevated. eg. I only have high tpo)
If both are normal, then you may be developing straight hypothyroidism, which is MUCH easier to treat. Though if your iron is also iffy, this is less likely to be the case...
Good luck getting to the bottom of it!
DIFFERENT LABS USE DIFFERENT REFERENCE RANGES FOR TPO ANTIBODIES!!!! The Mayo Clinic considers TPO antibodies above 9 IU/mL abnormal, and there are even labs that go as low as 6 IU/mL.
Personally, my TPO has shown up as 11 IU/mL, and also 20 IU/mL on another occasion, so obviously levels can fluctuate, too. I have almost every single symptom of Hashimoto's, and it runs in my family, so I believe I do have it, but I will be checking my thyroid antibodies again soon. Don't let Drs confuse you, if you believe you have it. Don't waste years, like I have!