# positive Anti-TPO antibodies now negative



## Calypso234 (May 11, 2014)

Hi I am new here and am hoping someone here can help me work out if I have Hashimoto's or not.. I was diagnosed hypothyroid in March this year and my doctor put me on levothyroxine 125mcg as my ft4 level was low at 14, normal range 12-22. In the past my Anti-TPO antibody result was 52IU/L but this has now dropped to 30IU/L. I keep searching using words like elevated anti-tpo and hypothyroid and everything keeps point to Hashimoto's..? Thankyou


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## joplin1975 (Jul 21, 2011)

TPO essentially tells you that something is attacking your thyroid, but it really doesn't define the nature of the attack. It is usually autoimmune, but there are certainly things like transient viruses and even cancer that cause elevated TPO. You should have an ultrasound of your thyroid and if there is anything suspicious, have that biopsied.

You didn't ask, but that's a very large starting dose of levo. How do you feel?


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## Calypso234 (May 11, 2014)

joplin1975 said:


> TPO essentially tells you that something is attacking your thyroid, but it really doesn't define the nature of the attack. It is usually autoimmune, but there are certainly things like transient viruses and even cancer that cause elevated TPO. You should have an ultrasound of your thyroid and if there is anything suspicious, have that biopsied.
> 
> You didn't ask, but that's a very large starting dose of levo. How do you feel?


Oops, sorry. I didn't look at my prescription script properly. The doctor has put the following:

25 March - 15 April: 50mcg
16 April - 7 May: 75mcg
8 May - 3 months onwards: 125mcg. I only read the bottom part...

I had an ultrasound done years ago and it was normal so no further action taken. Apart from that I feel no different - tired, sleeping during the afternoon, waking up early in the morning, stiff legs when getting up, explosive headaches and getting unexplained aches in my body.


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## Octavia (Aug 1, 2011)

Azureblue, welcome!

You have three different instructions for taking the meds...were all of those instructions given at the same time? If so, that's bad news. Your dosage should be moved up or down based on labwork and symptoms. Were your changes based on labwork/symptoms?

Could you post your lab results with ranges? That will give us a better look.


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## Calypso234 (May 11, 2014)

Octavia said:


> Azureblue, welcome!
> 
> You have three different instructions for taking the meds...were all of those instructions given at the same time? If so, that's bad news. Your dosage should be moved up or down based on labwork and symptoms. Were your changes based on labwork/symptoms?
> 
> Could you post your lab results with ranges? That will give us a better look.


Hi thank you for welcoming me.  With the instructions for taking the meds, they were given to me at the same time but the doctor wanted me to move the dose up every 3 weeks before settling on the one at 3 months onwards. The changes were not based on labwork/symptoms.

Lab results with ranges are TSH: 1.9 , normal range 0.2-4.2, Free T3: 4, normal range 3.1-6.8 and Free T4: 14, normal range 12-22.


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## Octavia (Aug 1, 2011)

Interesting.

Are those the ONLY lab results you have, or do you have others from the past year or so?

If you have had your labs drawn multiple times, would you mind posting the dates, results, and ranges? That way, we can see the progression.

I'm very concerned, though, with your doctor's approach to increasing your meds without getting labwork done. Small increases or decreases can have a dramatic effect on your body's hormone levels, and we all respond differently. This is one reason many doctors will not allow patients to take generic drugs for thyroid--the "margin of error" in generics is sometimes bigger than with name brand drugs, and even a small increase or decrease can impact the patient. Google "narrow therapeutic index and levothyroxine" and you'll see more information.

From the Synthroid website: "...Synthroid is a narrow therapeutic index drug, which means if your dosage is off even a little bit, it can throw off your TSH level and cause side effects."

My point is that getting the right dose is a little art and a lot of science, but you're missing the science part if you're not getting labwork. Because your doctor, at the very beginning, told you to increase your dose periodically, you are very much at risk of becoming hyperthyroid. In addition, 125 mcg is a common dose for someone who no longer has a thyroid gland...which means it's a very high dose for someone whose thyroid is still at least somewhat active.


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## Calypso234 (May 11, 2014)

Octavia said:


> Interesting.
> 
> Are those the ONLY lab results you have, or do you have others from the past year or so?
> 
> ...


Here are results from past year:

Jan 2013 - TSH 0.8, normal range 0.2-4.2, FT4 not tested

June 2013 - TSH 30, normal range 0.2-4.2, FT4 11, normal range 10-22

Aug 2013 - TSH 4, normal range 0.2-4.2, FT4 not tested

Oct 2013 - TSH 4.5, normal range 0.2-4.2, FT4 13.6, normal range 10-22, Anti-TPO 52, negative range 0-34

Nov 2013 - TSH 4.9 normal range 0.2-4.2, FT4 15.9, normal range 10-22

Jan 2014 - TSH 3.1, normal range 0.2-4.2, FT4 not tested

Mar 2014 (Different lab) TSH 1.9, normal range 0.2-4.2, FT4 14, normal range 12-22, FT3 4, normal range 3.1-6.8, Anti-TPO 30, negative range 0-34.


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## Octavia (Aug 1, 2011)

Thanks! This is helpful. 

So, I'm guessing based on these results that you started taking thyroid meds after those June 2013 results? Is that correct?

Your March 2014 results were a bit low for FT4 and FT3, so an increase was justified. Or if you weren't taking something already at that time, then starting on a small replacement dose was justified. But 125 mcg is WAY WAY WAY too high for those results. Like I mentioned above, 125 mcg is a common dose for someone with NO thyroid, and yours was just a little off, but still functioning.

So here's what I'm thinking...

1) I think you should get some labwork as soon as possible (TSH, Free T3, Free T4) to make sure that you're not hyperthyroid with your new dose. I suspect you are.

2) If you are hyperthyroid now, instead of hypothyroid, then that will go a long way in explaining why you're not feeling better yet.

3) I could be completely wrong on both items above, but labwork will tell us for sure. No sense guessing, you know?

:hugs:


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## Calypso234 (May 11, 2014)

Octavia said:


> Thanks! This is helpful.
> 
> So, I'm guessing based on these results that you started taking thyroid meds after those June 2013 results? Is that correct?
> 
> ...


Thanks for replying I was not on any meds when the June 2013 results came out. The doctor did not tell me of the high TSH result and a few months went by and I felt terrible.
The doctor kept testing me for thyroid as I had hypothyroid symptoms and I am not having a blood test done until a week from now. But there's a chance the doctor's lab will not test me for t4 or t3 if the TSH is normal so I will have to go down the private route. I thought based on my symptoms I am still hypothyroid?


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## Andros (Aug 26, 2009)

TPO Ab
Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
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Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
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Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis
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Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2
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http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
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The only definitive test for Hashimoto's is to have FNA (fine needle aspiration) and if the Hurthle Cells are present that are indigenous to Hashimoto's are present; then indeed, you do have Hashimoto's.

All else is speculation. When TPO is present, this suggests that many things need to be ruled out.

I am providing information for you.

Have you had an ultra-sound of your thyroid?

Welcome to the board.


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## Calypso234 (May 11, 2014)

Andros said:


> TPO Ab
> Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
> http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
> (Copy and paste into your browser)
> ...


Thankyou for providing me with the information. Yes I had an ultrasound - 2 of them. The first was done in 2008. This one showed my thyroid was enlarged. The second one I had done was this year and was normal. So that probably means I cannot have Hashimoto's even with positive anti-tpo and then negative anti-tpo.


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