Clearly elevated anti-TPO (>500 U/mL) is not usually found in normal individuals, i.e. It's highly likely that somebody with a clearly elevated anti-TPO level will need follow-up given risk of developing autoimmune thyroid disorder (1)
How quickly somebody with elevated anti-TPO progress to overt hypothyroidism cannot be precisely determined. Anti-TPO can also be associated with Graves' disease.
There is data to suggest that if the TSH is already elevated (that is, the body already is trying to make the thyroid gland work harder), there is higher rate of progression(2)
Other risk factors include presence of other auto-immune disorders, lithium therapy, interferon therapy and many other medications.
Another important factor for urgency of review is whether the person is pregnant or desiring pregancy, as presence of thyroid auto-antibodies require prompt review by a specialist to improve pregnancy outcome (beyond the scope of this question to discuss in detail).
1. Engler H, Riesen WF, Keller B. Anti-thyroid peroxidase (anti-TPO) antibodies in thyroid diseases, non-thyroidal illness and controls. Clinical validity of a new commercial method for detection of anti-TPO (thyroid microsomal) autoantibodies. Clin Chim Acta. 1994 Mar;225(2):123–36.
2. Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995;43:55-68.
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