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  • Q&A with Australian Health Practitioners

    Should I be concerned about thyroiditis?

    Related Topics
    Endocrinology Hypothyroidism
    My blood test shows the Anti- Thyroglobulin Abs (centaur) level @ 160 U/mL and Anti- Thyroidal Peroxidase Abs @ 974 U/mL.

    TSH, T3 and T4 within normal range.

    I know I need to see an Endocrinologist my question is how soon? I hate to say I'm too busy and don't follow up on things, but this is what tends to happen in my life.

    I am generally a well person but I was also diagnosed with Pulmonary Sarcoidosis 13 years ago, is it of any relation?
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    Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Writing as a health professional with a good knowledge of immunology, not a clinical health professional, to me those antibody levels are suggestive of an auto-immune disease affecting the thyroid gland - Grave's Disease and Hashimoto's Thyroiditis are possibilities (there are others).

    I suggest that you get your GP to refer you to a clinical endocrinologist and a clinical immunologist. They will be able to work as a team to make a differential diagnosis and suggest treatment.

    Both Grave's Disease and Hashimoto's Thyroiditis can usually be treated effectively but, as always, the earlier treatment starts the better the outcome.

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    Dr Kevin Lee

    Endocrinologist, Nuclear Medicine Physician

    Consultant Physician in Endocrinology, Diabetes & Nuclear Medicine. I am on Twitter @dr_kevinlee. I am on Facebook https://www.facebook.com/kevinleefracp/ I help patients with obesity, diabetes, thyroid, … View Profile

    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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    Anonymous

    I have been receiving 100mg of Thyroxine for the past 21 years.  None of the doctors I have question over whether there is another form of medication or alternatives for me have been answered.  They only test TSH, FT4 and FT3.  I am pretty sure I have an auto-immune disease, primarily adrenal fatigue.  Just a couple of month ago I managed to find a doctor who gave me my full antibodies as well and they were 197.8.  Whilst the others were in the normal range.  I had bloods taken this week and my TSH is up to 14.3 (Range 0.5-5.0) FT4 11 and he didn't think it necessary to test FT3!  But he did test my  Thyroid Peroxidase Ab which came in higher again at 342 (Range <34)

    Do I need to be referred to an Endocrinologist to be able to get any results or relief from this?  I am now taking a miriade of vitamins and minerals and starting to feel better with my main issues, brain fog, lethagy and muscle aches resolving.  I have read and researched so much and after so long I am getting tired of being tired so I really want to do something.  

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