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Research Thyroid Peroxidase Antibodies (Anti-TPO Ab)
Thyroid Panel

Thyroid Peroxidase Antibodies (Anti-TPO Ab)

Serum
Optimal Result: 0 - 34 IU/ml.

Thyroid Peroxidase (TPO) Antibodies: What They Are and Why They Matter

What are TPO Antibodies? Thyroid peroxidase (TPO) antibodies are a type of antibody that targets thyroid peroxidase, an enzyme essential for thyroid hormone production. These antibodies often develop in people with autoimmune thyroid diseases, such as Hashimoto's thyroiditis and Graves' disease. The presence of TPO antibodies in the blood can signal an autoimmune cause of thyroid disease.

What is Thyroid Peroxidase (TPO)? Thyroid peroxidase (TPO) is an enzyme found in the thyroid gland, which plays a critical role in producing thyroid hormones, including triiodothyronine (T3) and thyroxine (T4). TPO helps add iodine to thyroglobulin, a necessary process in the creation of these hormones. These thyroid hormones regulate essential body functions, such as metabolism, growth, and brain development.

Where is the Thyroid Gland? The thyroid gland is a small, bow-shaped organ located at the front of the neck, just below the Adam’s apple. It produces three hormones:

- Triiodothyronine (T3)

- Thyroxine (T4)

- Calcitonin, which helps regulate calcium levels in the body.

Why Do TPO Antibodies Form? Normally, the immune system produces antibodies to fight off harmful invaders like bacteria and viruses. However, in autoimmune conditions, the immune system mistakenly targets the body’s own proteins. In autoimmune thyroid diseases, TPO antibodies are produced when the immune system mistakenly attacks thyroid tissue, leading to inflammation and thyroid dysfunction.

Why Test for TPO Antibodies? A TPO antibody test is often recommended if you’ve been diagnosed with thyroid disease. It helps determine whether the thyroid condition is caused by an autoimmune disorder like Hashimoto's thyroiditis or Graves' disease. Detecting TPO antibodies in the blood suggests that the immune system is attacking the thyroid, which can lead to swelling, reduced thyroid function, and in some cases, tenderness.

It’s important to note that while some people with TPO antibodies don’t have thyroid disease, the presence of these antibodies increases the risk of developing thyroid issues in the future.

Autoimmune Thyroid Diseases: Graves' Disease and Hashimoto's Thyroiditis

  1. Graves' Disease: This condition leads to hyperthyroidism (overactive thyroid) due to excessive hormone production. The immune system attacks the thyroid, causing it to produce too much thyroid hormone, speeding up many body functions.

  2. Hashimoto’s Thyroiditis: The most common cause of hypothyroidism (underactive thyroid) in the U.S., Hashimoto's is characterized by chronic inflammation of the thyroid. Over time, this can impair the thyroid’s ability to produce hormones, leading to a gradual decline in thyroid function.

Normal Range for TPO Antibodies TPO antibody levels are measured in international units per milliliter (IU/mL). The normal range for TPO antibodies is typically less than 34 IU/mL, though this can vary by laboratory. Elevated TPO antibodies suggest an autoimmune process affecting the thyroid. It's important to note that there is no "too low" range for TPO antibodies.

Example Ranges from Laboratories:

  • Quest Diagnostics: <9 IU/mL
  • LabCorp:
    • Adults: <34 IU/mL
    • Children’s ranges vary by age, with younger children having higher upper limits.

TPO Antibodies vs. Thyroglobulin Antibodies Both TPO and thyroglobulin antibodies are types of thyroid antibodies, and they are often elevated in people with autoimmune thyroid diseases. Thyroglobulin is another protein necessary for thyroid hormone production. While both antibodies may be present in autoimmune conditions, TPO antibodies are found more frequently in those with autoimmune thyroid disorders.

Understanding and monitoring TPO antibodies can provide valuable insights into thyroid health and the potential risk for autoimmune thyroid disease.

References:

Frohlich E, Wahl R. (2017).Thyroid Autoimmunity: Role of Anti-thyroid Antibodies in Thyroid and Extra-Thyroidal Diseases. Front Immunol.9;8:521. PMID: 28536577; PMCID: PMC5422478. 

Godlewska M et al. (2019). Thyroid Peroxidase Revisited–What's New?. Hormone and Metabolic Research, 51(12), 765-769.

Rrupulli A et al. (2019). Significance of testing anti-thyroid peroxidase in euthyroid patients. In Endocrine Abstracts (Vol. 63). Bioscientifica.

Xiao Y et al. (2019). Positive thyroid antibodies and risk of thyroid cancer: A systematic review and meta-analysis. Molecular and clinical oncology, 11(3), 234–242.

Rayman, M. (2019). Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proceedings of the Nutrition Society, 78(1), 34-44.

Chahardoli R et al. (2019). [Can supplementation with vitamin D modify thyroid autoantibodies (Anti-TPO Ab, Anti-Tg Ab) and thyroid profile (T3, T4, TSH) in Hashimoto’s thyroiditis? A double blind, Randomized clinical trial. Hormone and Metabolic Research, 51(05), 296-301](https://doi.org/ 10.1055/a-0856-1044).

Zhang W et al. (2021) Immunomodulatory function of vitamin D and its role in autoimmune thyroid disease. Frontiers in immunology, 12, 574967. 

Thyroid function tests. American Thyroid Association. https://www.thyroid.org/thyroid-function-tests/.

Overview of thyroid function. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/thyroid-disorders/overview-of-thyroid-function?query=overview thyroid function.

Postpartum thyroiditis. American Thyroid Association. http://www.thyroid.org/postpartum-thyroiditis/

Jameson JL, et al., eds. Thyroid gland physiology and testing. In: Harrison's Principles of Internal Medicine. 20th ed. The McGraw-Hill Companies; 2018. https://accessmedicine.mhmedical.com

Laposata M. The endocrine system. In: Laposata's Laboratory Medicine: Diagnosis of Disease in the Clinical Laboratory. 3rd ed. The McGraw-Hill Companies; 2019. https://accessmedicine.mhmedical.com

What does it mean if your Thyroid Peroxidase Antibodies (Anti-TPO Ab) result is too high?

Thyroid peroxidase (TPO) antibodies are autoantibodies, which means the body mistakenly produces these antibodies that act against a normal protein, TPO. As such, thyroglobulin antibodies usually indicate an autoimmune disease. TPO antibodies are present in roughly 90% of people with Hashimoto's thyroiditis and in half to three-quarters of people with Graves' disease. Thyroglobulin antibodies may be detectable in people without symptoms of thyroid hormone imbalance (subclinical hypothyroidism).

When hypothyroidism causes symptoms, it may cause weakness and fatigue, cold intolerance, shortness of breath, weight gain, constipation, cognitive problems, dry skin, hoarseness, and swelling (edema). In about 10% of cases, TPO antibodies will be detectable in non-autoimmune thyroid disease such as pernicious anemia and type 1 diabetes mellitus.

Some specific causes of thyroid peroxidase (TPO) antibodies are:

- Hashimoto's thyroiditis/chronic autoimmune hypothyroidism

- Goitrous autoimmune thyroiditis 

- Atrophic autoimmune thyroiditis

- Grave’s disease

- Differentiated thyroid carcinoma

- Subclinical hypothyroidism

- Pregnancy (abnormal)

- Neonatal period (transient)

- Postpartum thyroiditis

- Painless (silent) thyroiditis

Does high TPO antibodies mean cancer?

High TPO antibodies does not necessarily mean cancer. TPO antibodies are raised in 1-20% of people who have thyroid cancer and they can be raised in healthy people. The main symptom of thyroid cancer is a painless neck lump. It is important to speak to your doctor if you think you have thyroid cancer or any other thyroid disease. At a population level, having a raised TPO antibody level alone does not increase your risk of developing thyroid cancer.  A raised TPO antibody level should be considered together with other blood tests and clinical assessment. The meaning of a raised TPO antibody test in isolation is difficult to interpret and additional investigations may be needed.

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