Yes, TPO and/or thyroglobulin antibodies may be undetectable despite the presence of Grave’s disease.
Most individuals with autoimmune thyroid disease/thyroiditis will have elevated TPO and/or thyroglobulin antibodies during the course of disease. TPO antibodies are the most prevalent and are found in 80-90% of Hashimoto’s patients and in 65-75% of those with Grave’s disease. In one study of 74 hospitalized patients evaluated for thyroid disorders, elevated TPO antibodies were observed in 2 out of 3 patients diagnosed with hyperthyroidism and ~60% of those diagnosed with Hashimoto’s. Antibody levels may be low or negative if autoimmune activity subsides. The presence of thyroid antibodies in otherwise healthy individuals may indicate an underlying autoimmune process that may manifest at a later time (Jeena 2013).
One study found that TPO antibodies were present up to 7 years prior to diagnosis in both Hashimoto’s and Grave’s (Hutfless 2011).
Full clinical evaluation and monitoring of thyroid dysfunction should include TSH, total and free T3 and T4, and TSH along with antibody levels. Nutrition status should also be incorporated into a thyroid evaluation, especially selenium status. Selenium sufficiency is associated with decrease antibodies and symptoms in patients with Grave’s disease (Rayman 2019).
References
Hutfless, Susan et al. “Significance of prediagnostic thyroid antibodies in women with autoimmune thyroid disease.” The Journal of clinical endocrinology and metabolism vol. 96,9 (2011): E1466-71. doi:10.1210/jc.2011-0228
Jeena, E. Jacob, M. Malathi, and K. Sudeep. "A hospital-based study of anti-TPO titer in patients with thyroid disease." Muller Journal of Medical Sciences and Research 4.2 (2013): 74.
Rayman, Margaret P. “Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease.” The Proceedings of the Nutrition Society vol. 78,1 (2019): 34-44. doi:10.1017/S0029665118001192
Regarding part 2 of the AMA question, we would need a bit more information.
Question: I have a patient that has the following thyroid levels: TSH 0.005 T4 14.5 FreeT4 3.97 T3 307 Tree t3 13.2 Reverse T3 48.5 TPO and Thyroglobulin Antibodies WNL Thyrotropin AB 14
Please provide the following information so that we can assist you with the Functional Blood Chemistry Analysis. Please follow up with us at support@optimaldx.com and direct your email to the ODX Research team
- Which lab was used? Antibody ranges differ between Quest and Labcorp.
- Was the patient a male or female?
- What age?
- What were the exact units used for the given values:
TSH 0.005
T4 14.5
FreeT4 3.97
T3 307
Free T3 13.2
Reverse T3 48.5
TPO and Thyroglobulin Antibodies WNL
Thyrotropin AB 14
Please note that this information is for educational purposes only, and we do not provide clinical advice or recommendations.