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  • Writer's pictureGavin Guard, Medical Director

What you need to know about your thyroid labs

Updated: Jan 22, 2022

Key Takeaways

  • Thyroid autoimmunity is the most common autoimmune disease

  • A common practice in some alternative medicine circles is to get thyroid antibody levels on all autoimmune thyroid patients

  • Thyroid antibodies may not do a great job of reflecting progression to hypothyroidism

  • Rather, they give us clues as to what may be going wrong in the body

  • It’s important to work with your doctor to get an accurate diagnosis of hypothyroidism and to uncover the root cause of your thyroid issues


About 1 in 100 people had some type of autoimmune thyroid disease. In fact, thyroid autoimmunity is the most common form of autoimmune conditions, affecting women more than men. In some alternative medicine communities, it is routine practice to get an expanded thyroid antibody panel. What do positive antibody levels mean and is it worth it to get these values? Let’s find out.

thyroid Gavin Guard

Are thyroid antibodies good predictors of low thyroid status?

There are generally two types of thyroid antibodies; TPO antibodies and thyroglobulin antibodies. Most practitioners get TPO antibodies, but there is a growing trend to also obtain thyroglobulin antibodies as well.

Unfortunately, many clinicians over-diagnose hypothyroidism, not knowing the difference between the presence of thyroid antibodies and true hypothyroidism.

TPO levels above 35-40 indicate that you are “positive” for thyroid antibodies. But do higher levels mean a higher chance of hypothyroidism?

A recent study of 335 autoimmune thyroid patients who were positive for antibodies looked at this question. What they found was that increasing antibody levels from 40-500 did not predict hypothyroidism. In other words, you did not have a higher chance of having hypothyroidism if your antibody levels were barely positive (e.g. 40) compared to higher levels (e.g. 400). What they did find was that TPO antibodies above 500 were associated with a higher chance of hypothyroidism.

However, the majority of these patients still did not develop hypothyroidism. This means that high antibody levels do not always necessitate treatment. You should also be careful not to try forcing your thyroid antibody levels down if you are symptom free and not hypothyroid.

Which thyroid antibodies are helpful?

The same study found that adding in thyroglobulin antibodies to the tests they ran did not add any predictive information as compared to just getting TPO antibodies alone. This finding throws some shade at some alternative health circles that routinely get this test and scare patients into thinking that they need to “treat” their antibody levels even though they are not truly hypothyroid.

In summary, TPO antibodies are most predictive of who develops true hypothyroidism.

However, just the presence of thyroid antibody levels alone does not mean hypothyroidism. In addition, the vast majority of people who do have thyroid antibodies do not develop hypothyroidism even a decade later.

Work with your doctor to uncover the root cause of your thyroid condition

The conventional treatment for hypothyroidism is usually thyroid medication such as Levothyroxine. However, just the presence of thyroid antibody levels alone does not necessitate medication most of the time. As I talked about in another article, low thyroid symptoms can often be traced back to gut issues.

When you do find elevated thyroid antibody levels and are not hypothyroid, you have an opportunity to intervene by addressing some of the lifestyle, nutrition, and other factors that are affecting autoimmune processes.

This often means assessing and managing your diet, stress levels, blood sugar control, gut health, nutrient status, inflammation, and sleep health.

As you can see, it’s important to take a comprehensive approach to this issue and this is exactly what I do at my clinic, Roots Integrated Care.

The Bottom Line

If you are having low thyroid symptoms such as fatigue, low energy, hard time sleeping but have normal thyroid levels, it may be worth it to look at other causes. In many cases, working on gut health can ameliorate these symptoms and improve thyroid antibody levels.

Don’t get caught up into unwarranted fear around your thyroid antibody levels if you are not truly hypothyroid (elevated TSH hormone levels). I have found too many of my patients on unnecessary thyroid medication and it wasn’t until we fixed the underlying root cause of their symptoms (oftentimes gut issues) that they started feeling better.

If you are struggling with managing your thyroid or having low thyroid symptoms despite normal lab values, I’d love to be a resource for you. You can schedule a free 15-minute consultation here.

I hope you found this information useful and helpful in your journey back to a healthier and happier life.

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