Thyroid Antibodies

February 1998 -- If your doctor has told you that you have tested positive for "thyroid antibodies" but you have a normal TSH, what does that mean? Usually, it indicates that your thyroid is in the process of autoimmune failure. Not failed yet, and not failed enough to register in the standard TSH thyroid test, but in the process of failing.

Many doctors believe that antibodies alone are NOT reason to treat someone with thyroid hormone. This is despite the fact that the presence of antibodies alone can cause thyroid-related symptoms, and have been shown to affect fertility or the ability to maintain a pregnancy. (An article in the Journal of Clinical Endocrinology and Metabolism, August 1997 states, "the risk of miscarriage is twice as high in women who have antithyroid antibodies than in those who do not..." and Obstetrics and Gynecology 1997 Volume 90:364-369, states "the risk of miscarriage is higher when a woman is positive for antithyroid microsomal antibody...")

There are, however, some endocrinologists, as well as holistic MDs, osteopaths and other practitioners who believe that the presence of thyroid antibodies alone is enough to warrant treatment with small amounts of thyroid hormone. If you've tested positive for antibodies, and have a TSH in the "normal range," but still don't feel well, you may with to consult with a practitioner who has this philosophy.

One such practitioner is Dr. Elizabeth Vliet, an MD who runs Her Place, a women's health clinic at All Saints Hospital in Fort Worth, and author of Screaming to be Heard: Hormonal Connections Women Suspect...and Doctors Ignore. Dr. Vliet does not believe that TSH tests are the almightly indicator of a woman's thyroid health. Dr. Vliet says that symptoms, along with elevated thyroid antibodies and normal TSH, may be a reason for treatment with thyroid hormone. Here's a quote from her book:

"The problem I have found is that too often women are told their thyroid is normal without having the complete thyroid tests done. Of course, what most people, and many physicians, don't realize is that...a 'normal range' on a laboratory report is just that: a range. A given person may require higher or lower levels to feel well and to function optimally. I think we must look at the lab results along with the clinical picture described by the patient...I have a series of more than a hundred patients, all but two are women, who had a normal TSH and turned out to have significantly elevated thyroid antibodies that meant they needed thyroid medication in order to feel normal. This type of oversight is particularly common with a type of thyroid disease called thyroiditis, which is about 25 times more common in females than males...a woman may experience the symptoms of disease months to years before TSH goes up..."

The other issue is the TSH level itself. While at many labs, "normal" range is .5 to 5.5 (with over 5.5 being hypothyroid), my endocrinologist (a 40 year old woman) believes FIRMLY that most women do not normalize unless TSH is between 1 and 2 (considered low by some docs) and that a woman with evidence of thyroid disease will find it hard to get and/or maintain a pregnancy at higher TSH's than 1-2. (I didn't get pregnant at a TSH of 4, a level considered totally NORMAL at my lab, but got pregnant in one month at TSH of 1.2 and just had my baby on Dec 31).(See my Pregnancy Guide.

If you haven't had your antibodies tested, and suspect you may be hypothyroid despite a so- called "normal" TSH test, I suggest you read the following article at my site for more ideas on how to proceed. HELP! My TSH Is "Normal" But I Think I'm Hypothyroid, which offers a look at your next steps -- including defining the "normal" range with your doc, antibody testing, TRH testing, and drugs beyond T4 therapy -- and where to find a doctor to help.