Healthcare provider examining patient's thyroid gland while discussing elevated thyroid peroxidase antibodies

Elevated Thyroid Peroxidase Antibodies: What Does It Mean?

Written on December 22, 2023 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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If you have a history of thyroid disease or have been feeling symptoms of thyroid disease, you may be looking at your bloodwork and wondering what the different tests are for. What does it mean if your thyroid peroxidase antibodies are elevated? How does this play into your thyroid disease and your health? We’ll delve into the world of thyroid hormone labs today, particularly thyroid peroxidase antibodies.

What Is The Thyroid Gland?

The thyroid gland is a small organ that lives at the base of your neck. It plays a huge role in metabolism and influences growth and development.[1] The thyroid gland is made up of two lobes that lay on either side of your trachea (windpipe). The thyroid gland is responsible for producing triiodothyronine (T3), tetraiodothyronine (T4), and calcitonin. The thyroid gland receives signals from the pituitary gland in the form of thyroid stimulating hormone (TSH) that tell it how much T3 and T4 to produce.

What Are The Functions Of Thyroid Hormone?

When we discuss thyroid hormones, we mostly think of T3 and T4. Calcitonin is produced in the C-cells of the thyroid gland and is responsible for calcium and bone metabolism.[2] T3 and T4 are responsible for increasing the basal metabolic rate, which is the amount of energy your body requires for basic bodily functions. It also affects other parts of your body, such as [1]:

  • Body temperature
  • Pulse rate and blood pressure
  • Digestion rate
  • Maturation of the brain in children
  • Growth in children
  • Concentration and reflexes

What Are Thyroid Peroxidase Antibodies?

Thyroid peroxidase is an enzyme in the body that is important for thyroid hormone production.[3] Antibodies against thyroid peroxidase attack the thyroid gland and cause swelling and reduced function of the thyroid gland. This is a form of autoimmune disorder. Not everyone with thyroid peroxidase antibodies will have a thyroid disease, but the presence of the antibodies increases the likelihood of having thyroid disease now or in the future.

There are other forms of thyroid antibodies such as thyroglobulin antibody and thyroid stimulating immunoglobulin. When taken together, the patterns of elevated antibody levels can help determine what kind of thyroid disease may be present.

Thyroiditis is a broad term for inflammation of the thyroid gland. Several types of diseases can cause this. The presence of thyroid antibodies can be suggestive of autoimmune thyroid disease. If you are experiencing pain in your thyroid gland, then you may have a condition called de Quervain’s thyroiditis (subacute granulomatous thyroiditis]. The thyroid diseases more commonly associated with elevated thyroid peroxidase antibody levels are Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis] and Graves’ disease.[4]

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Hashimoto's Thyroiditis

Hashimoto's thyroiditis is an extremely common condition and is one of the most common causes of hypothyroidism. It affects women and people assigned female at birth (AFAB] seven to ten times more often than men.[5] In Hashimoto's, your labs generally show elevated thyroid peroxidase as well as elevated thyroglobulin antibodies. With Hashimoto's, your thyroid hormone levels may be elevated, normal, or decreased. Symptoms of Hashimoto's include [6]:

  • Fatigue
  • Dry skin and brittle nails
  • Slow heart rate
  • Cold intolerance
  • Swelling of the face (particularly around the eyes], or swelling of the hands and feet
  • Slowed reflexes
  • Large tongue
  • Slow speech
  • High blood pressure
  • Difficulty walking
  • In severe cases, fluid around the heart or lungs

Graves’ Disease

Graves’ disease is another type of autoimmune thyroid disease. It usually causes elevated thyroid hormone levels. It is about ten times more common in women and people AFAB than in males.[7] In Graves’ disease, the labs may show elevated thyroid peroxidase antibodies but not thyroglobulin antibodies. Graves’ patients will also have elevated thyroid stimulating antibodies and thyrotropin binding inhibitory immunoglobulins. Graves’ disease is associated with the following symptoms [8]:

  • Eye symptoms such as bulging, feeling dry, pressure or pain, puffiness, redness, sensitivity to light, vision loss, or double vision
  • Anxiety or irritability
  • Tremor
  • Heat sensitivity
  • Weight loss
  • Enlargement of the thyroid gland
  • Menstrual cycle changes
  • Frequent or loose bowel movements
  • Fatigue
  • Thickened red skin on the legs or feet
  • Irregular heartbeat
  • Trouble sleeping

Learn More About Your Thyroid Hormones With Everlywell

If you have questions or are concerned about your thyroid or other hormone levels, the first step is to discuss your concerns with your healthcare provider. You may also want to consider lab testing to get more information about your thyroid or other hormone levels. You may also consider getting a virtual visit with one of our virtual consultants. Take control of your health with Everlywell’s variety of health services.

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  1. How does the thyroid gland work? Informed Published November 17, 2010. Accessed December 20, 2023.
  2. Felsenfeld AJ, Levine BS. Calcitonin, the forgotten hormone: does it deserve to be forgotten? Clinical Kidney Journal. April 2015; 8(2]:180-187.
  3. Nippoldt TB. Thyroid peroxidase antibody test: What is it? Mayo Clinic. Published July 16, 2022. Accessed December 20, 2023.
  4. Slatosky J, Shipton B, Wahba H. Thyroiditis: Differential Diagnosis and Management. American Family Physician. 2000;61(4]:1047-1052.
  5. Gwiezdzinska JK, Wartofsky L. Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment. Pol Arch Intern Med. 2022;132(3]:16222.
  6. Mincer DL, Jialal I. Hashimoto Thyroiditis. StatPearls. Published January 2023. Accessed December 20, 2023.
  7. Guia Lopes ML, Tavares Bello C, Cidade JP, Limbert C, Sequeira Duarte J. Influence of Thyroid Peroxidase Antibodies Serum Levels in Graves’ Disease: A retrospective Cohort Study. Cureus. June 2023; 15(6]:e40140.
  8. Graves’ disease. Mayo Clinic. Published June 14, 2022. Accessed December 20, 2023.
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