Written by Ada’s Medical Knowledge Team
Thyroid peroxidase (TPO) antibodies are a type of thyroid antibody. Thyroid antibodies can form in autoimmune thyroid disease. The body wrongly identifies thyroid cells and tissues as non-self. This means that our body sees our own cells and tissues as foreign, and attacks them.
The two main autoimmune thyroid diseases are Grave’s disease and Hashimoto’s thyroiditis. 1 Thyroid peroxidase antibodies are also called anti-TPO antibodies or TPO antibodies. You can read more about thyroid peroxidase antibodies in this article and find more general information about the thyroid in Ada's thyroid guide.
What are thyroid peroxidase antibodies?
Thyroid peroxidase (TPO) antibodies are a type of thyroid antibody. Thyroid peroxidase is an enzyme which helps to make thyroid hormones (T3, T4 and TSH). 2 The body’s immune system makes antibodies in response to non-self proteins. These non-self proteins are called antigens. Making antibodies is important to protect us from diseases. However sometimes the immune system identifies our own proteins as non-self, making autoantibodies.
The immune system then attacks our own body proteins in error. This is known as an autoimmune disease. Thyroid antibodies develop when the immune system identifies our own thyroid cells and tissues as non-self. This can cause inflammation and affect thyroid function. 1
What are thyroglobulin antibodies?
Thyroglobulin antibodies (Tg Ab) are another type of thyroid antibody. Thyroglobulin is a protein made by thyroid cells. It helps to make thyroid hormones. Thyroglobulin antibodies (Tg Ab) are made when the body attacks it’s own thyroglobulin. Thyroglobulin antibodies can be raised in Hashimoto’s thyroiditis (link to ada page on Hashimoto’s thyroiditis). They are also raised in 10-15% of the general population. 1
What is the thyroid peroxidase antibody normal range?
Normal TPO antibodies range is less than 30 international units per millimeter (IU/ml). 3 Thyroid peroxidase antibodies are considered high if above this. Note that the normal range used can differ in different laboratories. It is not possible for the thyroid peroxidase antibodies to be too low.
What causes high thyroid peroxidase antibodies?
Autoimmune thyroid disorders cause high thyroid peroxidase antibodies. 2 The two main autoimmune thyroid disorders are Grave’s disease (link to Ada page on Grave’s disease) and Hashimoto’s thyroiditis, (link to Ada page on Hashimoto’s thyroiditis )
Anti-TPO antibodies are present in:
- 80-95% of cases of Hashimoto’s thyroiditis
- 65-80% of cases of Grave’s disease
- 10-20% of cases of thyroid cancer. 1 2 3
10-15% of people who don’t have any thyroid disorder can have raised TPO antibodies. 1 3 High TPO antibodies may increase the risk of developing a thyroid disorder in the future. 2
What is the difference between thyroid peroxidase antibodies and thyroglobulin antibodies?
Thyroid peroxidase and thyroglobulin antibodies are two different types of thyroid antibodies. The body needs thyroglobulin and thyroid peroxidase to make thyroid hormones. Both types of thyroid antibodies are often raised in autoimmune thyroid disorders. Raised thyroid peroxidase antibodies are found in a higher percentage of people with autoimmune thyroid diseases. 1
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. 3 The main symptom of thyroid cancer is a painless neck lump. 4 It is important to speak to your doctor if you think you have thyroid cancer or any other thyroid disease.
You can read more about the symptoms of thyroiditis and hyperthyroidism on Ada's website.
At a population level, having a raised TPO antibody level alone doesn’t increase your risk of developing thyroid cancer. 4 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.
How to reduce TPO antibodies naturally?
There is some limited evidence that selenium supplementation can reduce anti-TPO antibodies. 2 More research in this area is needed. 5 The role of vitamin D supplementation in reducing TPO antibodies is being considered. Currently there is not enough evidence to support this claim. 6 7
Fröhlich 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. Accessed 12th July, 2022.
Godlewska M et al. (2019). Thyroid Peroxidase Revisited–Whatʼs New?. Hormone and Metabolic Research, 51(12), 765-769. Accessed 30th June, 2022.
Rrupulli A et al. (2019). Significance of testing anti-thyroid peroxidase in euthyroid patients. In Endocrine Abstracts (Vol. 63). Bioscientifica. Accessed 30th June, 2022.
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. Accessed 30th June, 2022.
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. Accessed 30th June, 2022.
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). Accessed 30th June, 2022.
Zhang W et al. (2021) Immunomodulatory function of vitamin D and its role in autoimmune thyroid disease. Frontiers in immunology, 12, 574967. Accessed 12th July, 2022.