Follow TSH Not TPO - Dr. Martin Rutherford

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Follow TSH not TPO. This came up a couple of times in the past couple of weeks when I had patients that I reevaluated their thyroid hormones and they were a little upset because I didn't rerun their thyroid antibodies. So I'm assuming if you're looking at this, you have some idea what TSH and TPO is, but we'll talk about it right now. So it's not that you never look for thyroid antibodies. Obviously you have to look for them. I'll assume that there's maybe one person out there who, for some reason, tripped on this and doesn't know what TSH and TPO is. So TPO is the thyroid peroxidase enzyme that is most, about 97% of the time, that's what comes up positive when a person has autoimmune thyroid disease, or you might know it as Hashimoto's. And a thyroid stimulating hormone is a hormone that everybody checks for your thyroid, all the endocrinologists check for the thyroid.

It's the holy grail. That's all they check. And if they just check that and they don't do the antibodies, they're not going to know that you have Hashimoto's, which 90% of hypothyroid patients or more, actually have Hashimoto's. So if they don't look for it, they don't know you have it, they're just going with your TSH. And so TSH, when they just go after that and you have Hashimoto's, a lot of you don't do well. And so, TSH has gotten a bad name. I was probably part of that at one point in time, as was the group of doctors that I was involved with because at the time we didn't know any better. And we were tracking thyroid peroxidase enzyme, TPO, to see if the patient was getting better. So, that was wrong. So here's how it goes.

The thyroid peroxidase enzyme, and there's another one called an antithyroglobulin enzyme. They're antithyroglobulin tissue test. So these tests tell you whether you have an antibody that flares up that tells your immune system to attack your thyroid. So these are the tests that need to be run to figure out, do you have Hashimoto's hypothyroidism? Once you figure that out, what someone figured out was that you really didn't need to run those antibodies anymore, but because we have been trained throughout our life that if you have a high blood sugar marker, and you do a blood sugar diet, you want to see the marker go down. So we intuitively think that's the same with the autoimmune thyroid disease markers, but it's not, because they're very erratic. They can go up and down for no reason at all. You can test them one day, they'll be down. You can test them the next day, they'll be high.

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