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What Do Borderline Positive TPO Antibodies Mean?

Learn why TPO antibodies may indicate a risk of developing hypothyroidism in this article.
What Do Borderline Positive TPO Antibodies Mean?
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You get your thyroid blood test results back, and your thyroid peroxidase (TPO) antibodies are borderline positive. Now you wondering, what does this mean?

Approximately 20 million people in the United States have some form of thyroid disease—including hypothyroidism (underactive thyroid). Often, people with thyroid disease are undiagnosed or misdiagnosed because symptoms can be unspecific and develop gradually. 

What do TPO antibodies mean?

Many labs look only at Thyroid Stimulating Hormone (TSH) to assess thyroid health. Still, we believe it is critical to measure the thyroid hormones—Free Triiodothyronine (fT3) and Free Thyroxine (fT4), and TPO antibodies. Finding the early appearance of TPO antibodies before the onset of thyroid hormone disruption may reduce longer-term health concerns.

Borderline positive TPO antibodies may suggest a possible evolving issue with Hashimoto's thyroiditis. Hashimoto's, an autoimmune condition, is the most common cause of hypothyroidism in the United States. An autoimmune disease occurs when immune cells mistakenly attack healthy tissue instead of protecting it. In Hashimoto's thyroiditis, immune cells mistakenly attack the healthy thyroid tissue, causing inflammation of the thyroid

If your thyroid experiences damage to the point that the gland no longer produces enough thyroid hormones for your body to function correctly. When your body does not make enough thyroid hormones, this condition is hypothyroidism. 

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Hashimoto's thyroiditis is a progressive disease

Hashimoto's thyroiditis is a progressive disease. ‍In the early stages of thyroid tissue destruction, when your TPO antibodies are borderline positive, the body compensates, producing more hormones to keep normal hormone levels. In this stage, your thyroid is still close to fully functional. Even though TPO antibodies may be present in the blood, it could take many years before symptoms appear. 

Progressively, as immune cells destroy more thyroid tissue, the gland loses the ability to compensate, and thyroid hormone production drops. You might start to feel symptoms as antibodies continue to attack your thyroid gland.

Eventually, the gland loses its ability to produce thyroid hormones. 

Often, thyroid antibodies can be the first indicator of a thyroid problem. While the presence of thyroid antibodies does not necessarily mean that you have hypothyroidism, it does indicate an ongoing attack against the thyroid, increasing your risk for future thyroid disorders.

A study in the Journal of Autoimmune Diseases evaluated TPO antibodies' significance as an early predictive marker in thyroid disease. Compared to the control group, patients with both subclinical and overt hypothyroidism and hyperthyroidism showed a significantly higher percentage of having TPO antibodies before the onset of thyroid dysfunction.

Will I have symptoms with borderline positive TPO?

You may experience elevated levels of TPO antibodies for many years before noticing any symptoms. However, as the condition destroys more and more thyroid tissue, the drop in thyroid hormone production may cause symptoms that include: 

  • Tiredness and fatigue
  • Constipation
  • Dry, thinning hair
  • Heavy or irregular menstrual periods
  • Feelings of depression
  • Memory problems
  • Slowed heart rate

How to lower TPO antibodies

As mentioned, the presence of TPO antibodies may indicate a possible risk of developing thyroid dysfunction. Most people with borderline positive TPO levels, who have normal TSH levels, do not require medical treatment. However, it may help to lower antibodies to protect your thyroid gland from future disorders. 


Here, a few strategies to help reduce TPO antibodies: 


Try an anti-inflammatory diet

Foods that can trigger inflammation include gluten, dairy, soy, grains, eggs, nuts, seeds, and nightshades. The autoimmune protocol (AIP) diet may help you identify which of these foods is triggering for you. A 2019 study shows that identifying your dietary triggers on the AIP diet may decrease systemic inflammation and modulate the immune system. 

Supplement with vitamin D

Supplementing with vitamin D may reduce TPO antibody levels. A study in the Indian Journal of Endocrinology and Metabolism shows a significant reduction in TPO antibodies in patients with newly diagnosed autoimmune thyroid disease after three months of vitamin D supplementation


Supplement with selenium

Research suggests that supplementing with selenium may be useful in managing TPO antibodies by defending against oxidative stress. 

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Remove or avoid environmental toxins

The development of autoimmune thyroid disease is mainly due to family background. However, environmental toxins like radiation, iodine excess, pesticides, or chemical exposure can also elevate TPO antibodies. 

Manage your stress

Stress is anything that disrupts the body's natural balance— from a heavy workload to a blood sugar imbalance. So, while it may sound trite, stress can affect virtually every system in your body. Find a few minutes each day to practice stress reduction—something that is genuinely enjoyable for you to calm your body and mind.


Get enough sleep

Your sleep hygiene affects everything from how your body processes food, remembers information, controls inflammation, and more. The thyroid functions best when your body is well-rested, aiming for 7-9 hours of quality sleep each night.

A note from Paloma Health

Finding the early appearance of TPO antibodies before the onset of thyroid hormone disruption may reduce longer-term health concerns. Eating an anti-inflammatory diet, taking supporting supplements, and managing stress can help you reduce the risk of progression.

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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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