From the Guidelines
Elevated Thyroid Peroxidase (TPO) levels should be treated by addressing the underlying thyroid dysfunction, with treatment focusing on normalizing thyroid hormone levels rather than directly targeting TPO levels. The presence of thyroid autoantibodies, such as TPO, identifies patients at increased risk for thyroid autoimmunity 1. In patients with elevated TSH levels, treatment with thyroid hormone replacement therapy is recommended 1. Comprehensive evaluation and treatment of hyperthyroidism should be initiated in patients with suppressed TSH and elevated T4/T3 levels 1. Key points to consider in treatment include:
- Monitoring thyroid function with TSH measurement, and if abnormal, free T4 and total T3 measurements as indicated 1
- Obtaining thyroid function tests at any time clinical thyroid dysfunction is suspected or in patients with thyromegaly 1
- Rechecking TSH levels every 1–2 years in patients with previously normal levels, or as indicated by abnormal growth rates 1
- Initiating treatment for thyroid hormone replacement or hyperthyroidism based on laboratory findings and clinical presentation 1.
From the Research
Treatment for Elevated Thyroid Peroxidase (TPO) Levels
- The treatment for elevated TPO levels is often related to the treatment of hypothyroidism, as elevated TPO antibodies are commonly found in patients with hypothyroidism 2.
- Levothyroxine (LT4) monotherapy is the current standard for management of primary hypothyroidism, and treatment can be started with the full calculated dose for most young patients 2.
- In patients with subclinical hypothyroidism, treatment should be considered in symptomatic patients, patients with infertility, and patients with goitre or positive anti-thyroid peroxidase (TPO) antibodies 2.
- The dosage of levothyroxine should be adjusted based on the patient's age, weight, and other factors, and treatment should be monitored with serum TSH levels, with a target of 0.5-2.0 mIU/L 2, 3.
- Patients with persistent symptoms after adequate levothyroxine dosing should be reassessed for other causes or the need for referral 3.
- There is no evidence that population screening is beneficial, and symptom relief and normalized thyroid-stimulating hormone levels are achieved with levothyroxine replacement therapy 3.
Special Considerations
- Patients older than 60 years or with known or suspected ischemic heart disease should start at a lower dosage of levothyroxine (12.5 to 50 mcg per day) 3.
- Women with hypothyroidism who become pregnant should increase their weekly dosage by 30% up to nine doses per week (i.e., take one extra dose twice per week), followed by monthly evaluation and management 3.
- Patients with central hypothyroidism require evaluation of other pituitary hormones, especially assessment of the hypothalamic-pituitary-adrenal axis, since hypocortisolism, if present, needs to be rectified prior to initiating thyroid hormone replacement 2.