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The Thyroid Peroxidase (TPO) IgG ELISA test system is an enzyme linked immunosorbent assay (ELISA) for the detection of IgG class antibodies to Thyroid Peroxidase in human serum or plasma. Thyroid peroxidase (TPO), is the major autoantigen (933 amino acid residue) in the thyroid microsomal antigen (TMA) particle. The purification and preparation of this antigen has made testing for TMA antibodies obsolete. ELISA using TPO recombinant antigen is the most popular assay. Detection of TPO antibodies is strong evidence against a goiter or non-autoimmune causes of hypothyroidism. The annual risk for the development of hypothyroidism is 3% to 4% per year if TPO antibodies are present and TSH is elevated. TPO antibodies are present in 8-9% normal controls, 57-74% patients with Graves disease, 99-100% of Hashimoto disease or idiopathic myxedema, 19% with differentiated thyroid cancer, no patients with subacute thyroiditis and 11% of those with other miscellaneous non-autoimmune thyroid diseases. The prevalence of positive TPO antibodies is higher in elderly (mean age 80 years) women (10%) compared to elderly men (2%). Autoantibody concentration in centenarians also decreases. Studies of TPO epitopes in each domain, A and B, and detection of their specific autoantibodies suggest that the epitope-specific TPO antibodies ratio (A/B) does not change over time in individual patients and that TPO epitope autoantibody patterns may be inherited.