The TSH Receptor Antibody test measures *all* of the Graves' antibodies:

TSI (stimulating)
TBII (blocking)
neutral (I can't remember the term for them - sorry. obviously, neutral
antibodies don't do anything)

Thanks. So sounds like the test I needed maybe from the beginning. Only had tsi done 2 yrs ago,

TSH Receptor Antibody is the same as the TBII.
It shows stimulating, blocking and binding Graves' antibodies.

TSI is only the stimulating antibodies.

Unfortunately you can not look at both together and guess what the % of blocking and binding antibodies might be. Though in some circumstances, say... HIGH TRabs and super low TSI, it does become clearer. At this time in history, tests for only blocking abs are still research only.

Cindee,
HI !

Easiest place to do quick reviews of labs is on our info page at the old MediBoard group. Now called Living with Graves' Disease. Come on over, it seems like the two groups have hit a point where their interchangeable now.

Here's the page I'm referring to.
http://www.livingwithgravesdisease.com/diagnosis/lab-tests

Thanks Pam, I will check it out. Still waiting for results. Local lab has to "send" sample out and then its 2-3 days to get results. Sometimes living in a rural area is a pain. Thanks for the help on the Antibody test - hopefully this will support remission....fingers, toes, anything else I can find crossed....LOL

LabCorp may say that TRab is the same as TBII but, Elaine Moore clarified for me that it's not.

TBII stands for thyrotropin binding inhibiting immunoglobulin.

TBII is the Graves' blocking antibody that can negate the effects of TSI and make the patient euthyroid (normal thyroid function) with suppressed TSH **OR** the ever-powerful TBII can override the effects of TSI and make the patient hypo with suppressed TSH.

TRab stands for TSH (or thyrotropin) receptor antibody....and there are the 3 kinds of TRab that I described in my first post on here.

Elaine was the one who mentioned looking at both together but acknowledged it's truly a guessing game.

It's a relatively accurate assessment that TBII are involved if the patient isn't taking any meds, is hypo and has suppressed TSH.

Quote: It's a relatively accurate assessment that TBII are involved if the patient isn't taking any meds, is hypo and has suppressed TSH

LOL.. that's the way we did it in the olden days. :)

Now I'm confused....back to the drawing board. sigh

So let me add to it a bit. I emailed Dr and asked about the test vs TSI - he said it ws the "better" test and was the standard test at OHSU. My response was basically how there is nothing standard in the medical preference. I guess as long as he can interpet the thing correctly, that's all that really matters.

So do you guys agree or disagree that it is the better test for graves and/or remission???

okay.. I think I'm caught up now. Thanks Carol. I see at one point I saved this page, then apparently forgot it. shoot...

http://www.ncbi.nlm.nih.gov/pubmed/9364248

I wouldn't use the word better..their just different.

The fact that he prefers the TSH receptor ab test could potentially help in a possible quest for partial BRT. I wonder what his method would be for a patient with elevated TRabs and not able to take the ATD without hypo symptoms ? Could this be the place where he relents....

Doctor... I feel 'normal' with a FT4 of X.

This 1.25 of MMI sends me too low.

What is the harm of maintaining my FT4 at what appears to be my optimum level, by adding a small dose of T4 ? which would then allow me the mild immune suppressing properties of the MMI, while I continue to heal.

I know you know. I'm just thinking of how I would phrase it. "What is the harm" was one of my fall backs.

:)) Good thought... It's worth a try. So what should I be looking for with this test result? See why I'm dazed and confused...LOL

This is like some crazy chess game at times. Block the doctor in the corner with such a reasonable question ( and that innocent face) .. what's he going to do ? LOL

If he says just go off the MMI and your TRAbs is above the reference point, I would question why he felt it is healthier to spend time relapsing then having to start meds all over again, rather than creating a stable thyroid level for my body, and being able to continue the benefits of the medication. Given I have been doing well for so long ( read compliant and responsible), yada, yada, yada....

I've seen a couple tests and results for the TRAbs. most seem to have 'less than 1' as the reference. but maybe we should start noticing what others have posted and report back here. ..good question. I'll go look at g_s.

I think that's where the term "oldie but goodie" comes into play.

This antibody stuff can make one nutz.

At the end of the day, TSH needs to be ignored.

If the lowest possible dose of ATD makes a person hypo, they either need to go off ATD's or convince the doctor to start some thyroid hormone replacement along with the low-dose ATD.

Rotsa ruck with the latter option as I have experienced - blech.

Common sense just doesn't seem to be too common with doctors treating thyroid disease.

I have a saying that seem applicable...."one cannot apply logic where logic has no home."

Yeah, I doubt he'll budge since our communication is by email. But, it is worth a try depending upon what the test says. I have no idea what to expect or look for so I will be awaiting what you guys think. Yeah, the idea of relapse doesn't excite me if I come off too soon, but I can't stay here. He tried to tell me the 1.25 and .625 were too low and weren't working about 3 weeks ago when I told him I was exhausted - I said, really? I have FT4 and Ft3 (he doesn't understand the FT3) that are where I feel good most of the time and you tell me they aren't working? I don't agree. I think they are working too well if they drop those numbers. I then explained for the umteenth time about my philosophy on TSH and his reply was - I'm on board with whatever you want to do.... Crazy huh? Of course this dialog all happened before this last lab - now he thinks it's genius...:))
I told him at the start - since he is Dr 4 - let me be your lab experiment and prove my point. Drs.......:)))

Well, there are those that claim a dose of 5 mg MMI or 50 mg PTU is the bare minimum that will lower antibodies. These people insist that diet and lifestyle has no affect, and the fact that steady levels assist in antibody reduction does not exist. For them..it's all about the pills.

In black and white, reading the studies at face value, not examining exactly how the study was done, then accepting the conclusion of a study without closer question.. then the 'only 5 mg or more' theory makes sense.

But in real life, we see this is not completely accurate, by our own experiences and being a longer term group member...we see how others do, depending on all the factors in each case. Over and over.. we see those that do great on the lower doses, and we watch their antibody levels drop. This is where the old stick in the muds say.. "Well, it would have happened anyway. Nobody knows the cause of Graves' for sure. " It's like they just shrug their shoulders and give up.

I've seen nothing that tells me this is as completely random as some claim. It's a left over from the pro RAI speech that was popular for so long. Shame it keeps being brought into discussion for those on ATDs, because it's not accurate.

First example I think of is Doris, the gal that set up MediBoard. Carol remembers part of that. She was on 1.25 mg of MMI the final year before her slide to remission.

BUT.. one other angle would be IF the antibodies are still raised... maybe he would consider 5 mg of MMI and some T4 to allow you to take such a high dose compared to what it takes now to remain euthyroid. ???

Sorry to go on and on... repeating what you know. It just pops out. Maybe if you can convince him it's all his idea, he like some men I've known, will happily go along, none the wiser. ;)

I'm so glad we met before you went up there. This is the first doctor up there that is at least trying. I imagine the peer pressure to convince all Graves' patients that RAI is preferable is going on. But this is a time of change. we see it in all the groups. More and more doctors are starting to learn a little more about Graves', and ATDs. They're like toddlers learning the ropes.

We need to be patient with them, especially since some of the truly good older, experienced endos are retiring now. We baby boomers are a force to be reckoned with, as a group, as we age, so much changes simply by our numbers. They built schools for us, hospitals, workplaces, and now the aging services will change. We forget as the professionals retire, we also loose some of the rare, great doctors. Though some of them retiring is a good thing.

I've been around long enough I've had the time to see treatment with ATDs become more and more popular. Access to information via the internet is a big part of this. Combine with the new antibody tests, and it puts us exactly where we are today... doctors trying, but still over dosing us, with too many patients and not enough time to study further.

As promised, I did come back with something from g_s.

What do you guys think of this post .

Quote:
TBII and TRab tests are measuring the same antibodies, but using a much different way.

Since antibodies cannot be seen, we can only measure them by looking at the effects they produce. For instance, TSI tests don't count antibodies; they only watch how a TSH receptor responds to a drop of your blood and measure how much stimulation it is now getting.

TBII test measures how effective your antibodies are at pushing TSH (thyrotrophin) away from the TSH-Receptors. They are watching to see how much the antibodies can inhibit the TSH from being able to bind on those sites --- and thus the TRab are binding there instead. (TBII means thyrotrophin-inhibiting binding immunoglobulin).

TRAb tests (biologic) typically measure the type of activity that occurs on that TSH-Receptor when exposed to your blood -- both blocking and stimulating effects.

The new third-generation TBII test uses actual monoclonal TRab stimulating antibodies in the process, and are now even better tests than the previous assays.