Your thyroid antibodies are not that high except for the TRAb. It looks like it is blocking your Free T4 which is why is low. You do have a positive TSI even though the number is low.

It is possible you may be in a phase where you will yo yo in and out of hypER/hypO. I don't suggest being put on meds yet.

Are you experiencing any thyroid symptoms? I believe this can be manage by following a diet such as avoiding raw goitrogens to get the Free T4 to come up.

{{{hugs}}}

P.S. The TRAb is also blocking the TSH, keeping it low.

If you haven't yet, please go to our thyroid expert Elaine Moore who has tons of articles, research info in her database at her website. She can also help you further if you need to ask her Qs. Only she will answer to your Qs.

{{{hugs again}}}

Thanks to mmztcass and cd3764. You are both very helpful and are always quick to answer my questions. I know this takes a lot of your time and I am very appreciative. I just want to make sure I understand so I have a few questions. Because I have the TRab my TSH is going to stay suppressed and if I had RAI the TRab could go up higher? I could eventually hit remission and the TRab would come down? Does a healthy person have any TSI? Last 2 weeks I have felt good. I am trying to eat better and exercise and chart how I feel. The days when I have a lot of muscle weakness and no energy is that hypo? One more question, I am still on atenolol 25mg 1xday. My pulse stays in the high 70's and 80's. 4 years prior to atenolol I was always in the 90's. Could that just be my norm because that does not correlate with hypo does it? Lots of questions, sorry.

TRab is a measurement of all the Graves' antibodies - TSI being one of them.

Your TSI level is low enough that it wouldn't cause hyPERthyroidism.

However, part of that TRab result contains Graves' blocking antibodies.

The blocking antibodies can either negate the effects of TSI (which stimulate the thyroid to produce hormone) or, they can overpower TSI and make the patient hypo. This is where I'm at.

All types of Graves' antibodies suppress TSH.

Your thyroid hormone levels are quite hypo - you would benefit from some thyroid hormone replacement such as Synthroid/levothyroxine.

Based upon your lab's ranges, a healthy person would have FreeT3 3.4 - 3.8 and FreeT4 1.4 - 1.7 so you can see just how low your levels are.

The thyroid antibodies goes up higher with the RAI.

{{{hugs}}}

For clarity, I'm listing the various symptoms of hypothyroidism that a person can have when their levels are too low for their body's needs. Not everyone will have every symptom on the list.

This list comes from thyroid textbook "The Thyroid and Its Diseases".

Fatigue
Swelling of eyelids
Emotional instability
Lethargy

Dry skin
Choking sensation
Low endurance
Dry mucous membranes

Fineness of hair
Slow speech
Constipation
Hair loss

Slow thinking
Weight gain unexplainably
Blueness of skin
Poor memory

Paleness of lips
Dry, thick, scaling skin
Poor concentration
Shortness of breath

Dry, coarse, brittle hair
Depression
Swelling
Paleness of skin

Nervousness
Hoarseness
Puffy skin
Anxiety

Loss of appetite
Puffy face or eyelids
Worrying
Prolonged menstrual bleeding

Swelling of ankles
Easy emotional upset
Heavy menstrual bleeding
Coarse skin

Obsessive thinking
Painful menstruation
Brittle or thin nails
Low motivation

Low sex drive
Dry ridges down nails
Dizziness
Difficulty in swallowing

Sensation of cold
Hearing loss
Weakness
Cold skin

Rapid heart rate
Vague body aches & pains
Decreased sweating
Pounding heart beat

Muscle pain
Heat intolerance
Slow pulse rate
Joint pain

Non-restful sleep/interrupted sleep
Pain at front of chest
Numbness or tingling
Insomnia

Poor vision
Protrusion of one or both eyeballs
Thick tongue
Weight loss or gain

Sparse eyebrows/loss of outer third of eyebrows
Swelling of face
Wasting of tongue
Gas/bloating


And, for whatever it's worth, the average adult heart rate is 60-100 beats per minute per below:

http://www.mayoclinic.com/health/heart-rate/AN01906

I forgot to answer your question.

Yes, if you had RAI, your antibodies (TRab and TSI) would increase significantly right after the treatment....and would continue to increase for many years afterwards.

There is no chance of remission after RAI.

Right now, with you being hypo, this can actually increase antibody production since being hypo is stressful to the body.

The best you can do is take some thyroid hormone replacement to bring your levels up to the types of levels healthy people have.

It's possible that you will eventually no longer need any type of treatment but, hypothyroidism needs to be treated just as hyperthyroidism does.

Healthy people have TSI less than 2.

Here's a link that includes a graph which illustrates how high the antibodies can get after RAI

http://eje-online.org/content/158/1/69.full

Finally, the online thyroid textbook "Thyroid Disease Manager" published a study that showed increased risk of cardiac and cancer mortality in post-RAI patients. It was because of this study that endo #3 stopped recommending RAI for patients wanting a permanent treatment.

I've copied and pasted the article.....


From www.thyroidmanager.org

This is copied from their home page:

Thyroid Disease Manager offers an up-to-date analysis of thyrotoxicosis, hypothyroidism, thyroid nodules and cancer, thyroiditis, and all aspects of human thyroid disease and thyroid physiology. It provides physicians, researchers, and trainees (as well as patients) around the world with an authoritative, current, complete, objective, FREE, and down-loadable source on the thyroid. This website is directed to helping physicians care for their patients with thyroid problems. WWW.THYROIDMANAGER.ORG is updated continually with important new information, and major revisions are done annually. The latest revisions were introduced 17 September 2009. We greatly appreciate contributions for support of THYROIDMANAGER.ORG. Contributions are tax-deductible, and should be sent to Endocrine Education, Inc.P O Box P-94, 24 Nonquitt Ave, South Dartmouth, MS 02748. For all inquiries .


This is copied from their Thyroid news section for 2007:

Mortality and radioiodine treatment

TOPIC: Increased risk of cardiovascular & cancer deaths from radioiodine treatment for hyperthyroidism

Title: Increased cardiovascular and cancer mortality after radioiodine treatment of hyperthyroidism.
Authors: Metso S, Jaatinen P, Huhtala H, Auvinen A, Oksala H, & Salmi J.

Reference: Journal of Clinical Endocrinology & Metabolism 92: 2190-2196, 2007

SUMMARY
Background: Although patients treated with radioiodine (RI) for hyperthyroidism are at increased risk for death, it is unclear if this is due to the disease itself or due to the treatment.

Purpose: To compare the mortality of hyperthyroid patients treated with RI with that of an age- and gender-matched controlled population.

Patients and Methods: A total of 2.793 hyperthyroid Finnish patients who received RI treatment between 1965 and 2002 were compared with 2.793 reference subjects, and followed for a median of 9 years.

Methods: Diagnosis, dates, and doses of RI treatment for 2.793 patients were retrospectively reviewed. The study included an age- and sex-matched control group of the same number of subjects using the Population Register Center.

Results: Patients and controls had a median age of 62 years at treatment or study; the median follow-up period was 9.8 & 10 years, for patients and controls, respectively. Overall, there was an increased all-cause mortality in the RI-treated patients versus controls. Mortality was increased due to cerebro-vascular disease (atrial fibrillation) as well as upper gastro-intestinal tumors.

Conclusions: Hyperthyroidism probably accounts for increased cerebrovascular mortality after radioiodine treatment. Results emphasize the need for careful, long-term follow-up of RI-treated hyperthyroid patients.




COMMENTARY
Radioactive iodine (131-I, RI) has been used for over six decades to treat hyperthyroidism. It is considered an effective treatment for patients with diffuse toxic goiter (Graves- disease) or those with toxic nodular goiter (toxic adenoma or Plummer-s disease). Moreover, it is the most popular treatment modality and treatment of choice for hyperthyroid patients in the U.S., although not so in other countries such as Japan, Germany, or U.K.

The safety of RI and its long-term side effects have been subject of many reports through the years. It was reassuring that the U.S. Public Health Service Cooperative Thyrotoxicosis Therapy follow-up Study of 1946-1964 (Hoffman DA et al, 1982) reported no increased mortality after RI treatment. In a subsequent report from the same group, another study, including 35.593 patients, showed no increased risk of mortality or cancer after RAI treatment was found (Ron E et al, 1998). More recent data on this subject have been conflicting, some suggesting an increased risk of death or of cancer after RI. For example, one U.K. study showed that the all-cause mortality was increased, whereas cancer mortality was in fact decreased (Franklyn J et al, 1998); the slightly increased mortality was caused by heart failure and arrhythmias. On the other hand, another U.K. group published a population-study and reported no increase in mortality after RAI treatment (Flynn RW et al, 2006).

In present study from Finland, Metso and colleagues report on the frequency of death and cancer after RI treatment for hyperthyroidism. The authors reviewed records of 2.793 hyperthyroid Finnish patients who had received RI treatment between 1965-2002, with a median age of 62 years and a median follow-up period of 9 years. The study included a similar number of controls, age- and gender-matched, followed for the same duration. Main results showed the following:

Increased all-cause mortality in treated patients.
Increased mortality appeared due to cerebro-vascular disease but not to coronary artery disease.
Patients treated with radioiodine had an increased rate of atrial fibrillation (AF).
Increased frequency of malignancies, especially upper GI cancer, particularly in elderly men.
Analysis showed that cancer risk increased with cumulative radioiodine doses.
The strengths of this report include the presence of a controlled population as well as the thoroughness and length of duration of both RI-treated and controlled groups. Although there was documented increased mortality in patients treated with radioiodine, it was not established that radioiodine was the cause of this observation. In fact, the authors state that -the present study of patients treated with RI for hyperthyroidism reports an increase cerebro-vascular mortality in patients treated with RI compared with age- and sex-matched control groups which is probably explained by hyperthyroidism. Furthermore, cancer mortality increased among the patients-. The authors recommend careful and continued follow-up of hyperthyroid patients treated with radioiodine. In conclusion, RI is still considered safe and effective, and it is likely that endocrinologists and large clinics will continue to use it to treat hyperthyroid patients, either with Graves- disease or with toxic nodular goiter. These patients should be followed for development of post-therapy hypothyroidism as well as for cerebrovascular events due to AF caused by hyperthyroidism. The small risk of cancer in elderly men, reported here, is of doubtful clinical significance. Summary and commentary prepared by Hossein Gharib (related to Chapters 11 & 17 of TDM)

Sheesh....forgot another thing

The TGab's (thyroglobulin antibodies) you had tested are most often seen in Hashi's, the most common cause of hypothyroidism.

Obviously, you don't have that.

You guys are great! I think I am beginning to understand it all I just have a hard time verbalizing it. Anybody want to go to the Dr. with me?Lol. It is amazing now that I understand and look back at my numbers and realize how many times I have been hypo. In 2009 my Free T-4 was 0.8 (0.6-2.0) bet I felt like crap then but didn't know what was happening. I always felt like I was hypo not hyper but until I really started feeling bad I did not take the time to understand this disease. Now that I am armed with all the info I need to find a Dr. to listen to me. Thanks again!

Finding a thyroid-savvy doctor can be challenging but, it's possible.

Now that you know what's going on with your situation, "all" you need to do is find a doctor that knows to ignore TSH and will recognize your hypothyroid symptoms and related hypothyroid levels.

You shouldn't have to present anything to a doctor - he/she should be aware of this stuff...it's just that many aren't.

You could very well find a thyroid-savvy doctor in the form of a DO, internist or holistic doctor.

Some thyroid forum members have had success by getting contact info from local pharmacists (including compounding pharmacists) for doctors that Rx Armour and/or Cytomel.

These are two types of thyroid hormone replacement meds that thyroid-savvy doctors Rx.

Best of luck to you moving forward - please keep us posted :)

Yes, let us know. CD has provided with great info and links.

My 19 y/o son is sick right now. He has Type 1 Diabetes and we're thinking he's going to have to go to the ER. :-(

More later.

{{{hugs}}}