I have never gone to an NP, but I didn't think one would be even as likely to over-treat the Graves' as an Endocrinologist. My Endo #2 wouldn't let me get as hypo as it seems like you are, and he said that MMI stays in your system for about 2 months after going off it.

I don't think I ever had a TRab test. TSI was tested frequently, and Endo #3 said she would run tests for Hashimoto's as well, and she ran TPO antibody test and Thyroglobulin antibody test.

Do you have additional updates to your condition since April?

Maglady...your levels are low on the 7.5 mg of MMI...a reduction is the right move...but...I would wean off the MMI by reduction rather that just stop. Since you are hypo and being hypo generates antibodies..your results may be higher than you would like...thats why tapering off slowly and keeping your FT4 in the top half of your ranges is helpful. Here's a link that may help you understand the test...Big Hugs...Kathy

http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Thanks for the link, Kathy.

Does that mean that TSI and TRab are the same test, with a different name? Also, does that mean that the TSI doesn't just act like the TSH but outside of the feedback loop, but also attacks the TSH, lowering it, while stimulating the thyroid to produce more hormones?

That is very interesting and something I never understood before.

Its my understanding that the TRAb is the latest and newest form of antibody testing...however...TSI is still very good...Big Hugs...Kathy

I would just like to mention...here in Canada I could not get the TSI only the TRAb

@Maglady

I agree with dairytech. The right way to be medicated for Graves' is to have the dose slowly lowered while maintaining the FT4 level near the high end of the range until the patient is taking the lowest possible dose (1.25mg every other day).

If TSH is .3 or higher at that point, then there's a chance remission is imminent.


@FernRL

The TSI (thyroid stimulating immunoglobulin) test measures the stimulating Graves' antibodies - those that stimulate the thyroid to produce hormone and suppress TSH.

TRab (thyrotropin receptor antibody) *should* measure *all* of the Graves' antibodies - the stimulating antibodies (TSI),blocking antibodies (TBII) and neutral antibodies.

http://www.ncbi.nlm.nih.gov/pubmed/20844004

However, as noted in the article below, most TRab tests only measure TBII:

http://www.hindawi.com/journals/jtr/2012/525936/

It's the predominance of blocking antibodies that can make a Graves' patient hypo (and I'm not talking about those who are overmedicated on ATD's....it's more those of us who go hypo after remission)

Thanks, Kathy, and CD,

That was a lot of information to read through, and I don't understand very much of it, but I searched for, and found this, comparing the TSI and TRAb tests:

"While the gold standard for thyroid-stimulating immunoglobulins is the bioassay (see TSI/8634 Thyroid-Stimulating Immunoglobulin [TSI], Serum), the thyrotropin receptor antibody test has a shorter turnaround time, less analytical variability, and is less expensive."

The source is:

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81797

I just wrote to Elaine Moore about the TSI vs TRAb...I will post her response when she posts it..Big Hugs...Kathy

In the meantime...here is a link that kind of covers them all.

http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies#TSH_receptor_antibodies