Graves' Disease Support Group
Graves-Basedow disease is a medical disorder that may manifest several different conditions including hyperthyroidism (over activity of thyroid hormone production), infiltrative exophthalmos (protruberance of one or both eyes and associated problems) and infiltrative dermopathy (a skin condition usually of the lower extremities). This disorder is the most common cause of...
In the grand scheme of things- where and to what importance does the TSI and TPO tests play? I've been researching this and wanted to get your opinions. In my particular case, at my initial diagnosis, I had a nearly undetectable TSH and FT3 and FT4 were fine. This would indicate and told to me by a handful of you and Elaine that I should not have been medicated and only monitored. However, my TSI and TPO did show elevated results.
Thyroid Stim Immglob :4.7 TSI index- Normal range: less than =1.3
(Aug 27- before treatment)
Aug 27th- before treatment: TPO Antibodies156.9 IU/mL- Normal range: less than 9.0
So, where does this leave me? Also, I must add that I gave birth to my son a year prior to diagnosis and at the time of diagnosis, just stopped breastfeeding 2 weeks before. I also am wondering if my hormones, especially estrogen, played a part in anything. Do any of you have insight to this?
Thyroid Stim Immglob :4.7 TSI index- Normal range: less than =1.3
(Aug 27- before treatment)
Aug 27th- before treatment: TPO Antibodies156.9 IU/mL- Normal range: less than 9.0
So, where does this leave me? Also, I must add that I gave birth to my son a year prior to diagnosis and at the time of diagnosis, just stopped breastfeeding 2 weeks before. I also am wondering if my hormones, especially estrogen, played a part in anything. Do any of you have insight to this?
TPOab's are markers of thyroid inflammation and are seen in Graves' and, at higher levels in Hashi's.
You might also have TBII (thyrotropin binding inhibiting immunoglobulin) which is another type of Graves' antibody.
TBII also suppress TSH but, instead of stimulating the thyroid to produce hormone, they block the production of hormone.
TBII can either negate the effects of TSI and leave the patient euthyroid (normal FT4/FT3) with suppressed TSH.
*Or* the ever-powerful TBII can leave the patient hyPOthyroid (with suppressed TSH).
This is what Elaine Moore shared with me a couple of years ago because I questioned my situation of being hypo with suppressed TSH.
Thyroid Receptors antibodies test.
{{{hugs}}}
Maybe there's more there I just haven't gotten to yet. Here's the full PDF file.
http://www.thyroidguidelines.net/sites/thyroidguidelines.net/files/file/thy.2012.0205.pdf
First quote found :
TSHRAb may act as a TSH agonist or antagonist (41).
Thyroid stimulating immunoglobulin (TSI) and/or thyrotropin
binding inhibitory immunoglobulin (TBII) levels,
employing sensitive assays, should be measured in euthyroid
or L-thyroxinetreated hypothyroid pregnant women
with a history of Graves disease because they are predictors
of fetal and neonatal thyrotoxicosis (42). Since the risk for
thyrotoxicosis correlates with the magnitude of elevation of
TSI, and since TSI levels tend to fall during the second trimester,
TSI measurements are most informative when done
in the early third trimester. The argument for measurement
earlier in pregnancy is also based, in part, on determining
whether establishing a surveillance program for ongoing
fetal and subsequent neonatal thyroid dysfunction is
necessary (43).
See my last post also with the quote proving dosing by TSH is wrong for those of us with Graves' antibodies, rather we must be dosed by the FT4.
How are you doing ? I keep thinking of you sliding further into hypo. :( While the 'fix' here is elusive, not causing harm needs to be the first priority, and hypo is the wrong way to go.
Given your higher antibodies but low thyroid levels ( with suppressed TSH) what we call loosely' Hypo Graves', the only route I have thought of at this point would be adding back a small amount of T4 ( Synthroid or such) plus the lower ATD dose. The mix would prevent hypo while providing the benefits of the lowering of the antibodies of the ATD.
If you ask for "Block and Replace " treatment, doctors tend to automatically reject that idea because a study came out some time back saying the original study could not be replicated..but my question is how where these studies different..not the results.
The original BRT ( block and replace therapy) is done with high dose of both medications, giving an increased risk of side effects. Though it is still done elsewhere, just not as commonly as years back. It does work. But my warning here is to not use the term BRT, instead ask a new endo if he/she thinks using the ATD to lower antibodies , then adding replacement hormone to prevent hypo might be something to consider ?
Internet slang calls this type of treatment " Add back therapy"..but that's not a real medical term.
http://www.ccjm.org/content/77/11/803.full
We know why yours is low, the TSI and probably also blocking antibodies ( else you would be hyperthyroid). Various names for the TSH receptor tests, but they all count the mix of blocking, binding, and stimulating antibodies. They can not be compared to the TSI result to guess the % of blocking antibodies, but they show our true case of Graves' disease.
I've seen hints of research only tests showing just blocking abs, but noting for real life patients yet. Not that it makes a big difference, just saying to help the understanding.
Thanks for responding!
Thanks for the info. I also contacted Elaine and she shared some of the same information with me. I bit of a foreign language to me still, but I'm learning, slowly but surely. I searched back and found some past test results- I believe this may be useful:
Aug 27- (before any treatment) TRAb 5.46 ( 0.00 - 1.75 )
Nov 14- (After MM- went hypo at this time, not sure if that matters) TRAb 3.29 ( 0.00 - 1.75 )
@pam- I'm also beating my head against a wall. So hard to find information about my particular circumstance. Thank you a hundred times over for searching in my behalf. That PDF- wowza- I skimmed it but I definitely need to search through that . Funny, your second article I read a week back or so- found it quite interesting. I have read it a few times- uses medical terminology that I'm not as familiar with but I'm certain with my labs I was sub-clinical, which you and Elaine also said. My doctor said nothing of the sort.
I also left a message with my family med doc to order an ultrasound of my throat and neck. I haven't gotten this done before and with my persistent ache, I think it is wise to complete. We'll see if she orders it, so far, she hasn't help me out much.
I think that the thing that is weighing on me most is this whole pregnancy thing. I'm completely terrified that I won't be able to get pregnant again. We worked so hard for my son- took years- and here I am again, waiting. I was planning on taking the meds and hopeful to go into remission in a year- wait a bit- and then thaw my embryos to give pregnancy a shot again. I find myself not only scared that the embryos will not take, but nervous that I'm not even close to even trying to get pregnant. Then, when this all started I thought to myself that if the drugs don't work- I'll have a thyroidectomy. That thought is dashed- the same people would dose my meds after that surgery are the same ones that are neglecting me now. I need my thyroid- and I want a baby... I guess I just want my cake and to eat it, too... I guess I'm just so scared... and honestly, sad. Adding hypo to messing with my mind... urg...
Also, I'm going to be contacting my reproductive endocrinologist to get him in the mix. He is an amazing doctor- the epitome of what a doctor should be. I know he cares about me and he will also help me. Not sure exactly where he fits in to all of this but I know he will help me. My husband has also been researching like crazy with me- he's pretty awesome. He will not let me go to my next appointment alone- he's a numbers man and quick to learn.
Thanks for everything- especially for making it this far in my rant! Hopefully a new endo will ease my anxieties and give me a little confidence. Please know that I have learned so much from this site- impacts me HUGELY! I appreciate you!!!
On that note, I'm off to take a nice, hot shower...
I read that Brasil nuts, with about 100% of the daily requirement of Selenium per nut, can help with lowering the autoimmune antibodies. I have not heard that the ATDs do that. If so, could someone post the link?
Iodine is important for producing thyroid hormones, which is why they started making iodized salt. The Mayo clinic says they think the use of table salt in America has made it such that iodine-deficiency as a factor in hypothyroidism or goiters is not applicable here in the states.
Estrogen in particular tends to bind with thyroid hormones which can leave a women hypo. (I read that somewhere.)
Here is an interesting case study I read:
http://www.neuroendocrinology.org/thyroid-hormone-resistance.html