Hi everyone. Well I am still on Tapazole 20mg a day for 6 months now and TSH is mid range from low and FT3 and FT4 are way low from normal. I am positive for a lot of antibodies and I am confused if I have Graves, Hashi's, or a combo??? I have hyper symptoms though. Thoughts? Thanks Suz
It may take an ultrasound or raiu and scan to decide. The tapazole may be surpressing the antibodies. A hashis thyroid shows a distinctive pattern upon scanning. It will look a bit, for lack of a better word, mottled. A graves thyroid has an even pattern. The uptakes on a raiu will be different too. Graves high, hashis low. I place my bet on graves. TGAb's can be positive in either.
This is my understanding of these particular antibodies tests:
TPO-Ab shows if there is inflammation present; it is not definitive for either Hashi's or Graves.
The presence of TSI means you have Graves disease, regardless of whether or not the number is elevated above the "normal" range. With TSI, there is no normal. Most people exhibit clear hyperthyroid symptoms when the levels rise to about 125%-130%. Your level is at 112% which matches the fact that you have "some hyperthyroid symptoms" as you put it. Graves is considered "in remission" when TSI drops to less then 2%.
TRAb measures Thyrotropin/TSH Receptor Antibodies, of which there are three kinds: Stimulating (TSI), Binding, and Blocking. The TRAb test tells you the total of those three kinds of antibodies present, but it doesn't tell you how much of each kind--i.e., whether you have more stimulating TRAbs (TSI) or more blocking/binding TRAbs. The TSI test discussed above measures only the Stimulating kind of TRAbs.
As Helen already said, Tg-Abs can be present in either Graves or Hashi's.
To answer your question as to what you have, TSI is definitive for Graves regardless of level. Keep in mind you can be hypo, hyper or euthyroid and still have Graves. An RAI-uptake scan only shows if you are hypo, hyper, etc. The TSI indicates you do have Graves disease.
Yeah, suz, what is your scheduling on the tapazole? mmztcass does have a point. Some people do do better with a scheduling change.
Iris, you've got a pretty good understanding. However, most people do not realize that there are two totally different methods for testing TSI. One measures the actual antibodies. That's where the magic 2 comes in. People without graves have an antibody level of less than 2. It's an expensive test. The other, less expensive test, measures what's known as basal activity. It's a really complicated concept and it took me years of reading and tons of research before finally comprehending it, but what it comes down to is that it is not a measure of how many antibodies are present. It causes a lot of confusion. People without graves have a lower level of basal activity. You can tell the difference between the two tests cause the one for basal activity is usually followed by a % sign or says percent basal activity. The other test will actually show a normal range that says <2. So, in actuality, all people have some basal activity. The higher the level, the more likely it is graves if it is accompanied by signs and symptoms but some people can get to the high level of the normal range and never have graves.
It was a very important thing for me to learn. I have antibodies less than 2. I have basal activity that usually runs in the 80's. Confirmed many times except the time the idiot endo did a basal activity test one week after one of my raiu scans and it came back borderline which, later, come to find out would be normal for anyone. I do not have graves. I carried an erroneous diagnosis of graves for 15 years because of it. I have pituitary dysunction.
There's also some pretty darn expensive tests that can determine the different types of TRAb present. It's almost never necessary to know that unless hypo symptoms predominate and many of the blocking antibodies are present or they're trying to prove an autoimmune basis.
I'll disagree on the raiu scan. If a diagnosis is questionable, a scan can be very helpful. Hashis, and graves and a whole range of the various thyroid disorders all show distinct patterns. That, in combination with the thyroid hormone levels, antibody tests, signs and symptoms can confirm the diagnosis.
Suz has been around for a while. She's already been proven to have graves. She has tested positive for graves in the past. My bet was placed on knowledge of her history and previous tests.
Thanks for the explanation, Helen. LOL, just when I think I understand these darn antibodies, it gets even more complicated! But this is good info to know.
How was your pituitary dysfunction diagnosed? And how is pituitary dysfunction treated?
Very interesting on the two different TSI tests. How does one order the more expensive test of actual antibodies? Does it go by a different name?
What would you say about my case? I have a benign cold nodule 1.9cm x 2.8cm on the left lobe which FNA showed to contain a mix of colloid and hyperplastic cells. I had an RAI-uptake scan in Feb 2007 which showed 6-hr low uptake; 24-hr low-normal uptake. I had a TSI test in March 2007 with a result of 107%; another in May 2007 showing a result of 106%. TPO-Abs were <10 (range <35); Tg-Abs were <20 (range <20). All my other thyroid lab tests were in the normal ranges.
Most of the time I feel more hypo than hyper, but sometimes have hyper symptoms... and, looking back at my history, I can see I had episodes where I was probably hyperT but no lab tests were done to catch it. I also had pretibial rash for over 2 years, which resolved about the time the nodule was found. Off and on I have mild eye issues that could be TED. A Graves diagnosis makes sense to me, except I think I may have more blocking than stimulating TRAb most of the time.
Last edited by IrisBlue; 08-15-2007 at 09:26 AM.
Reason: add info
Actually you have a better understanding of antibodies than the endos I've seen.
Pituitary dysfunction was my original diagnosis in 1991. I have normal to high TSH and elevated thyroid hormones and am clinically hyper but have some hypo things thrown in like high cholesterol and such. It was changed to graves after that bumbled antibody test in 1993 cause no one would bother to research what was really going on and they were too busy bouncing me hither and yon on all kinds of anti-thyroid med schemes while trying to convince me the only treatment was rai. I was finally put on just plain beta blockers by a gp and did much better. I ran into trouble about a year and a half ago. My new gp sent me to 3 endos. I came away with another diagnosis of "most likely graves" tx: rai, one hypertension and one menopause. My gp finally took over, talked to a thyroidologist, did some research and now, we're finally back on the right track. I've still gotta do the TRH stimulation and have a SHBG level checked but those are pretty much formalities now. Treatment is with beta blockers and the addition of thyroid hormones or analogs to lower the tsh and stop the overproduction of thyroid hormones while maintaining the proper level of hormones for the organs that are actually hypo. Really quite simple.
I'd say in your case, you're another weird one. That's kinda strange seeing a cold nodule that's also labeled hyperplastic. Is it for sure cold? It's for sure benign being colloid/hyperplastic. I think your conclusions are very valid. Have you had an eye ultrasound or a good eye exam to check for proptosis? If it's there, it would probably cinch the diagnosis for you. It can be so mild sometimes that it can only be found by actually measuring.
There's a really good chapter at [url]http://thyroidmanager.org[/url] on graves and the different antibodies that can be seen and talks about those blocking antibodies. There's also a chapter devoted to the different thyroid tests and methods.
The only way to find out which TSI you're getting is to check with the lab as to the method they use. They are both called TSI. The <2 one's that I had done were thru SmithKline and I think Mayo ran one too but I know there's lots of other labs that do it. A lot of labs have web pages where they post what they offer and the reference ranges. You may need to search out a few and look for ones where the TSI normal range is <2.
And yes the nodule is described as cold on the Uptake scan report: "There is evidence of a large photopenic deficit involving the left lobe encompassing almost the entire left lobe of the thyroid gland. This probably represents a cold nodule. Differential diagnosis includes a colloid cyst, adenoma, multinodular goiter, or local thyroiditis or abscess."
The FNA Cytology report said: "COMMENTS: Abundant colloid, hemosiderophages and moderate follicular cell cellularity is consistent with a mixed colloid-hyperplastic (adenomatoid) nodule. DIAGNOSIS: Consistent with mixed colloid-hyperplastic nodule."
I feel bad for hijacking this thread--very sorry to the original poster!
Helen, if I start a new thread and list all my stuff (reports, labs, symptoms, etc.) would you be willing to look at it and tell me what you think?
Knowing suz, she'll be cool with it. Right suz??? She likes to learn.
I'll be back after awhile. I got a couple things going right now. I need a chance to think too. If you'd rather start a new thread, that's fine too. If I don't see anything back here, repost the info you just did plus whatever else and I'll check in later. Right now, I'm running around like a chicken with my head cut off. I haven't had a chance to check the main page at all today.
Helen...I'm still confused about the antibodies tests. I have a tsi or whatever it's called of 109, okay that's Graves, but what's the diff between anti-tpo and tpo..anything? Also her anti thyrooglobulin was 385 I think,is that the same as anti-tg? Mine is 12.7 with my lab range being (0.0-2.2) So I'm over that norm,I'm with MMZTCASS, I still don't get it!Also what's TBG?Mine was in range for that. It's my anti-tpo that was sky high.
Last edited by Bran'sNana; 08-15-2007 at 03:01 PM.