Labs - questions

[Guest guest]

P.S. Is my TSI high enough to skew my TSH results? (And, if so, in which

direction - low?)

[Guest guest]

Hi Jill,

I'm reposting your main query but will only try to answer your follow-up note,

about TSI (stimulating TSH receptor antibodies) affecting TSH: as I understand

it, they will (eventually, as there's a lag time) lower TSH by increasing your

thyroid levels. However, you may also have blocking TSH receptor antibodies,

which can " cancel out " the TSI by having the opposite effect. The answer then is

that you can't tell what effect the TSI are having unless you know the blocking

level, too.

I'll leave the rest of your post for more experienced feedback. I'm particularly

confused myself about the relevance of TPO, which is the only test my endo ever

ran for Graves' (mine started out high too).

Best wishes

Labs - questions

I just got my latest labs - the FT4, FT3, and TSI that I had to fight for.

The results are below, followed by most of my labs from most recent to

oldest (when I was diagnosed 15 mos. ago).

In general, my T4 and FT4 have both tested in the low-normal range once my

hyperT was controlled, but my T3 and FT3 have been more mid-range or even

high-normal - no apparent relationship to how I feel. Why would that be? I'm

tempted in the future to only go for the FT4, not the FT3.

What is the significance of the moderately elevated TSI? It is well out of

the normal range, and over half of what it was at when I was quite hyper -

but I definitely feel hypo now and have for months.

I hadn't noticed before - the Thyroid peroxidase AB test on 10/17 - the

results came back as " >70.0 " (0.0-2.0). Doesn't that mean it could be much

higher? My orginal testing for this returned a value of 617. If this is

still higher than reflected here, could that account for my feeling hypo?

I plan to start on .025mg of Synthroid tomorrow morning. Does it really take

weeks to notice a difference when starting hormone replacement?

Thanks for any help,

Jill

10/29/03 (felt hypo!)

FT4 0.9 (0.8-1.8)

T4 6.0 (4.5-12.0)

FT3 307 (230-420)

TSH 1.74 (0.40-5.50)

TSI 188 (<125) - compared to my peak hyperT state, 8/02: 314

10/17/03 (felt hypo!)

T4 6.7 (4.5-12)

T3 126 (60-181)

TSH 2.14 (0.40-5.50)

Thyroid peroxidase AB >70.0 (0.0-2.0)

Thyroglobulin AB 16.7 (<2.0)

7/30/03 (felt hypo!)

FT4 0.9 (0.8-1.8)

T3 164 (70-170)

TSH 2.85 (0.40-5.50)

(Felt my thyroid levels plummeting; went from 125mg of PTU to 100mg to 0mg

in very short order.)

6/5/03 (felt middling to OK, but trending hypo; recent recovery from

pneumonia)

FT4 1.0 (0.8-1.8)

T3 116 (70-170)

TSH 1.77 (0.40-5.50)

12/23/02 (felt hypo)

FT4 0.9 (0.8-1.8)

T3 121 (70-170)

TSH 1.21 (0.40-5.50)

11/6/02 (felt hypo)

FT4 0.7 (0.8-1.8)

T3 85 (70-170)

TSH 1.03 (0.40-5.50)

9/25/02

FT4 1.2 (0.8-1.8)

T3 - not done

TSH undetected (0.40-5.50)

(Started 300mg PTU at beginning of Sept.)

8/14/02 (felt very hyperT!!)

FT4 2.5 (0.8-1.8)

T4 13.2 (4.5-12)

T3 242 (70-170)

TSH undetected (0.40-5.50)

TSI 314 (<125)

Thyroid peroxidase AB 617 (0.0-2.0)

Thyroglobulin AB 1444 (<2.0)

[Guest guest]

> I'm reposting your main query but will only try to answer your follow-up

note, about TSI (stimulating TSH receptor antibodies) affecting TSH: as I

understand it, they will (eventually, as there's a lag time) lower TSH by

increasing your thyroid levels. However, you may also have blocking TSH

receptor antibodies, which can " cancel out " the TSI by having the opposite

effect. The answer then is that you can't tell what effect the TSI are

having unless you know the blocking level, too.

>

> I'll leave the rest of your post for more experienced feedback. I'm

particularly confused myself about the relevance of TPO, which is the only

test my endo ever ran for Graves' (mine started out high too).

>

> Best wishes

>

Thanks, . I did have the TPO test (results were on the second to last

test results - below), which were out of the normal range, but very low

compared to where they had been when I was first diagnosed with Graves. The

numbers on the TPO were huge compared to the TSI; obviously " it doesn't work

that way " , because I was hyper, not hypo. Now, with my TPO just a little

high and my TSI still at over half the level when I was peak hyper, I'm hypo

(by symptoms).

-Jill

> 10/29/03 (felt hypo!)

> TSI 188 (<125) - compared to my peak hyperT state, 8/02: 314

>

> 10/17/03 (felt hypo!)

> Thyroid peroxidase AB >70.0 (0.0-2.0)

> Thyroglobulin AB 16.7 (<2.0)

> 8/14/02 (felt very hyperT!!)

> TSI 314 (<125)

> Thyroid peroxidase AB 617 (0.0-2.0)

> Thyroglobulin AB 1444 (<2.0)

[Guest guest]

Hi Jill,

Several studies in the last few ones, particularly those by Brokken et al.,

show that the pituitary gland also recognizes TSI and also blocking TSH

receptor antibodies as if they were TSH....similar to the way the TSH receptor

protein on thyroid cells recognizes TSI as if these antibodies were TSH.

When the pituitary mistakes TSI for TSH and thinks that you have adequate TSH

in your blood, it stops secreting TSH so your TSH level is falsely decreased.

For years, doctors knew that it could take a very long time for TSH to rise

after one was hyperthyroid. Sometimes, TSH is not even produced until one is

quite hypothyroid. It was thought that the pituitary was ineffective after being

hyperthyroid, but with these new studies the reason for the lengthy TSH

suppression is more fully understood.

Dr. Utiger described Brokken's study in an article on the American

Thyroid Association web site. Take care, Elaine

[Guest guest]

Hey Elaine,

If I am reading Utiger's commentary correctly, he disagrees with Bokken's

conclusion that TSI is a factor that inhibits TSH secretion.

http://www.thyroid.org/professionals/publications/clinthy/clinthy_v141.pdf

I'm really not sure if I'm reading it right. On a gut level, I think Bokken

is right, perhaps because I am currently experiencing mid-range thyroid

levels with a suppressed TSH while on no medication.

At 04:41 PM 11/6/2003, you wrote:

>Dr. Utiger described Brokken's study in an article on the American

>Thyroid Association web site. Take care, Elaine