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TSI of 83
I had posted previous about my 11 year old daughter and strange lab results. As I learn more about Thyroid Tests the more frustrated I'm getting with her Dr's. In my last post it was suggested that I have her TSI and TPO also tested. The nurse called me back yesterday and informed me that they DID run these tests back in June 2011:
TSI: 83 (<123)
TPO: .4 (0 - 9.0)
From my research I'm gathering that ANY TSI present suggests Hyper. Right now, they want to test her for Thyroid Hormone Resistance Due to the elevated FT4 and non-surpressed TSH - If this comes back negative they will just call her thyroid function "normal", and suggesting that we stop testing her thyroid. But now that I learn that she DOES have TSI present - I'm not sure that the test for THR is needed.
So do I proceed with the test for THR, or is this the time to find a new Dr. for her and start over? Is it possible that the TSI present is blocking something that is preventing the TSH from being surpressed?
The following labs were run in different locations. 2011 - at university location, these labs differ quite a bit from the labs ran at our local clinic. The labs run in our local clinic have always been simular to the latest one from Nov 2012:
Labs from ped endo aug 2011:
TSH: 3.53 ( .4 - 5.0 ),
FT4: 0.51 (1.1 -2.0) - Measured via Equilibrium Dialysis
Total T3: 166 (83 - 213),
Total T4: 15 (5.0 - 11.0),
thyroglobulin antibody was negative
thyroglobulin normal 22.8
Test results from our local Clinic Nov 2012:
Elevated FT4 1.89 (.58 - 1.64 ng/dl)
Normal FT3 4.02 (2.50 - 3.90 pg/mL)
Normal TSH 2.03; (.34 - 5.60 mIu/mL)
Thyroid binding globulin was normal at 21 (13-30)
Sorry for the lab re-post just wanted all the information together.
TSI: 83 (<123)
TPO: .4 (0 - 9.0)
From my research I'm gathering that ANY TSI present suggests Hyper. Right now, they want to test her for Thyroid Hormone Resistance Due to the elevated FT4 and non-surpressed TSH - If this comes back negative they will just call her thyroid function "normal", and suggesting that we stop testing her thyroid. But now that I learn that she DOES have TSI present - I'm not sure that the test for THR is needed.
So do I proceed with the test for THR, or is this the time to find a new Dr. for her and start over? Is it possible that the TSI present is blocking something that is preventing the TSH from being surpressed?
The following labs were run in different locations. 2011 - at university location, these labs differ quite a bit from the labs ran at our local clinic. The labs run in our local clinic have always been simular to the latest one from Nov 2012:
Labs from ped endo aug 2011:
TSH: 3.53 ( .4 - 5.0 ),
FT4: 0.51 (1.1 -2.0) - Measured via Equilibrium Dialysis
Total T3: 166 (83 - 213),
Total T4: 15 (5.0 - 11.0),
thyroglobulin antibody was negative
thyroglobulin normal 22.8
Test results from our local Clinic Nov 2012:
Elevated FT4 1.89 (.58 - 1.64 ng/dl)
Normal FT3 4.02 (2.50 - 3.90 pg/mL)
Normal TSH 2.03; (.34 - 5.60 mIu/mL)
Thyroid binding globulin was normal at 21 (13-30)
Sorry for the lab re-post just wanted all the information together.
Someone asked this same question on Elaine Moore's website. Elaine Moore is a medical writer and clinical laboratory scientist, MT, CLS, with more than 30 years of experience in immunology. A good person to ask on immune issues! This is from her website:
TSI Test Results
Hi,
I have been having a lot of hyperthyroid problems lately and just got some TSI test results back that I'm a little confused about. I have a result of 74 with a reference range of 0-139. What should I make of this? It seems like there are antibodies present...but not at levels that are problematic? What do I do from here?
Thank you for your help!
Hi Lauren,
Studies show that most people with TSI develop symptoms when their TSI level is right above the cutoff or higher. But this varies because there are subtypes of TSI, some with greater affinity for the more active receptors. The presence of blocking TSH receptor antibodies also matters since these antibodies block TSI from reacting with the TSH receptor.
Your result can suggest many things depending on where you are in terms of diagnosis and treatment. If you're a new patient, it can suggest that your hyperthyroidism is related to early Graves' disease (in which case you can have more TSI in your thyroid gland than your bloodstream). If you're suspecting remission, you could interpret your result as a declining TSI and the possibility of remission depending on your thyroid function tests.
The TSI result has to be looked at with clinical symptoms and with thyroid function tests. Where it's often interpreted incorrectly is when patients with hyperthyroidism are told their result is normal just because it's below the cutoff. In the normal population, TSI would be <2% activity or thereabouts. In people with a family history of Graves' disease, TSI levels are often higher. If your thyroid function tests are normal, you'd at most be said to have thyroid autoimmunity but not thyroid disease. Best, Elaine
TSI Test Results
Hi,
I have been having a lot of hyperthyroid problems lately and just got some TSI test results back that I'm a little confused about. I have a result of 74 with a reference range of 0-139. What should I make of this? It seems like there are antibodies present...but not at levels that are problematic? What do I do from here?
Thank you for your help!
Hi Lauren,
Studies show that most people with TSI develop symptoms when their TSI level is right above the cutoff or higher. But this varies because there are subtypes of TSI, some with greater affinity for the more active receptors. The presence of blocking TSH receptor antibodies also matters since these antibodies block TSI from reacting with the TSH receptor.
Your result can suggest many things depending on where you are in terms of diagnosis and treatment. If you're a new patient, it can suggest that your hyperthyroidism is related to early Graves' disease (in which case you can have more TSI in your thyroid gland than your bloodstream). If you're suspecting remission, you could interpret your result as a declining TSI and the possibility of remission depending on your thyroid function tests.
The TSI result has to be looked at with clinical symptoms and with thyroid function tests. Where it's often interpreted incorrectly is when patients with hyperthyroidism are told their result is normal just because it's below the cutoff. In the normal population, TSI would be <2% activity or thereabouts. In people with a family history of Graves' disease, TSI levels are often higher. If your thyroid function tests are normal, you'd at most be said to have thyroid autoimmunity but not thyroid disease. Best, Elaine
Oh, I'm so sorry to hear they're tying your hands...
If I remember correctly, her TPOab was very slight and in range? Was her TGab test result "20" or "<20". Sometimes results are reported that way. TGab can also be somewhat elevated with Graves' (and other autoimmune diseases).
Your pedi ought to be able to order retests of all the antibodies. I totally agree with you that all three ought to be run again. 2011 is ancient history when it comes to antibodies.
Wow, I can't even imagine hunting for a pedi endo. A decent endo is hard enough to find. I'm not surprised you're having a tough time of it. I can't imagine there are too many pedi endos out there. Sorry, I wouldn't know where to start myself.
If I remember correctly, her TPOab was very slight and in range? Was her TGab test result "20" or "<20". Sometimes results are reported that way. TGab can also be somewhat elevated with Graves' (and other autoimmune diseases).
Your pedi ought to be able to order retests of all the antibodies. I totally agree with you that all three ought to be run again. 2011 is ancient history when it comes to antibodies.
Wow, I can't even imagine hunting for a pedi endo. A decent endo is hard enough to find. I'm not surprised you're having a tough time of it. I can't imagine there are too many pedi endos out there. Sorry, I wouldn't know where to start myself.
Hey there just wanted to give you an update/non update.
I'm NOT having any luck finding a Dr. to get a second opinion. With her being 11 the adult endos in town will NOT see her. Our local pediatrian is working on just now getting a copy of the Aug 2011 labs results from the current Peds Endo.
I just got copies of the labs from Nov this year and those ones way back in June 2011 - the last time the antibodies were run. Interesting her TSH then was 5.59 (.34 - 5.6) of course this didn't get flagged because it was in the "normal" range, and that negative TgAB had a value of 20 (<=20)
So she absolutely needs the antibodies run again considering ALL 3 are present, just not high enough to flag the positives. I'm almost thinking that this is early Hashi's now instead of early Graves. I'm also going to push for the ultrasound and try to get a MRI of the pituritary - the change in vision over the last 2 years has me concerned. Now I just need to find a Dr. that will see her!!!
Anyway that's where we are now. In the hunt for a Dr. - Any advice on how to go about finding one.
I'm NOT having any luck finding a Dr. to get a second opinion. With her being 11 the adult endos in town will NOT see her. Our local pediatrian is working on just now getting a copy of the Aug 2011 labs results from the current Peds Endo.
I just got copies of the labs from Nov this year and those ones way back in June 2011 - the last time the antibodies were run. Interesting her TSH then was 5.59 (.34 - 5.6) of course this didn't get flagged because it was in the "normal" range, and that negative TgAB had a value of 20 (<=20)
So she absolutely needs the antibodies run again considering ALL 3 are present, just not high enough to flag the positives. I'm almost thinking that this is early Hashi's now instead of early Graves. I'm also going to push for the ultrasound and try to get a MRI of the pituritary - the change in vision over the last 2 years has me concerned. Now I just need to find a Dr. that will see her!!!
Anyway that's where we are now. In the hunt for a Dr. - Any advice on how to go about finding one.
Thanks again,
Nope no ultrasound has been done, agree this would make sense to have done, could give some more insight on the TSI being present.
Called this morning to inquire about appointment with a new Endo. She is booked out and entire YEAR. They told me to have my current Dr. talk to the new Dr about the referral and they MIGHT be able to see her sooner.
Current Dr is out of office till Monday, so can't do much more till I can talk with her :-)
Nope no ultrasound has been done, agree this would make sense to have done, could give some more insight on the TSI being present.
Called this morning to inquire about appointment with a new Endo. She is booked out and entire YEAR. They told me to have my current Dr. talk to the new Dr about the referral and they MIGHT be able to see her sooner.
Current Dr is out of office till Monday, so can't do much more till I can talk with her :-)
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