graves & Hashimoto AB?

[kkan627]

what questions should I be asking my endocrinologist?

my blood in march 2018 was showing
free t4 1.0
tsh 7.51
thyroglobulin ab  2610.0
thyroid peroxidase ab  1852.4

now June, 2018  after starting synthroid (112)
free t4 2.0
tsh .049
tsh receptor ab TSI 306
                  TBI 3.2

[Red_Star]

I see from your results your lab was nice enough to list both stimulating TSI and blocking (TBI) instead of one result listed under TRAb.

[Red_Star]

TSH receptor antibodies (TRAb) are a measure of both stimulating (TSI - causes hyperthyroidism) and blocking TSH receptor antibodies. I much prefer just testing TSI but some labs will not do this (found this out the hard way). They will only test TRAb.

Treatment for Hashitoxicosis (Graves and Hashimoto's thyroiditis antibodies) is block and replace therapy: anti-thyroid medication as well as thyroid hormone.  

[kkan627]

Thank you

[gimel]

I never have run across TSH receptor antibodies testing before.  When I try to find info this is what I see:  "TSH R is the dominant target of autoreactive agonistic antibodies in Graves’ disease but is a more rare target in Hashimoto’s thyroiditis. "  So I really don't understand what the doctor was testing for.   Then when TSI is tacked on to the end, as TSH receptor antibodies TSI, I have no clue what that is supposed to be.   I suspect that you were tested for TSI, for Graves' and it was way over the range.   So it may be that your Graves' Disease has returned or was never really in remission from before.   This would be consistent with the high result for Free T4 also.  

The TBI test seems to be for assessment for Peripheral Artery Disease.  Here is a link on that.     https://www.sciencedirect.com/science/article/pii/S0741521413007106   From the dim recesses of my mind I think I recall that atherosclerosis can be adversely affected by homocysteine, so it might be a good idea to test for that.    If it is high, it can be lowered easily and inexpensively with a trio of B vitamins — B6, B12, and folic acid.

Just from the different symptoms you listed I think there may be more than one issue to be investigated.    But since you have a history of Graves' I think you should start by asking the doctor to confirm if that is his conclusion now.    In addition you should make sure they always test for both Free T4 and Free T3, every time you go in for tests.  Your thyroid status is dependent on Tissue T3 Effect, which is determine by both the supply of, and response to, thyroid hormone.     Just to make sure I would also ask for tests for the antibodies of Hashimoto's Thyroiditis.  Those are Thyroid Peroxidase antibodies and Thyroglobulin antibodies (TPO ab and TG ab).   In addition it would be good to test for Reverse T3 and cortisol to assure no problem there.  The response to thyroid hormone is significantly affected by Vitamin D, B12 and ferritin so you should also get those tested and then supplemented as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end fo its range adn ferritin should be at least 100.  

In addition I think  you should ask the doctor about testing for any possible blood sugar problem.

Once you have all these test results I think it will be much clearer as to what needs to be done from there.  If you can get these tests done and then post results and reference ranges here we will be glad to help interpret and advise further.  

[kkan627]

Thank you. Interesting my father and several siblings have all had regular b12 injections as well as vitamin d deficiency.

[gimel]

What about my question on the last two tests?

[kkan627]

Want to thank you. I’m trying to really understand what is going on.  Here is a bit more info. Not sure what these tests are.   Tsi range is less than 150.   TBI Standard range less than 1.  The description says. TSH  receptor AB and those are my results with these standard ranges.

Wanted to share a bit more of my history. Might help. Years ago about 25-30 I was severely hyper with Graves and took PTU for quite a long time. Appeared to level out and tried several Endocrinologist when my original retired. No luck with drs. and at time I was under care of fertility specialists all over the country.  Was told All looked ok with thyroid blood tests. . Over the years my gen physician monitored and also said all ok. Only looked at minimal blood work. In hindsight  Looking at results over years with new endocrinologist she said wasn’t quite accurate. Showed in 2010 hypo, but no meds given.

Now going forward many years I’m experiencing lots of symptoms. Trying to figure out what is autoimmune and what is menopause. Btw my entire immediate family has autoimmune issues. Lupus, RA, Addison’s, MS, celiac and  thyroid. (8 siblings and parent. )

Thanks again. Want to ask right question to get good answers and proper treatment.

[gimel]

What was the reference range listed for the Free T4 test?   Also please double check the description of the last two tests listed.   I haven't located any useful info on those two.  Any explanation would be helpful.  

[kkan627]

I believe the range for the free t4 was .9-1.7

[gimel]

In trying to assess anyone's thyroid status the most important consideration should always be symptoms.  So please tell us about any symptoms you have now.

[kkan627]

I’m not too sure what is normal feeling. I’ve had years of not feeling well. Many years ago diagnosed with fibromyalgia was treated for graves l.  I hadn’t taken any meds for many years until this march.   I have constant tingling in my muscles and upper back area.  I have weakness in all my muscles. As a former athlete that’s frustrating.  I am the heaviest I’ve ever been.   Tired. My hands joints ache and swell. At this time my vision gets blurry through the day. Some times worse than others.  Had been told a couple years ago I had start of cateracts. Am 55 so not sure what if any of these is related to what!   A few months ago had bouts of racing heart and light headed causing me to  seek endo dr.   Brain Fog, confusion and light headed have subsided for most part. BP is high although got my entire life had been low BP.   So you wanted some symptoms. Name them and I think I experience them.

[kkan627]

Forgot yo say thanks for your help.