# New Lab Results, Do I have Graves?



## Kaylasly (Nov 14, 2009)

I am not really sure how to read Antibodies Results here are my tests for the last two weeks:

2/5/10
Thyroxine T4 Direct 0.96 (0.82-1.77)
TSH 1.10 (0.450-4.500)
Thyrotropin Receptor Ab, Serum <0.51 (0.00-1.75)
Thyroid Stim Immunoglobulin 55 (0-139)
Antithyroglobulin Ab <20 (0-40)
Triiodothyronine, Free 3.2 (2.0-4.4)

2/12/10
Thyroxine (T4) Free Direct 1.04 (0.82-1.77)
Cortisol 18.6 (2.3-19.4)
TSH 0.269 (0.450-4.500)
Triiodothyronine Free 2.9 (2.0-4.4)

The first test will reflect two days of 120 mg of Erfa
I lowered my dosage due to feeling hyper and decided to cut one pill in half to make approx. 105, I did that on 2/7/10 Why did my TSH drop so much after lowering my dosage. I am starting to wonder if Erfa is not right for me. What do you think?


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## Andros (Aug 26, 2009)

Kaylasly said:


> I am not really sure how to read Antibodies Results here are my tests for the last two weeks:
> 
> 2/5/10
> Thyroxine T4 Direct 0.96 (0.82-1.77)
> ...


Wow!! You have TSI. TSI (thyroid stimulating immunoglobulin) is present only in hyperthyroid. You should have no TSI and if you do, you are experiencing hyperthyroid.

That said, I don't think that thyroxine replacement is the way to go here. No wonder you are more hyper when you take it.

Here is info on TSI.....

What do the test results mean?
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that this abnormal antibody is responsible for causing the person's hyperthyroidism.
http://uimc.discoveryhospital.com/main.php?t=enc&id=1516

THEN, get this.............you have a smattering of Thyrotropin Receptor Ab which are below range but the range is only a "suggestion" for the mean population on a cohort.

Thyrotropin Receptor Ab is present in Graves'! Holy cats. I sure don't think you should be on Erfa or any other but I am NOT the doctor here. I wish others would give some feed back on this!!'

The most widely used assay for thyrotropin receptor antibody is based on immunoglobulin mediated inhibition of the binding of radiolabeled thyrotropin to thyrotropin receptors. With this assay, antibody is detectable in >90% of patients with Graves' disease. The degree of positivity does not always correlate with the severity of hyperthyroidism. Borderline antibody levels are present in about 4% of healthy individuals. High TSI levels usually persist for several months following treatment with radioiodine.
http://www.clinlabnavigator.com/Tests/ThyrotropinReceptorAntibody.html

You do have ambiguous clinical findings but the antibodies' tests have sorted it out for sure.

Here is more evidence; Thyrotopin receptors are commonly referred to as Trab.

http://www.ncbi.nlm.nih.gov/pubmed/1633635

What has your doctor said about this stuff? If he/she has said nothing, I must urge you to find another doctor.


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## Kaylasly (Nov 14, 2009)

What do they do in a case like this??? Do they take the thyroid out??? I know I can't RAI it. Do many people have this problem? Could it be temporary? My doctor still hasn't called. I am scared!


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## Andros (Aug 26, 2009)

Kaylasly said:


> What do they do in a case like this??? Do they take the thyroid out??? I know I can't RAI it. Do many people have this problem? Could it be temporary? My doctor still hasn't called. I am scared!


To my knowledge, this is not a temporary situation because this is autoimmune in nature as evidenced by the presence of antibodies.

If it comes to that, it would be better to have surgical removal for many reasons.

Please don't be scared and if for any reason you feel really unwell, do not hesitate to get to the ER. I trust you have relatives or a friend that you can rely on if need be?

Here is a list of Thyroid Storm Symptoms.......

Thyroid Storm Symptoms

Rapid heart beats

Greatly increased body temperature

Chest pain/arrhythmia

Shortness of breath

Anxiety and irritability

Disorientation/psychosis

Increased sweating

Weakness

Heart failure

http://www.emedicinehealth.com/thyroid_storm/article_em.htm

When did you place a call to your doctor?


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## Kaylasly (Nov 14, 2009)

What does that mean? I can have a storm at any time? I called him yesterday.


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## Andros (Aug 26, 2009)

Kaylasly said:


> What does that mean? I can have a storm at any time? I called him yesterday.


It means that you should be cognizant of those symptoms. Being informed does not mean it is going to happen. But, you claim to feel hyperthyoid so I thought it would be a nice thing to do to find you the list of symptoms to be aware of.

As you know, I am worried about you and I certainly would not want to be guilty of not keeping you well informed.

Do you think your doc will call you on a Saturday?

Sending hugs!


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## Kaylasly (Nov 14, 2009)

What I find interesting in that link is they said a thyroid storm could be caused by a lung infection. That is when all this stuff started happening, I had bronchitis. I seem to be doing better, anxiety is better, although my heart rate is still high in the morning. I noticed this long before this all hit me. Do you think it could be hormones? I know you don't think I should be on Erfa, what should I be on? My numbers and symptoms were very hypothyroid before. This is so confusing! I am wondering if doing Synthroid with a little bit of Cytomel might be better? I am not sure if it is the t3 causing the heart thing.
It is fine when I am resting or sitting down.


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## Kaylasly (Nov 14, 2009)

Oh yeah, you kind of scared me with the hospital thing. My doc does sometimes call on Saturdays.


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## Andros (Aug 26, 2009)

Kaylasly said:


> What I find interesting in that link is they said a thyroid storm could be caused by a lung infection. That is when all this stuff started happening, I had bronchitis. I seem to be doing better, anxiety is better, although my heart rate is still high in the morning. I noticed this long before this all hit me. Do you think it could be hormones? I know you don't think I should be on Erfa, what should I be on? My numbers and symptoms were very hypothyroid before. This is so confusing! I am wondering if doing Synthroid with a little bit of Cytomel might be better? I am not sure if it is the t3 causing the heart thing.
> It is fine when I am resting or sitting down.


It's not just the Erfa; it would be any thyroxine replacement. You seem to be flitting back and forth which is most common w/Graves' and Hyper. And, "if" you are currently in a hyper state, well....................one would not want to be egging it on by taking thyroxine replacement. This is were a very good and attentive doctor is needed.

However, some docs understand "Block and Replace" for patients like you where you are placed on thyroxine and an anti-thyroid med at the same time. Sometimes that works to keep the patient more in balance.

Additionally, symptoms do cross over.

How long ago did you have the bronchitis? I find that interesting as well.


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## Kaylasly (Nov 14, 2009)

I had bronchitis in November and that is when all this started. I did not have problems before that. At least not significant problems, I was noticing my heart rate would get high when I exercised and I was not very tolerant of heat but that could be meno symptoms too. Now I still have the high heart
rate and severe anxiety and depression are taking over. I am going to probably go on Lexapro. 
"THEN, get this.............you have a smattering of Thyrotropin Receptor Ab which are below range but the range is only a "suggestion" for the mean population on a cohort." 
Andros, you said this, what does that mean? It looks like I don't have that????


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## Andros (Aug 26, 2009)

Kaylasly said:


> I had bronchitis in November and that is when all this started. I did not have problems before that. At least not significant problems, I was noticing my heart rate would get high when I exercised and I was not very tolerant of heat but that could be meno symptoms too. Now I still have the high heart
> rate and severe anxiety and depression are taking over. I am going to probably go on Lexapro.
> "THEN, get this.............you have a smattering of Thyrotropin Receptor Ab which are below range but the range is only a "suggestion" for the mean population on a cohort."
> Andros, you said this, what does that mean? It looks like I don't have that????


It means that you have Trab but that they are below the recommended range. These are like the TSI; you should not have any. And they are actually there because of the TSI. There are antibodies to the autoantibodies. Some are binding, stimulating and blocking. It is a confusing area of study. I do not pretend to be an expert at this.


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## Kaylasly (Nov 14, 2009)

But it is showing negative????


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## Andros (Aug 26, 2009)

Kaylasly said:


> But it is showing negative????


If it was negative, there would be a zero there. It is showing below the range.

< less than


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