# TSI level



## McKenna (Jun 23, 2010)

Finally! I got my TSI level. Would someone interpret??

My family doc's office called and said my TSI was 103. I asked her what range was, and she told me that it's supposed to be under 125. She said the doc said I did not have Graves and they were faxing the results over to the endo. I will pick up a copy either tomorrow or Weds to see for myself.

So, is TSI like TPO, where you're not supposed to have any present? If so, then what can I share with my endo, since I'm sure he won't do anything.


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## Phoenix (Mar 20, 2010)

Hi McKenna,

Did they do any other tests besides the TSI? And yes, the TSI is like the TPO.

I would be very curious to know what your TSH, free T3 and free T4 numbers look like. If they are out of range, then hopefully your doctor will do something to help.

When you get your results, please post them for us with the ranges.

Phoenix


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## McKenna (Jun 23, 2010)

Phoenix,
These were my labs from 2 weeks ago:
6/29
TSH 3.150 uIU/mL .450-4.5
Free T4 1.17 ng/dL .82-1.77
Free T3 2.6 pg/mL 2.0 - 4.4
TPO 269 IU/mL 0 - 34

This was after being on Synthroid, 25mcg, and having what I thought was a hyper flare. TSH went down, but so did my Free T's. And my TPO went up.

These were my first labs in May, before being diagnosed with Hashi's.
T4 Free 1.27 ng/dL 0.82 - 1.77
T3 Free 3.5 pg/mL 2.0 - 4.4
TSH 5.330 uIU/mL 0.450 - 4.5 
TPO antibody 198.30 IU/ML range: 0.00 - 9.00

I also have a cold, solid nodule, with inconclusive results from FNA, a high uptake scan, and periods of very hyper symptoms. Andros and a few others had suggested getting the TSI. Now I'm trying to figure out what it can mean. Not necessarily Graves, but definitely hyper too?

I was off synthroid for one week (per the endo's suggestion), then recently started Armour 15mgs every other day.

Can someone explain how TSI works? Is it an antibody or something that makes your thryoid produce extra hormones? If so, does that mean that it bypasses the pituatary so the TSH level doesn't change?


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## Lovlkn (Dec 20, 2009)

With hashitoxicosis test results can swing hyper/hypo which might explain your low yet positive TSI result.

While on Anti thyroid medications I tested normal once with thyrotropin receptor antibodies (about the same as a TSI) and had in range Free's.

With thyroid disease such as hashitoxicosis lab results can go back and forth, sometimes very quickly as can the symptoms which you appear to have already experienced.

I was under the understanding that a high uptake would confirm a graves dx. Anyone care to clarify that for me.


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## Andros (Aug 26, 2009)

McKenna said:


> Finally! I got my TSI level. Would someone interpret??
> 
> My family doc's office called and said my TSI was 103. I asked her what range was, and she told me that it's supposed to be under 125. She said the doc said I did not have Graves and they were faxing the results over to the endo. I will pick up a copy either tomorrow or Weds to see for myself.
> 
> So, is TSI like TPO, where you're not supposed to have any present? If so, then what can I share with my endo, since I'm sure he won't do anything.


Okay; you are hyperthyroid. The healthy person should have absolutely no TSI. The only reason there is a range is so that any movement can be detected from the "baseline." Your baseline is 103 since this is your very first TSI Test.

You must read the info I am going to furnish about this. You are going to have to advocate for yourself. I knew it the whole time. That is why I urged you to get the test. And I am very very glad you did.

You may or may not have Graves' but the bottom line is you do have hyperthyroid. Graves' has clinical criteria as per Dr. Robert Graves'.

http://www.hopkinsmedicine.org/endocrine/graves/TopicAnswer.asp?QuestionID=22

Results and Values
What do the test results mean?
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.

http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

The criteria for Graves' are.....

Exophthalmos, goiter, pretibial myxedema and thryotoxicosis.

http://emedicine.medscape.com/article/120619-overview


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## McKenna (Jun 23, 2010)

Ok, what do I need to do?

I did not hear from the endo's office about these results yet, but I'm not surprised. He has yet to address the nodule or FNA. But I do have an appointment on Thursday with another surgeon for the nodule and I'm going to talk about having a TT. I think with the hyper evidence now, maybe he will go for it. I don't think the endo will be of help and my test results are so weird and he doesn't look further into them.

I'm still extremely tired, I have a lot of tight feelings in my throat/neck and a lot of head pressure for a few days. And this headache that only goes away every so often. I also broke out in a rash on my lips (itchy, small bumps, NOT cold sores) that I had a bout with the first time I went hyper in April. Are rashes common? I'm not having heart palps per se....but a very hard heart beat, I can see my shirt moving that's how hard it is sometimes. No shaking or shakey feelings like before. No internal tremors today. My upper back and shoulders are so stiff it hurts to turn my head.


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## Lovlkn (Dec 20, 2009)

McKenna said:


> Ok, what do I need to do?
> 
> I did not hear from the endo's office about these results yet, but I'm not surprised. He has yet to address the nodule or FNA. But I do have an appointment on Thursday with another surgeon for the nodule and I'm going to talk about having a TT. I think with the hyper evidence now, maybe he will go for it. I don't think the endo will be of help and my test results are so weird and he doesn't look further into them.
> 
> I'm still extremely tired, I have a lot of tight feelings in my throat/neck and a lot of head pressure for a few days. And this headache that only goes away every so often. I also broke out in a rash on my lips (itchy, small bumps, NOT cold sores) that I had a bout with the first time I went hyper in April. Are rashes common? I'm not having heart palps per se....but a very hard heart beat, I can see my shirt moving that's how hard it is sometimes. No shaking or shakey feelings like before. No internal tremors today. My upper back and shoulders are so stiff it hurts to turn my head.


McKenna,

Try your best to compile all the lab tests run on you then write out your symptom list.

I want to point out that a surgeon gets paid to do surgery - I can almost guarantee you if you take your lab's and your symptom list the surgeon will remove your thyroid - no endo or any other doctor report is necessary. My surgeon did not even know who my endo was - I brought a excel print out of lab dates and result with ranges - she did a sonogram of my thyroid and set the surgery date.

Maybe all you surgeon will need to do is the sonogram to get insurance approval and set up the surgery date. Be prepared to ask the surgeon questions as far as their experience level and such.


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## McKenna (Jun 23, 2010)

I finally got the attention of the endo. I had to call today to change my next appointment (he didn't want to see me for another 8 weeks after he put me on Armour last week) and asked if they received the TSI results. They put me through to the nurses line and I left a message asking if they got the TSI results from my family doc and to let me know what the endo thinks about them now that they show I'm hyper and that I still have some hyper symptoms. The nurse called me back within 15 minutes and said to get my thyroid panel done and come in asap. He wanted to see me tomorrow, but my bloodwork won't be back by then so I'm going on Friday morning. I just got back from getting the blood drawn.

I asked the nurse if he said anything about the hyper results and she said no, that she didn't understand them and went right to him, and when she told him about my message that he said I needed to come in.

I still have my appointment with the surgeon tomorrow and I'm getting all my papers together.


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## Debbie from Milwaukee (Apr 18, 2010)

I know this IS very serious stuff, but you can go ahead and give yourself a pat on the back for persevering! It is a VERY daunting challenge to keep asking the test/health questions in the face of The Authoritative Docs and their sometimes rude and ignorant nurses. You now have your endo looking at your results as well as the 2nd opinion surgeon in the wings.

Do you have the luxury of taking someone with you to either or both appointments? You are very skilled at researching this stuff, but even the most adept person may not get all of the details if the news is extremely complex or negative in any way. Just a thought...

I think your endo will have some new respect for you. Hang in there, and let's hope and pray that the medical news will be accurate and that you'll get correct treatment instructions!


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## McKenna (Jun 23, 2010)

Thanks for the encouragement. It's very frustrating, as I'm sure you all know. I never expected to have to do so much on my own.

My husband is coming with me tomorrow to the surgeon.


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## Andros (Aug 26, 2009)

McKenna said:


> Ok, what do I need to do?
> 
> I did not hear from the endo's office about these results yet, but I'm not surprised. He has yet to address the nodule or FNA. But I do have an appointment on Thursday with another surgeon for the nodule and I'm going to talk about having a TT. I think with the hyper evidence now, maybe he will go for it. I don't think the endo will be of help and my test results are so weird and he doesn't look further into them.
> 
> I'm still extremely tired, I have a lot of tight feelings in my throat/neck and a lot of head pressure for a few days. And this headache that only goes away every so often. I also broke out in a rash on my lips (itchy, small bumps, NOT cold sores) that I had a bout with the first time I went hyper in April. Are rashes common? I'm not having heart palps per se....but a very hard heart beat, I can see my shirt moving that's how hard it is sometimes. No shaking or shakey feelings like before. No internal tremors today. My upper back and shoulders are so stiff it hurts to turn my head.


Yes; rashes are common most likely due to the high levels of thyroxine being put out by your thyroid. Also, yes.............you would be tired because even at rest, your metabolism is running in high gear.

I am not pleased w/your endo either. I am not a doctor as you well know but really, you should not be on thyroxine replacement and you should be on a beta blocker to protect your heart.

Even if you need to see your PCP, Internest, Ob/Gyn..........whatever you have to do to get these heart palps calmed down; please do it.

I am worried for and about you so please do keep us posted here.


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## McKenna (Jun 23, 2010)

> I am not a doctor as you well know but really, you should not be on thyroxine replacement and you should be on a beta blocker to protect your heart.


Thanks Andros.
I am on a beta blocker (inderal). I had my family doc put me on it a week and a half ago. It really helped with the palps, but sometimes I still get a few. The endo wanted me to go to a cardiologist for a check up, which I did yesterday.


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## Andros (Aug 26, 2009)

McKenna said:


> Thanks Andros.
> I am on a beta blocker (inderal). I had my family doc put me on it a week and a half ago. It really helped with the palps, but sometimes I still get a few. The endo wanted me to go to a cardiologist for a check up, which I did yesterday.


Okay; stay on top of it and I am glad hubby is going w/ you.


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