# Does the presence of any TSI, even in range, ALWAYS indicate Graves of Hashitoxicosis?



## digifem (Sep 25, 2014)

Is the presence of any TSI always indicative of Graves?

I've spent the last 2 years sick and visiting a dozen doctors, only to finally be diagnosed with Hashimoto's (diagnosed hypo 5 years ago). After months and months of weening up on Synthroid(88mcg) and Cytomel(18mcg), I became overmedicated (TSH 0.012). I stopped all meds for a few days, but am having a lot of trouble getting back on them, even low doses. I had no problem titrating up in the past.

Last October one of my doctors randomly ordered TSI along with other thyroid labs. This was the only time my TSI has ever been tested. It was at 35 (0-139) 10/14/14. On that same date my TGab was completely negative, and my TPO was 15 (0-34). I was not on ANY thyroid medication(as an experiment) at that time and was definitely feeling hypo. TSH was 2.42, FT3 was 2.9(2-4.4), and FT4 was 1.27(.82-1.77).

My most recent labs on 6/15/15 were TSH 0.012, FT3 4.0 (2-4.4), FT4 1.67(.82-1.77). I felt myself going hyper for a week or so before it became unbearable. Things like weightloss, increased hair loss, shakiness, anxiety, etc. I was going through a breakup, though, so I thought that may have been contributing.

I'm now on 62.5mcg Synthroid and no Cytomel. I've been on this dose for 3 weeks and I feel really hypo with crazy afternoon drops to the point of not being able to work. Every time I try to take a little Cytomel, even just 2 mcg I get palps, sweating, restlessness, and can't sleep that night. The same happened when I tried to raise my Synthroid to 75.

Could my previous TSI result be indicative of Graves or Hashitoxicosis? Do people with Hashimoto's ever have TSI without having Graves also? I have labs in a week, but thought I would ask here because my doctor doesn't seem to think hashitoxicosis is a thing and ignored my TSI the first time.

I attached a screenshot of my thyroid labwork from January 2015-now.


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## Andros (Aug 26, 2009)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

TSI
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://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
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Substances not found in normal serum
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm
(Copy and paste into your browser)

TSI
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://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
(Copy and paste into your browser)

The info above may help you understand that TSI is definitive of hyper. That could be Graves', Hashi's or just plain hyper.


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## Lovlkn (Dec 20, 2009)

> I'm now on 62.5mcg Synthroid and no Cytomel. I've been on this dose for 3 weeks and I feel really hypo with crazy afternoon drops to the point of not being able to work.


Your current labs have you hyper.

If you feel hypo - have you had your Ferritin and Vit D and B 12 labs run recently? Being low in any of those 3 could contribute to fatigue.


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## digifem (Sep 25, 2014)

Lovlkn said:


> Your current labs have you hyper.
> 
> If you feel hypo - have you had your Ferritin and Vit D and B 12 labs run recently? Being low in any of those 3 could contribute to fatigue.


I was definitely feeling hyper when my last labs were done. I stopped all medication completely for a few days, then started back on 50mcg Synthroid and have made it up to 62.5 over 3 weeks. I now feel really hypo and I have all of my personal hypo symptoms like burning mouth, petechiae, flaky skin, etc. I'm pretty sure I'm currently undermedicated but I can't seem to tolerate adding anything.

I take 5000iu of D per day and my last test was at 70, B12 is good and I supplement, Ferritin is in the optimal range.

This whole thing is so frustrating and I don't even remember what it's like to feel good anymore.


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## Lovlkn (Dec 20, 2009)

> I was definitely feeling hyper when my last labs were done. I stopped all medication completely for a few days, then started back on 50mcg Synthroid and have made it up to 62.5 over 3 weeks.


Does your posted lab sheet read from left to right? If so - it shows your last medication amount 88-100 and 18 mcg Cyt

How long had you been on the 62.5 prior to your labs that

showed you hyper?

How long was it between labs? I don't see any dates.

Changing medication dosages often can definitely cause issues.

Skipping a few days of medication helps eliminate the hyper symptoms but it sounds like you were off too long. Climbing out of hypo has always been more difficult than gliding down from hyper for me.


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## digifem (Sep 25, 2014)

I am on 62.5mcg Synthroid now. I have not had labs done on this dose. The last lab results are from a month ago when I was hyper on the higher dose with added Cytomel. There are no dates because that's just a snapshot of a portion of the spreadsheet with all of my other tests. There was generally 3-4 weeks between each entry.

How long does it usually take you to go from hyper back down to normal? How much do you usually decrease. I just kind of panicked because I've never been hyper before and I was completely non-functional. My doctor was worried about my heart, so that's why I went off of the meds for a few days.


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## joplin1975 (Jul 21, 2011)

Everyone is totally different. It can be complicated when you have TSI.

Speaking of different, I can functional fairly well hypo, but loose my noodles when I'm even close to hyper. So I get it...I would have stopped the meds, too. There's no set or right path. I just think your choices need to be informed by both labs and symptoms.


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