# Graves in remission, TPO AB still positive



## oscalulo (Aug 5, 2013)

This may be a very elementary question but I'm still relatively new to Graves. Will my TPO AB always be positive even if my Graves is in apparent remission?

Background:

I was diagnosed almost exactly a year ago, very typical symptoms. At that time a year ago, my Thyroid Peroxidase Antibody level was: 232 (standard range said 0 - 35 IU/ml). (I also had an ultrasound, uptake, etc. and all of it pointed to Graves). I went on methimazole, responded really well, and as of April of this year, have been off medication. I feel great, and my two most recent labs confirm that my T4, T3 total, T3 Free, and TSH are totally normal now. My recent TPO AB test, however, still says "positive" (I moved and changed facilities, and I guess my new lab doesn't give a number like my last one, just whether it's positive or negative).

I asked my doctor that since my Graves seems to be in remission, shouldn't my antibodies also be gone since my understanding is that the active antibodies are what attacked my thyroid so if my thyroid is normal, presumably it's no longer being attacked by the antibodies? She said no, since I have Graves, whether it's in remission or not, the antibodies will always be there and that it's not anything to worry about or anything that needs monitoring.

I'm concerned because even though my hormone levels are good, won't the continued presence of antibodies continue to attack my thyroid? Should I be worried? Should I try to get another test that will show the levels of my antibodies rather than just a positive or negative?


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## HotGrandma (Sep 21, 2012)

Wishing you the best. TPO is almost always positive in graves. Have you ever had TRab or TSI antibodies tested? Yes you will always have antibodies present but the key is the amount present. TSI and TRab need to be in the 25-50% range to obtain a successful remission. Not that that figure is set in stone its the majority's average.

If it were me, I would have either TRab or TSI tested now and every six months or a year just to be sure the antibodies don't go on the attack. Could you post your labs with ranges.

What is your doctors plan with labs?


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## Lovlkn (Dec 20, 2009)

HotGrandma said:


> Wishing you the best. TPO is almost always positive in graves. Have you ever had TRab or TSI antibodies tested? Yes you will always have antibodies present but the key is the amount present. TSI and TRab need to be in the 25-50% range to obtain a successful remission. Not that that figure is set in stone its the majority's average.
> 
> If it were me, I would have either TRab or TSI tested now and every six months or a year just to be sure the antibodies don't go on the attack. Could you post your labs with ranges.
> 
> What is your doctors plan with labs?


I agree. I'm not sure how your doctor can say you are in remission without running the TSI test.



> I went on methimazole, responded really well, and as of April of this year, have been off medication. I feel great, and my two most recent labs confirm that my T4, T3 total, T3 Free, and TSH are totally normal now.


Can you please post those labs with ranges.

In my experiences - many times patients become over medicated and when meth is stopped those numbers slowly creep back to hyper - range is quite large so "normal" doesn't mean much if your labs are moving.


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## oscalulo (Aug 5, 2013)

Oh boy. Every time I look into Graves further, it just becomes more complicated.

Exactly one year ago in July 2012, when I was first diagnosed, my doctor at the time did a TSI:

Thyroid Stimultn Immuno Quant
Standard Range: <=1.3 - TSI Index
My value: 5.0 TSI Index

I have not had another TSI test since the one above from July 2012. Here are my most recent labs from July 2013. Can anyone make any sense of them?

T4 FREE
Standard Range: 0.6-1.7 NG/DL
My value: 1.15

T3 FREE
Standard Range: 2.57-4.43 PG/ML
My value: 2.42

T3
Standard Range: 60-181 NG/DL
My value: 70.1

TSH,BLD,QN
Standard Range: 0.320-5.500 MIU/ML
My value: 0.462

THYROGLOBULIN AB
Standard Range: NEG IU/ML
My value: NEGATIVE

TPO AB
Standard Range: NEG IU/ML
My value: POSITIVE


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## HotGrandma (Sep 21, 2012)

Okay, you have a starting place with TSI of 5.0 (=1.3). Typically TSI is checked every 6 months or once per year. Your Free T4 is exactly at the 50% of range which is great. I suspect your TSI is causing the low Free T3 and TSH. Are you on any other medications at the time of these labs? Beta Blockers?

Any chance you can get you TSI tested now?

As Lovlkn stated


> In my experiences - many times patients become over medicated and when meth is stopped those numbers slowly creep back to hyper - range is quite large so "normal" doesn't mean much if your labs are moving.


Do you have labs for April, May and June with ranges so we can see if there is any movement? I feel this is important as I have read its harder to get graves under control the 2nd or 3rd time around. I personally don't think I could do graves a 2nd time. Uggh.


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## oscalulo (Aug 5, 2013)

Nope - not on any other medications at all, and I really want it to stay that way! The only medication I've ever had to take was methimazole for about 9 months after I was diagnosed (my heart palpitations responded almost immediately to being put on methimazole so did not need beta blockers). I've been off all medication since April, so at the time of these labs in July, I didn't have anything in my system for several months already. I'm going to ask my doctor to test my TSI so we can see what it's at. Thanks!


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