# Thread for those with stimulating and blocking antibiodies!



## Koof (Nov 9, 2011)

I thought I'd start a thread for those of us who have both stimulating and blocking antibodies. This can lead to labs that seem normal, while the body is still symptomatic. I thought it might be nice to share experiences to help each other.

I have relatively normal TSH and Frees, but my TSI was 93 the last time I had labs done. I am currently waiting for my doctor to send a lab slip for a TBII test - it was supposed to be sent 11/30 and when I contacted her last Fri 12/9 she replied Monday she was writing a new one to send out... and it has not yet arrived :/

I have primarily hypo symptoms,but since TSI stimulated the production of TSH it seems to me (and others have suggested) that I probably have blocking antibodies too, causing the hypo symptoms.

Anyone else? explode


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## HeidiBR (Apr 4, 2010)

There is an entire forum here for just this topic - you might want to move your post there?


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## Koof (Nov 9, 2011)

But it states you have to have TPO to post there and I don't, nor is my TSI high... I was thinking of this more for people who can't get a doctor to treat because we don't test above the reference ranges


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## Andros (Aug 26, 2009)

Koof said:


> But it states you have to have TPO to post there and I don't, nor is my TSI high... I was thinking of this more for people who can't get a doctor to treat because we don't test above the reference ranges


And as you know, the ranges are only to establish a baseline and detect movement.

The healthy patient should have no TSI, TPO Ab or TBII.

Did I give you this link?

Substances not found in normal serum
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm

I hope you get responses because not to many doctor's get it re the TSI, TBII and the "fact" that these 2 trouble-makers skew the ordinary Thyroid panel numbers.

Do you have some of your own research you can share with us??


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## Koof (Nov 9, 2011)

I came across this phrase "Atrophic thyroiditis" but I can't find more about it besides "Atrophic chronic thyroiditis is a rare autoimmune cause of hypothyroidism. This condition is characterized by the presence of blocking autoantibodies to the TSH receptors." http://emedicine.medscape.com/article/261913-overview#a0104

I'd love to know more about it (and I'm looking) but if anyone has information, can they pass it along? I'll post if I find anything 

ETA: This preview form a book mentions that atrophic thyroiditis presents with the absence of a goiter:
http://books.google.com/books?id=7v...page&q="Atrophic chronic thyroiditis"&f=false


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## Andros (Aug 26, 2009)

Koof said:


> I came across this phrase "Atrophic thyroiditis" but I can't find more about it besides "Atrophic chronic thyroiditis is a rare autoimmune cause of hypothyroidism. This condition is characterized by the presence of blocking autoantibodies to the TSH receptors." http://emedicine.medscape.com/article/261913-overview#a0104
> 
> I'd love to know more about it (and I'm looking) but if anyone has information, can they pass it along? I'll post if I find anything
> 
> ...


Good find; I read the entire article. Thanx!

And I will share this.........
http://www.ncbi.nlm.nih.gov/pubmed/1633635

And this...........
http://jcem.endojournals.org/content/92/3/1058.full


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## Koof (Nov 9, 2011)

I found this:


> An alternative cause of "atrophic" hypothyroidism is the development of thyroid stimulation blocking antibodies (TSBAb), which, as the name implies, prevent TSH binding to TSH-R, but do not stimulate thyroid cells and produce hypothyroidism. It has been proposed that TSBAb bind to epitopes near the carboxyl end of the TSH-R extracellular domain, in contrast to thyroid stimulating antibodies (TSAb), which bind to epitopes near aa 40 at the amino terminus(20). This syndrome occurs in neonates, children and adults. The prevalence of TSBAb in adult hypothyroid patients has been reported to be 10%(21). However, in contrast to the usual progressive and irreversible thyroid damage occurring in the usual setting, these blocking antibodies tend to follow the course of TSAb--that is, they decrease or disappear over time, and the patient may become euthyroid again(22). A change from a predominant TSAb response to a predominant TSBAb response can cause patients to have sequential episodes of hyper- and hypothyroid function(23). HLA antigens of hypothyroid patients with TSBAb were found to be different from patients with idiopathic myxedema or Hashimoto's thyroiditis, and rather similar to patients with Graves' disease(24).


 http://www.thyroidmanager.org/Chapter8/8-frame.htm

This seems like it can come and go, which may explain the times in my life that I have been fairly normal.

Then there is this:


> Blocking TSH receptor antibodies (thyrotropin blocking antibodies or TBA) prevent TSH from reacting with thyroid cells, which, in turn, reduces thyroid hormone production. TBA are seen in autoimmune atrophic thyroiditis, at lower levels than TSI in patients with Graves' disease, in higher levels than TSI in patients with Hashitoxicosis, in patients with thyroid eye disease.
> 
> In euthyroid Graves' disease, a condition of normal thyroid function and thyroid eye disease, levels of stimulating and blocking antibodies are both elevated to the same degree.


 http://elaine-moore.suite101.com/thyroiddiseasetriggers-a516

And this:


> Atrophic thyroiditis is considered the opposite of Graves' disease in that TSH is blocked from activating thyroid cells. The signal is lost and thyroid hormone fails to be produced. Consequently, thyroid cells fail to grow even when TSH levels become markedly elevated. Tissue changes in atrophic thyroiditis are characterized by fibrosis and stunted cell growth, and hypothyroidism generally progresses to complete thyroid failure.


http://www.elaine-moore.com/Article...toimmuneHypothyroidism/tabid/223/Default.aspx

More:


> Blocking TRAb are seen in Hashimoto's thyroiditis and atrophic thyroiditis where they contribute to hypothyroidism. They're also seen along with TSI in Hashitoxicosis. In people with euthyroid Graves' disease, equal amounts of both blocking and stimulating TRAb are present.


http://www.elaine-moore.com/Article...ngGravesOphthalmopathy/tabid/187/Default.aspx

And another, this from a PDF:


> Rarely, patients have a mixture of TSI- and TSH-R-blocking antibodies, and thyroid function can oscillate between hyperthyroidism and hypothyroidism as one or the other antibody becomes dominant. Predicting the course of disease in such individuals is difficult, and they require close monitoring of thyroid function. Bioassays can be used to document that TSH-R-blocking antibodies reduce the cyclic AMP-inducing effect of TSH on cultured TSH-R-expressing cells, but these assays are difficult to perform. Assays that measure the binding of antibodies to the receptor by competition with radiolabeled TSH [TSH-binding inhibiting immunoglobulins (TBII)] do not distinguish between TSI- and TSHR- blocking antibodies, but a positive result in a patient with spontaneous hypothyroidism is strong evidence for the presence of blocking antibodies. The use of these assays does not generally alter clinical management, although they may be useful to confirm the cause of transient neonatal hypothyroidism.


found here: http://www.google.com/url?sa=t&rct=...c19iqc6g-avk89NQw&sig2=oM4y3vxp_MbkdLe8T3QEkA


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## Serenia (Sep 27, 2011)

Latest blood tests done December 8, 2011.

TSH - 1.39 (0.40 - 5.50)
FT3 - 4.7 (3.8 - 6.0)
FT4 - 9.7 (7.5 - 16.0)
TRab(TSI) - 6.3 (normal - <1.0, borderline - 1.0 - 2.0, elevated - > 2.0)

TSH finally normal 2 years after my thyrotoxicosis storm, TSI still elevated, and endo still pushing me to have RAI or surgery....


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## Andros (Aug 26, 2009)

Serenia said:


> Latest blood tests done December 8, 2011.
> 
> TSH - 1.39 (0.40 - 5.50)
> FT3 - 4.7 (3.8 - 6.0)
> ...


Are you considering surgery? That might be the best course to make sure you don't have cancer. Pathologist will have a good look at the gland.

You sure don't want another thyroid storm, that is too scary!


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## MrsLabrat (Nov 19, 2011)

Hey Koof. I'm glad that you started this. I am going to another Endo tomorrow and hes going to do the ultrasound. I just can't get passed the hyper and hypo symptoms. It's odd.


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## Koof (Nov 9, 2011)

Well, if you do have both stimulating and blocking antibiodies the can cause your system to go haywire, even if your net blood tests show normal. This can make your symptoms crazy, because you may flip from hypo to hyper and my guess is your body reacts to the flip by going from one extreme to the other. So, you may end up with symptoms of both.

I'm frustrated by my sleeping temperature. I can't tell whether to dress for cold night or a hot one. I've had more hot nights lately though. For instance, this morning I woke up soaked from a night sweat but before I went to sleep I was chilly, so I wore fleece pants and a t shirt. When I think it will be a cold night I will wear long sleeves, sometimes two layers and on hot nights I wear a t shirt and shorts. I compromised last night :/ I can't seem to get it right because right now I'm having both hypo and hyper symptoms. in early November I was only having hypo symptoms and I knew what to expect...


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## Andros (Aug 26, 2009)

Koof said:


> I found this:
> http://www.thyroidmanager.org/Chapter8/8-frame.htm
> 
> This seems like it can come and go, which may explain the times in my life that I have been fairly normal.
> ...


This is awesome. I have found the last link to be of great interest! Of course they "all" are. See, these antibodies and immunoglobulins do give false test results.

And yes, the antibodies and immunoglobulins do wax and wane. That is why the patient feels like they are on a roller coaster ride sometimes.

Thank you for sharing all of your research. You have spent a lot of time on this and it is appreciated.


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## shakielady (Dec 22, 2010)

Hope you can help me. Been on tapazole since oct.2010. My endo doesn't tell me my lab results. Saw him last week because I have been having heart palps very bad again and shaking inside, also sweaty. He told me my blood work is fine and it is anxiety. Told me to make an appointment with my family doctor. I told him that I want the RAI done now, but he said he wants me to stay on tapazole till spring and then see how I do. I told him that I want this stopped as it is ruining my life. I cannot think clearly or remember well anymore. Why didn't he give me something for this supposed anxiety. I can't get in to doctor for 2 weeks. Blood pressure was 154 over 82. How am I ever going to work again like this. I had to quit my job as a PSW because of this condition. I feel he really doesn't give a crap!! I feel very lost and alone. Thanks for any input you can give me. Sincerely shakielady!!!


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