# High TSI with High TSH?



## McKenna (Jun 23, 2010)

Nasdaqphil, I was hoping you can chime in with your experience with TSI. I've read your article on Hashitoxicosis (I thank God I found it doing a search online a few months ago, or I would have thought I was crazy!) and I saw some of your labs that you posted. I was wondering what your TSI levels were when your TSH levels were high. Or did your TSH go down when your TSI went up? My TSH levels were consistantly higher the two times I've had a high TSI level done, which is confusing to me. Or is this a case of the binding/blocking antibodies messing up labs?

I haven't had a TSI done in two months so I have no idea where I am now, and my endo's only comment on the high TSI was "it's below 125 so you dont' have Graves'." He did dx me with hashitoxicosis at my first visit.

I have an appointment with a new surgeon next week to talk about a TT. I was scheduled to have it earlier this month, but the surgeon left his practice so I had to find another. I'm praying that once I get this out that my levels will become manageable.

Thanks in advance!


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## chopper (Mar 4, 2007)

Hi...I haven't had enough TSI tests relative to TSH to really compare....I've only had about 5 TSI tests in my life but probably 40 TSH.

I do know for sure that one time about 3 years ago I was doing really good - felt almost totally normal and during that time I got tested with a TSI at like 75 or something pretty low like that. I was great for about 4 months - went fishing with the kids, had a good time...felt good. Shortly after I started getting the jitters and feeling like crap again so I got tested and sure enough my TSI was back up in the 180 range. 170 - 180 seems to be where my TSI hangs out most of the time but my TSH is all over the place, between 5.5 the lowest and 22.5 the highest. Usually, however, my TSH is between 7 and 14 most of the time. My TPO and TG Ab's fluctuate all over the place too. I've been tested for TG Ab's in the 900's and recently tested around 85 - go figure?! Same goes for TPO....I've been in the 3000's for TPO and I've been as low as around 1200.

If you want to look at some numbers, I have some old labs on file and my TSH was at my lower end of 8 when my TSI was at one the lowest (130). When my TSI was high (170's) my TSH was also very high (19.5!):

3/18/2008

Free T4 0.82 (0.61 - 1.76) 
Thyroglobulin Antibody 75 (0 - 40) 
Thyroglobulin, Quant. 5.9 (0.5 - 55) 
Thyroid Stimulating Immunoglobulin (TSI) 179 (<= 125)
Thyroxine Binding Globulin (TBG) 25 (13 - 39)
Total T3 130 (85 - 205) 
Total T4 5.4 (4.5 - 12.0) 
TSH 19.561 (0.35 - 5.5)

1/16/2006

Ferritin, Serum 412 (20 - 345)
Free T3 343 (230 - 420)
Free T4 0.9 (0.8 - 1.8)
Hemoglobin 17.2 (13.2 - 17.1)
Iron % Saturation 35 (15 - 50%)
Iron, TIBC 395 (250 - 400)
Iron, Total 140 (40 - 190)
Testosterone, Free 99 (34 - 194)
Testosterone, Free & Weakly Bound 216 (84 - 402)
Testosterone, Sex Hormone Binding Globulin 17 (7 - 50)
Testosterone, Total 341 (241 - 827)
Thyroglobulin Antibody 82 (<= 20)
Thyroid Peroxidase Antibody >1000 (<35)
Thyroid Stimulating Immunoglobulin (TSI) 130 (<= 125)
Thyrotropin Binding Inhibitory Immunoglob. (TBII) 9.9 (<= 16%)
Total T3 131 (60 - 181)
Total T4 6.8 (4.5 - 12.0)
TSH 8.86 (0.40 - 5.5)

One of the things that gets me is that my Free and Total T3 and my Free T4 barely moves. It has always been right around the same number since 2004 when I first got diagnosed. My T3 is nearly perfect all the time but my T4 is low so it must mean that I convert like crazy.


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## Andros (Aug 26, 2009)

McKenna said:


> Nasdaqphil, I was hoping you can chime in with your experience with TSI. I've read your article on Hashitoxicosis (I thank God I found it doing a search online a few months ago, or I would have thought I was crazy!) and I saw some of your labs that you posted. I was wondering what your TSI levels were when your TSH levels were high. Or did your TSH go down when your TSI went up? My TSH levels were consistantly higher the two times I've had a high TSI level done, which is confusing to me. Or is this a case of the binding/blocking antibodies messing up labs?
> 
> I haven't had a TSI done in two months so I have no idea where I am now, and my endo's only comment on the high TSI was "it's below 125 so you dont' have Graves'." He did dx me with hashitoxicosis at my first visit.
> 
> ...


It could be a case of binding and blocking. There traditionally is a lag time between increased antibodies, FREE T3 and FREE T4 re the TSH.

Did You get the Frees at the same time? Just curious. That would paint a more complete scenario.

TRAb can act as blocking antibodies or growth-promoting antibodies and, thus, cause hypothyroidism (primary myxedema) or endemic and sporadic goiters etc..
http://www.ncbi.nlm.nih.gov/pubmed/1633635

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


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## McKenna (Jun 23, 2010)

Thank you both for your replies. If there's one thing I've learned so far, is that I still can't figure out this thryoid stuff! I do appreciate how much knowledge you have and your willingness to share.

In hindsite, I had hypo symptoms for a while, but didn't know it. Weight gain, feeling cold, hair loss, slowing down, tired. It wasn't until I had a hyper incident in April that a thyroid issue was found. My labs have always shown hypo but with Andros' help, I insisted on a TSI test from my family doc (endo was no help). The TSI I had was on 7/6/10 and the results were 103. This was three months after the worst of the hyper issue and at a time when I felt a little better. I'm sure my TSI had to have been much higher back then, but no one tested me.

The nearest labs to the TSI of 103 I have are from 6/29/10 (one week prior) and they were:
TSH 3.150 .450 - 4.5
Free T4 1.17 .82 - 1.77
Free T 3 2.6 2.0 - 4.4
TPO 269
antithryoglobulin ab <20 0 - 40

8 days after the TSI on 7/6, I had another one by my endo and it was down to 43. I felt better, less hyper at that point.
My other labs that day were:
TSH 3.22 .450 - 4.5
Free t4 1.21 .82 - 1.77
free t3 2.8 2.0 - 4.4
TSI 43 0 - 139

I guess I'm trying to see what the TSI does to the other numbers, if anything. My TSH has been higher than where it should be and my frees have been lower than they should be while my TSI was up. I'm trying to make sense of why. I would think a higher TSI would make the frees go up. ???

These are my most recent labs from 8/26/10
TSH 2.890 .450 - 4.5
Free t4 1.05 .82 - 1.77
Free t3 2.7 2.0 - 4.4
It was at this appointment that the endo put me on Armour 15 mgs every day. I had been taking it every other day prior to that.

Thanks again for your input!


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## McKenna (Jun 23, 2010)

I met with the new surgeon yesterday and he agreed with removing my thyroid. My surgery date is at the end of the month. He does laparoscopic surgery so the scar will be very small, probably under one inch.

We talked about my cold nodule, FNA that was inconclusive, my swinging from hyper to hypo symptoms and he said it was all the more reason to get it out.

Phil, when you wrote the article about hashitoxicosis you wrote that you were looking into surgery for it. I saw on another post that you are not on any thyroid meds, I assume you still have your thryoid? If so, have you changed your mind about the surgery? Just curious as to the outcome of your story.


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## Andros (Aug 26, 2009)

McKenna said:


> I met with the new surgeon yesterday and he agreed with removing my thyroid. My surgery date is at the end of the month. He does laparoscopic surgery so the scar will be very small, probably under one inch.
> 
> We talked about my cold nodule, FNA that was inconclusive, my swinging from hyper to hypo symptoms and he said it was all the more reason to get it out.
> 
> Phil, when you wrote the article about hashitoxicosis you wrote that you were looking into surgery for it. I saw on another post that you are not on any thyroid meds, I assume you still have your thryoid? If so, have you changed your mind about the surgery? Just curious as to the outcome of your story.


I am happy for you about this. Has the date been set?


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## McKenna (Jun 23, 2010)

Yep....10/27!


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## Andros (Aug 26, 2009)

McKenna said:


> Yep....10/27!


You don't have to wait long; that is also awesome. Are you excited??? I know I would be!


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## McKenna (Jun 23, 2010)

Somewhat excited, somewhat nervous. I'm not nervous about the surgery itself, but how I'll feel afterwards, until my meds get right. I guess I'm afraid of crashing into hypo-land very hard and then having to wait a long time until the dose is right. I think if I was starting from a stable place instead of feeling so awful right now I would be more optimistic. On the flip side, those hyper feelings should go, right? The anxiety, heart palps, inner vibe craziness that happens sometimes.

And it will be a big relief to get the nodule out since we don't know if it's cancer or not b/c the FNA was inconclusive. The FNA report said that "rare fibrous fragments" were found so I'm curious to finally find out what that means. LOL! And I am thrilled that the incision will be very small, probably under 1 inch, b/c of the endoscope/laparascope. ( I don't know the correct term! LOL!)

All in all, it will be positive and I'm glad I decided to get it out.


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