antibody confusion (cont'd) - Question and Answer Forum - Elaine Moore Graves' Disease and Autoimmune Disease Education

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Tuesday, February 07, 2012

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Welcome to The Q&A with Elaine Moore. Registered members are invited to ask any question of Elaine Moore on autoimmune diseases, Graves' disease, other thyroid diseases and subconditions, laboratory work, traditional and complementary medicine, triggers and environmental influences, thyroid and immune disorders in pets and animals, and other relevant areas of inquiry.

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antibody confusion (cont'd)

7/7/2010 11:57 AM

Carol

Joined: 1/28/2009

Posts: 79

antibody confusion (cont'd)

Hello again Elaine

I recently asked you about my antibody lab results and, you, too understood my confusion since my TRAb came back in range and my TSI was still elevated.....yet, my TSH is still very low (.01 most recently) and, without levothyroxine, I'd be hyPO.

You suggested trying another lab (I've been using LabCorp all along) yet I've begun to wonder if the TRAb result is more suspect.

Here is my full antibody history:

June 2007 Graves' Dx TSI 222

July 2008 (overmedicated on MMI, TSH over 3) TSI 588

Dec 09 (off MMI for 2 months) TSI 379 TRAb 2.74 (.0-1.75) - this was the first time I was ever able to get a TRAb test done - you told me back then that my blocking antibodies were probably suppressing my TSH and preventing my TSI from causing hyperT

Mar 10 TSI 300 TRAb 2.33

July 10 TSI 270 TRAb 1.32

My TSH was below range when I entered remission from Graves' in Oct. 09 and continues to be low after taking levothyroxine for 4 months.

In light of this additional information, would you kindly provide interpretation of my situation and guidance moving forward?

Thanks again for everything!

Best regards,

Carol

7/7/2010 11:35 PM

Elaine

Joined: 8/1/2008

Posts: 3166

Re: antibody confusion (cont'd)

Hi Carol,

I'm not sure I'd put much stock in either of these results except for confirming that you initially had Graves' hyperthyroidism and you still have thyroid autoimmunity. Because the TSI result represents the change in thyroid hormone produced by a cell culture when your serum is added, your replacement hormone can also have an effect on the result. Normally, a patient on replacement hormone wouldn't be having a TSI test and there wouldn't be an effect. The TRAB should be measuring all antibodies that bind to the TSH receptor---it's a different methodology. These tests are designed to help diagnose autoimmune thyroid disorders and to help in predicting remission, but as you can see there are limits when interpreting results. My guess would be that your replacement hormone and not your antibodies is causing the elevation in thyroid hormone seen in the cell cultures. These tests aren't FDA approved but the new TSI test that came out last year uses a different methodology and is FDA approved. I'd see if you could have that test although the results would still be more for academic than medical reasons in your situation. Best, Elaine

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antibody confusion (cont'd)

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