Re Graves and Hashi's

[Guest guest]

My questions:

Are these TSH receptor antibodies why my TSH never rose to indicate

the severity of my hypothyroidism?

i've never had any indication of TED - should i be concerned?

Is it possible that I actually have Atrophic Thyroiditis...and how

would this be diagnosed if that were the case?

Thank you.

cindi

Hi Cindi,

Yes, very likely. TSH Receptor antibodies (all types) can trick the pituitary into thinking there is plenty of TSH available and will keep the TSH suppressed. TSH Recptor antibodies (which can also be called TBII) attach to the TSH-receptors on both the thyroid and the pituitary. The way they attach to these receptors makes the difference in whether they will be "blocking" or "stimulating" the thyroid.

I'm not familiar with atrophic thyroiditis - I assume this means a thyroid that is dying due to inflammation? That sounds very much like Hashimotos, which is often diagnosed by TPOabs and TGabs (but sometimes these antibodies may be only located within the thyroid itself and wont be picked up via blood test - only via biopsy). TPOabs and TGabs don't directly cause the inflammation, but do contribute by attracting other immune system cells to the area- and once those others cause more cell damage, more TPO is spilled out, triggering more TPOabs - so it's a vicious cycle of inflammation that is hard to get under control.

But if you test for TRab and they are positive plus have thyroid inflammation, this will mean that you have overlapping Graves disease. The TRab that is known as TSI is what causes the hypERthyroid state in Graves so that is how GD is diagnosed when a person is HypERthyroid. When a person is hypOthyroid, however, too often the endos skip the TRab testing and go straight for determining if its autoimmune inflammation - TPOab and TGab. The reason they dont look for Blocking TRab is that there is currently no commercially available test for TBab (blocking TRab) and the disease would likely be treated the same way anyhow.

However if I were an endo, (for people with blocking TRab) I would use Block and Replace (low dose anti-thyroid methimazole and high dose synthroid) until the TRab were in remission. New studies show that Methimazole can also reduce thyroid inflammation.

TRab are what causes pretibial myxedema and the eye disease. You are at higher risk for the eye part, but many people with Graves never have eye trouble (me included).

But getting what causes the inflammation into remission is a lot harder.

I have both Graves disease and the thyroid inflammation. This means I have overlapping disorders. As long as I have TRab antibodies, then I will most likely be considered to have Graves. If my TRab turn to blocking TRab, then I'll become hyPO but still have Graves --- and would now be called "Euthyroid Graves" or "HypO phase of Graves". Sometimes this is mistaken as remission. This is not always permanent and I could go hypER again down the road. If my TRab go away totally, but I remain hyPOthyroid - then we can say my condition shifted away from Graves and more toward Hashimotos.

Since I also have TPOabs and I don't know how many years I've had them, then there's a good chance my thyroid is heading for loss of function. TPOabs are what denote inflammation via lymphocytes. Long term inflammation via these lymphocytes usually results in permanent thyroid disfunction. That's what Hashimotos thyroiditis is.

To complicate things even more.....When our lymphocytes are especially destructive and cause a lot of damage all at once, the numerous broken thyroid cells will dump hormone into our system and create a temporary hypER situation. This is called Hashitoxicosis and can really throw a wrench into treatment. But once too many cells have been destroyed the person will then become chronically hyPO - probably permanently in time.

There are very few docs who will delve into all these possibililties, since the treatment for hyPO via any source is usually the same for all types of hyPO = replacement hormone. But they are learning a lot more about TRab (TBII) antibodies and perhaps many GD folks who were previously incorrectly diagnosed with "Hashimotos" may actually find some sort form of "remission" treatment using a combination of MMI and synthetic hormone together.

Also - keep in mind that many professionals assume Blocking TRab are Hashimotos antibodies and that makes it even more complicated when researching on the Net.

And making it even more frustrating is that there is currently not a test for Blocking TRab - - you have to get a Total TRab (or TBII) and a TSI - then subtract the TSI from the Total TRab. If you have no TSI but have ample TRab - then you can assume you have many blocking TRab.

Hope that helps!

Val

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