Help with hyperthyroid diagnosis for my sister

[TraceyLE]

Hi, I have hashis and underactive and know a lot about my condition from this site and other research. I was worried about my sister so I made her take a BH blood test and it appears she is overactive so I am a bit confused as I know nothing about the other end of the scale.

I have posted her results below and hope someone who is hyper can give me advice on what to tell her to expect. I already take all the vitamin supplements as I don't absorb and it appears she doesn't either, except for ferritin which is really high.

She doesn't take any supplements at the moment. Hopefully someone can help.

CRP 0.50 <5.0 mg/L

Ferritin 448.2 20 - 150 ug/L

TSH 0.005 0.27 - 4.20 mIU/L

T4 Total 215.9 64.5 - 142.0 nmol/L

Free T4 60.16 12 - 22 pmol/L

Free T3 32.07 3.1 - 6.8 pmol/L

Anti-Thyroidperoxidase abs 244.4 <34 kIU/L

Anti-Thyroglobulin Abs 210.2 <115 kU/L

itamin D (25 OH) 14 Deficient <25 nmol/L

Vitamin B12 203 Deficient <140 pmol/L

Insufficient 140 - 250

Serum Folate 9.19 8.83 - 60.8 nmol/L

Thank you in advance.

[greygoose]

Well, she has Hashi's, just like you. But, the question now is, is she on a 'hyper' Hashi's swing, or does she also have Graves? Some people do have both. If it's just the Hashi's, then levels will come down naturally. But, the only way to know if she has Graves, is to get the Graves antibodies tested.

Her vit d, B12 and folate are all too low.

[Arab in reply to greygoose]

Hope you don't mind me asking..

Which are the Graves antibodies that need testing?..

Arab.

[greygoose in reply to Arab]

TSI, TRab, TSH Receptor antibodies or TBII

I think that's correct. Somebody please correct me if I'm wrong?

[TraceyLE in reply to greygoose]

Wow I have never heard of those tests. Will a doctor know they need doing or will I need to sort out a private test for her?

[humanbean in reply to TraceyLE]

This might help :

labtestsonline.org.uk/under...

A doctor should do the tests. But whether it will be a GP or a referral to a hospital consultant I don't know.

[greygoose in reply to TraceyLE]

I'm sorry, I don't know the answer to that, I've never been tested for Graves.

But, it can't hurt to ask. Although, if it were me, I think I would prefer private. If a doctor sees those results of hers, he's going to want to put her on anti-thyroid drugs. And if it's the Hashi's doing that, I'm not sure that that would be the best choice of treatment. I would want to know if I had Grave's or not before I saw the doctor.

[helvella Administrator in reply to greygoose]

As I understand, and anyone who knows better, please correct me:

Thyrotropin Receptor antibodies (also called TSH receptor antibodies or TRab) come in three flavours.

Stimulating

Blocking

Don't-really-do-much

Stimulating TRabs are sometimes specifically called Thyroid Stimulating Immunoglobulin or TSI.

Blocking and Don't-really-do-much antibodies are most often ignored.

Some tests (I think actually most tests) cannot distinguish among these three types. So it is necessary to take a postive TRab test aling with elevated FT4 / FT3 (and usually rock bottom TSH) to recognise stimulating.

[greygoose in reply to helvella]

Oh help! It's even more complicated than I thought!

[helvella Administrator in reply to greygoose]

I despair of any medics following it all.

We virtually never hear of antibodies to T4, to T3, to TSH - let alone them being tested for. Though "the literature" has sufficient evidence they exist and can be significant.

For example, as I have posted before, TSH antibodies can attach to TSH (after all, antibodies are proteins with specific characteristics which make them very likely to attach to only one other molecule). When that happens the combination of the TSH and the antibody is called macro-TSH. It still exposes TSH sufficiently to be detected as TSH in a TSH blood test but the much greater size of macro-TSH looks like a much higher result.

Some TSH tests filter this out and do not give a falsely high result.

[greygoose in reply to helvella]

Well, certainly not any of the medics I've seen! They just don't have a clue! They just muddle through to the detriment of the patient, whilst proclaiming that they know it all!

[Arab in reply to greygoose]

Thanks! Just asking, because these are the tests that my GP refuses to do even though I've asked, as have had a diagnosis of Graves. Only TPO were done, and those only mildly elevated.

It would be nice to have a definite diagnosis, but it's unlikely unless I'm prepared to pay for the tests myself - and they're expensive!

Arab. 🙂

[TraceyLE]

Thank you all for your help. It looks like its far more complicated than my condition so I shall have to start reading up on it. I personally am going down the route of trying to get my gut health well to see if that can reduce antibodies, so will try and talk her into that as well.

Thanks again.