One doctor says borderline TSHRAB is basically positive , another doctor says it's in normal range

[Justiina]

I just can't take this anymore GP said regardless of tshrab being borderline it means negative. I am like why thr range has negative/borderline/positive then. I have understood positive in some cases mentioned strong positive just means the autoimmune attack is on/active.

Another doctor says borderline is positive, as normal person without thyroid issues simply does not have that much tsh receptor antibodies. Everyone has some , but for healthy individual it does not exceed the limit.

I don't know how much current thyroid values affect interpretation of tshrab as many guides says that even though one has low tshrab they can still have graves and never rule out graves/hyperthyroidism without full evaluation.

I know tshrab has not much value and is not routinely run for one with thyroid issues. My TSH is 3.2 (0.4-4) and ft4 13 (10-25). I am not medicated.

This second doctor will start levo trial but the problem is that my GP didn't think borderline tshrab has nothing to do with my thyroid.

I am like so effin bored of this s***. As my GP doesn't see any connection between tshrab and my thyroid levels and symptoms they do not approve my trial of levo so I have to be creative to get money for testing. ..

I don't even know who to believe, have Googled my brain out and still not much I can understand. On the other hand I have had borderline TPOAB and it was considered either upcoming or passing flare up. Was not upcoming as later on it was normal, but few months before the borderline TPOAB I had hyper like symptoms.

Problem is that I have been gluten , dairy and sugar free for years. My selenium has been good and been supplementing a bit to get it to optimal. I don't have many of those "triggers" in my life so I have no idea are my antibodies borderline because of life habits.

I just feel so helpless being "borderline" on everything ... never enough.

Haven't yet had proper chat with this second doc so maybe they have more answers, but as they are so fully booked and no new patients are accepted at this point I will be squeezed in as they promised they feel it's their obligation to fix this situation for me. I just feel so alone with thousands of questions. I still don't have diagnosis except their word it's basedow but being undiagnosed has continued for so long it stars to affect me. I don't know who I am and where I fit if you understand what I mean by it.

Sigh.

[Clutter]

Justiina,

You can have Graves (Basedow) and/or Hashimoto's antibodies and have euthyroid (normal) TSH, FT4 and FT3. Graves antibodies usually cause hyperthyroidism but TSH 3.2 and FT4 13 are not hyperthyroid. TSH >2.0 indicates your thyroid is struggling to produce hormone and FT4 13 is low in range. If you are prescribed Levothyroxine it will be to treat low FT4. There is no treatment for Graves (Basedow) or Hashimoto's antibodies.

thyroiduk.org.uk/tuk/about_...

[Justiina in reply to Clutter]

Thanks Clutter.

It's just so confusing to have graves but hypothyroidism. I had sort of understood it's possible but it never occurred to my mind I could have it!

[Clutter in reply to Justiina]

Justiina,

It's not unusual to have Graves hyperthyroidism which goes into remission and eventually becomes hypothyroid. Quite a few previously Graves hyperthyroid members are now hypothyroid without having RAI or thyroidectomy.

[Justiina in reply to Clutter]

That is interesting. I did have hyper type of symptoms when I fell ill in the beginning. Rapid weight loss for example. We were at Greece and the heat was intolerable and I lost 10 kilos in two weeks. Doctors didn't see that as a problem even though I wasn't heavy in the beginning.

Also constant nausea seems to be one symptom. My TSH and Ft4 was tested back then but not ft3 nor any antibodies so can't say if I had them. I know that doesn't change things, but it would have explained it.

I had highish heart rate at some point 90-100 but it didn't sort of feel bad. And so on.

So those indeed could be hyper symptoms

When I started to swing hypo my symptoms changed , I can tolerate heat for example. I do not get nauseated after physical stress, I started to sleep more and so on.

But can't really say without test results even though symptoms would fit.

[helvella]

There are (broadly) three "flavours" of TSHRab - stimulating, blocking and "don't have much effect". As the standard test cannot distinguish between the flavours, I wonder how they have established the range?

(The type is assumed from the effect - if you are effectively hyperthyroid, they must be stimulating.)

In years past, the expression widely used was long-acting thyroid stimulating factor (LATS).

What happens if you have two or three flavours acting at the same time? Or you shift from one flavour to another? I certainly do not know.

[Justiina in reply to helvella]

I have understood one can go for whole life not knowing they have thyroid issues at these antibodies balance each other for them.

Tshrab test has very little value except while on blocking meds. I mean it confirm the diagnosis but otherwise I assume the range is made to reflect severity of flare up. Strong positive means that blocking failed, borderline is questionable and negative to undetectable is considered success.

That's how I understand it based on what I have read. I can't say for sure as tshrab is not widely used except in very obvious graves.

I will have phone consultation with the rogue doctor in a week and I hope he will explain some of it. Tho he ordered the test based on my history with chronic YE which he reckon triggers autoimmune and antibodies to thyroid which are not all even measurable but he said they can be any antibodies which then makes just TSH ft4 and ft3 a bit unreliable in some cases.

But like I said how I think it is , might not be true at all. So I can just hope they can give me some type of explanation of the mechanism. I hope they explain how they justify borderline tshrab as positive , what if all were those antibodies that have no impact?

[Justiina in reply to helvella]

Havent had a chance to talk the doctor yet, but I think I understand the test a bit better. I went to see my results online, as first I got them on phone from nurse and didnt really get it. There is range < 2.9 negative, 2.9 -3.3 borderline, > 3.3 positive. My result is marked > 2.9 and flagged. So my result is higher than 2.9 , but no exact number, which I assume means that my number is somewhere in that borderline range, exact numbers are probably not used then. I have seen that in my test results before, for example folate is sometimes just typed as above or below certain number without giving the certain number.

Tho for some reason there is another range saying -1 mU/l. Like nothing else except that in a column for a range. Range above is typed under the result in comment box. So I can just hope my new doctor can interpret this weird number. I have to say I hate this. I want to know and I want to know now!

[helvella in reply to Justiina]

I would too!

Sheer nosiness if nothing else.

Just in case it wasn't clear before, there has been work done to identify the different types of TSHRab - but I don't think any tests are yet commercially available. Might be very interesting to see what is found when (eventually) they do get out of the lab.

[Justiina in reply to helvella]

Yeah I think I read about it too. It will be uncool if those meaningless antibodies have caused false diagnosis for some. If those can be so high.

It certainly will be very interesting!