Hashimoto's. Am I on my way to Graves, too? TSI results.

[ShootingStars]

Hello. I am wondering if I could get your opinions about my thyroid antibodies, particularly TSI? I have Hashimoto's with very high TPO antibodies. I recently decided to test TSI, thyroid stimulating immunoglobulin, which is a Graves antibody. My TSH is suppressed as it should be with Hashimoto's (0.09, but my previous results was 0.009, so I reduced my T3 a tiny bit and this brought it up to 0.09). My FT3 is optimal (just over 3/4 range). My FT4 is optimal (at 3/4 range). I have no hypo symptoms, nor do I have any hyper symptoms (knock knock wood). Despite very, very high TPO, I have no autoimmune symptoms (knock wood).

My TSH immediately went down under 1.0 when I first started 50 mcg T4 and 10 mcg T3 medication, and has remained under 1.0 the entire time. It's mainly been under 0.50. My FT3 and FT4 remained sub optimal (under 1/4 before medication, then FT4 at 1/2 and 3/4 a little over 1/2) and my TPO remained very very high for a year. (I was under medicated). I had a few hypo symptoms and had lots of autoimmune symptoms back then. My FT3 and FT4 have never fluctuated since starting medication. They only went down a tiny bit and then I'd eventually increase medication a small amount.

Back to my TSI. Last week was the first time I've tested TSI. I mainly did it for the heck of it and out of curiosity. My result is 100%, ref range <122%.

INTERPRETIVE INFORMATION: Thyroid Stimulating Immunoglobulin

Negative - 122 percent basal activity or less

Positive - 123 percent basal activity or greater

Positive results (123 percent or greater) are consistent with Graves disease but do not always correlate with the presence and severity of hyperthyroidism. Antibodies to the thyroid stimulating hormone receptor (TSHR) may be stimulating, blocking, or neutral. Stimulating antibodies mimic the action of TSH and may cause hyperthyroidism (Graves disease). This test determines the net effect of all TSHR antibody types present in the serum specimen.

I know that it is impossible to predict if I will get Graves or not. Since I already have very, very high TPO, I imagine that with TSI already at 100, that I run a greater risk than someone who doesn't have such high TPO and high in range TSI? I will be testing my TG again this week. It's always been negative. I'm supposed to test TBII (thyrotropin-binding inhibitory immunoglobulin), too, but the code is missing from the test request. I hope I can get that added tomorrow.

I value all of your opinions and advice, so thank you to anyone who reads this and responds.

[Valarian]

TSI is part of the autoimmune response, and may be seen in people with Hashi’s too - as in your case, TPO will be much higher.

In Graves’, TSI is typically very high - your lab looks at >122 as indicative of Graves’, and you are some way below this. hbmag.com/hashimotos-graves...

One of the things about autoimmune disease is that once you’ve had one, you are more likely to get another anyway.

[SlowDragon Administrator]

At moment (and probably in future) your TSI is below range and therefore negative

Are you on strictly gluten free diet? Obviously with Hashimoto's this helps enormous number with reducing antibodies and sometimes symptoms too