This case study doi.org/10.1530/EDM-15-0131 describes a girl with rapidly changing blood test results reflecting alternating hyper- and hypo-thyroidism caused by stimulating and blocking TSH receptor antibodies. The switches from hyper to hypo were rapid and substantial. The paper mentions that 10-20% of patients with autoimmune thyroiditis have TSH receptor antibodies (TRAb). Reference 5 gives a link to a paper giving more details on how this can happen, I printed it off and then chickened out! Don't have time to read it.
Unlike many doctors in the UK (and elsewhere) these doctors did not tell the patient they were 'subclinical', didn't accuse them of non-compliance and ran the TRAb assays that uncovered the problem.
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jimh111
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It was hyper and hypo. There were antibodies that stimulate the TSH receptors in the thyroid and antibodies that block the TSH receptors in the thyroid causing erratic thyroid all secretion.
Not going anywhere....other than to a long soak in a deep, hot, foam bath!
Currently on a long term - at least 6 months - dose of antibiotics ( after years of probs) for what now turns out to be an embedded UTI ( found brilliant research by a world renowned urology Prof in London and my GP is supporting). Got really hacked off by advice to drink plenty of water and rest....I know I'm 76 but I'm as "tough as old boots" though my badly frayed laces are undergoing replacement ..... I knew rest wasn't the answer!! I'll be fine once the antibiotics get murderous!
I'm convinced that embedded UTI has been caused by decades of gradually falling cellular T3 levels. I've at last sorted the T3 problem, which now appears to be congenital, but now tackling the damned bugs!
The thyroid has receptors for TSH. Antibodies that stimulate or block these receptors can cause the thyroid to secrete too much (Graves’) or too little hormone.
Thanks Jim ...I live and learn.So the cause is too much glandular hormone (antibodies stimulation) - or reverse - rather than overmedication by too much exogenous hormone.
Having a dippy day, see my response above to tatty!
It’s not easy, is it? But I read and reread and hope that slowly it goes in and makes better sense! I had atropic autoimmune thyroiditis a kind of graves/hashis hybrid. Luckily she explains it well she had the same one as me. The deiodinases are still a very murky mire in my brain too! I bet we still know a lot more than most GP’s tho 👍🏽😁👍🏽
I have often wondered if I swing between TSab and TBab.2013 asked for thyroid test as I had a few HYPO symptoms. Only TSH measured and at 4.3 told I was ok.
Lots of ups and downs on Carbimazole. Now on long term low dose BR which keeps me more stable.
What I don't understand ( well actually there is a lot I don't understand ! ) and wonder if anyone could comment on is - whether TSab or TBab is dominating at any time surely both scenarios would cause TSH to be low and so my theory of being hypo in 2013 due to blocking ABs is wrong.
As I understand it TSH blocking antibodies (TBAb) would cause TSH to rise, as can been seen on the 3rd June figures in the case study. Blocking the TSH receptors in the thyroid would cause reduced secretion of T3 and T4 leading to low blood levels, the pituitary would detect these low levels and produce a lot of TSH.
I suspect some hypothyroid patients have elevated TBAb causing their hypothyroidism and that this is misdiagnosed as primary hypothyroidism. Since they are medicated according to TSH and symptoms they end up correctly treated for the wrong reason.
they end up correctly treated for the wrong reason.
And then spend the next 20 years getting told off for 'not taking the tablets' and finding "? poor compliance" written on their notes to explain away any weird results.
I've never understood why anyone would go into a career like endocrinology , and then not be remotely curious about this sort of stuff... but there you go.
If they'd just test peoples fT3 and the TRab a bit more often than they do , without kicking up such a fuss about it 'not being necessary' they would surely observe some interesting things that would be very useful and promote further understanding for everybody.
Ok, some people who feel perfectly fine on Levo might well be a bit random in their Levo habits cos it's not very important to them , and it might not bother them symptom wise , they might get fluctuating results but still feel fine.
But if you're still feeling crap and it's affecting your life , what reasonably competent adult "doesn't bother to take their Levo as regularly as they can " ?
I find it grossly insulting that on the basis of the very few cases of 'factitious' deceit, or psychiatric issues, or mental incapacity, that the rest of us are automatically assumed to be "forgetting to take the tablets" .....
no matter if we've said for years " yes , i take them every day Dr. ... i might have missed one last December , but that's all "
Instead of assuming we all are too thick to remember, or too deceitful to be trusted... why can't they assume that once they've asked us once , they've dealt with that possibility and perhaps it's time to move on to some other line of thought that might explain our continuously 'unexpected' test results .
(Sorry for ranting ... but i thought i'd better do one , since Dippy D's gone for a bath, so she won't be available for ranting )
Not to worry, my imaginary friends think I'm special!!
A ranting, dippy, ( well cleansed) geriatric....hang on until I get those new bootlaces I mentioned earlier!!
On patient non- compliance ...
I think Dr P had the correct philosophy. He said that he treated his patients "as if they were as bright as he and perfectly able to work things out given the knowledge".
Knowledgeable and confident practitioners don't feel the need to patronise their patients!! Nor do they need to spew out a string of excuses to cover their shortcomings.
Rant over.....apologies everyone.
Now back on earth.... I'm off to make some Tiffin!!
It is unbelievable that they want to invent a fictional agenda, rather than simply accept that we are telling the truth. It makes me wonder what sort of twisted minds they have! Is it a case of projection cos that’s the sort stupid thing they would do?
Thanks Tatty and Jim. I mistakenly thought like TSabs they took over control leaving TSH redundant. I am on a steep learning curve here so apologies for adding another scenario. I believe we can have Neutral ABs too. What would happen to TSH if they dominate ? Would they too block TSH and cause thyroid hormones to increase ?@
Sounds a sensible strategy but you have let me down. When my lazy brain reaches overload I rely on people like yourself digesting it all and giving a simpler more understandable explanation ! Ah well I suppose I better give Tania another try 😱
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On Block and Replace - can I have both hyper and hypo symptoms?
hyper/hypo
Hypo To Hyper?
Hyper but now hypo why should I stay on carbimazole?
