My GP surgery has carried out some thyroid tests for an endocrinologist I have consulted privately. This I did at the Gps suggestion as the county I live in has a very long waiting time. One test result has just arrived.TSH binding site inhibitor globulin level 1.76 U/L (<1.75)
I don't recall ever having this test before and would like to know what it is for.
Thanking you in anticipation
TSH-binding inhibitor immunoglobulin or TBII is a older version or TRab which measures blocking, neural & stimulating antibodies affecting the TSH. It’s usually tested if Graves hyper is suspected.
Thank you. I have the opposite symptoms to my diagnosed underactive thyroid in that I have a fast heart rate and frequent hot sweats! I guess that is why this test was requested.
If you have existing Hashimoto’s & low function from autoimmune damage you can have the TSH antibodies but the stimulating affect would be lessened as there’s less thyroid to stimulate.
Plus the measure includes blocking antibodies so It might mean high blocking contributing to hypothyroid levels.
Do you have TED? has been mentioned in previous posts. TRab (TBII) are the main biomarker for TED as well as Graves so your specialist may be looking to measure for this too.
It’s raised result - so technically positive, but presumably you are on replacement & your FT4 & FT3 are not high? So the usual treatment for hyper wouldn’t be applicable.
it's one of the Tests used for measuring the antibodies that can cause graves. (TRab= Thyroid Stimulating Hormone Receptor antibodies = TSHRab ~ .all same thing)
I'm more used to seeing this test written as TSH Binding site Inhibitory Immunoglobulin ... (TBII) , but i'm pretty certain that's what your test is .
The result is only very marginally above the ref range .. so possibly doesn't mean much at all.
There are 3 kinds of TRab antibodies and , only one of them causes Graves Hyperthyroidism ~'Stimualting' TRab.
the other causes Hypothyroidism ~ 'Blockng' TRab.
and the other is kind of neutral.. doesn't do much .
if i remember correctly , the TBII test (and most TRab tests) can't tell which kind they are measuring ... a TSI (Thyroid Stimulating Immunoglobulins) test can measure just the stimulating ones .
.
Thank you. I hope the endo can explain whats going on.
bjo.bmj.com/content/81/12/1080 Value of thyroid stimulating antibody in the diagnosis of thyroid associated ophthalmopathy of euthyroid patients.
"Abstract
AIMS/BACKGROUND Thyroid associated ophthalmopathy (TAO) of euthyroid patients is difficult to diagnose because clinical findings overlap with other conditions, and no confirmatory diagnostic tests are available. Recently, it was reported that TSH binding inhibitor immunoglobulin (TBII) and thyroid stimulating antibody (TSAb) are sensitive markers of TAO. The sensitivity of these antibodies in the detection of TAO were therefore studied to determine if they could be a useful criterion in the diagnosis of TAO of euthyroid patients.
METHODS Serum values of TBII and TSAb of 35 patients with euthyroid TAO (group A) were compared with those of 27 patients with Graves’ disease and TAO (group B). The relation between the serum value of TSAb and the eye symptoms of patients with euthyroid TAO were also examined by multiple linear regression analysis.
RESULTS In group A, TBII was positive in 10 cases (28.6%) and TSAb was positive in 29 cases (82.9%). In group B, both TBII and TSAb were positive in all cases (100%). The titre of serum TBII in group A (15.6% (SD 18.0%)) was significantly lower (p<0.0001) than in group B (57.9% (21.5%)). The titre of serum TSAb in group A (1400.9% (2163.9%)) was significantly lower (p=0.0026) than in group B (2243.9% (1472.8%)). Among the eye findings of patients with euthyroid TAO, keratopathy was significantly (p=0.034) related to the value of TSAb.
CONCLUSION These results suggest that the activity of TSAb is a more sensitive marker of euthyroid TAO than is TBII, and could be a useful criterion in the diagnosis of TAO of euthyroid patients."
(*note TSAb here means same as TSI ~ie measures just the stimulating ones )
presumably given your eye symptoms , endo is looking for cause/ confirmation of TED ?
I expect so. I have been referred to an occuplastic surgeon who has a specialty in TED but have now been waiting since my referral in April. I would just like to know what is causing these problems.
Thank you. The problem has been getting the person with the TED knowledge. I was referred after a routine eye exam showed loss of peripheral vision. This was after months of swollen eyes and no gp help. Specsavers referred me, then another optician had to do another test begore the referral then went to New Medica. I travelled 70 miles (140 round trip) twice to New Medica before I was told they needed to refer me to a hospital to see a surgeon with a specialism in TED. This started in April - although the swelling reported to GP months before this. My Gp suggested consulting an endo privately due to the waiting time in our county. I booked an endo through Spire only to discover this endo does only telephone appointments. I am so despondant with all this.
As SlowDragon has highlighted, I’d definitely recommend optimising key vitamins for BOTH overall thyroid and TED health. I always take 200ug selenium if I’m having a TED flare (then reduce to 100ug as a maintenance dose). I also take lutein and zeazanthin for overall eye health. A forum member called Ling has useful posts on TED and gave me this advice.
TEDct helped me find a TED specialist ophthalmologist in my area and I saw him privately at a Spire hospital. TEDct has an extremely helpful administrator who has phoned me back with information/ updates.
previous post
healthunlocked.com/thyroidu....
Are you now taking vitamin B complex daily and separate B12 initially until B12 over 500
Then just continue with vitamin B complex
Remember to stop taking vitamin B complex 5-7 days before any blood test
How much vitamin D are you currently taking
Aiming for vitamin D at least around 80nmol minimum and between 100-125nmol may be better
Also are you now on strictly gluten free diet ?
Hot sweats often low B12
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