TSH and blocking TRAb

[asiatic]

Further to a recent post by HealthStarDust on TRAb results and a discussion with tattybogle and pennyannie as to whether having blocking ABs dominating would give high or low TSH, I posted a question on Elaine Moore forum. The following is her reply :-

About 20% of patients who move into remission using meds or naturally have a 20% of moving into hypotjyroidism. You're right in that the cause is blocking TSH receptor antibodies. All TSH receptor antibodies are recognized by the pituitary as if they were TSH. So the pituitary thinks you have enough TSH and stops secreting TSH normally. This causes a falsely lowered TSH result. I have the same problem with my TSH staying at <.07 even if I'm hypothyroid. That's why we say TSH is misleading in Graves' disease. You want to be closer to the high end of the range for FT4 and midway between the middle and high ends of the range for FT3.

[pennyannie]

Thank you - seems my Alert button isn't working !!

Presume the suggestion of where the T3 and T4 need to ' sit ' is based on the assumption one has the flexibility and ability to dose both T3 and T4 independently to achieve same.

[tattybogle]

however... there is good quality evidence from these case studies showing patients with very High TSH at the times when blocking TRab were dominant :

eg. this patient had TSH of 47 when blocking TRab were shown to be dominating : sciencedirect.com/science/a... Usefulness of Functional Thyroid-Stimulating and Thyroid-Blocking Immunoglobulin Bioassays in an Atypical Presentation of Graves’ Disease 2023

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and here , another patient had TSH over 500 when blocking TRab were dominating : (fig. 2a shows blocking TRab dominant at diagnosis, fig. 2b shows very high TSH at same time .....the patient later became hyperthyroid/ low TSH when stimulating TRab were dominating)

and from the same study, another patient whose TSH rose very sharply to 100 when blocking TRab were dominating ( fig. 4b )onlinelibrary.wiley.com/doi... Changes of TSH-Stimulation Blocking Antibody (TSBAb) and Thyroid Stimulating Antibody (TSAb) Over 10 Years in 34 TSBAb-Positive Patients with Hypothyroidism and in 98 TSAb-Positive Graves’ Patients with Hyperthyroidism: Reevaluation of TSBAb and TSAb in TSH-Receptor-Antibody (TRAb)-Positive Patients

[pennyannie in reply to tattybogle]

I think all I can take from any of this is -

the TSH is a very unreliable measure of anything -

and just a 1st line blood test possibly highlighting a potential health issue -

which will require further blood test analysis -

to substantiate through antibody readings if an Auto Immune disease prevails -

and we should track on what causes the symptoms being tolerated -

whether hyper or hypo -

and that is not on the TSH reading - which does not cause symptoms -

but on the level of Free T3 and Free T4 circulating in the blood.

[asiatic in reply to pennyannie]

I am taking from it that TSH might be above OR below range when blocking TRAb are dominating. In my case and at this time it is below range. I will ignore it and continue adjusting Levo to keep T3 mid range where I know I feel well

[pennyannie in reply to asiatic]

Yes I tend to agree - blocking and stimulating antibodies can change places as the immune system becomes more volatile -

Whatever is going on with the immune system we can't do much about it -

But we have a means of lowering high, over the range thyroid hormones with AT drugs-

and we can adjust T3 and T4 levels within the ranges with thyroid hormone replacements -

as it is optimal levels of Free T3 and Free T4 that give one back ones health and well being which surely should be the ultimate aim of any medication.

[HealthStarDust in reply to tattybogle]

It would be interesting to know if both stimulating and blocking were checked in each patient in these studies thus demonstrating which may be dominant.

[tattybogle in reply to HealthStarDust]

.... if you read them you'll see they did just that .

[TSH110 in reply to tattybogle]

That’s for these links they are very interesting.

[HealthStarDust]

I’m confused, doesn’t blocking trabs lead to increased TSH and stimulating trabs to suppressed TSH?

[radd in reply to HealthStarDust]

Yes, generally when we medicate thyroid hormone replacements meds TSAb will reduce TSH and TBAb will elevate TSH higher than it should be given the levels of thyroid hormones. However, as tattys examples demonstrate it's not always the dominating antibody that wins, and so different variations might occur.

In un-medicated peeps a straight ward explanation would be TRAbs prevent TSH from stimulating TSH receptors found mainly in the thyroid gland but also some other tissues. Sometimes even when extremely high TSH levels are present this might not have enough stimulation value when TRAb's are strong enough to block these receptors. This is when thyroid hormones plummet and thyroid atrophy might eventually occur.

Elaine Moore says TSH maybe misleading in Graves but it can be an unreliable measure in Hashi also as we can get any mix of antibodies.

[HealthStarDust]

My brain hurts to get my head around all these trabs and their significance. Honestly, I am beginning to think the science only makes sense to a point in explaining usually straightforward aka text book thyroid disease and not much else.

This forum and others like it proves people have such vast differences in their thyroid experiences that I think anything is possible!

[TSH110 in reply to HealthStarDust]

That’s badly understood science being oversimplified until it’s utterly meaningless. The science behind the antibodies is very interesting I find it illuminates although I agree it’s not easy to grasp, which is probably why so many medics are so bad at treating it -but it’s their job to get their head around all this stuff! Sadly it’s left up to those with the problems to try and plough through it all.