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Positive TSI, but normal TPO and TG?

I am REALLY confused. The abbridged version is this:

2001, u/s performed, within normal limits, no masses, TSH- 2.12 (Range: .27-4.2), T4 .98 (.93-1.7), T3 2.3 (1.8-2.46)
2003- eye problems (redness, dryness, gritty, blurry vision), diagnosed with 'dry eye snydrome'
2003-2007 TSH 1.5-2.5
2008- swallowing problems, tremors, feeling hot all the time, very fast heartrate (100-140)
u/s performed Impression: 3mm nodule found, heterogenous echotexture, ,enlarged, multinodular in appearance
RAIU permormed 3mm nodule not seen, overall appearance is that of a multinodular goiter and/or early form of thyroiditis
Placed on Synthroid .25mg to shrink down goiter

TSH- 2.24 (I don't have the free t3 and t4 levels, but they are similar to 2001)
TPO - <10 (Range: 0-20)
TG - <20 (Range 0-40)
TSI - 156% (Range <129%)

I was placed on Snythroid before the TSI was preformed. I actually had that test done on my own and JUST got the results. I am confused as to why the TSI is positive but the TPO and TG are not. I asked my ENT (I have an appt with my endo on the 25th) and he said he'd never seen the TSI positive and not the TPO or TG be high. I thought maybe Euthyroid Graves Disease but my ENT said even with that, TPO and/or TG should be high as well. What is going on here?
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Avatar universal
Thanks again. I did actually ask my dr about the contrast dye, but he just said to take a benadryl. I don't think he really understood what I was trying to say, even though I believe I explained it very well. I know I am not allergic to it, so I don't think that's going to help.

I was looking over your profile and I found it really interesting. Part of it sounds very familiar to me. Especially the weight loss/gain/loss/gain! That happens to me a LOT! Mostly the gain though. Ugh. I also have hypertension, seemingly out of nowhere. I always had really low, and at one point it was dangerously low bp. The Dr told me to eat a lot of salt (doh!). And then I started gaining weight and it  just shot up and stayed that way (I'm on a diuretic for that). I also have started to know food triggers, well I knew I felt weird after them, but I never pieced it together as to why. It just all makes sense now. I didn't start having symptoms besides the eye thing until I was on Effexor (for ADD) and I really thing that may have brought it out.

I really do think I caught this very early (thankfully I did not listen to the Dr and got my own TSI or who knows what would have happened).

Anyway, thanks for your input... and hopefully soon I'll have some answers.
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Avatar universal
I don't remember having any problems with the contrast dye. But I didn't know anything back then because I didn't have a computer and access to all the wonderful information. However, years later after RAI I got a reaction from iodize salt, needless to say I have stopped using it.

Medications can sometimes be given before the contrast material is administered to lessen the risk of reactions in susceptible patients. You may also be prescribed an antihistamine of cortisone before the procedure to lessen the chance of a reaction.  Ask your doctor!
Older dye preparations that have a high concentration of iodine are
more likely to trigger a reaction. Contrast dye has been adjusted in a
variety of ways in order to make it less likely to cause a reaction.
Ask your doctor to use one of the newer dyes, which while are more expensive, are far less reaction.

I am messaging you the test, I hope you don't mind.

When you get back  all the results, we'll go through and try to figure out what they mean. I am not an expert though! ;)

Good luck!
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Avatar universal
Thank you, GravesLady.

I think I have a better handle on it now. So, what you are saying is I am in a 'dormant phase' of Graves and it may go either way... either go into remission or turn into actual Graves?

I have never had a TSH over 2.5, so I was never technically hypo... although, with the new lab ranges, I would be at the upper end of the spectrum towards hypo, so that makes sense.

Is there anything I should ask my endo to test (I don't know how cooperative he will be because apparently--per his nurse--he is not too happy with the fact that I went on my own to get the TSI done, because he told me 'there's no way that would be positive') in addition to the ones I've had  (TG, TPO, TSI)?

I really wish I had my TSI level checked in the beginning of when I started having eye symptoms (in 2003) to compare to where they are now. I would imagine that would give a good indication as to whether this is getting worse or on its way out.

Another question for you... when I had my RAIU test done, I had very intense hyper symptoms (I had terrible insomnia, my heart rate was through the roof, I felt like I was on fire, etc). Previously, I noticed a that a much less version of these symptoms occured after eating something salty. Never did I make the connection between my thyroid and the iodine until I started talking to some people who were hyperthroid that said the RAIU aggrivated their hyper symptoms. Anyway.. this is my question. Have you had any experience with CT scan contrast doing what I just mentioned? I have a CT scan w/contrast (for this particular test the contrast must be used) and I am quite worried about it making the hyper symptoms worse. I asked the dr but like so many he had no idea what I was talking about. It is not something I HAVE to have, it's more to ease my paranoia about lymph nodes in my neck. So I'm considering cancelling the CT scan. This wouldn't bring ON active Graves would it?

Thanks so much for your time.
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Avatar universal
Your thyroid levels do not relate to autoimmune.  However, positive TSI suggest non-active Graves' Disease (active Graves' would be TSI with thyroid levels of Graves'). Positive TSI with normal TOPs suggest hypothyroid phase which is early or first stage of Graves' disease.

Graves' disease, most everyone has an initial period of hypothyroidism that's mild and not diagnosed although some people have overt hypothyroidism for years before moving into Graves' disease.

There are reports saying that 1/2 of all people with GD can move into remission without treatment.

If you are subclinical hypothyroid with the presence other antibodies such as TPOs with the presence of TSI suggest Hashitoxicosis, a condition that's primarily related to hypothyroidism with transient hyper symptoms caused by bursts of TSI raising thyroid hormone levels.

Hope this explains it some what.
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