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should i test antibodies?

I recently got my Free T3/T4 tested with the following results

F T4, FREE 1.1 0.8-1.8 (ng/dL)
F T3, FREE 3.0 2.3-4.2 (pg/mL)

It seems like its in the perfect range but I have the following hyperthyroid symptoms

Rapid heartbeat
Increased appetite
Nervousness, anxiety and irritability
Tremor — usually a fine trembling in your hands and fingers
Increased sensitivity to heat
Changes in bowel patterns, especially more frequent bowel movements
Fatigue, muscle weakness
Difficulty sleeping
Skin thinning
Fine, brittle hair

Is it worth it to pay for Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb) test or were the free t3/t4 enough? Thanks
3 Responses
1756321 tn?1547095325
When I had Hashitoxicosis (both types but the hyperthyroidism is far worse with Graves antibodies) with very bad hyperthyroid symptoms my labs showed I was hypothyroid. The thyroglobulin serum (not antibodies) was elevated showing I was hyperthyroid.  Hashitoxicosis can mess with the labs for sure.


Excerpt from the article: The Medical Journal Of European Endocrinology - Hashitoxicosis – Three Cases and a Review of the Literature...

"It should be pointed out that, especially in the US literature, the term ‘hashitoxicosis’ is sometimes used to describe an autoimmune thyroid disease overlap syndrome of Graves’ and Hashimoto’s disease.  In this article the term is strictly limited to the ‘leakage’ symptoms of active Hashimoto’s disease."


Excerpts from the book: Thyroid Disorders and Related Health Conditions by James M. Lowrance...

"Some Hashimoto's Hypothyroid Patients Experience 'Hashitoxicosis'

While Hashimoto's typically causes hypothyroidism (low thyroid hormone levels) some patients can have fluctuations in their thyroid hormones, that go from hypothyroid to hyperthyroid (from abnormally-low to abnormally-high thyroid hormone) and this can be due to them having high levels of a certain type of thyroid antibody. The condition I refer to is "Hashitoxicosis".

The antibodies that are blood tested for, when Hashimoto's is being determined/diagnosed, are the anti-TPO (anti-thyroidperoxidase) and the anti-TG (anti-thyroglobulin) antibodies (also referred to as "autoantibodies"). Either or both of these testing positive helps to confirm presence of this hypothyroid disease.

However some Hashimoto's patients can also test positive for autoimmunity cells called "TSI" antibodies (Thyroid Stimulating Immunoglobulin). This antibody is what usually contributes to Grave's Disease or "autoimmune hyperthyroidism" however, some Hashimoto's patients have these antibodies at high levels, as well as having the TPO and or TG ones, that typically cause Hashimoto's.  

You could say they are suffering from Grave's and Hashimoto's, simultaneously, usually for a limited period of time. This phenomenon is most prominent during the early stage of Hashimoto's and for many patients, the hyperthyroid phases will diminish over time."

'Block and Replace' Treatment for Non-Resolving Hashitoxicosis

Even without having TSI antibodies present, Hashimoto's thyroiditis patients can potentially experience flares of thyroiditis, which can also cause mild hyperthyroid type symptoms that are not as severe as those caused by Hashitoxicosis, if phases of hyperthyroidism symptoms are severe.  Some patients who have both Hashimoto's thyroiditis and Grave's antibodies that cause continually unstable thyroid hormone levels and that do not resolve over time, are sometimes placed on a treatment called "block and replace".

This is a treatment in which they will block the hyper-stimulation of the thyroid with an anti thyroid drug (the medication slows hormone production) and afterward, at the appropriate timing, they will give the patient thyroid hormone therapy (replacing the diminished thyroid hormone levels).  This is an alternative treatment to thyroid removal (thyroidectomy and ablation), however, if the treatment fails, once given an ample trial, thyroid removal might be recommended as a follow up treatment.

For Most Hashimoto's Patients - Hashitoxicosis Resolves on Its Own

Some Hashimoto's patients have been known to actually transition over to Graves Disease over time, when having both types of antibodies (those that destroy thyroid cells and those that stimulate thyroid hormone production) and they become progressively hyperthyroid (not common).

Most Hashimoto's thyroiditis patients who experience Hashitoxicosis however, will have intermittent hyperthyroid phase for periods of weeks or months but they will still become progressively hypothyroid afterwards and there comes a point at which the Hashitoxicosis resolves and never returns."
Hmm read your post but there's no answer. Is it worth getting my antibodies checked or is it not worth it due to my FT4 FT3 results?
It's worth getting your antibody tested just in case.
Avatar universal
So i got the antibodies and tsi done can someone give me some insight into my updated tests thank you. It looks like im negative but have most of hyper symptoms.

6 months ago
t-3 uptake                          47.8     32-48.4
t4                                       8.79     4.5-11.8
t7 (free thyroxine index)    10.5     4.0-11.0
tsh                                     1.52     0.35-6.99
vitamin d, 25 hydroxy        23.62   30.0-100.0

F T4, FREE 1.1 | Range: 0.8-1.8 (ng/dL)
F T3, FREE 3.0 | Range: 2.3-4.2 (pg/mL)
THYROGLOBULIN (IU/mL) <1 | Range: < OR = 1
TSI (% baseline) < 89 | Range: <140

1756321 tn?1547095325
Hmmm well your labs are show you have a vitamin D deficiency at the very least. Optimal vitamin D is around 40 - 60 ng/mL (100 - 150 nmol/L).

I'm not too sure about the TSI result though. I have read normal people have TSI levels under 2% activity.  Elaine Moore mentions this on her website in regards to a question on TSI who had similar results to yours...

"In the case of TSI, some labs think that since hyperthyroidism occurs at a level of around 125% activity, that a TSI lower than say 122% activity isn't significant. These aren't the best labs. As we know, normal people have TSI levels at <2% activity.

So you can tell that the test that measured antibody level at 90% activity confirmed that your excess iodine contributed to the development of autoimmune thyroid disease. Some labs would even classify your 90 result as suggestive of autoimmune thyroid disease. This is not a negative result by any stretch of the imagination.

Your TSI level should decline over time unless you encounter some trigger that stimulates increased TSI production. The triggers, as you know, include excess dietary iodine, allergic reactions, infections, vaccines, pretty much any immune system stimulant."


Right Diagnosis lists other possible conditions to look as well...

"For a diagnosis of Hyperthyroidism, the following list of conditions have been mentioned in sources as possible alternative diagnoses to consider during the diagnostic process for Hyperthyroidism:

Graves disease
Thyroid cancer
General anxiety
Hypermetabolic state
Atrial fibrillation
Acute psychiatric disorders
High estrogen states
Anxiety disorder
Hashimoto thyroiditis
Drug abuse
Drug withdrawal
Pituitary adenoma (type of Adenoma)
Wolff-Parkinson-White syndrome
Cocaine toxicity
Hyperemesis gravidarum
Infectious thyroiditis (bacterial, fungal, mycobacterial, parasitic, viral)
Medication-induced hyperthyroidism
Toxic thyroid adenoma (Plummer's disease)
Toxic multinodular goiter
Hyperthyroid goiter
Ovarian teratoma (type of Teratoma)
Metastatic functional thyroid cancer
Acute intermittent porphyria"

I did read hypermetabolism typically occurs after significant injury to the body. The most common causes are infections, sepsis, burns, multiple traumas, fever, long-bone fractures, hyperthyroidism, prolonged steroid therapy, surgery, bone marrow transplants, traumatic brain injury.
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