[Ski]

#1073396

I have not heard of a connection between antibody levels and the decompression surgery ~ antibody levels wax and wane for reasons that are not really well understood, and they do not always translate to "how sick we are," so the presence of antibodies is what is typically being investigated when the test is run, though rising and falling levels may be relevant as well (not necessarily the precise numbers, but the fact that they are rising or falling).

Ordinarily, with the results of an uptake/scan and blood tests, the doctor can conclusively say it’s Graves’ without having to do an antibody test. Sometimes it’s not so clear, and the antibody tests can provide the conclusive evidence, but that has to do with the thyroid disease, not TED.

In theory, perhaps a TSI reading could give an idea of the level of antibody activity prior to surgery, as some kind of predictor of triggering antibody response and further reaction in the tissues by performing surgery, but you shouldn’t be doing surgery when the eye disease is active anyway, so the antibody activity wouldn’t be relevant at that point. Maybe this comes into play when decompression MUST be done to protect the optic nerve during the hot phase.

I haven’t experienced the worst of TED, so some of what you’re asking may be familiar ground to those who have. I will defer to their expertise. ” title=”Very Happy” />

[Jake_George]

#1073397

Actually there is current data to say the TSI test is not really of much use and many doctors are stopping it. Nancy and I will be rewriting the NGDF book "Graves’ Disease In Our Own Words" and we will be rewriting that section of the book to state that many doctors no longer perform this test.

Perhaps that is why they will not do the test in Canada?

[elf]

#1073398

They never did this test in Canada, even when it was done in the States. TPO test and uptake scan, yes. I don’t think they are ahead of USA, they now appear ahead because they have been behind.

Ski – this perception of having TSI in check before ANY eye surgery prevails on other Graves boards. I will have to see if I can find any article about this connection.

[elf]

#1019682

I am confused. On one hand, it is said that the TSI reading needs to be "normal" to be sure if you are safe for OD (in addition to normal thyroid hormone levels). On the other hand, there are articles saying TSI can be high way post any RAI or TT, and even in healthy people TSI can be high but not resulting in any disease.

So how is TSI important for pre-OD people?

(I should mention that you can’t get TSI testing from doctors here in Canada so for me personally it’s a theoretical question. I was denied this test, pre-RAI and post-RAI, and most likely will never know my TSI levels).

[elf]

#1073399

I think having high TSI indicates a hot TED stage, so TSI test serves as an additional tool for determining how cold the stage is. I found this article that basically says that high TSI corresponds to the inflammatory stage of TED. Maybe that’s where the advise comes on other boards, to make sure to lower your TSI before any eye surgery.

Longitudinal correlation of thyroid-stimulating immunoglobulin with clinical activity of disease in thyroid-associated orbitopathy
Ophthal Plast Reconstr Surg. 2006 Jan-Feb;22(1):13-19

To investigate the possible correlation between the changes in inflammatory active phase of thyroid-associated orbitopathy (TAO) with measured changes in thyroid-stimulating immunoglobulin (TSI) levels over time. This study was undertaken to evaluate the potential usefulness of measured TSI values in following and treating patients with TAO. 9 A retrospective chart analysis was performed on 23 patients who had been referred to a tertiary care oculoplastics service between July of 2002 and April of 2004 with suspected TAO. The activity status of patients with TAO was graded by using the TAO activity scale (TAOS), created to distinguish between the active and cicatricial phases of TAO. Laboratory values of TSI reported during the course of the study period were compiled for each study patientLinear regression analysis revealed a statistical correlation between the changes in activity of TAO, as measured by the TAOS score, and changes in measured values of TSI over time. A statistically significant correlation was also found between the activity of TAO (measured by the TAOS score) and TSI valueIt was found that changes in inflammatory phase of TAO, as measured by the TAOS score, statistically correlate with changes in measured TSI. An additional correlation was also found between the absolute score of TAO activity and measured level of TSI. These findings suggest that serial TSI measurements may be an adjunct in assessing clinical inflammatory activity of TAO and may help direct clinical decision making regarding treatment decisions in TAO.

[DianneW]

#1073400

I don’t think TSI testing is necessary for a diagnosis of GD, just as Jake said, but the study Elf posted is consistent with other studies I’ve been reading about the relationship between the activity of TED and TSI antibodies. Most specifically, positive TBII (which are TSI) are correlated with TED activity.

My TBII levels were still high when I had several of my surgeries, and the surgeries caused a reactivation of the disease process. It makes sense that waiting for the levels to lower would be a good idea.

[Author]

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