[butterfly007]

#1060215

Hi there,
I’m a bit confused and hoping someone can explain this to me….Can anyone tell me what antibodies are usually present with Graves, and what antibodies are usually present with Hashimotos? Are they the same antibodies in both?
Because I was thinking, I know with Hashi’s some people can have periods where there levels are actually high and they are hyperthyroid. So for these people, there must be factors other than the antibodies in play, in order to know if they have hashis, or graves – right? Does anyone know what these factors might be? Or where I can get some good, relatively easy to understand info from? I am just wondering about people who have both – how do they know? – not looking for a diagnosis – just trying to understand a little better and google is getting me nowhere, just confusing me more!

[Kimberly]

#1181295

Hello – TSI and TRAb are antibody tests that are specific to Graves’ disease. The TSI test is specific to the antibodies that cause *stimulation* of the thyroid in Graves’ disease, leading to hyperthyroidism. The TRAb test picks up both stimulating and blocking antibodies in Graves’ disease. (Blocking antibodies *can* sometimes cause hypOthyroidism in Graves’ patients). TPOab and TGab are “markers” for autoimmune thyroid disease. They are very common in Hashimoto’s Thyroiditis, but a certain percentage of Graves’ patients (even those who do not have HT) test positive for them.

The hyperthyroid periods in a patient with Hashi’s are caused when the destruction of thyroid tissue spills stored thyroid hormone out into the body.

[Kalty]

#1181296

I’m sorry if this question is stupid. If a person has both, and both can cause a hyperthyroid state, how does a doctor decide what a person has?

[butterfly007]

#1181297

Thanks Kimberley, that helped.
Kalty – thank you for rephrasing my question so it makes more sense!
I understand how Graves is diagnosed – and that TSI is graves specific.
My TSI was never tested, but I am not doubting my graves diagnosis at all.
What I am really wondering is – we know that the positive antibody tests used for hashis – TPOab and TGab, can also be found positive in some graves patients – so how do they diagnose Hashis and Graves together? Mine are high as below, how do they know I don’t have hashis as well? Is there another test they can do to either confirm or rule out Hashi’s?
Can anyone help? I am very curious.

What they have tested for are these:
TPOab – 142.6 (<34)
TGab – 441.6 (<115)
TSH receptor antibodies 10.1 (<1.

[Kimberly]

#1181298

Honestly, I don’t know that there is a good way to confirm whether someone has Graves’ and Hashi’s – or whether they just have Graves’ and happen to have the Hashi antibodies. If levels were consistently swinging hyper/hypo despite careful management of anti-thyroid drugs, that might be an indicator of having both. But to make things more confusing, Graves’ antibodies can actually block thyroid hormone production instead of stimulating it.

You can tell for sure after thyroidectomy, as the tissue damage from the Hashi’s will be evident. I know of one thyroidectomy patient who never knew she had Hashi’s in addition to Graves’ until after the surgery. Her surgeon said her thyroid looked like “Swiss Cheese”!

[butterfly007]

#1181299

Thanks Kimberley, that well and truly answers my question. I am a bit cognitively challenged at the moment – please excuse my rambling circles to try get what I want to say out. It’s a bit frustrating knowing there is no sure way to tell – other than possibly fluctuating levels on ATD’s. And even then – for me -if I get really stressed/sick/rundown it throws my levels out. Am currently hypo – (down to 5mg daily carbimazole.)
I really think it would affect my current choice of treatment, (to ride it out with ATD’s and try for remission or just maintainence) if I did have both. It would be heartbreaking to go years and years thinking I just have graves, trying to maintain normal levels on ATD’s, only to find my thyroid has been destroyed via Hashi’s and it was all a big waste of time/tears/frustration riding the rolercoaster trying for a normally functioning thyroid. If I knew for sure – I think I would have surgery straight away and avoid unnecessary rollercoaster riding.
And – even if I was swinging hyper/hypo – which seems to be the case – I still won’t know if it’s Graves doing the blocking, and is fixable – or if it’s hashi’s destroying my thyroid – ARRGGHH!
But then – with not really knowing – I hate the thought of removing a body part while there is still a chance of it being restored to normal functioning! – Tough one! – I think I think too much! – lol.
Thanks heaps for answering my question!!!
Kalty – hope this helps you too!

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