Hey!

I have a history with Graves Disease, which has mostly been a non-issue (no meds, etc) for the last 10 years or so. Over the last 5 years, I started experiencing symptoms more consistent with hypothyroid, though T4 was usually normal.

Right now I've got high TSH, TSI, & TPO, with a low-normal T4 (but have also been struggling with weight gain, overall metabolism slump, brain fog, etc). I also have some of the symptoms associated with hyper-thyroid (anxiety, trouble sleeping, occasional palpitations, etc), but if I had to pick, I'd say the hypo (or hypo-like) symptoms are more prevalent (am also willing to attribute all, or none, of it to perimenopause).

I started with a new doctor this past summer, but with covid our appointments have all been online and I never get to ask as many follow up questions as I like :-) She said something about having antibodies for both hyper and hypo thyroid conditions, but from what I can tell, the TSH, TSI and TPO all seem like they could indicate Graves or simply a history of Graves.

Is having all three of these high at the same time a *regular* result of having or having had Graves? I honestly don't recall if I was ever tested for TPO before. I'm mostly not sure how they work together, and beyond “TSH stimulates thyroid” I'm not really sure what the presence of TSI and TPO indicate– if anything. Antibodies to something? Thanks for your insights!

Hello - TSI and TRAb are the two 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).

TPOabs are tricker, as that is a “marker” 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.

Your doc will likely help you make your treatment decision based on your actual levels. If your TSH is too high, your Free T4 and T3 are too low, and you are having symptoms of hypO - your doc will likely recommend replacement hormone (Synthroid, Tirosint, generic levothyroxine, etc.).

Thanks for the clarification!

I started levothyroxine a few months ago, but was also confused because when I looked at the labs they looked like they were shifting back to where they were when I was really struggling with Graves/hyperthyroid, but this time around the symptoms are so different than they were 10 years ago when it was all pretty clearly hyper thyroid– now it's some hyper, some hypo, all annoying :-) All I remember from my first few times around was the T3, T4 and TSH numbers, so the antibody info is a whole new thing to learn more about…

Thanks for the clarification!

I started levothyroxine a few months ago, but was also confused because when I looked at the labs they looked like they were shifting back to where they were when I was really struggling with Graves/hyperthyroid, but this time around the symptoms are so different than they were 10 years ago when it was all pretty clearly hyper thyroid– now it's some hyper, some hypo, all annoying :-) All I remember from my first few times around was the T3, T4 and TSH numbers, so the antibody info is a whole new thing to learn more about…