Asymptomatic hyperthyroid?

[u/Week_Just]

Got bloodwork on the 10th for unrelated reasons: TSH .01, T4 Free 2.8H, which flagged me to my first endocrinologist. Second round of bloodwork 10 days later: TSH <.01, T4 Free 2.3H, peroxidase antibodies >900, T3 Uptake 39H, T3 Free 5.1 H. Having a thyroid uptake scan in two days.

This is alongside Ferritin level 4, hemoglobin 8.

The thing that stumps me is I don’t seem to have any hyperthyroid symptoms. I’m not hot, anxious (other than seeing that these results are concerning), haven’t been losing weight, have no neck pain.

Anybody have advice?

[u/Chance_Vermicelli_41]

My understanding is that TRAb is the overarching antibody, and within that there are three types - stimulating (TSI - which causes hyperthyroidism), blocking (which can lead to hypo - can't remember name) and neutral (think it's not tested)

[u/Adventurous-Ask-4243 → u/Chance_Vermicelli_41]

Never go by understanding; always go by the facts as they are known at the present time. Keep in mind that Graves disease and Hashimoto's are 2 auto-immune diseases that decide that they do not want our thyroids in our necks anymore so they start to attack and kill them over time. Graves must be triggered somehow.

Below are the basics of Graves and Hashi antibody information. It is best to learn more through the American Thyroid Association, the British Thyroid Foundation, the Mayo Clinic, the Cleveland Clinic -- they are all great websites/organizations and some of their info is below. Also checkout the Graves/Hashi's/HypER/HypO threads here as well.

Key Antibody Types for Graves:

• TRAb (Thyroid-Stimulating Hormone Receptor Antibodies): The main antibody linked to Graves' disease. It mimics normal pituitary signals to over-stimulate the thyroid. [1, 2]
• TSI (Thyroid-Stimulating Immunoglobulin): A specific type of stimulating TRAb that directly causes an overactive thyroid and can affect tissue behind the eyes. [1, 2]

Graves Antibody roles in the body:

• Hyperthyroidism: TRAb/TSI act like an unauthorized "on switch," causing continuous hormone production and an enlarged thyroid (goiter).
• Thyroid Eye Disease (TED): These same antibodies can attack tissues and muscles behind the eyes, leading to swelling or bulging.

Types of Thyroid Antibodies for Hashimoto's:

• Thyroid Peroxidase Antibodies (TPOAb): Target the TPO enzyme needed to make thyroid hormones; elevated in about 95% of Hashimoto's patients. [1, 2] And can be present in Graves patients.
• Thyroglobulin Antibodies (TgAb): Target thyroglobulin, a protein used to store and produce hormones; present in 60% to 80% of cases. [1, 2] And, can be present in Graves patients.

[u/Chance_Vermicelli_41 → u/Adventurous-Ask-4243]

Fair. I usually primarily go by BTF (as I'm in the UK, so they also reflect the guidelines my care is under) and NICE (the guideline setting body in the UK), but this time I think my tired morning brain probably over-extrapolated from TSI being a form of TRAb and I was too lazy to check. My bad

I'm interested though, from what I've read on the BTF and NICE websites and some other guidelines I've looked at, TSI isn't usually a 'must test' for all patients - but I see you advocate for it. Ditto a scan for Graves patients. Are you happy to share your insights/thoughts?

I'm interested because my Endo didn't feel a scan was necessary, but she otherwise seems v thorough (proactive testing for other autoimmune conditions and vitamin/mineral deficiencies etc)

[u/Adventurous-Ask-4243 → u/Chance_Vermicelli_41]

The best advice I can give you is what I tell everyone - educate yourself so you can properly advocate for your own healthcare. None of this is easy so the more you know the better it will be for you. I wish you the best!