What Is the TRAb Test for Hyperthyroidism? (2023)

The thyrotropin receptor antibody (TRAb) test is a blood test that helps healthcare providers diagnose the autoimmune thyroid condition called Graves' Disease. The antibodies it tests for are present in between 90% and 100% of the people who have this disease.

Other names for the TRAb test include:

  • Anti-thyrotropin
  • Anti-TSHR
  • Antibodies to TSH receptor
  • Inhibitory immunoglobulin
  • TBII
  • TBII (Thyrotropin-binding inhibitory immunoglobulin)
  • Thyroid stimulating immunoglobulin
  • Thyroid-stimulating hormone receptor (TSH Receptor) antibody
  • Thyrotropin receptor antibody
  • TRAb
  • TSH receptor antibody
  • TSH receptor-blocking antibody

This article will go over the TRAb test, why you may need it, what it looks for, and what to expect during the test.

Purpose of the TRAb Test

Your healthcare provider may send you for a TRAb test if you have symptoms that are consistent with hyperthyroidism (an over-active thyroid gland) or Graves' Disease. This is the cause of thyroid over-activity more than 70% of the time hyperthyroidism is diagnosed. These symptoms include:

  • Unexplained weight loss
  • Anxiety and/or irritability
  • Heat intolerance (feeling hot when the people around you are cold)
  • Excessive sweating
  • Muscle weakness
  • Hair loss
  • Unusually smooth skin
  • Rapid, irregular heartbeat
  • Fatigue
  • Goiter (a lump in the front of your neck where the thyroid gland is that you can see or feel)

These are some of the major symptoms, but hyperthyroidism can cause many other symptoms as well.

A few symptoms are associated with Graves' disease but not other forms of hyperthyroidism. Not everyone has them, but when they're present, they make Graves' more highly suspected. They are:

  • Bulging eyes (called Graves' ophthalmopathy)
  • Skin lesions (called thyroid dermopathy), which cause swelling and severe itching

What Is the TRAb Test for Hyperthyroidism? (1)

What the TRAb Test Looks For

The TRAb test detects the autoantibody that's associated with Graves' disease. An antibody is a specialized protein made by your immune system. Antibodies are custom made to kill pathogens in your body, such as viruses or bacteria.

(Video) TSH Receptor Antibody Test | Thyrotropin Receptor Antibody Test | TRAb Test | TSH Antibodies |

An autoantibody is a mistake—your immune system has wrongly identified a healthy tissue as a pathogen and seeks to destroy it.

Thyrotropin is also called thyroid-stimulating hormone, or TSH. TSH binds to receptors on the thyroid gland to tell it to produce thyroid hormone. The thyrotropin receptor antibody mimics TSH, so when it's present, it directs the thyroid to keep releasing hormone when your body doesn't need it. That results in high levels of thyroid hormones, which is what causes symptoms. If the thyrotropin receptor antibody is present, it's an indicator of Graves' disease.

Limitations of the Test

Because this autoantibody is only present in 90% of people with Graves', a negative test doesn't automatically rule out the disease. Your healthcare provider will have to rely on the symptoms you report as well as other tests in order to make a diagnosis.

The TRAb test has seen some controversy over how accurate it is. An analysis of research on the subject, though, finds that the science behind the test has come a long way. Now in its third generation, researchers concluded that better testing has provided a springboard for better, individualized treatment.

Other Common Tests

Along with the TRAb, your healthcare provider may order a number of blood tests to help diagnose you. In someone who has symptoms consistent with hyperthyroidism, those tests are likely to include:

  • TSH
  • Thyroxine (T4)
  • Free thyroxine T4
  • Triiodothyronine (T3)

Healthcare providers may also request an ultrasound of the thyroid or a thyroid iodine uptake scan to see if the thyroid gland's appearance has been altered.

Reading Your Thyroid Blood Test Results

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Risks and Contraindications of the TRAb Test

Blood tests are common and quite safe. You may feel a sting from the needle. Afterward, you may have a small red mark where the needle was inserted, and sometimes the area can bruise. Keep the injection site clean as you would any cut or scrape.

Long-Term Effects

Simple blood tests like those performed for hyperthyroidism are not associated with any long-term effects.


If you have a bleeding disorder, cellulitis, or problems with your veins, let your healthcare provider know before you go for a blood test.

Before the TRAb Test

You shouldn't need to go without food or drink or prepare in any way before your TRAb or other thyroid-hormone tests. These tests can typically be performed at any time of day.

For any blood draw, it's important that you're hydrated—both for your own sake and to make the procedure easier.

Location and Timing

A blood draw for a TRAb is sometimes done by a nurse in your healthcare provider's office, but you may be sent to a lab. The test itself takes very little time—just a couple of minutes.

However, when you go in for the test, you may have to fill out forms and/or wait for the lab tech to get to you. If you're concerned about how much time it will take, call the lab to check on wait times or ask what time of day is usually fastest.

If you're anxious about the test, you may want to give yourself extra time in case you suffer negative effects from the anxiety, such as dizziness or a panic attack. You may also want to arrange for someone to drive you to and from the test.

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You probably will not get the results of your TRAb right away. It's more likely that your healthcare provider will contact you later with the results. You may want to ask the practitioner how long it should take to hear from them and check with the office if it seems like you've waited too long. Expect it to take at least several days.

What to Wear

Wear short sleeves or sleeves that can easily be pushed or rolled up. You shouldn't need to change into a hospital gown for a TRAb.

Cost and Health Insurance

Your health insurance may require pre-approval before you get a TRAb test, so check with the company. You may have a copay or be responsible for a portion of the cost. Your healthcare provider's office or the lab should be able to tell you the price before the test.

What to Bring

When you go to be tested, have your insurance card and any paperwork your healthcare provider may have given you regarding the test. You may want to bring something to occupy your time if you expect a long wait.

Factors That May Affect Your Thyroid Test Results

During the TRAb Test

The test procedure is fairly simple. Here's what to expect.


The nurse or phlebotomist who draws your blood may ask you to confirm your name, birth date, and other information to ensure there's no mix-up and everything is properly labeled.

They'll ask you to push up your sleeve or remove a long-sleeved layer if necessary. Then they'll tie something around your upper arm to trap blood in the vein they're planning to use and swab the site with alcohol to clean it. They may ask you to make a fist or squeeze your hands open and closed.

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Throughout the Test

They'll then insert the needle and release the tourniquet on your arm to encourage blood flow. If multiple tests are being performed on your blood, they may switch out vials one or more times. Once the requisite blood is withdrawn, they'll slip the needle out and put pressure on the site to stop the bleeding.


After that, they'll bandage it and you should be free to go. If you're having any problems, such as anxiety or dizziness, let them know. They may want to monitor you for a while to make sure it's safe for you to leave.

After the TRAb Test

You may have a little soreness around the site, and it may bruise a little, which is normal. The bruise should go away in a few days.

You shouldn't have any other lingering effects from a simple blood draw. If you experience any other adverse effects, call your healthcare provider.

Interpreting TRAb Test Results

TRAb test results are pretty simple to interpret—if you test positive for the autoantibodies, you likely have Graves' disease. If not, your healthcare provider may do other tests to determine whether you have Graves' or another condition, depending on how your other thyroid hormone levels are.


Once you've received your results, you may need to go back to the healthcare provider to discuss treatment options or for further testing, if results were negative or inconclusive.

Thyroid Testing and Diagnosis

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The TRAb test is a blood test that helps diagnose the thyroid condition Graves' Disease. It looks for an antibody associated with the condition.

The TRAb test is a simple blood test that does not require fasting. It can typically be done at any time of the day. The test will either be positive or negative for the antibodies. If it's positive, it's likely you have Graves' disease.


What Is the TRAb Test for Hyperthyroidism? ›

The TRAb test is a blood test that helps diagnose the thyroid condition Graves' Disease. It looks for an antibody associated with the condition. The TRAb test is a simple blood test that does not require fasting. It can typically be done at any time of the day.

What is a normal TRAb level? ›

Minimum volume: 2 mL serum (1 mL for paediatrics). TRAB > 1.8 IU/L us regarded as positive. TRAB 1.0 to 1.8 IU/L is regarded as equivocal. TRAB < 1.0 IU/L is regarded as negative.

What is the TRAb level for Graves disease? ›

TRAb level >12 IU/l at diagnosis of GD is associated with 60% risk of relapse at 2 years and 84% at 4 years. The prediction of risk of relapse improves further to >90% with TRAb >7·5 IU/l at 12 months or >3·85 IU/l at cessation of ATD therapy.

Is TRAb the same as TSH antibody? ›

TSH receptor autoantibodies (TRAb) are heterogeneous and may either mimic the action of TSH and cause hyperthyroidism as observed in Graves' disease or alternatively, antagonize the action of TSH and cause hypothyroidism. The latter occurs most notably in the neonate as a result of a mother with antibodies due to AITD.

What does TRAb stand for in blood test? ›

[Thyrotropin receptor antibodies (TRAb) as a test of surgical treatment effectiveness in Graves-Basedow's diseases]

What does it mean when your TRAb is positive? ›

TRAb test results are pretty simple to interpret—if you test positive for the autoantibodies, you likely have Graves' disease. If not, your healthcare provider may do other tests to determine whether you have Graves' or another condition, depending on how your other thyroid hormone levels are.

What does TRAb 1.00 mean? ›

TRAB <1.0 IU/L is regarded as negative. Reference Ranges: Results of greater than 1.8 U/L are considered positive. Results of greater than 1.8 U/L are considered positive.

What is high in Graves disease? ›

Thyroid gland

Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves' disease is a common cause.

Which antibodies are high in graves? ›

The antibody that is detectable in Graves' disease is known as TRAb and it has also been reported following thyroiditis.

How does TRAb cause hyperthyroidism? ›

Graves' disease (GD) is a frequent cause of hyperthyroidism and is associated occasionally with orbitopathy and dermopathy. The disease is caused by thyroid stimulating hormone receptor antibodies (TRAbs), which stimulate the thyroid stimulating hormone (TSH) receptor on the surface of thyroid follicular cells.

What autoimmune disease will be positive to TSH receptor antibody? ›

The hyperthyroidism of Graves' disease (GD) is caused by TSH-receptor (TSH-R) stimulating autoantibodies (TSAb), leading to overproduction of thyroid hormones.

What is the other name for thyroid receptor antibody test? ›

TSH-R-Ab, often referred to as TRAb, refers to any type of Ab interacting specifically with the TSH-R. Because these Ab are commonly assessed in a competitive binding assay, they are referred to as TSH-R-binding inhibitory immunoglobulins (TBII).

Why is TRAb test important? ›

TSH receptor antibody (TRAb) is considered the gold standard diagnostic test for the autoimmunity of Graves' disease (GD), which is commonly diagnosed clinically.

What is the long term prognosis for Graves disease? ›

Treatment for Graves' disease is lifelong. People who receive definitive treatment for Graves' disease (radioactive iodine or thyroidectomy) will eventually develop hypothyroidism (underactive thyroid), which requires lifelong medication.

Does Graves disease go away? ›

In approximately 40 to 50 percent of cases, anti-thyroid medication leads to remission of Graves' disease after the medication is taken daily for 12 to 18 months. If testing shows thyroid activity has returned to normal levels after that, the medication can be discontinued.

Should I worry about thyroid antibodies? ›

When thyroid antibodies attack healthy thyroid cells, it can lead to an autoimmune disorder of the thyroid. These disorders can cause serious health problems if not treated.

How long does it take to get TRAb results? ›

3-4 days. May take longer based on weather, holiday or lab delays.

How do you lower TRAb antibodies? ›

If you find you are experiencing these symptoms or conditions, implementing a gluten-free, whole-foods diet may reduce thyroid antibodies and help you feel better. If removing gluten doesn't seem to be enough, then opting for a paleo-style diet may be more beneficial.

How tired does Graves disease make you? ›

Summary. When you have thyroid disease, it can make you feel exhausted all of the time. Unfortunately, you may continue to experience fatigue even after a healthcare provider provides treatment for your thyroid condition. Your healthcare provider may need to adjust your thyroid medication to help with your exhaustion.

What is the difference between Graves disease and hyperthyroidism? ›

The difference between Graves' disease and hyperthyroidism. Graves' disease is an autoimmune condition that causes the thyroid to overproduce thyroid hormones. Hyperthyroidism is the state of having an overactive thyroid that produces too many thyroid hormones.

What not to eat if you have Graves disease? ›

Foods to avoid
  • wheat and wheat products.
  • rye.
  • barley.
  • malt.
  • triticale.
  • brewer's yeast.
  • grains of all kinds such as spelt, kamut, farro, and durum.
Sep 29, 2018

What is the best treatment for Graves disease? ›

Total thyroid removal (total thyroidectomy) is the best and most definitive way to treat Graves' disease. Simply put, you cannot have Graves' disease if you do not have a thyroid gland.

How does hyperthyroidism affect the brain? ›

Patients with hyperthyroidism frequently have neuropsychiatric complaints such as lack of concentration, poor memory, depression, anxiety, nervousness, and irritability, suggesting brain dysfunction.

What causes hyperthyroidism if not Graves disease? ›

Inflammation (thyroiditis) of the thyroid due to viral infections, some medicines, or after pregnancy (common) Taking too much thyroid hormone (common) Noncancerous growths of the thyroid gland or pituitary gland (rare) Some tumors of the testes or ovaries (rare)

What organ system does hyperthyroidism affect? ›

These hormones affect nearly every organ in your body and control many of your body's most important functions. For example, they affect your breathing, heart rate, weight, digestion, and moods. If not treated, hyperthyroidism can cause serious problems with your heart, bones, muscles, menstrual cycle, and fertility.

What is the most likely complication of hyperthyroidism? ›

Heart problems. Some of the most serious complications of hyperthyroidism involve the heart, including: A heart rhythm disorder called atrial fibrillation that increases the risk of stroke. Congestive heart failure, a condition in which the heart can't circulate enough blood to meet the body's needs.

What mimics hyperthyroidism? ›

  • Alcoholism.
  • Alzheimer's Disease.
  • Amenorrhea.
  • Amyloidosis.
  • Anorexia Nervosa.
  • Bulimia Nervosa.
  • Chronic Obstructive Pulmonary Disease.
  • Cirrhosis.

Can Graves disease cause an autoimmune switch from hyperthyroidism to hypothyroidism? ›

Graves' disease (GD) is an autoimmune thyroid disease usually associated with hyperthyroidism. There have been cases of patients switching from hyperthyroidism to hypothyroidism, and even rarer patients flipping from hypothyroidism to hyperthyroidism.

Does hyperthyroidism cause joint pain? ›

This joint pain may stem from how the thyroid hormone affects the proliferation and differentiation of bone and cartilage at the cellular level.

What is the difference between thyroid TRAb and TSI? ›

Differences between TRAb and TSI assays

Thyroid stimulating autoantibodies (TSAb)—that is, TSI—are the direct cause of Graves' disease, while thyroid blocking antibodies (TBAb), which inhibit TSH binding to the thyroid receptor, can cause hypothyroidism.

What are the two thyroid antibodies? ›

anti-thyroglobulin antibody (TgAb) TSH receptor antibodies (TrAb)

What's the difference between a thyroid test and a thyroid antibody test? ›

If the initial thyroid test results show signs of a thyroid problem, and if there is a suspicion of autoimmune thyroid disease, one or more thyroid antibody tests may be ordered. Antibody tests are used to confirm the diagnosis of autoimmune thyroid diseases.

What is the function of the TRAb? ›

Thyrotrophin receptor antibodies (TRAb) exist as stimulating or blocking antibodies in the serum (neutral TRAb have been identified recently). The clinical features of GD occur when stimulating TRAb predominate.

Does Graves disease go away when thyroid is removed? ›

Total thyroidectomy prevents further progression of Graves' eye disease and is an immediate cure of the process. For this reason, surgery is the preferred treatment for patients with Graves' eye disease. The best surgery for Graves' disease is complete expert removal of the entire thyroid gland.

What is end stage Graves disease? ›

Heart disorders: If left untreated, Graves' disease can lead to heart rhythm disorders, changes in the structure and function of the heart muscles, and inability of the heart to pump enough blood to the body (congestive heart failure).

Do you still have Graves disease if your thyroid is removed? ›

Despite this, there have been cases of Graves' disease after total thyroidectomy. Rates of recurrence are variable from 0% to 33%. Graves' disease after total thyroidectomy (removal of all visible thyroid tissue in the neck) can recur in the thyroid bed if tissue is missed during surgery or in ectopic thyroid tissue.

What does a Graves disease flare up feel like? ›

You feel warmer than usual, or overheated

Hyperthyroidism can make you feel warmer than usual. If you are wearing shorts and a T-shirt when everyone else is bundling up, this could be a sign of an overactive thyroid. You may also notice that you feel especially overheated after even mild exercise or exertion.

Is Graves disease cancerous? ›

Patients with Graves' disease (GD) are at a 2.5 times higher risk of developing thyroid cancer than the general population. Previous studies reported conflicting results about the prognosis of thyroid cancer concomitant with GD.

What not to eat for hyperthyroidism? ›

A person with hyperthyroidism should avoid eating excessive amounts of iodine-rich foods, such as:
  • iodized salt.
  • fish and shellfish.
  • seaweed or kelp.
  • dairy products.
  • iodine supplements.
  • food products containing red dye.
  • egg yolks.
  • blackstrap molasses.

What does high TRAb level mean? ›

The presence of TRAb suggests a person has Graves' disease. Approximately 95% of patients with Graves' disease will have raised TRAb and 70% will also have raised TPOAb. The severity of Graves' disease is often reflected in the levels of TRAb present.

What is the normal range of anti TSH receptor antibodies? ›

(1) In healthy individuals and in patients with thyroid disease without diagnosis of GD, the upper limit of antithyrotropin receptor values are 1.22 IU/L and 1.58 IU/L, respectively (97.5th percentiles).

What is the correct cut off value for anti TSH receptor antibodies? ›

Therefore, ROC curve analysis was applied as was performed in previous studies. Our analysis revealed a cut-off value of 4.5 IU/l, with 96% sensitivity and 91% specificity.

What is the normal range for anti TPO? ›

What is the normal range of Anti-TPO Test? The normal range for the Anti-TPO test is 0 to 34 IU/mL. Anything above the normal range is considered high and may indicate autoimmune thyroid disease.

What are normal antibodies for hyperthyroidism? ›

Thyroid Antibody Test Results

Normal values are: Thyroid peroxidase antibody (TPOAb) test: Less than 9 IU/mL. Thyroid-stimulating immunoglobulin (TSI) test: Less than 1.75 IU/L. Thyroglobulin antibody (TgAb) test: Less than 4 IU/mL.

What autoimmune disease will be positive to TSH receptors? ›

The hyperthyroidism of Graves' disease (GD) is caused by TSH-receptor (TSH-R) stimulating autoantibodies (TSAb), leading to overproduction of thyroid hormones.

What if TSH receptor antibody is high? ›

What Do the Results of a TSH Antibody Receptor Test Mean? You may have an autoimmune disorder if the test results exceed the TSH Antibody Receptor test normal range. Your doctor will recommend further tests and medical treatment depending on your test results.

What is TSH receptor antibody for Graves? ›

Thyrotropin-receptor antibody is an autoantibody to the thyroid cell receptor for thyroid-stimulating hormone. It can be demonstrated in 90% of patients with Graves' disease, and is the cause of the hyperthyroidism of that condition.

What are anti TSH receptor antibodies in Graves disease? ›

Graves' disease happens when the immune system of an individual makes specialized proteins called antibodies, which circulate in the blood then attach to the thyroid gland at a place called the TSH receptor. These TSH receptor antibodies then stimulate the thyroid to make excess amounts of thyroid hormone.

Should thyroid antibodies be zero? ›

Antibodies, the reference range should be anything less than 200 mUI/ml or Ab Index no higher than 0.9, and for the Antithyroid Peroxidase Antibodies, anything less than 150 mUI/ml or Ab Index no higher than 0.9.

How high is too high for TPO antibodies? ›

Normal TPO antibodies range is less than 30 international units per millimeter (IU/ml). Thyroid peroxidase antibodies are considered high if above this. Note that the normal range used can differ in different laboratories.

Does high TPO always mean Hashimoto's? ›

High levels of TPO antibodies may be indicative of autoimmune thyroid disease. On their own, the presence of TPO antibodies does not necessarily mean hypothyroidism. Instead, Hashimoto's is the most common cause of hypothyroidism.

What disease is anti TPO positive? ›

Thyroid peroxidase antibodies (TPO).

These antibodies can be a sign of: Hashimoto disease, also known as Hashimoto thyroiditis. This is an autoimmune disease and the most common cause of hypothyroidism. Hypothyroidism is a condition in which the thyroid doesn't make enough thyroid hormones.


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