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Pediatric Endocrinology (Expert Forum)
SO CONFUSED
Answered by
Deanna L Aftab Guy, MD - Short Stature, thyroid, Pituitary abnormalit, Puberty concerns, Rapid Growth, Adrenal problems, Parathyroid abnormal, Rickets and bone dis
Vanderbilt Children’s Hospital
Nashville - TN
Questions in the Pediatric Endocrinology forum are answered by Dr. Deanna L Aftab Guy, affiliated with Vanderbilt Children's Hospital. Topics covered include adrenal problems, diabetes insipidus, menstrual irregularities, obesity, parathyroid abnormalities, pituitary abnormalities, puberty concerns, rapid growth, rickets and bone disease, short stature, and thyroid.
SO CONFUSED
by EMSMOM97, Feb 18, 2008 09:39PM
HI, LAST WEEK MY 11 YR OLD DAUGHTER HAD A FULL BLOOD WORKUP INCLUDING THYROID. HER TSH CAME BACK VERY HIGH. 4 DAYS LATER OUR DR SENT HER FOR FULL REPEAT THYROID BLOOD WORK. HYPOTHYROID DSEASE RUNS IN MY FAMILY ON MY MOMS SIDE. MY DAUGHTER HAS HAD MANY OF THE SYMPTOMS SINCE SHE WAS A BABY.
I FINALLY GOT HER 2ND LAB RESULTS BACK TODAY EXCEPT ONE. I DON'T UNDERSTAND. HER THYROGLOBULIN AB IS NOT BACK YET. HER T4 LOOKS A LITTLE HIGH AND NOW HER TSH IS FINE. I STILL DON'T UNDERSTAND IF SHE HAS UNDER ACTIVE THYROID OR NOT? HER 1ST TSH TEST WAS SO BAD, HOW COULD IT BE FINE 6 DAYS LATER?
THE THYROGLOBULIN AB RESULT THAT WE ARE STILL WAITING FOR IS THE THYROID ANTIBODIES THAT WILL DETERMINE FOR SURE IF SHE HAS HYPOTHYROID DISEASE OR NOT. I'VE BEEN TRYING TO RESEARCH ALL THIS ALL EVENING. I FINALLY GOT AN EMAIL FROM OUR DR.
"The thyroid antibode tests are done to rule out an autoimmune thyroiditis which means the body itself is making antibodies against the thyroid.
The most common is Hashimoto's thyroiditis and may be due to hereditary factors also. If her antibody test is positive, we typically refer the patient to an endocrinologist who will do further testing to distinguish what's really going on. I will let you know as soon as her test is back."
I'M STILL COMPLETELY CONFUSED!!!!!! DOES ANYONE KNOW ANYTHING ABOUT HASHIMOTO'S THYROIDITIS? IF HER ANTIBODY TEST DOES COME BACK POSITIVE AND THEN WE GET REFERRED TO A GOOD PEDIATRIC ENDOCRINOLOGIST DO YOU HAVE ANY IDEA WHAT KIND OF OTHER TESTS THEY'LL DO? THIS WHOLE THING IS MAKING MY SO NERVOUS. THANKS
I FINALLY GOT HER 2ND LAB RESULTS BACK TODAY EXCEPT ONE. I DON'T UNDERSTAND. HER THYROGLOBULIN AB IS NOT BACK YET. HER T4 LOOKS A LITTLE HIGH AND NOW HER TSH IS FINE. I STILL DON'T UNDERSTAND IF SHE HAS UNDER ACTIVE THYROID OR NOT? HER 1ST TSH TEST WAS SO BAD, HOW COULD IT BE FINE 6 DAYS LATER?
THE THYROGLOBULIN AB RESULT THAT WE ARE STILL WAITING FOR IS THE THYROID ANTIBODIES THAT WILL DETERMINE FOR SURE IF SHE HAS HYPOTHYROID DISEASE OR NOT. I'VE BEEN TRYING TO RESEARCH ALL THIS ALL EVENING. I FINALLY GOT AN EMAIL FROM OUR DR.
"The thyroid antibode tests are done to rule out an autoimmune thyroiditis which means the body itself is making antibodies against the thyroid.
The most common is Hashimoto's thyroiditis and may be due to hereditary factors also. If her antibody test is positive, we typically refer the patient to an endocrinologist who will do further testing to distinguish what's really going on. I will let you know as soon as her test is back."
I'M STILL COMPLETELY CONFUSED!!!!!! DOES ANYONE KNOW ANYTHING ABOUT HASHIMOTO'S THYROIDITIS? IF HER ANTIBODY TEST DOES COME BACK POSITIVE AND THEN WE GET REFERRED TO A GOOD PEDIATRIC ENDOCRINOLOGIST DO YOU HAVE ANY IDEA WHAT KIND OF OTHER TESTS THEY'LL DO? THIS WHOLE THING IS MAKING MY SO NERVOUS. THANKS
Doctor's Answer
by Deanna L Aftab Guy, MD, Feb 19, 2008 03:19PM
, Feb 19, 2008 03:19PMTo: EMSMOM97
I know you are concerned, first thing, take your keyboard off of caps lock!!! :)
Now I get so many crazy thyroid labs back and you are so right, we need to correlate things with how the patient is doing. So unfortunately there may have been a lab error and your doc no doubt is just as confused as you are (and I am!)
I need you to call your pediatrician and ask for a referral to a pediatric endocrinologist. There are specific thyroid assays that are better than others and if there are antibodies this can also be tested for.
Hashimoto's is an autoimmune thyroid disorder in which our body makes antibodies that cross react per se with our thyroid gland and enzymes that the gland makes. These antibodies can attack the gland, causing inflammation (goiter) and sometimes (usually) and underactive thyroid gland, therefore the free T4 and sometimes total T4 may be low and we will see a higher TSH which is the hormone that the brain is making to regulate the thyroid gland(so if the thyroid falls down on the job the brain tells it so with more tsh).
So the first test made me feel she was hypothyroid but who knows what happened with the second test. If she has antibodies this would make me look further.
where do you live?
Ok now breathe easy, she is going to be ok, you will get this sorted out-no more caps lock promise?
Now I get so many crazy thyroid labs back and you are so right, we need to correlate things with how the patient is doing. So unfortunately there may have been a lab error and your doc no doubt is just as confused as you are (and I am!)
I need you to call your pediatrician and ask for a referral to a pediatric endocrinologist. There are specific thyroid assays that are better than others and if there are antibodies this can also be tested for.
Hashimoto's is an autoimmune thyroid disorder in which our body makes antibodies that cross react per se with our thyroid gland and enzymes that the gland makes. These antibodies can attack the gland, causing inflammation (goiter) and sometimes (usually) and underactive thyroid gland, therefore the free T4 and sometimes total T4 may be low and we will see a higher TSH which is the hormone that the brain is making to regulate the thyroid gland(so if the thyroid falls down on the job the brain tells it so with more tsh).
So the first test made me feel she was hypothyroid but who knows what happened with the second test. If she has antibodies this would make me look further.
where do you live?
Ok now breathe easy, she is going to be ok, you will get this sorted out-no more caps lock promise?
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WE ARE STILL WAITING FOR MY DAUGHTER'S THYROID ANTIBODIES RESULTS. WHAT I DO NOT UNDERSTAND IS, HER 1ST TSH TEST WAS VERY HIGH. HER 2ND TSH RESULT WAS NORMAL. BOTH BLOOD TESTS WERE DONE ONLY 4 DAYS APART. HOW OR WHY COULD THE EXACT SAME TEST, 4 DAYS APART BE SO DRASTICALLY DIFFERENT? OUR FAMILY DR EXPECTS HER ANTIBODIES RESULTS TO COME BACK POSITIVE, IN WHICH CASE HE WILL REFER US TO A PEDIATRIC ENDOCRINOLOGIST FOR FURTHER TESTING. WHAT KIND OF FURTHER TESTING WOULD A PEDIATRIC ENDOCRINOLOGIST DO? THANK YOU. I promise I will work on no more all caps.
the repeat thyroid tests are again another blood test, honestly the peds endo might get a specific type of thyroid assay called 3rd generation or there are others called equilibrium dialysis that are more specific in a situation like this-sometimes antibodies get in the way of accurate measurement of thyroid. Many labs are variable and sometimes we see an unusual test with one time and another one that is normal. Samples are mixed up or perhaps run in a way leading to slightly abnormal results. So let the peds endo get the labs they need including perhaps repeating antibodies if needed, let them decide based on the presentation whether treatment is needed.