I recently posted a question to you on 3/25/08 regarding some confusing lab results for my six year old daughter. We recently learned her ANA was less than 1-40 (normal), her thyroglobulin AB was 2.8 (norm = 0-14.4), and her thyroid peroxidase was 1.5 (norm = 0-3.9).
As you'll recall, her result initially were TSH = 2.820 (norm 0.360-5.400), her Total T4 = 18.7 (norm 4.5-16.1), and her Total T3 = 361 (norm 121-233). Then, a week later, she had results as follows: Her CBC and Sed were completely normal; Her TSH = 6.910 (high this time), Free T4 = 1.24 (norm 0.65 - 2.30), and her Total T3 = 224 (normal this time). Her pediatrician wasn't sure if there was some sort of lab error w/ the first results, or she was in very early thyroiditis.
I would like to know what the normal TSH level is for a six year old female, preferably in uIU/ml. I would also mention that w/ her first blood draw, the phlebotomist said she only had enough to run the test once, and by the looks of the tube, I'd say she probably had 2 ml of serum (I am a nurse). Do you know whether such a small amt of serum would effect the concentration of thyroid hormones, and subsequently alter the first test results?
I don't want to put my daughter through anything unneccessarily, but I am afraid to just dismiss the first results as a "lab error". My thoughts are that we need to have these tests repeated in a month or so, to see if ther's something going on.
I also have read of thyroid hormone resistence, and wondered what you'd see w/ this diagnosis.
there is no normal tsh per se, yes, there are standards but each lab has its normal ranges depending on the assay. At our institution tsh above 5 or so is out of range but not necessarily needing treatment till we assess the whole picture. In the face of normal free T4 I would say the repeat tsh that was a little elevated was worth watching and repeating, her antibodies are negative also making it less likely that there is a thyroiditis or autoimmune process going on that is detectable at this time.
Repeat labs in a month to include tsh and free T4 only, no more Total t4 or t3, not necessary in a child with no symptoms.
Hormone resistance would have an elevated free T4 in the face of a tsh that also was elevated or normal and not coming down like it should.
Your thoughts are right repeat in a month and do not treat unless a pediatric endocrinologist sees her an truly feels it is necessary
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