Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Should we re-test via Equilibrium Dialysis Again
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Should we re-test via Equilibrium Dialysis Again

THANK YOU  - You answered my question about if my 11 year old needed to see a pediatric endo for elevated T4 and T3 but normal TSH.  In your response you said we should check using a different lab.  We had done this about 18 months ago at the pediatric endo.  Lab results:

TSH: 3.53 ( .4 - 5.0 ),
FT4 0.51 (1.1 -2.0) - Measured via Equilibrium Dialysis
Total T3: 166 (83 - 213),
Total T4: 15 (5.0 - 11.0),
thyroglobulin antibody was negative
thyroglobulin normal 22.8

No follow-up was recommended from this appointment.  Since then she developed some new symptoms (lazy eye and IBS).  This is why I took her back into our local Dr.  they ran her labs again, showing the elevated FT4 and FT3 but normal TSH  - Our local lab does NOT run via equilibrium dialysis, and results have been VERY similar to the latest labs each time they have been run:

Test results from our local Clinic Nov 2012:
Elevated FT4 1.89 (.58 - 1.64 ng/dl)
Normal FT3 4.02 (2.50 - 3.90 pg/mL)
Normal TSH 2.03; (.34 - 5.60 mIu/mL)
Thyroid binding globulin was normal at 21 (13-30)

We were sent back out to the pediatric endo last month - no labs were taken at this appointment, and they sent us home with the information on testing for THR.

She is an 11 year female does well in school not ADHD  she in the 18% - 19% for height and weight, has symptoms: Excessive sweating on the hands and feet, thicker arm hair, Irritable, sensitive (cries about EVERYTHING), Anxiety, very low pain tolerance, Changes in vision one "Lazy Eye" - This eye is also slightly larger than the other, IBS, Frequent Bowel movements (3x/day), headaches, and shortness of breath.  Thyroid does NOT appear to be enlarged.

The pediatric endo is giving us the feeling that they think her body just naturally has a higher T4 level and no treatment is needed, and our local Dr. should stop testing her thyroid levels.

Should we run the Free T4 test via Equillibrium Dialysis again?  I welcome ANY insight or advice!
97953_tn?1193367871
I am not sure if that would solve the problem, but would be an option.  This could be THR.  Would follow advice of pediatric endocrinologist and if symptoms persist/worsen, get opinion of another.  My practice is adult only, so my experience with children is very limited.
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Thanks Dr. Lupo!

I'm trying to find a Dr. just get another opinion.  I've found out the adult endo's around here will NOT see her due to her age.  With our current peds endo being so far away I feel like she is getting lost in the shuffle; the communication between the endo and our local pediatrician has been poor.  Our local Dr. was unaware that the labs from the peds endo showed the FT4  as LOW (.51   1.1 - 2.0).  They (local) didn't even have a copy of the labs from the peds endo.

I'm mainly concern right now about the changes in vision - eye sight was fine 2 years ago, now one eye has been termed "lazy".  I also recently found out that the labs from June of 2011 did show TSI anitbodies present  - but negative (83 <123) So I was thinking it might be a good idea to have those re-tested as well.  Just don't know who to turn to at this point.

Again THANK YOU for the help, It is VERY much appreciated!!!

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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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