6yo son slightly elevated TSH

Question

My 6 year old son's TSH level was 4.160 and the highest end of normal for our lab is 4.140, so a little elevated. However, in the past year he has gained 20 lbs. He eats less than the rest of our children and I upped his activity six months ago, making him exercise at least an hour a night (soccer, gym class at my gym, playing outside and running around) but he just continued to gain. He doesn't drink juice or milk (only in cereal), just water. The only differences between him and my other two sons are, he is shorter, moodier, not your typical hyperkid, and now he weighs as much as my 8 year old. He has chronic diarrhea (always has) and is scheduled for the pediatric gastroenterologist for June 1st (suspect celiacs-the test came back inconclusive). We go back next week to have a FreeT4 test done. What is this going to tell us? Of course, I will talk to the Dr then, but I am worried NOW. Because of his weight gain, sluggishness, moodiness, and persistant "growing pains", they decided to test his thyroid--I don't think it is a significant elevation, but could this be causing his symptoms?

goolarra · Answer

TPOab and TGab are two of the antibodies implicated in autoimmune thyroid disease, Hashimoto's thyroiditis (hypo) and Grave's Disease (hyper).  Your son's are both negative, so it's doubtful he has autoimmune thyroid disease (the most prevalent cause of thyroid problems in developed countries).

His FT4 is a bit on the low side...it should be around midrange, and it's at 37%.  The doctor should really be testing FT3 as well.  T3 is the active form of the thyroid hormones and correlates best with symptoms.  If FT4 levels are adequate, byt FT3 is too low, the result will be hypo symptoms.

Hope you have good luck with the pedi endo...keep us posted.

bouncingbabyboys · Answer

I would say that he has soft fingernails, but no softer than my other 5 children, so I would attribute it to age rather than symptom, but I don't know.

bouncingbabyboys · Answer

I called around Friday and couldn't find a pediatric endocrinologist to answer my questions.  I did leave a message with two and hope to hear back from them tomorrow.  I did get the Dr. office to fax me the results and this is what it says:

TSH                                              3.360        expected .660-4.140
T4, Free (direct)                              1.19         expected .90-1.67
Antithyroglobulin Ab                         <20         expected 0-40
Thyroid Peroxidase (TPO) Ab             9           expected 0-21

I guess I couldn't read my own writing when I said the Antithyroglobulin was 7.20!  

So what does the antithryoglobulin Ab and Thyroid Peroxidase tell me?  If these were out of range, what would it mean?

foreverlostmom · Answer

Curious does your son seem to have soft fingernails?

goolarra · Answer

If the doctor's office won't give you the range, I'd call the lab directly and ask for the ranges for your son's age group.  They should have no trouble providing you with those.  Another alternative is to ask the doctor to make you a copy of the results "for your records".  The printed report will have reference ranges next to results.

As I mentioned above, the TSH range your lab is using is outdated.  According to the current AACE range, 0.3-3.0, your son is hypo.  Also, most of us who are hypo don't feel well at the top of the TSH range...some need it around 1...some need it almost zero before symptoms are relieved.

No, I agree with you completely...don't wait 3-4 months.  Find a new doctor (interview them first)...don't waste all that time...it will just make recovery all the longer, too.

bouncingbabyboys · Answer

Ok, his second tests came back "within range" but I cannot deny the symtoms.  They did a TSH and it came back 3.60 this time.  His FT4 was 1.19.  TPOab was 9.  Antithryoid globulin(?)- was 7.20.  The bad thing is, as long as it is within range, they don't tell me if it's in the high side of the range or where.  Can any of you provide any thoughts?  She told me to bring him back in 3-4 months to be rechecked.  Personally, I've watched him gain 20 lbs in 1 year and I don't want to continue helplessly watching him gain.

goolarra · Answer

An endo is the specialist you want to see...but, you do have to be careful as many of them are really only interested in diabetes and are not good thyroid doctors.  It helps to preinterview them over the phone (probably through a nurse) and ask some pertinent questions before making an appointment.  One good question is what tests they regularly order for their patients and which they use to adjust meds...if they're only interested in TSH, run!

AACE has a website...I'm on my way out the door for a couple of days, or I'd try to provide you with a link.  The TSH range recommendation dates back to 2002 or 2003, I believe, so you can see how quickly the medical community has changed!  Virtually all labs still use old ranges and many doctors don't know any better, either.  Actually, that would be a good question for a prospective endo also...what TSH range do YOU personally use?

I don't think you can go wrong having the tests.  They're relatively inexpensive and just a simple blood draw, and you'll know so much more than you do now.  Best of luck.

magpieannie · Answer

Here's a good place to start http://thyroid.about.com/od/gettestedanddiagnosed/a/normaltshlevel.htm

My daughter is 9 and born without a thyroid gland. When ever her TSH is in the 4's she experiences many of the same symptoms of hypOthyroidism as your son is having now. Get all the test that goolarra recomended. Ask for a copy of the labs and report back to us with ranges and we'll let you know our opinions. Make sure they test the FREE t3 and FREEt4 (not TOTAL). Trust your gut mom! We know when something is up with our kids!

bouncingbabyboys · Answer

Wow...thank you so much!  I feel much better going in and knowing what tests to ask for.  Is an Endocrinologist one that would specialize in this area?  

The Dr's PA doesn't seem to think there is anything to worry about, that it is just a little high but we'll do the other test anyway (acts as if it's precautionary).  However, if the AACE recommends changing the range, my family physician is probably not on top of that one...is there anywhere on the net that I could print that off?

goolarra · Answer

Definitely!  Your son's TSH is too high.  I don't know what the range is for children his age, but I do know that the adult TSH range is obsolete...doctors and labs are not conforming to the American Association of Clinical Endocrinologists recommendation that TSH range for adults be changed to 0.3-3.0.  I can only assume that the ranges for children are also flawed.

Definitely have FT4 tested.  T4 is one of the thyroid hormones and gives a much better profile of thyroid function than TSH.  Also, demand that your doctor test FT3.  T3 is the active form of the thyroid hormones and correlates best with symptoms.  FT3 and FT4 together will tell you exactly how your son's thyroid is functioning.

Diarrhea is not a classic symptom of hypothyroid (constipation is), but if Celiac is suspected, that might tip the balance in the diarrhea direction.

You should also have your son's thyroid antibodies tested...TPOab and TGab.  These will indicate if he has the autoimmune disease Hashimoto's thyroiditis, the most prevalent cause of hypo in the U.S.  Both Celiac and Hashi's are autoimmune diseases, and once you have one, you are much more apt to develop a second than the general population.

Most of your son's symptoms could be attributed to thyroid disease.  Have FT3, FT4, TPOab and TGab tested.  These will give you a very good idea of what's going on with his thyroid.