thyroid

[jhollie]

I know this can lead to heart problems. Please help me. I am desperately trying to help my 12 year old son. He was diagnosed with Hashimoto's/Hypothyroidism when he was 10 years old.  The past two years have been a nightmare. He has been to 3 doctors. Levothyroxine has been increased 5 times. He is currently taking 100. His hypo symptoms are still present. It breaks my heart to see what this is doing to him.  He has trouble focusing and concentrating on school work.  He will forget the oral instructions for an assignment.  He will take a U before he will ask for repeated instructions. The slow thought process is also noticeable when he plays sports.  I honesty think he is worse then when he first got diagnosed.  We see an improvement when they increase his medication. He wakes up refreshed. Little things like making sure his shirt is tucked in before he leaves for school. He will get a burst of energy and you can tell he even walks faster.  Then he returns to having a hard time waking up in the morning.  Seems like a struggle to even half way tuck in his shirt. He will get in trouble at school if it isn't tucked in all the way.  Teachers will tell me he is lazy and doesn't care, but then they see a difference when his medicine is increased. His TSH is normal, but I have read not to go by this.  I demanded FREE T3 & FREE T4. The doctor didn't want to do this, but I insisted!  They both came back on the very bottom of LOW/NORMAL.  I think this could be the problem, but what do they need to do?  His lipid studies are so bad. See results and please give advise.

TSH                         1.58       0.34-4.82 uiu/ml
Free T4                    0.60       0.59-1.17 ng/dl
Free T3                     4.4        4.3-8.3 pg/ml
Triglycerides            285       30-150
HDL cholesterol        29        40-60

[Barb135]

I agree with everything gimel said, and I'd like to add that you can't know whether or not your son is converting the T4 to T3 until his levels of Free T4 come up.

Typically, when one is not converting well, the FT4 will be relatively high in the range, while the FT3 remains very low.  At this point, your son's FT3 and FT4 are both very low.

In addition to asking about the pituitary and adrenal tests, you might want to consider having your son tested for vitamin B12 and vitamin D deficiency.  I have pernicious anemia (vitamin B12 deficiency) and that can cause the extreme fatigue and can also cause the "highs and lows" in the energy levels.  

Has your son been tested for antibodies - Thyroid Peroxidase antibodies (TPOab) and Thyroglobulin antibodies (TGab).  These tests will confirm or rule out the autoimmune disease, Hashimoto's Thyroiditis.  Although Hashi's is usually treated the same as hypothyroidism, it can cause the hypo to be harder to control.  Hashi's is the main cause of hypothyroidism in the US.

I also agree that you should start looking for another doctor.  I'm not sure what you meant by "The doctor called and only wants to add T3.  I'm not sure where his Free levels need to be."  Do you mean that the doctor only wants to add the T3 test?  Any test labeled "T3" is going to be Total, and will be a useless waste of $.  *Insist* on FREE T3 and FREE T4.  

Typically, many people feel best when their FT3 is adjusted to the upper 1/3 of it's range, while the FT4 is adjusted to approximately  mid range.  Your son has quite a way to go with both.   Remember, there are always exceptions to the rule.

[gimel]

TSH is a pituitary hormone that is affected by so many variables that it is inadequate as a diagnostic for thyroid problems.  At best it should be considered as an indicator, to be considered along with more important indicators such as symptoms, and also the levels of the actual, biologically active thyroid hormones free T3 and free T4.  Your son's TSH is somewhat inconsistent with the low FT3 and FT4 results.  This may indicate the need to also do some testing for the pituitary function.  In view of your son's situation, I would also ask for the 24 hour saliva test for adrenal function as well.  Adrenal problems frequently occur with hypo conditions.

Of the thyroid tests, FT3 is most important because it is four times as active as FT4, plus studies have shown that FT3 correlates best with hypo symptoms.  Your son's  FT3 and FT4 results are too low in their ranges.  Forum members frequently report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.   Symptom relief should be the objective of treatment, not just getting test results anywhere within the range.  


As far as the thyroid problems, in my opinion the very best way to treat a thyroid patient is to test and adjust levels of FT3 and FT4 with whatever type of medication is necessary to relieve symptoms, without being constrained by resultant TSH levels.  I think you need to find out if the doctor is willing to treat your son's symptoms in this manner.  If not, then you will need to find a good thyroid doctor that will do so.  Based on the doctor's response so far, I think you might as well start looking anyway, because it sometimes takes a while to find a good thyroid doctor.

To possibly speed up finding a good thyroid doctor, if you make a new post and say that you need a good thyroid doctor, and list your zip code, members may be able to provide a PM with a recommendation based on personal experience.  Members sometimes get lucky that way.  

[jhollie]

I think I need to get some more tests done.  The doctor called and only wants to add T3.  I'm not sure where his Free levels need to be.

[debbie0413]

Hello:
   I also post on here because of my child.  My middle daughter was diagnosed and treated for Grave's disease hyperthyroidism 3 years ago at 17 with radioiodine.  I thought she was OK on her 150 mg. of levothyroxine, but for the last 6 months she has had seroius psychological problems (you can read it all later if you want).  Anyway, one of the significant things we have found out is that my daughter apparently doesn't convert the T4 levothyroixine into usable T3 that her body needs.  This is greatly affecting her thyroid function, possibly her adrenal function, and has caused critically low levels of magnesium and ferritin.  I wonder if some of these things could be going on with your son.

   My daughter also has that thing happen where her energy level turns off and on like a switch.  We will be consulting with a new doctor (because the other doctor she was was very good but also did not bill insurance and we couldn't afford it any more).  I am eager to see what some of the other forum members say about your son's levels.  People on this forum are very well versed in what questions to ask health professionals.  I wish you and your son well!

- Debbie from Milwaukee