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My daughter's thyroid results

My 16 year old daughter has been experiencing weight gain (30 lb), sluggishness (she sometimes just falls asleep in the evening for three hours--which is unlike her), cold hands and feet, severe constipation, worsened acne, irregular periods, and lots of fluid retention. She is a very active person that eats extremely healthy, but she can't seem to quit gaining weight (and she can't lose weight). Even though she is still at a "normal" weight, she has still gained 30 pounds since September. She has also been diagnosed with Systemic Lupus Erythmatosus. Because of the problems she has been experiencing over the past year, I have always suspected a thyroid problem. Her readings have come back fine, but this time her Free T4 was at 0.8. On some scales, the normal is 0.9 and some scales it is at 0.82. Could this still be hypothyroidism that is causing her symptoms?
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Avatar universal
Just a heads up or a warning if you will.

It "sounds easy" to just request your Dr to do a Free T3 test.  However many of us find that the Dr's are VERY, VERY resistant to have the test done.  I just wanted to let you know to be very insistent on it and don't be surprised if the Dr. resists or gives you considerable push back when you ask for the Free T3 test especially.

And just another reminder as mentioned above to specifically as for the FREE T3 hormone test. As otherwise you will get "total T3" which is outdated test of limited value.
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Avatar universal
Thank you so much for all your information!! I'm calling her rheumatologist today to discuss thyroid and endocrinologist referral.
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649848 tn?1534633700
COMMUNITY LEADER
Okay, that FT4 range looks more in line with what we normally see.

The low TPOab (20) could be from the lupus; could also be an indication of "coming" Hashimoto's.  

Be careful, when it comes to endos; not all endos are good thyroid doctors because they tend to specialize in diabetes vs thyriod.  Many believe only in TSH, which is not going to be adequate for your daughter.  

Be sure to ask for the entire thyroid panel, which is TSH, FT3 and FT4, again, make sure you specify "Free".  You might also ask for a thyroid ultra sound to check for inflammation/nodules.

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Avatar universal
I'm apologize, I accidentally got the two antibodies mixed up and the reference ranges. The thyroid peroxidase antibody result was 20. The reference range on the sheet is 0.0- 35.0. Thyroglobulin AB returned at <20 and the reference range is 0.0-40.0. The FT4 reference range they used was 0.8 to 1.76. We are going to see her rheumatologist in a week and a half, so we are hoping she will refer us to an endocrinologist. The tsh was between 0.5 and 5.3. and hers came back at 2.5 almost 2.6. Thank you so much for your information!! I will be sure to ask the doctor to run a FT3 test.
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649848 tn?1534633700
COMMUNITY LEADER
What's the reference range for the TPOab?  Usually, we see something like <20.  As I said before TPOab is often present in small amounts in other autoimmune conditions, as well.

Please recheck the range on the FT4.  We often see 0.8-1.8, but I've never seen 0.8-1.1; that's pretty narrow range.  Your daughter's FT4 is bottom of the range, indicating hypothyroidism.  The lab is using an outdated reference range for TSH.  The currently recommended range is 0.3-3.0, so according to that range, her TSH would be borderline high. Between the low FT4 and the higher TSH, along with her symptoms, I'd say your daughter could very well have a thyroid condition; however, you really need to get a Free T3 test done and see where her level falls within that range to be sure.  When asking for T3 or T4 blood tests, always be sure to specify FREE, otherwise you will get total.  

Has she been tested for TGab? Because your daughter already has one autoimmune, the chances are greater that she, either already has, or will develop another (or more).

Periactin can cause drowsiness, sedation, as well as weight gain.  If you add hypothyroidism to that, I can see why she wants to sleep and is gaining weight.  
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Avatar universal
also the range they used for the tsh was in between 1 and 5. For the Free T4 it was between 0.8 and 1.1
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Avatar universal
She had her tsh tested and it was 2.6, her antiTPO came back at twenty and the other antibody was absent. They have not tested T3. She is currently on Plaquenil, Amlodopine (for raynaud's), and Periactin (for severe headaches).She has not been on any steroids or anything for the lupus. Thank you for your response.
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649848 tn?1534633700
COMMUNITY LEADER
What medication(s) is your daughter taking for her SLE?  My daughter has that also and the meds she has to take prevent her from losing weight and cause her to be very fatigued; she has many of the same symptoms and many of her days horrific at best.  

Different labs use different ranges, so the range must come from the particular lab report that you're quoting the result from.

What other thyroid tests have been done on your daughter?  Are they also running TSH and Free T3?  If so, please post the results, with reference ranges listed on the report.

Has she been tested for thyroid antibodies - Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab)?  TPOab can be present in SLE, so she must also be tested for TGab to determine Hashimoto's, which is another autoimmune, as is SLE.
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