For about the past year my son has had a number of health issues. He's 17 years old, about 230 pounds, depressed, exhausted immediately when he wakes up, has general aches all over his body, and has also been suffering from migraines for about 5 years.
Things have taken a turn for the worse on all fronts the past 2 months, so we wanted to have some blood work done. His PED ordered some bloodwork, standard CBC, CMP, and also a thyroid profile including T4, TSH, Free T4, and Anti-TPO. Everything came back "normal" except for his T4. I'll post the Thyroid levels below, and can offer more results if helpful on other tests.
Basically my questions are this: Do those references take into account his age/weight, or are they adult standards? His regular T4 being low means what? Are there additional thyroid tests (or others in general) to seek an answer for his issues?
His doctor's response was everything was normal, so we're at an impass now. It's horrible seeing my son feel like this, and we really need answers.
Total T4 is less reliable than free T4. The labs i found online for Total T4:
– Under 5 years of age range is 7-15 mcg/dl
– Between 6 and 10 yrs range is 6-13
– Over 10 years and adults: range is 5-12
Low total T4 can suggest hypothyroidism. Also, severe illness or the use of corticosteroids can decrease binding protein levels and the total T4 will be low but this is not due to hypothyroidism. That said, the free T4 is quite low in the range which is never a good sign as most people feel much better mid way or higher in the range.
Other thyroid lab tests that would be worth checking: free T3 (T4 must be converted to T3 to be used by the body/T3 since that is the only hormone the cells use to regulate metabolism) and thyroglobulin antibody (this may be high even is TPOAb is negative). There is also a test called reverse T3 and if this is elevated you can suffer hypothyroid symptoms as it is blocking the action of free T3.
There is also the possibility of central hypothyroidism. Usually this is a TSH below 1.5 mU/L and free T3 (and possibly the free T4 as well) will be below normal.
Also, a clinical sign that is only seen with hypothyroidism is a skin condition called myxedema. While not everyone with hypothyroidism will have this symptom, this symptom is unique to hypothyroidism. You can look online for the video demo of the myxedema skin pinch test.
He should have more than just a thyroid panel. Testosterone, cortisol, and growth hormone. I read over and over, low growth hormone is often a first sign of pituitary problems. I know from experience that low testosterone will mess you up. Cortisol at least roughly checks adrenal functions. But I think adrenals are hard to test.
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.