Testing for Graves disease

[amh33]

My 6-yr old Molly has been under the care of a pediatric endocrinologist for 18 months due to growth issues. She has fallen into the 0.8% on the growth chart for both height and weight. Her dr initially tested all her hormone levels with a standard blood test, as well as testing her for Turner syndrome and celiac disease. Everything came back normal. We have had regular check-ups every 4-6 months to continue monitoring her growth, and she has been on an appetite stimulant that seems to be helping a little. Our pediatrician has now referred us to a neurologist because she has developed a fine hand tremor. That appointment is in 4 wks, and our endocrinology follow-up is in 5 wks. Through this process, several people have recently come out of the wood work and ask if she might have Graves disease. If she does, would an increase in TSH have shown up on the standard blood test taken a year ago? What questions should I ask her neurologist and endocrinologist?

[amh33]

Thank you. This helps. It has been tough knowing she isn't growing, yet we cannot figure why. I've heard diagnosing growth issues often requires patience.

I'll bring this up at her next check-up with the endocrinologist in a few weeks.

[goolarra]

Some of it does sound thyroid related.  However, as you know, it can be tough to pinpoint the cause of symptoms, especailly in growing children.  Diarrhea, hand tremors, inability to gain weight, intolerance to heat (feeling hot when others don't) are all symptoms usually associated with hyper.  On the other hand, insomnia is usually associated with hyper...Molly's sleep pattern sounds almost more hypo.  Fatigue is typical of both.  When hyper, people are often fatigued due to insomnia, when hypo, fatigued no matter how much they sleep (which can be a lot).

In order to cover all the bases, if you do further thyroid testing, you might also consider testing TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies).  These are the two antibodies implicated in autoimmune thyroid disease.  Hashimoto's thyroiditis is an autoimmune thyroid disease (the most prevalent cause of hypo in the developed world) that eventually leaves the person hypo.  However, early stages can be characterized by hyper or swimgs back and forth between hypo and hyper.

I certainly think Molly has enough symptoms to do a full thyroid workup.  If you want to explore further, you might google "hyperthyroidism + symptoms".  

[amh33]

I'm not sure what symptoms are related to thyroid, but she has diarrhea often -- has her whole life -- and hand tremors.  In addition to struggling to gain weight, she is also extremely short; her pediatric endocrinologist is hoping she reaches 4 ft 10 in. as an adult.  Molly has no trouble sleeping; in fact, she very rarely wakes up at night and frequently takes 2 hour naps on weekends.  She often complains of being hot, which I have found strange given that she has no meat on her little bones.  Does any of this sound thyroid related?

[goolarra]

TSH is counterintuitive...as it rises, your thyroid becomes more underactive (hypo), and as it falls, it becomes more overactive (hyper).

TSI (thyroid stimulating immunoglobulin) is a blood test that is the definitive test for Graves'.  Your pedi could order that for you, and that might help you to decide which specialist is most appropriate.  TSH from a year ago is really too old to draw any conclusions from.  A new thryoid panel, FT3, FT4 and TSH (as FTB pointed out) will give you a lot more useful information on thyroid function.

Does Molly have any other thyroid symptoms?  Constipation or diarrhea?  Fatigue and/or insomnia?  Increased/decreased HR or BP?  etc.  

[FTB4]

Hand tremor is a symptom of Hyperactive thyroid (graves), although Hyper reduces the TSH, Hypo would increase the level. But TSH is a Pituitary hormone, not a thyroid hormone, the pituitary senses the amount of thyroid hormone in the system, then sends a hormone(Thyroid Stimulating Hormone) to the thyroid when the hormone level is low, The thyroid produces the hormone T4, then the body converts it to T3, this is the hormone the body needs to function, they are known as Free T4 and Free T3, these two are tests that should be taken to determine thyroid balance. It is known that thyroid can cause problems with growth. So if she had graves disease or just underactive (Hyper) thyroid then the TSH would decrease, Ask for your daughters lab results ie: Free T3 Free T4 and TSH, also the reference ranges provided for each and post them here for comments and advice by members. There are other test that should be done (Antibody) to indicate Graves, an Auto immune disorder in case of Hyper and Hashimoto's, which is a Hypo Auto Immune disorder. Welcome to the forum and Best Regards FTB4