Thyroid lab results...Hyperthyroid? Graves?

[DominantJean]

I have lab results for my 12 yo daughter. In the last few years she has suffered with morning nausea, diarrhea, and weight loss. She tested positive for high risk celiac genes and has been gluten free for two years. Her bathroom issues have improved but she still fights nausea and in the last year she's been having issues with dizziness, feeling faint, and blurry vision (she's been to an optometrist and her vision is fine). She also has a high resting heart rate and postural tachycardia. Her pediatrician gave her referrals for a cardiologist, endocrinologist, a gastroenterologist, an ophthalmologist, and a metabolic specialist. Before seeing all these doctors I wanted to try to understand her thyroid lab results better. She isn't on any medication.

Thyroid peroxidase (TPO) Ab.  14       Range 0-26
Thyroglobulin by IMA.               37.9    Range 3.7-31
Thyroglobulin Antibody.              <1      Range .0-.9
Thyroxine (T4).                          10.7    Range 4.5-12
TSI.                                            46%    Range 0-139
TSH.                                          1.59    Range .45-4.5
Free T4.                                     1.47    Range .93-1.6

Only the thyroglobulin (measured by IMA) is high. But I am reading that peroxidase and TSI should be close to zero. I appreciate any insight and would like to know what questions I should ask the doctors, particularly the endo.

[DominantJean]

Thank you, this helps so much! I am hypothyroid myself, and I've done a lot of research, but I know there is plenty that I could be missing and I want to be as prepared as possible at all these appointments. I didn't think of low cortisol, but you're right, she does have a lot of those symptoms. I will bring it up at the endo appt.  

I knew T3 was missing when I saw the lab order, but I already had to push for 'complete' thyroid labs in the first place and I was just happy that she included antibodies. I will definitely get the T3s next time.

My daughter had her cardiology appointment today and her ekg was normal. The doctor is ordering an echocardiogram as well. I've since heard about Pots syndrome and my daughter's symptoms definitely fit the description. I mentioned this to the doctor and he didn't give much validity to Pots, even though her heart rate went from 116 (lying) to 155 upon standing. He did recommend increased salts and fluids.

I am anxious to see the endocrinologist, were still waiting on that referral.  :/

[gimel]

Hyperthyroidism is not an area that I have researched very much; however, I did want to respond to your post and provide any info I can.  Even though your daughter's TSH is well within range, her Total T4 and Free T4 are near the high end of their ranges, which tends to be on the hyper side.  It would have been very helpful if she had also been tested for Free T3, which is the most biologically active and is metabolized by all the cells of the body.  

Her TSI test is not over the range, but as you said, a lot of what I found was that anything above the very bottom of the range is suspect of Graves' Disease.  I think the other tests mainly indicate the existence of an autoimmune system problem.  So, I think the best thing for you to do next is to take her to the Endocrinologist, rather than the other doctors.  I think the best thing you can discuss with the Endo is to emphasize the symptoms she has.  I would also make sure she is tested for Free T3 every time she is tested for thyroid.  

All of your daughter's symptoms may be hyperthyroid related, but grasping at straws, I also suggest that she should be tested for possible low cortisol.  I say that for no other reason than her dizziness and feeling faint, and before that the nausea and diarrhea.  You can find those symptoms in listings of low cortisol symptoms.   For cortisol the best test is supposedly a diurnal saliva (free) cortisol panel of 4 tests taken at different times of the day.  Doctors typically won't order that test panel and will only order a morning serum (total) cortisol test, which is not as revealing.

I hope this helps instead of adding to your concern.  Either of the possibilities I have mentioned is very treatable.  Once you find out more please update us with test results and doctor analysis.   Also, if it is Graves', then ultimately she will end up hypothyroid and we can provide a lot of needed information on how best to treat it, that you won't hear from most doctors.  So please keep that in mind for the future.