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Thyroid test, to believe it or not?
Hi everybody,
My little 4 1/2 year old daughter had some blood teststs done in July and another one in September. The reason for the test was an exsess body hair, legs, arms, back but none in the androgenic areas. The July Thyroid test results were TSH=1.9 ,FT4=13.4 ,FT3= 5.6 . The doc said all was OK. The second test in September came out as TSH=0.16 , FT4=13.6 , FT3=6 . We haven't see the doc yet.
It is my suspicion that somehow she is making a bit more FT3, just enough in exsess to alter the the body hair normal cycles of growth, regretion and rest.
The FT4 and FT3 do not look too much different but the TSH is way out of line on the second test. I would like to point out that as she is only 4 and a half, she is really expected to have higher TSH, maybe in the region of 2 to 3. She is not exactly a typical Hyper.., but I can say that she tolerates cold a lot better than her brother and night time the blanket is allways off.
From researching I got idea that the FT4/ FT3 should be around 2.5 or slightly more. Ideal should be 2.5 . Her's is, the first one 2.39 and the second 2.26 , indicating she is converting a bit too much or is she?
I agree that by just looking at the reference ranges you can't always say if one has problematic thyroid or TSH (pituitary). Everybody is different to extent and Thyroid hormone values could be at different spot for everyone, slight variation up or down within the ref range and we have a problem.
I would like to hear your opinion as I am desperately hoping to resolve the original symptom.
PS. My thyroid seems OK, but my birth family have history of thyroid problems, hyper and hypo.
Thanks for taking the time to read this.
My little 4 1/2 year old daughter had some blood teststs done in July and another one in September. The reason for the test was an exsess body hair, legs, arms, back but none in the androgenic areas. The July Thyroid test results were TSH=1.9 ,FT4=13.4 ,FT3= 5.6 . The doc said all was OK. The second test in September came out as TSH=0.16 , FT4=13.6 , FT3=6 . We haven't see the doc yet.
It is my suspicion that somehow she is making a bit more FT3, just enough in exsess to alter the the body hair normal cycles of growth, regretion and rest.
The FT4 and FT3 do not look too much different but the TSH is way out of line on the second test. I would like to point out that as she is only 4 and a half, she is really expected to have higher TSH, maybe in the region of 2 to 3. She is not exactly a typical Hyper.., but I can say that she tolerates cold a lot better than her brother and night time the blanket is allways off.
From researching I got idea that the FT4/ FT3 should be around 2.5 or slightly more. Ideal should be 2.5 . Her's is, the first one 2.39 and the second 2.26 , indicating she is converting a bit too much or is she?
I agree that by just looking at the reference ranges you can't always say if one has problematic thyroid or TSH (pituitary). Everybody is different to extent and Thyroid hormone values could be at different spot for everyone, slight variation up or down within the ref range and we have a problem.
I would like to hear your opinion as I am desperately hoping to resolve the original symptom.
PS. My thyroid seems OK, but my birth family have history of thyroid problems, hyper and hypo.
Thanks for taking the time to read this.
I agree that the ranges, AT THEIR EXTREMITIES, only tell you when you are severely out of line. However, if your results are solidly around midrange, then I think you are safe to assume that the levels are basically "normal".
Yes, endocrine systems are sensitive to deviation, but they also change constantly in response to bodily demands. It's fairly telling that we, medicated thyroid patients, take a pill usually once a day, so our levels are more or less constant. We function pretty well despite our lack of ability to respond to higher and lower levels of demand (and fluctuating FT3 and FT4 levels because of that). Yes, I think we all have a personal reference range, for most of us within the population reference range, where we feel comfortable. However, our personal comfort level is still a range, not a specific number.
I agree with Barb that a toxic nodule would likely produce higher FT3 levels, and that it's a bit of a long shot. However, I thought a U/S might help to eliminate one of the possibilities and set your mind at ease. Since FT3 is a "snapshot", spikes can be hard to pin down..
I also think you're putting too much emphasis on the ratio of FT4 to FT3, or perhaps I should say that you are putting too much emphasis on that being exactly 2.5. To me, that's a little like saying that everyone's FT4 should be exactly 1.3 all the time. Surely, that ratio is also subject to "range". I've never seen a discussion on this forum of the ratio of FT4 to FT3 in those precise terms. We often discuss it in broad strokes...FT3 should be higher in it's range than FT4 is in it's, or slow conversion is indicated (if symptoms prevail) Furthermore, if the 2.5 ratio IS valid, I would guess that your daughter's results of 2.39 and 2.2 ARE "around" 2.5..
I ran the ratio on the midpoint of both my ranges, and the number came out to 4.1. Now, as a rule of thumb, we often say that FT4 should be midrange, and FT3 upper half to upper third of range. Comparing midrange on FT4 with the lower end of the top third on FT3, you still get a ratio of 3.6. That 2.5 number doesn't seem to be holding water.
Once again, I agree with you about ranges for the most part, but I DO think that they are quite reliable around midpoint. Yes, if you're close to one or the other limit, you probably have a problem, but if you're square in the middle...less certain. Your daughter's pretty much in the middle, allowing for daily variations.
Yes, endocrine systems are sensitive to deviation, but they also change constantly in response to bodily demands. It's fairly telling that we, medicated thyroid patients, take a pill usually once a day, so our levels are more or less constant. We function pretty well despite our lack of ability to respond to higher and lower levels of demand (and fluctuating FT3 and FT4 levels because of that). Yes, I think we all have a personal reference range, for most of us within the population reference range, where we feel comfortable. However, our personal comfort level is still a range, not a specific number.
I agree with Barb that a toxic nodule would likely produce higher FT3 levels, and that it's a bit of a long shot. However, I thought a U/S might help to eliminate one of the possibilities and set your mind at ease. Since FT3 is a "snapshot", spikes can be hard to pin down..
I also think you're putting too much emphasis on the ratio of FT4 to FT3, or perhaps I should say that you are putting too much emphasis on that being exactly 2.5. To me, that's a little like saying that everyone's FT4 should be exactly 1.3 all the time. Surely, that ratio is also subject to "range". I've never seen a discussion on this forum of the ratio of FT4 to FT3 in those precise terms. We often discuss it in broad strokes...FT3 should be higher in it's range than FT4 is in it's, or slow conversion is indicated (if symptoms prevail) Furthermore, if the 2.5 ratio IS valid, I would guess that your daughter's results of 2.39 and 2.2 ARE "around" 2.5..
I ran the ratio on the midpoint of both my ranges, and the number came out to 4.1. Now, as a rule of thumb, we often say that FT4 should be midrange, and FT3 upper half to upper third of range. Comparing midrange on FT4 with the lower end of the top third on FT3, you still get a ratio of 3.6. That 2.5 number doesn't seem to be holding water.
Once again, I agree with you about ranges for the most part, but I DO think that they are quite reliable around midpoint. Yes, if you're close to one or the other limit, you probably have a problem, but if you're square in the middle...less certain. Your daughter's pretty much in the middle, allowing for daily variations.
Forgot the link, sorry, here it is: http://vimeo.com/3927642
and also: http://vimeo.com/3161062
and also: http://vimeo.com/3161062
Thanks "Barb135"
Yes, I agree with you. I need to keep an open mind as to what might be causing the symptom we are concerned about.
Regarding Ref Ranges, I agree that they are needed but in their current way too broad range, they become if not useless then pretty much close to it. OK, I am being a bit extreme, I agree. The point I am trying to make is that if you visit an endo and he specificaly base his opinion on wether the values are within the range or out, then it is pretty likely that you would not be diagnosed with having a problem unless you have suffered for years and or it is way too late maybe, and have very few options left to correct the problem.
I came accross this website that has a video representation by Dr Bryan Walsh, subject is Thyroid Physiology. You can have a look also at what he says about the "Problem with Modern Blood Chemistries".
Yes, I agree with you. I need to keep an open mind as to what might be causing the symptom we are concerned about.
Regarding Ref Ranges, I agree that they are needed but in their current way too broad range, they become if not useless then pretty much close to it. OK, I am being a bit extreme, I agree. The point I am trying to make is that if you visit an endo and he specificaly base his opinion on wether the values are within the range or out, then it is pretty likely that you would not be diagnosed with having a problem unless you have suffered for years and or it is way too late maybe, and have very few options left to correct the problem.
I came accross this website that has a video representation by Dr Bryan Walsh, subject is Thyroid Physiology. You can have a look also at what he says about the "Problem with Modern Blood Chemistries".
COMMUNITY LEADER
Are you referring to a ratio of FT4/FT3 being at 2.5?
While I can agree that the reference ranges are not designed to give a completely clean bill of health, I can't agree that they are totally useless, either. What good would a lab result be without something, with which to reference it? Because each lab uses different methods of testing and units of measure, the ranges will change accordingly.
Even if your daughter's TSH still comes back that low in subsequent testing, I'd still not look at it specifically as a thyroid issue. I'd be more inclined to look at other possibilities, first, since her FT's don't indicate that she's hyper.
If your daughter had a nodule that's over producing, chances are pretty great that her FT3 and/or FT4 levels would be higher than they are. Additionally, from my reading, nodules secreting hormones independent of the thyroid, are outside the regulatory influence of the pituitary gland, therefore, would not necessarily cause the TSH to drop that low.
Like you, I'm not a doctor
While I can agree that the reference ranges are not designed to give a completely clean bill of health, I can't agree that they are totally useless, either. What good would a lab result be without something, with which to reference it? Because each lab uses different methods of testing and units of measure, the ranges will change accordingly.
Even if your daughter's TSH still comes back that low in subsequent testing, I'd still not look at it specifically as a thyroid issue. I'd be more inclined to look at other possibilities, first, since her FT's don't indicate that she's hyper.
If your daughter had a nodule that's over producing, chances are pretty great that her FT3 and/or FT4 levels would be higher than they are. Additionally, from my reading, nodules secreting hormones independent of the thyroid, are outside the regulatory influence of the pituitary gland, therefore, would not necessarily cause the TSH to drop that low.
Like you, I'm not a doctor
Thanks "Barb135" and "goolarra",
I think both tests have their inconsistencies and leave room to question some of the results. I also agree that one of the biggest problems with those labs is the useless ref. ranges. They are not designed to give you a clean bill of health but to simply state if you are severely out of line. Thyroid as well as other endocrine systems are very sencetive to even a small deviation from the normal set point for each person. Also if I keep going to different lab each time I am suspicious, I am afraid would probably end up in the same position. I have decided to go for another test at the same lab and see what the values are going to be. If TSH is still that low and FT3 and FT4 within the mid range then I can assume we are dealing possibly with a subclinical hyper or symply a nodule that is over producing T4 or T3 and causing the TSH to go low. Another bother is that in my researsh and it is not supported by any documents, but symply by observations the FT4 / FT3 should be around 2.5 or slighly more for a healthy individual. The link I provided in my previous post, which could be viewed in PDF prefferably, could help in establishing that relationship. But then again, I am not a doctor and what I am talking could be completely nonsence.
Thanks for your opinions so far.
I think both tests have their inconsistencies and leave room to question some of the results. I also agree that one of the biggest problems with those labs is the useless ref. ranges. They are not designed to give you a clean bill of health but to simply state if you are severely out of line. Thyroid as well as other endocrine systems are very sencetive to even a small deviation from the normal set point for each person. Also if I keep going to different lab each time I am suspicious, I am afraid would probably end up in the same position. I have decided to go for another test at the same lab and see what the values are going to be. If TSH is still that low and FT3 and FT4 within the mid range then I can assume we are dealing possibly with a subclinical hyper or symply a nodule that is over producing T4 or T3 and causing the TSH to go low. Another bother is that in my researsh and it is not supported by any documents, but symply by observations the FT4 / FT3 should be around 2.5 or slighly more for a healthy individual. The link I provided in my previous post, which could be viewed in PDF prefferably, could help in establishing that relationship. But then again, I am not a doctor and what I am talking could be completely nonsence.
Thanks for your opinions so far.
I agree with you on both points: The ranges are very broad (broader than for adults, which is bad news), and two labs in the same city, using the same equipment, should have more similar (the same?) ranges.
I eyeballed the range for your daughter's age group on the link you provided. Since it's a chart, I came up with roughly 4.25-7.5 as the range that 95% fall into. Interestingly, that's very close to the range from the second lab (4.28-7.23). If, indeed, both labs use the same methodology, I'd feel fairly confident applying that range to both labs.
That would put your daughter's result of 5.6 at the 44th percentile and the second result of 6.0 at the 58th percentile, which would indicate that she's hovering right around midrange, which is good.
The upshot of all this is that both FT3 and FT4 have been not only in range, but well away from the extremes of the ranges in both cases. The only result out of range is the TSH of 0.16. As gimel pointed out above, TSH is volatile, even the time of day the blood was drawn can effect it. Though you might want to keep a watchful eye on thyroid labs, I really am having a hard time seeing a thyroid problem in your daughter's labs.
I'd suggest a thyroid ultrasound to rule out any autonymous nodules. However, I think I'd continue to pursue other possible causes of your daughter's symptoms.
This, of course, is just my opinion as a layperson, not a medical professional.
I eyeballed the range for your daughter's age group on the link you provided. Since it's a chart, I came up with roughly 4.25-7.5 as the range that 95% fall into. Interestingly, that's very close to the range from the second lab (4.28-7.23). If, indeed, both labs use the same methodology, I'd feel fairly confident applying that range to both labs.
That would put your daughter's result of 5.6 at the 44th percentile and the second result of 6.0 at the 58th percentile, which would indicate that she's hovering right around midrange, which is good.
The upshot of all this is that both FT3 and FT4 have been not only in range, but well away from the extremes of the ranges in both cases. The only result out of range is the TSH of 0.16. As gimel pointed out above, TSH is volatile, even the time of day the blood was drawn can effect it. Though you might want to keep a watchful eye on thyroid labs, I really am having a hard time seeing a thyroid problem in your daughter's labs.
I'd suggest a thyroid ultrasound to rule out any autonymous nodules. However, I think I'd continue to pursue other possible causes of your daughter's symptoms.
This, of course, is just my opinion as a layperson, not a medical professional.
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