Thyroid test, to believe it or not?

[balkanFX]

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.    

[goolarra]

When you have different reference ranges (sometimes they vary because they're expressed in different units, sometimes it has to do with the labs' methods and/or equipment), you can convert the numbers to a percentage of range to compare them.

The math for the first labs:

Upper limit of range - lower limit of range (10.2 - 5.2 = 5.0)
Result - lower limit of range (5.6 - 5.2 = 0.4)
Divide second result by first X 100 (0.4 / 5.0 X 100 = 8%)

For the second:
7.23 - 4.28 = 2.95
6.0 - 4.28 = 1.72
1.72 / 2.95 X 100 = 58%

As a rule of thumb (which like all rules is broken by many of us), FT4 should be about midrange (50%).  Your daughter's were at 32% and 27%, respectively for the two tests.  This is a little low.

FT3's rule of thumb is upper half to upper third of range.  At 8%, her FT3 was dismally low, but at 58% looked excellent.  However, this kind of variation is fairly unusual.  That's why I'm questioning the range from one or both labs...it seems too inconsistent to me, and we already know there was some confusion.

I'm not thinking paranoia at all...I'd verify both those lab ranges again.  I agree with Barb...get another test at a lab you trust and make sure you get ranges accurately adjusted for your daughter's age.

I'd also once again suggest a thyroid ultrasound.

[balkanFX]

Hi "goolarra",
Could you please explain how did you work out those persentages of FT3, 8% and 58%, and what is their significance. The FT3 went up from 5.6 to 6, and the FT4 from 12.4 to 12.6 ???

Thanks

[Barb135]

TSH is variable for a variety of reasons (this is why TSH is useless as a diagnostic), so without follow up tests to see where your daughter is now, you won't know.  I would doubt that the result is a typo, but anything's possible.  

Thyroid blood work should always be done in the same manner - in other words, if it's done once fasting, it should always be done fasting; and it should always be done near the same time of day

I really think you need to take your daughter to a different lab, for the same tests.  

[balkanFX]

The first test was a 12h fasting one the second was a normal one with a breakfast. I just wonder it that somehow could have pushed the TSH so low down from 1.9 to 0.16 . FT4 and FT3 did not move so much though. Risking to sound even crazy, it crossed my mind that the second test TSH value could have been a human typing error, just puting the decimal point in the wrong place. If it was 1.6, then maybe would have made sence. I know what you might be thinking, - "paranoia".

[goolarra]

I agree that a third set of labs wouldn't hurt.   I'd have a discussion with the lab beforehand to make sure they have ranges adjusted for age and that those ranges get on the lab report that goes to the doctor.

"As far as I am concerned every good endo should know where the values should be, if not from medical schol then atleast from experience. After all they study to become endos for more than 10 years."  Unfortunately, it's not that simple since the values that "should be" are very individual for all of us.  Most people have to have levels adjusted to fairly high in the ranges; I'm quite comfortable barely in the lower end of the ranges.  Add to that that different labs, using different methods, have different "normal" populations, and range becomes even more illusive.

I have to say that were I convinced that this was a thyroid problem, I really wouldn't know how to suggest you go about treating it.  FT4 is a little on the low side in both labs.  FT3 (still questionable, in my opinion) varied from 8% to 58% of range.  Yet, you feel that her symptoms are hyper, which is not supported in those labs.  I really wouldn't know whether to suggest treatment for hypo or hyper.  I feel that the results are not definitive enough to medicate (at this time).

I believe gimel suggested above that you have an ultrasound, and I'd agree with that to rule out the possibility of a hyperfunctioning nodule.  Hyperfunctioning nodules put out T3 independent of the influence of TSH.  T3 is produced in spurts, so FT3 levels can vary wildly.  Has anyone in either of your families ever been diagnosed with Plummer's Disease?      

[Barb135]

Since you seem very distrustful of the lab that did the analysis, maybe you could try to get the tests done at a different lab?

The second set of tests was done in Sept, which would be close to 6 weeks ago, so assuming that you'd want to keep a close eye on the situation, it would be about time to retest to see where all of your daughter's levels are now.  If possible, this should be done at a lab you trust.  You might even want to talk to the lab prior in order to insure quality.

You mentioned that both your and your wife's family have a history of thyroid disease.  Have either you or your wife been diagnosed with a thyroid issue?  Has the hypertrichosis showed up in any other family members with thyroid disease?