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.    

[balkanFX]

Thank you "Barb135"

On the second test I have put down "questionable range" due to the lack of knowledge of the lab that children often have different ranges than adults. As I already mentioned I only phoned in to question the TSH and FT3 with their chief hospital Biochemist Scientist. Only then I was given the different ranges that I have included as "corrected to", the rest is still questioable. From my research FSH should be exactly at 2.3, often quoted as the median of the range. SHBG is usually higher for children, but yet again who am I to argue with the lab that was probably responsible for hundrends of wrong diagnoses based on their unupdated ranges. I can not comment, what the paediatric endos relying fully on the labs reports would say about this. 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. Just my opinion.

Lastly I agree with you on the other points that it might not be just or at all the thyroid. From my research I have come accross a lot of cases where the docs would treat a child for hypothyroidism or hyper and their primary symptom of increased body hair gets resolved. It is not explaned fully or understood why those body hair folicles sometimes would shut down on severe hypo or hyper patients and sometimes a problem with more than normal body hair gets resolved when the Thyroid hormones get back where they need to be.

I have come across, quote: "In research studies it has been shown that hair follicles express thyroid hormone receptors and they can respond with increased hair growth when exposed to the thyroid derived hormone triiodothyronine (T3)." and " However, occasionally there are reports of people with hypothyroidism or hyperthyroidism experiencing hypertrichosis - an excess of hair growth. This might be expected in people with mild hyperthyroidism, where a modest increase in thyroid hormones may stimulate the hair follicles into increased growth but not be so high as to be toxic for the cells."

For those who might be in the same bandwagon or fall into it in the future here is the link:http://www.keratin.com/ab/ab011.shtml

Even though the following is a bit extreme but still usefull to know is the following link: http://www.nature.com/jp/journal/v26/n4/full/7211461a.html

Due to my births family of thyroid disorders and I forgot to mention my wife's side family too, I feel there might be a strong possibility that we may be having a case of mild or subclinical hyperthyroidism where the FT3 is just a bit higher but still in range. It is a difficult one and I do not know where to beging to get some indication if this is the case. Most endos would just send you away, lets hope I get a good one that is willing to think outside the constrains imposed by old fashioned believes.

Thanks again for your time to put down your opinion and also research on my account.

[goolarra]

I have to say that I'm still a little uncomfortable with the ranges on your daughter's two FT3 tests.  If the ranges are to be believed (the second as corrected to 4.28 to 7.23), she went from 8% of range on the first test to 58% on the second.  That's a huge jump.  However, that jump is compatable with the rapid decrease in TSH.  Interestingly, FT4 was quite stable through all this.

To answer one of yout original questions on whether she converts too much T4 to T3.  I would say definitely not.  At 8%, she's barely in range, and at 58%, she's still well within (even a little on the low side) of the upper half of range that most of us feel well in.

I see I'm flirting with the 11:00 am PDT that MH is shutting down for maintenance, so I'll post and comment further later.

[Barb135]

Thyroid issues are generally associated with hair loss, rather than excessive hair growth.  I've done a bit of research, and only found one site that mentioned excessive hair growth with thyroid issues of any kind. However, excessive hair growth can be an endocrine issue, though not necessarily thyroid, even though the thyroid is part of the endocrine system.

I did read that it's entirely possible to have the excessive hair growth, even though androgen levels are normal. It's possible that the hair follicles are  more sensitive to the normal androgen levels. The second FSH is high, but not sure about the "questionable range".  FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body

The urine steroid profile suggests adrenarche as a possibility.  Adrenarche is a process related to puberty, but distinct from hypothalamic-pituitary-gonadal maturation and function. I'd have to do more research, but it sounds like this can occasionally take place quite early.

I notice that your daughter's SHBG is elevated; however, there is, again, the "questionable range" beside it.  Low SHBG may be related to several issues, including hypothyroidism, while high SHBG may be associated with hyperthyroidism.  High levels of growth hormone, estrogen or thyroxine (T4) can increase SHBG; however, neither of your daughter's FT4 levels can be considered high, so I'd most likely rule that one out.  

I also see that her ACTH is low.  ACTH is produced and secreted by the  pituitary gland and is an important component of the hypothalamic-pituitary-adrenal axis. It's often produced in response to biological stress.

With the exception of the one low TSH, I don't really see anything indicative a thyroid issue.  I do think you should look at possible adrenal function, growth hormone levels, etc.  I'd suggest that you have the thyroid levels tested periodically, and you might want to think about getting a thyroid ultra sound.

[balkanFX]

Thank you "gimel" and everybody else who looked and considered this case.

"gimel" on the subject of TSH and its importance I totaly agree with you. I felt like I finally found somebody who think the same as me and that gives me a boost of confidence when and if I try to defend my opinion in front of old fashioned doctors.

Looking forward to read your opinions when you are ready to write one.

Thanks a lot everybody.

[gimel]

Haven't forgotten your questions here.  Several members are doing some searching around for info because there may be more than thyroid issues involved with your daughter.  

Regarding your last question on TSH, the answer is yes it does vary during the day.  Studies have shown as much as 70% higher from low around 9 a.m. to high around 9 p.m.  Also, TSH is a pituitary hormone that is affected by many variables, to the extent that it is inadequate as a diagnostic.  At best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T3 and Free T4.

[balkanFX]

I wonder if the time of the day that the TSH is taken, matters for the reading. Does it peaks and drops during the day or it should be pretty much stable.
Also is it influenced by normal day to day phsycological upsets or joy?

Thanks