confused about thyroid results

[Spud267]

6 year old son has had blood work done re thyroid function.  first 2 blood tests tsh levels came back slightly elevated, the 2nd being 5.1.   Re-tested in December and tsh was 3.8, ft4 was 13, can't remember what ft3 was and tpo was less than 1.   The peadiatrician told me to get it re-tested every 3 months and has put me under my general practitioner, but he has told me the last results were fine and no future tests were necessary - but what would have caused the first 2 to be elevated and should i just forget about it or follow up.  He sweats alot at night, wakes at night for no apparent reasons, gets leg cramps, irritable, giant mood swings, teary.  I don't know what i should do. Any suggestions

[goolarra]

I found this study, which does indicate that children younger than 12 have mean FT3 levels close to the upper limit of the adult range:

http://www.ncbi.nlm.nih.gov/pubmed/3232955

So, perhaps this is closer to "normal" than it appears.  However, it can in no way be considered hypo.  

FT4 is perfectly at midrange.  (I'm assuming the same ranges as in your previous post.)

Children also have TSH levels that run higher than adult levels.

All of which is very frustrating...symptoms sound like thyroid, but they're not really supported by the numbers when adjusted for his age.

I'm still wondering about celiac after re-reading your comments.  You said that he had a positive blood test for celiac (i.e. celiac antibodies are elevated).  I'm of the understanding that a positive antibody test is confirmation of celiac.  Many people with celiac test NEGATIVE in blood tests, so biopsy is done to check for damage to the intestinal villae.  It seems to me that your son does have celiac, but it has not yet had time to damage the intestine sufficiently to  be detectable by biopsy.  As with autoimmune thyroid disease, one can be positive for thyroid antibodies for years or even decades before the antibodies do enough damage to cause symptoms and overt changes to the thyroid.

I'd question your son's doctor about that to determine why he had positive celiac blood antibodies.  Has the celiac bloodwork ever been repeated to see if the results are consistent?  Were results borderline?   Have you discussed a trial gluten free diet with your doctor?

I'd certainly continue to monitor thyroid levels every three months if your doctor will agree.  This is a really tough call...I'd hate to discount thyroid completely, but don't want to ignore other possibilities as well.  You might try the g/f diet for a few months to see how symptoms are affected.  If that doesn't help, you might really get on your doctor about a trial dose of thyroid meds to see if that helps.

I'm quite skeptical about the acid reflux.  It seems to me like "we can't treat your symptoms because your lab work is all within range, but we sure can treat you for something that isn't bothering you because there was an 'abnormal' result".  

Good luck with the next biopsy...I hope it sheds some light.  Let us know how it goes.

[Spud267]

Hi, it has been a while but my son had his endoscopy in November and biopsy showed negative to coeliac's.  He did show some inflammation of the lower osophagus though.  They put him on 40mg omeprazole once a day and he is having a follow up endoscopy this coming Thursday, 27th January to rule out or confirm reflux.  He has never displayed symptoms of reflux but apparently they don't have to.  If the inflammation is still there then they will look at allergen aetiology.  I also just got his tests results from latest blood work for thyroid.  TSH 6.04, ft3 6.5 and ft4 14.  Still doesn't explain anything but we can rule out the celiacs being responsible for apparent resistance levels, which I'm told they probably are!  I am told that an ft3 of 6.5 is probably normal levels for a child of his age, although they don't really  have study levels to confirm.  I'm just so confused about what to do in light of the fact that paediatric endocrinologist told me not to bother him unless his TSH went over 10.

Thanks for listening

[Spud267]

I saw my GP today who told me that the paediatric endocrinologist felt that his ft3 was probably normal for his age and that the range was for adult.  If his TSh goes up over 10 then he will review.  I am making appointment this afternoon to see paediatric gastroenterologist to follow up biopsy for coeliacs.  Apparently coeliac and ADHD? can create resistance TSH levels - apparently.

Will keep you posted.

Thanks

[goolarra]

I should also have mentioned that your son should not go g/f until all celiac testing is complete...being g/f at the time of the test can return a false negative, since the damage to the intestine from celiac reverses quite quickly on a g/f diet (and probably even quicker still in a six-year-old).

[goolarra]

I'm just reading this for the first time and looking at your son's latest labs.  The one thing that really bothers me is the inconsistency among the TSH, FT3 and FT4. TSH, the worst indicator, is quite high, indicating hypo.  FT4 is at 40% of range, and 50% is the rcommendation for FT4.  It's a bit low, but, in my opinion, not a real concern for someone not on thyroid meds.   However his FT3 of 6.6 with a range of 3.0-5.5 (correct?) is quite high, indicating hyper.  Did your doctor in any way try to explain this inconsistency?

Celiac disease can affect conversion of T4 to T3, although it usually slows the conversion, and your son seems to be converting too much.  However, we all react differently, so I'd say the celiac is a prime suspect and may be contributing to the overconversion.  Since he's tested positive for celiac, that has to be addressed anyway, so I'd be on the biopsy to confirm asap.  If biopsy confirms, he needs to scrupulously avoid gluten, probably for the rest of his life.  Once on a g/f diet, and once the intestine has a chance to heal, you can retest to see what this has done to his thyroid numbers.

The pedi endo's examination of your son sounds pretty pathetic.  Once again, any explanation for the high FT3 at all?  I'm sorry, but inconsistencies really need to be explained.

Has your son had a thyroid ultrasound?  Was there any mention of nodules when the endo palpated his thyroid (not always a reliable way to diagnose nodules)?  The other possibility that comes to mind is a toxic nodule (also called toxic adenoma).  Many of us have nodules (a very generic term for any overgrowth of tissue within the thyroid).  Rarely, a nodule starts to function autonimously...it just keeps cranking out T3 and does not require TSH to stimulate it to do so.  When this happens, swings between hypo and hyper are common.  An ultrasound would confirm or rule this out as a possibility.

I wouldn't be able to let this rest until someone explained the high FT3 to me.  And, of course, your son's symptoms need to be explained, too.  If it's not thyroid, then we have to look further and find out what IS going on.  I certainly would not give this six months to fester and possibly worsen.  

Best of luck, and do keep us posted.

  

[Spud267]

Hi,

Just an update, my GP referred me to see Paediatric Endocrinologist and he took his weight, height and felt his thyroid and told me there was nothing wrong with his thyroid and that obviously his syptoms/behaviour were caused by something else.  The only other thing I can tell you is that he had a blood test which showed positive for Coeliac disease.  He is yet to have a biopsy for confirmation of this.  Basically the endocrinologist told me I was wasting his time and come back and see him if his TSH goes over 10.  What is a person supposed to do?

[Super_sally888]

Hi,

I think this means that your son has subclinical hypothyroid.

This means that although his thyroid is managing to put out the hormones he needs, it is struggling and thus needs a higher level than usual of TSH to make it work.

Some doctors would in this case give a low dose of thyroid meds to 'support' the thyroid.  Others would choose to observe.

Given that he is a growing boy, and the implications of hypothyroid on development can be significant, I think that it would be wise to get a second opinion.  I would prefer to be giving him a low dose of thyroid meds and monitoring closely in this case.

Regardless of the approach, close monitoring is recommended (I would say at least every 6 months, more frequently if he develops any new symptoms).

See what others think.

Best wishes.

[Spud267]

Finally have another lot of test results - interesting.

S thyroglobulin                   31     ug/L     ( <  54)
Anti thyrogobulin Ab          <20    kU/L     ( < 40)

Heres where it gets interesting

Free T4                             13    pmol/L    (range 9-19)
TSH                                  5.60 mU/L      (range 0.4 - 4.00)
Free T3                              6.6  pmol/L    (range 3.0 - 5.5)
TPO antibodies                  <1    kU/L       ( < 6)

Does this mean anything because the doctor isn't concerned!

Thanks again

  

[Spud267]

As I said, i have an appt next Thursday so will keep you posted.  I don't even think they are putting his symptoms in general down to anything, when i asked previously about him having sore legs and waking him during the night i was told he would grow out of it, that was about 2 years ago!  Another symptom i have failed to mention is constipation, he has been treated with laxative and given parachoc but still has ongoing constipation where he soils his pants - no one seems to be putting two and two together - except me!  Anyway, enough whingeing, will let you know how i get on.  Thanks again, its nice to have someone to talk to who understands.

[gimel]

Even if it is fine with the doctor, more importantly it should be fine with your son.  Remember that the doctor needs to decide what is causing his symptoms and take steps to alleviate them.   If the FT3 result is in the lower end of its range, I would ask the doctor to at least consider a therapeutic trial of thyroid meds, with careful monitoring of his symptomatic response.  It is not normal for  a child to have those problems and your doctor needs to keep investigating until a solution is found.  Don't let him off the hook, for your son's sake.

Here is a link to an article that may give you some insight about the importance of FT3 and FT4 levels.

http://www.xxxxxxxxx.xxx/Thyroid.html

[Spud267]

Thank you so much.  I know my doctor is a bit of a wait and see, but i personally can't ignore the symptoms anymore.  I feel that maybe i am giving him such a hard time because of his behaviour and it may not be his fault.  I don't react to many things but upon reading more and more information i just feel in my gut that it should be checked again.  I will mention it to the doctor when I see him next Thursday (28th Jan) and will keep you posted.  I still feel a little like maybe i am over-reacting and wasting his time - but i suppose that at least if it is tested and is fine (according to them) then i have done the right thing by having it checked out.  If the FT3 is in the lower range, what does it actually mean?  Is it the start of something or maybe just coincidence?  Thanks again

[gimel]

Understand that with youngsters it is very important to be very cautious.  It is not easy to get diagnosed and treated properly, even for adults.   That said, my opinion is that the FT 4 reading being below the midpoint, along with TSH being near the high of the range, is enough evidence to request additional testing.  I would suggest that you insist on FT3 testing, along with the TG ab test mentioned by 6hashi.   I would not be surprised to learn that the FT3 test result is also in the lower end of its range, consistent with the other indicators.  

If the doctor will not agree with this, then you may have to beat him up a bit, or find a good thyroid doctor.

[Spud267]

Sorry for the delay, dr was on leave.  There was no FT3 test done.

all i can tell you is that FT4 was 13 (range between 9-19);
TSH was 3.8 (range between 0.4-4)
TPOab was less than 1 (no range given).

Sorry i can't give you any more information.  Do you have any suggestions on what I should do next?

[Spud267]

thanks for your concern.  Will try and get a hold of the lab report and let you know.  I believe the ft3 was normal for their range.  That's all I know.  Will let you know once I have the information

[gimel]

It would be very helpful if you can get a copy of the lab report and post all results, along with reference ranges.  I especially want to see the FT3 result, and its range.

[Spud267]

I don't actually have the lab results in hard copy - was given to me over the phone - told all were in normal ranges.  I know his TSH was 3.8 (range supposed to be 0.4 - 4) and his ft4 was 13 (range supposed to be between 9 - 19 i think) his TPO ab was less than 1 (wasn't given a range) its just the ft3 i can't remember, sorry.  Can't give you any more information at this stage.  ft3 could have been 6 or 8 from memory but can't be sure. Both his previous TSh results were elevated - the 2nd being 5.1

[gimel]

Symptoms like you described are not normal.  If they are not caused by thyroid, then there is something else that needs to be identified.  Therefore I would follow the advice of your pediatrician and continue to get testing done.  Also, I would not rely too much on TSH.  TSH is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn.  At best it is an indicator, to be considered along wtih more important indicators, which are symptoms, and the levels of the actual, biologically active thyroid hormones, free T3 and free T4 (FT3 and FT4 should not be confused with total T3 and total T4).  

Before commenting further, I would like to see the test results for both FT3 and FT4 and their reference ranges shown on the lab report.

[6hashi]

am sorry         0.7-5.4 , but again this is statics so take this in account !

[6hashi]

the statically normal range for TSH is 0.6-5.1 for the age of 6-10 , keep checking frequently and do the above mentioned anti thyroid test !

[Spud267]

Thx alot for that.  I just wondered whether i was being paranoid.  When it involves children you are always worried, will keep at them.

Cheers

[Spud267]

Thx alot for that.  I just wondered whether i was being paranoid.  When it involves children you are always worried, will keep at them.

Cheers

[TamraW]

His TSH is very high for an adult. I'm not sure about children, but I honestly don't trust the adult reference ranges, so why would I trust the reference ranges for children?
My endo agrees that adult TSH standards need to be lowered from 3.0 to 2.0.

Let's not look at the numbers for a moment. Let's look at his symptoms. The kiddo is in pain. He has obvious hypo/hyper symptoms that NEED to be addressed and treated. Hashimoto's commonly causes these hypo/hyper swings in early stages. Therefore, TSH swings up and down, so it is not a lab value to be trusted, anyway. The only way to know for sure are the antibody tests and a thyroid ultrasound all done by a knowledgeable thyroid specialist.

Hashimoto's is the most common cause of hypothyroidism in developed countries, so why don't docs test the TGab and TPOab antibodies when they run the other thyroid tests?

Hashimoto's and/or hypothyroidism is miserable to live with if left untreated. Not fun at all. It can also cause developmental problems. You want what's best for your kiddo. Get him to an endo pronto!

This website lists recommended endos, but be sure to call the endo's office and ask if the doc treats primarily thyroid, not diabetes.
http://www.thyroid-info.com/topdrs/

:) Tamra

[6hashi]

I have a document that list the normal ranges of TSH for each age interval,I need to check whether 3.8 is normal for 6 years old child ,I would suggest to consult with an endo and to keep testing every few months .

also ask for the anti TGab ,they can be positive while anti TPOab are not ,if positive then his numbers are not normal !!

keep in touch ,
all the best .