which tests to ask for

[tomaso65]

Hi
I suspect my daughter has a thyroid issue.  She has many symptoms including low energy, easy bruising, constipation, elevated heart rate (she has had all of these for as long as i can remember).  She has lost a significant amount of hair over the last few years.  She is 12.  She had some blood work done (TSH, Iron and hemoglobin).  Everything came back normal except the iron was a little low.  Are there other tests i should ask for to try to determine if there is an issue with thyroid.  She is a pretty happy kid with lots of friends and does not exhibit any signs of depression or extreme moodiness.  Thanks for any help.

[Barb135]

Obviously, you know the ferritin is too low, and it's good that you have her on an iron supplement.

Her FT4 is pretty low in the range, so that could be an issue.  Are you sure that's a Total T3 and not Free?  It's probably right, but both the result and range look like something we might see with FT3, not TT3, except that the low end of the range is extremely low.

If it really IS Total T3, I hate to say it's of limited value, because of the total T3 in circulation, some of it will be bound by protein and will be unavailable for use.  The free T3 shows how  much is free (unattached to protein) and available for use.

Did you ask the doctor about antibody testing?  Have there been any other adrenal tests done?

What about vitamin B12?  I know when my B12 levels were low, I bruised horribly, plus had the most horrible fatigue imaginable.

If you have an endo in mind, why not call and ask if they require a referral? Some don't.   Also check with your insurance, if you have it, to see if they require referrals to specialists. Some don't.   If neither does, just go ahead and make an appointment, without the pcp...

[tomaso65]

Hi
My daughter's test results are as follows:

ferritin 35
which is in the reduced iron store category (31-79).  Previously it was 28 which was in the depleted iron store category (12-30).  We currently have her on an iron supplement

TSH 2.22
Normal lab range .5-5.30

Free T4 14
Normal lab range 10-28

T3 Total 2.4
normal lab range 1.0-4.3

DHEAS 1.5
normal lab range .92 - 7.6

As mentioned in a previous post, she exhibits many signs of having a thyroid issue.  I would like to get a referral to see an endo but the GP is reluctant given the blood work.  Any help interpreting the numbers or formulating an argument to get a referral would be helpful.

[Red_Star]

There are many possible symptoms of iron deficiency including low energy, easy bruising, constipation, elevated heart rate, hair loss.

Iron deficiency can be the result of numerous causes which includes:

* Inadequate iron intake

* Rapid periods of growth

* Heavy menstruation

* Pregnancy

* Frequent or excessive blood donations

* Surgery or accidents

* Medications that cause bleeding such as aspirin, non-steroidal anti-inflammatory medicines (NSAIDs)

* Bleeding due to conditions such as ulcers, haemorrhoids, hiatal hernias, colon polyp, colon cancer

* Hypochloridia (low stomach acid), achlorhydria (no stomach acid)

* Bowel diseases such as Crohn's disease, ulcerative colitis, Celiac disease

* Inherited disorders such as thalassaemia, sickle cell disease

* Autoimmune diseases such as autoimmune haemolytic anaemia, systemic lupus erythematosus, rheumatoid arthritis, polymyalgia rheumatica

* Infections such as malaria, septicaemia, tuberculosis, osteomyelitis, intestinal infections (hookworm and other parasites), chronic/recurrent urinary tract infections

* Bone marrow conditions such as aplastic anemia (bone marrow failure), leukemia

* Hormonal conditions such as hypothyroidism

* Uterine fibroids (growths in the uterus)

* Chronic conditions such as cancer, HIV/AIDS

* Kidney disease/failure (erythropoietin [EPO] stimulates the bone marrow to make red blood cells)

* Liver disorders such as hepatitis C

* Poisoning from lead, toxic chemicals, alcohol abuse

* Intestinal surgery such as gastric bypass

* Excessive exercise (iron is lost in sweat)

* Diets that do not include heme iron (the form of iron in red meat) which is absorbed more efficiently than non-heme iron found in plants and dietary supplements

* Low or deficient vitamin C, vitamin B12, folate or zinc (nutrients that facilitates sufficient non-heme iron absorption)

* Lack of intrinsic factor (a protein necessary for the absorption of vitamin B12)

* Consuming foods, substances or medications that interfere with the absorption of iron such as:

- taking antacids
- proton pump inhibitors  
- calcium supplements
- dairy products
- coffee
- tea
- chocolate
- eggs
- fiber

[goolarra]

You should ask your doctor to run FREE T3 and FREE T4.  These are the actual thyroid hormones and much more important than TSH is determining thyroid status.  FREE T3 and FREE T4 are different and much more useful than total T3 and total T4.

In addition, you might want to request TPOab (thyroid peroxidase antibody), TGab (thyroglobulin antibody) and TSI (thyroid stimulating immunoglobulin) to see if she might be in the early stages of autoimmune thyroid disease.  Most thyroid dysfunction in the developed world is autoimmune.

Be aware that FT3 and FT4 just "in range" often isn't sufficient.  Many times levels have to be in the upper half of range before we have no hypo symptoms.  If you get results and want help interpreting them, we can do that.  Be sure to get reference ranges with results as they vary lab to lab and have to come from your own lab report.

Iron deficiency can cause thyroid hormones to be not properly metabolized, so you might want to consider asking your doctor about supplementing.