Aa
15 year old daughter
My 15 year old daughter was recently seen by her family physician for thoracic back problems. She has been treating for this for 2 years with no relief from traditional trreatments. He ordered an MRI Scan and blood tests. Apparently a thyroid test (TSH) showed a level of 7.84. He then followed up with additional thyroid screen blood tests the following week and the TSH was 5.39. Apparently the T3 and T4 levels were within normal limits and the thyroglobulin was at 5.18. She has no typical symptoms of hypothyroidism. She is 5' 7" and 116 pounds. Her doctor thinks this may be related to her back problems. We are scheduled to see the endocrinologist this week I would just like to understand what these tests results mean. We are pretty confused and not sure what all these blood tests mean. Any information you can give us would be very helpful. Is it possible to have hypothyroidism and have no symptoms and could this be causing her muscle "knots" in her back which cause her daily pain? Thank you for any help and information you can give us.
Unfortunately, I can't help you there. Every lab is different. On the lab sheets (which you did insist on getting a copy of, right?) it will either have the range for that lab printed or it will say "N" for normal (which is always frustrating). TSH is the range which is most disputed; the anti-TPO's range that your lab uses is probably appropriate.
Thyroid hormone is a very important regulator for most of the body's functions and effects almost every organ of the body.
Some basic anatomy:
When the body needs thyroid hormone:
The pituitary gland send TRH to the hypothalamus;
The hypothalamus then sends TSH to the thyroid;
A healthy thyroid responds by producing about 87% T4 and the rest T3. (T4 "turns into" T3 when needed).
If the thyroid is unhealthy, and someone is hypothyroid, the thyroid does not produce enough thyroid hormone in the form of T3 and T4. So the pituitary gland keeps trying harder, sending more TRH. So the hypothalamus sends more TSH.
Therefore high TSH and high TRH = hypothyroidism (too little thyroid hormone.)
Low T3, low T4, and especially low "free" T3 and T4 are also hypothyroid. (Incidentally, the "free" measures of T3 and T4 are much better indicators of what is really going on in the body, and the best guide for thyroid treatment.)
(Hyperthyroidism is the opposite.)
As I told someone else:
According to the American Thyroid Association, "normal" is classified as a TSH between 0.4 and 2.5; back in 2003 they classified 2.5 to 4.0 as "at risk" and 4.0 to 10.0 as subclinical hypothyroidism, which doctors could treat at their own discretion. Above 10 is classified as overt hypothyroidism.
Your daughter, with elevated TSH and normal T3 and T4, is a typical subclinical thyroid patient.
Research since 2003 has shown that even very small elevations in TSH - within the 2.5 to 4.0 range - carry significant health issues (cardiovascular, etc) and more recently, evidence has shown that treating those patients helps to lower such risks. 95% of the normal population has a TSH between .4 and 2.5. (Previous ranges were based on data skewed by including those with thyroid disorders).
A joint statement by the ATA and the CDC states that women who want to become pregnant and have a TSH over 2.5 should be treated to prevent miscarriages, premature births, and other significant health issues to the fetus.
Someone who has lived with hypothyroidism for some time may not realize that their body is different from others. While they may experience slow digestion and constipation, they may believe that to be normal. While they may experience a foggy mind or periods of lethargy, they may think everyone does. Or these may be falsely attributed to anemia that is actually caused by hypothyroidism. Dry skin, brittle nails and hair, and even sensitivity to cold weather can be brushed off as minor issues. Dizziness (created by the body's inability to regulate carbohydrates as effectively) is simply thought to be caused by not eating often enough. Unfortunately, hypoglycemia in any form is very dangerous!
I personally thought that 10-day periods were the norm. The idea that most people have 5-day periods was crazy to me. I also have extremely horrible PMS that causes nausea and vomiting, but because my sister also did, I thought it was normal. My periods vary from 78 to 24 days relentlessly.
However, hypothyroidism should not be brushed off. Long term issues include cardiovascular disease, hair loss, depression, and acute psychological disorders - among others.
One condition associated with hypothyroidism is muscle hypotonia. Hypothyroidism reduces the body's ability to synthesize protein. That is why it weakens the immune system (so patients get sick more easily and stay sick much longer.) Patients with weakened muscles are less able to support normal posture; as a result, they may find the muscles knotting up in response. This is only a theory, however. I would hope your doctors can guide you better.
Remember that medicating for hypothyroidism is not the same as most medications. Instead of introducing an artificial agent, this is simply replacing what your body should be making on its own. The "side effects" of medicating are typically experienced when people take more than they need. The ATA states that it is safe to medicate those with subclinical thyroid disorders as long as the dosage is controlled (in other words, as long as the patient is not given so much hormone that they actually become hyperthyroid.) In the old days, before these lab tests were available, doctors would simply increase dosages until hyper-symptoms emerged, then cut back a little for the correct dosage. For better or for worse, in the past people were given far larger dosages than they receive today.
The target range for medication is between .5 and 2.0.
Let me know if that's confusing at all.
Some basic anatomy:
When the body needs thyroid hormone:
The pituitary gland send TRH to the hypothalamus;
The hypothalamus then sends TSH to the thyroid;
A healthy thyroid responds by producing about 87% T4 and the rest T3. (T4 "turns into" T3 when needed).
If the thyroid is unhealthy, and someone is hypothyroid, the thyroid does not produce enough thyroid hormone in the form of T3 and T4. So the pituitary gland keeps trying harder, sending more TRH. So the hypothalamus sends more TSH.
Therefore high TSH and high TRH = hypothyroidism (too little thyroid hormone.)
Low T3, low T4, and especially low "free" T3 and T4 are also hypothyroid. (Incidentally, the "free" measures of T3 and T4 are much better indicators of what is really going on in the body, and the best guide for thyroid treatment.)
(Hyperthyroidism is the opposite.)
As I told someone else:
According to the American Thyroid Association, "normal" is classified as a TSH between 0.4 and 2.5; back in 2003 they classified 2.5 to 4.0 as "at risk" and 4.0 to 10.0 as subclinical hypothyroidism, which doctors could treat at their own discretion. Above 10 is classified as overt hypothyroidism.
Your daughter, with elevated TSH and normal T3 and T4, is a typical subclinical thyroid patient.
Research since 2003 has shown that even very small elevations in TSH - within the 2.5 to 4.0 range - carry significant health issues (cardiovascular, etc) and more recently, evidence has shown that treating those patients helps to lower such risks. 95% of the normal population has a TSH between .4 and 2.5. (Previous ranges were based on data skewed by including those with thyroid disorders).
A joint statement by the ATA and the CDC states that women who want to become pregnant and have a TSH over 2.5 should be treated to prevent miscarriages, premature births, and other significant health issues to the fetus.
Someone who has lived with hypothyroidism for some time may not realize that their body is different from others. While they may experience slow digestion and constipation, they may believe that to be normal. While they may experience a foggy mind or periods of lethargy, they may think everyone does. Or these may be falsely attributed to anemia that is actually caused by hypothyroidism. Dry skin, brittle nails and hair, and even sensitivity to cold weather can be brushed off as minor issues. Dizziness (created by the body's inability to regulate carbohydrates as effectively) is simply thought to be caused by not eating often enough. Unfortunately, hypoglycemia in any form is very dangerous!
I personally thought that 10-day periods were the norm. The idea that most people have 5-day periods was crazy to me. I also have extremely horrible PMS that causes nausea and vomiting, but because my sister also did, I thought it was normal. My periods vary from 78 to 24 days relentlessly.
However, hypothyroidism should not be brushed off. Long term issues include cardiovascular disease, hair loss, depression, and acute psychological disorders - among others.
One condition associated with hypothyroidism is muscle hypotonia. Hypothyroidism reduces the body's ability to synthesize protein. That is why it weakens the immune system (so patients get sick more easily and stay sick much longer.) Patients with weakened muscles are less able to support normal posture; as a result, they may find the muscles knotting up in response. This is only a theory, however. I would hope your doctors can guide you better.
Remember that medicating for hypothyroidism is not the same as most medications. Instead of introducing an artificial agent, this is simply replacing what your body should be making on its own. The "side effects" of medicating are typically experienced when people take more than they need. The ATA states that it is safe to medicate those with subclinical thyroid disorders as long as the dosage is controlled (in other words, as long as the patient is not given so much hormone that they actually become hyperthyroid.) In the old days, before these lab tests were available, doctors would simply increase dosages until hyper-symptoms emerged, then cut back a little for the correct dosage. For better or for worse, in the past people were given far larger dosages than they receive today.
The target range for medication is between .5 and 2.0.
Let me know if that's confusing at all.
Re the scan...I would have thought that she should have one....just in case. Better to know exactly where you stand.
...Julia
...Julia
Well, I'm guessing that she has other underlying symptoms that she will realise later on. The medication will control it....you/she will always have to look out for the signs and possibly adjust medication. The medication she's on only works for some. Many people find they need to add T3 to the mix.
Seeing she has an autoimmune disease then you will probably recognise now others in the family who have an autoimmune disease....not necessarily Hashimotos. Diabetes, Celiac Disease, Raynauds, etc etc. Usually something triggers them off. In my daughters case I believe it was the Hep B vaccination as my son began getting sick at the same time (but I haven't figured out exactly what's going on with him yet).
You can be thankful that you have found it before it did affect her and her relationships, schooling etc. Give yourself and your doc a gold star because more often than not, people with thyroid disease get sent out of that doctor-revolving-door all too often told they are normal....and then considered hypocondriacs. They go on for years before getting a diagnosis and some help. Because they LOOK ok, they are not taken seriously.
I would certainly get you your other girl tested and keep up on autoimmune disease symtpoms. It may come from the other side of the family. Best wishes.
...Julia
Seeing she has an autoimmune disease then you will probably recognise now others in the family who have an autoimmune disease....not necessarily Hashimotos. Diabetes, Celiac Disease, Raynauds, etc etc. Usually something triggers them off. In my daughters case I believe it was the Hep B vaccination as my son began getting sick at the same time (but I haven't figured out exactly what's going on with him yet).
You can be thankful that you have found it before it did affect her and her relationships, schooling etc. Give yourself and your doc a gold star because more often than not, people with thyroid disease get sent out of that doctor-revolving-door all too often told they are normal....and then considered hypocondriacs. They go on for years before getting a diagnosis and some help. Because they LOOK ok, they are not taken seriously.
I would certainly get you your other girl tested and keep up on autoimmune disease symtpoms. It may come from the other side of the family. Best wishes.
...Julia
Thank you so much for your helpful comments. We saw the endocrinologist this week. She does have the Hashimoto' disease. She has a goiter and her antibodies were elevated. He has started her on Synthroid like .075. He wants to see her back in 3 months. Hopefully the medicine will help her. She really (other than the back muscles) has no other symptoms of hypothyroidism. She does not experience any cold feelings, she's not argumentative or fatiqued and is probably a little underweight for her height. Was hoping he would opt to watch her for awhile, but with the back, goiter and increased antibodies he put her right on the medicine. I guess if any good can come from this I am hoping that she won't suffer from the daily pain of her upper back pain/spasms. I guess I will believe it when they are gone. Still hard for me to believe that her thyroid is causing them but am hopeful the cramps will go away.
The doctor felt a pretty sizeable goiter. Is this something that she should have a thyroid scan or ultrasound or something on? I did request copies of all the blood work as this is now something I will have to keep track of. He also said there is a 50/50% chance my 18 year old daughter does/will develop it and she should get tested and that I porbably already have it. I guess it means blood tests for all the girls in the house. Thanks for the kind thoughts and suggestions.
The doctor felt a pretty sizeable goiter. Is this something that she should have a thyroid scan or ultrasound or something on? I did request copies of all the blood work as this is now something I will have to keep track of. He also said there is a 50/50% chance my 18 year old daughter does/will develop it and she should get tested and that I porbably already have it. I guess it means blood tests for all the girls in the house. Thanks for the kind thoughts and suggestions.
May I suggest you ring your clinic and collect a copy of your tests. I and my 14yo daughter have thyroid disease and I was told normal on 2 separate occasions before diagnosis when I was well hypothyroid and should have been treated. This is because the lab used old ranges and the doctor relied on the lab!
Both my daughter and I get very bad back/neck/shoulder pain pre diagnosis and if we go "down" these back aches are one of the first things to come back. Also every morning your whole body will ache as though you've been sleeping in a bad position!
Also we get slight "buffalo" humps....not obvious to the eye but you tend to rub the middle of the back/neck to try and get some relief.
Both the 7.89 and 5.39 are high TSH scores. I would be feeling very very shabby with my TSH that high. The new standard ranges are 0.3 to 3.0. If she has antibodies then the TSH score will be affected.
If you don't have hypothyroidism you may not be "switched" on to the symptoms which begin slowy. I noticed things in my daughter which others would not have....shedding more hair than usual, colder than usual, neck getting "pudgy", irritable and argumentative, heel pain, dizzy on standing in morning, neck/back/shoulder pain, concentration becoming more of a problem (re homework), writing lists, resentment of family, more fatigued than usual. All things that could be put down to being a teenager....but put them all together and you have Hashimoto's hypothyroidism!!
Remember to get copies of all your tests! Best wishes for your girl. Get some thyroid hormone into her as soon as you can. It takes ages to see any results I found it was about 12 months, so the sooner the better.
...Julia
Both my daughter and I get very bad back/neck/shoulder pain pre diagnosis and if we go "down" these back aches are one of the first things to come back. Also every morning your whole body will ache as though you've been sleeping in a bad position!
Also we get slight "buffalo" humps....not obvious to the eye but you tend to rub the middle of the back/neck to try and get some relief.
Both the 7.89 and 5.39 are high TSH scores. I would be feeling very very shabby with my TSH that high. The new standard ranges are 0.3 to 3.0. If she has antibodies then the TSH score will be affected.
If you don't have hypothyroidism you may not be "switched" on to the symptoms which begin slowy. I noticed things in my daughter which others would not have....shedding more hair than usual, colder than usual, neck getting "pudgy", irritable and argumentative, heel pain, dizzy on standing in morning, neck/back/shoulder pain, concentration becoming more of a problem (re homework), writing lists, resentment of family, more fatigued than usual. All things that could be put down to being a teenager....but put them all together and you have Hashimoto's hypothyroidism!!
Remember to get copies of all your tests! Best wishes for your girl. Get some thyroid hormone into her as soon as you can. It takes ages to see any results I found it was about 12 months, so the sooner the better.
...Julia
Important correction: the actual cascade is
TRH from the hypothalamus stimulates TSH from the pituitary.
(I accidentally wrote that TRH went from the pituitary to stimulate TSH in the hypothalamus. My apologies).
TRH from the hypothalamus stimulates TSH from the pituitary.
(I accidentally wrote that TRH went from the pituitary to stimulate TSH in the hypothalamus. My apologies).
MEDICAL PROFESSIONAL
The thyroglobulin level is likely normal. The TSH is high on two separate tests -- suggesting a slightly underactive thyroid. Would need to know reference range for TPO - as Hashimoto's would be the most common cause of thyroid underactivity. Also, would retest TSH 6 weeks apart from the slightly high levels to make sure it is not a transient problem that will self-correct. Muscle spasms can come from hypothyroidism. The back problems are not likely to cause a thyroid problem.
Thanks again. The doctors office also told me what I thought was something ppo, but it was probably this TPO you are speaking of. The level for that test was 3.89. Not sure if this is "normal" considering all of the other results. Any last help? You have been so very helpful and patient. What can you tell me about this last test? Still just hoping to have a better understanding for when I speak to the endocrinologist at tomorrow's appointment. Is there a "normal" range for this test? I'm sure we will discuss all of this at the appointment, just want to be as prepared as possible. Thanks!
The issue with the thyroglobulin is that you probably don't know whether the test was for thyroglobulin specifically or thyroglobulin antibodies. Thyroglobulin is used by the thyroid to make T3 and T4. If you have certain forms of hypothyroidism and some other conditions, you will have high levels of antibodies in your blood that actually attack thyroglobulin. The first test (thyroglobulin) may or may not be of minor significance compared to the other tests your daughter has had. The second test may be slightly more meaningful. Ask your doctor for his professional opinion on that test.
However, according to the American Thyroid Association, because your daughter got above 2.5 on her TSH, she should get an Anti-Thyroid Peroxidase antibody (anti-TPO) test to see if she has an autoimmune thyroid disorder, which is the most frequent cause of hypothyroidism. This test may be very meaningful to your doctor.
However, according to the American Thyroid Association, because your daughter got above 2.5 on her TSH, she should get an Anti-Thyroid Peroxidase antibody (anti-TPO) test to see if she has an autoimmune thyroid disorder, which is the most frequent cause of hypothyroidism. This test may be very meaningful to your doctor.
Thank you so much for all your information. It was very clear and very helpful. You answered all my questions in terms that were easy to understand. One last question is about these thyroglobulin levels. I can't seem to find any information on them. All I know is that I heard the number 5.18 in regards to this test. Perhaps I don't have all the information about it. Any additional help with this test is appreciated. Thanks again!
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