what's the diagnosis and treatment

[yes139]

Hello Doctor,

my 27 years old daughter recently had a blood test which showed

TPOab  > 1000            ( >35)
THyroglobulin AB < 20  (< 20)

TSH      1.58    (0.4-4.5)
T4 Free  0.9     (0.8-1.8)
T3 Total  71     (76-181)
T3 Uptake  33  (22-35%)

Her PCP recommended her to see an Endocrinlogist.  I just don't understand why her TSH is normal but  T3 & T4 all relatively low.  And her antiboy is extremely high.
Does she has underactive Thyroid (Hashimotos) ?  Any treatment needed ?

ALso my 19 years old daughter has a blood test which showed

TPO AB             < 10
THyroglobulin AB < 20

TSH = 0.68         (0.5-4.3)
T4 total    5.3      (5.6 - 14.9)
T3 Update  33     (22-35)
T4 Free    1.7      (1.4-3.8)

What's her problem, why everthing is relatively low ?  What if the number is getting lower and lower (compared her TSH with previous years, it is getting lower)?  What treatment is needed in the future ?

They both have some hypothyrodism symptoms (constipation, weight gain,thin hair).

Please advise,  I really appriciate it.  Thanks !!

[Ksladybug]

I was diagnosed with hypothyroidism about 10 years ago. Hypothyroidism means that my thyroid gland does not produce enough of the required hormones and they refer to it as a slow metabolism. Without medication to control the hypothyroidism, the hormone deficiency effects everything. My menstral cycle goes nuts, I am sleepy all the time, and my blood levels are effected among other things. The only effects I have had from synthroid were more energy, my appetite back and my levels are finally normal.

[yes139]

Thank you so much for explaining.   When usually the time  to take the thyroid replacement if TSH goes up to over 5 or over 10 ?   Why there is different opinion ?
Please advise.  THanks !!

[V. Kumaravel, MD]

Dear yes139,

I do understand that your daughter has features of constipation, weight gain and has some abnormality in blood results.

Your first daughter's TPOab (Thyroid Peroxidase Antibody) of > 1000, TSH (Thyroid Stimulating Hormone) and FT4 (tetra-iodothyronine) is normal with a low T3 (tri-iodothyronine). Your daughter is probably suffering from autoimmune thyroid disease due to Hashimotos disease. Her thyroid functions are normal as her TSH and FT4 is normal. She may not require any thyroid replacement as of now, but in view of high TPOab, she may require regular thyroid blood test and treatment if required.

Your second daughter's report is relatively normal, except for T4 total. Free hormones are more reliable than total hormones. As her Free T4 is normal we can ignore the value of T4 total. TSH is a range and as long as it is within normal ranges nothing to be concerned.
  
Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. V. Kumaravel