11-year-old son diagnosed with Graves. Please help with test results and next steps.

[tsomshku]

Our 11-year-old son was recently diagnosed with Graves disease and we are still in shock and trying to process this sharp turn in our lives. Three weeks before he was diagnosed he passed his annual physical exam (where his goiter was checked as well) and he was 'labeled' a healthy boy. He also got a tdap shot required for school and we think this played a role with his immune system. Three weeks later, an abnormal blood test sent us to the endocrinologist where we also realized that our son's goiter was enlarged. A more detailed blood test confirmed Graves diagnosis.
He was put on 10mg of methimazole. A blood test that was done two weeks later showed a drastic reduction in “T3, Total” and “T4, Free”. We were told to continue with blood tests every month for the next two months. As we are trying to educate ourselves and find any available info about Graves disease, we are concerned that if his “T3, Total” and “T4, Free” fell to almost half its original value in just two weeks, these values might go down much further, even below the minimum reference range,  in a month, when another blood test has to be done.
Below are the blood test results. Please, any information or thoughts will be helpful.
Thank you.

06/06/2018:
TSH    < 0.01 (0.50-4.30 mIU/L)
T4,Free    3.9 (0.9-1.4 ng/dL)
T3 Uptake    40 (22-35 Percent)
T3, Total    610 (105-207 ng/dL)
GGT    52 (3-22 U/L)
AST    114 (12-32 U/L)
ALT    266 (8-30 U/L)

06/07/2018:
TSH    700 (<140% baseline)
Thyroid Peroxidase Antibodies    457 (<9 IU/mL)
Thyroglobulin Ab    99 (OR = 1 IU/mL)

06/08/2018: started 10mg methimazole

06/21/2018:
TSH, 3RD Generation    700 % baseline (<140 % baseline)
GGT    31 U/L (3 - 22 U/L)
AST    25 U/L (12 - 32 U/L)
ALT    26 U/L (8 - 30 U/L)

[Barb135]

I've contacted the mods and requested that unnecessary posts be deleted to eliminate confusion in the thread.

It's not unusual to have, both, Hashimoto's and Grave Disease.  It appears that's what your son has, with Graves being dominant at the moment.

It's unfortunate the doctor ordered obsolete tests, such as T3 Uptake and Total T3.  Next time tests are ordered you should make sure Free T3 is ordered instead of Total T3 since Total T3 is the sum of bound and unbound T3.  

I agree that if your son continues on the same dosage of methimazole his levels could/should continue to drop at the same level; he may end up at the opposite end of the range by the time he has the next blood tests.  I'm wondering if the doctor is looking only at the TSH level, which stayed at < 0.01 from one test to the next.  

Please do not let them make the mistake of treating your son by TSH level only, even though they may be testing Free T4 and T3.  They must treat by Free T4 and Free T3 levels, not TSH which is a pituitary hormone, not a thyroid hormone.

[Red_Star]

The symbols disappeared. lol

[Red_Star]

I had the same issue with my answers. I figured out medhelp has issues with the symbols:  

"The etiology and the trigger mechanism of autoimmune disease are still unclear [11], but several studies suggest that a vaccine component (inactive viral/bacterial agent or attenuated living microorganism) or a wild superimposed infectious agent can induce autoimmune disease in people with a genetic predisposition [12, 13]."*

*Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon? - EPMA Journal 2017 Sep; 8(3): 295–311.

I had Graves antibodies for a couple of months and besides being very hyperthyroid I also had pretibal myxedema (on my shin) and thyroid eye disease symptoms (thankfully no bulging). I have Hashimoto's but a seriously stressful event triggered Graves antibodies. The moment that stress resolved Graves went away. I have had a moment this year with Graves again but only a few days.

[tsomshku]

Thank you, Sarahjogs!
Yes there are  the symbols for less than and greater than in the cut off test results. I am trying to repost once again:

06/06/2018:
TSH    < 0.01 (0.50-4.30 mIU/L)
T4,Free    3.9 (0.9-1.4 ng/dL)
T3 Uptake    40 (22-35 Percent)
T3, Total    610 (105-207 ng/dL)
GGT    52 (3-22 U/L)
AST    114 (12-32 U/L)
ALT    266 (8-30 U/L)

06/07/2018:
TSH    < 0.01 (0.50-4.30 mIU/L)
T4, Free    3.6 (0.9-1.4 ng/dL)
T3, Total    517 (105-207 ng/dL)
TSI    more than 700 (140% baseline)
Thyroid Peroxidase Antibodies    457 (<9 IU/mL)
Thyroglobulin Ab    99 (OR = 1 IU/mL)

06/08/2018: started 10mg methimazole

06/21/2018:
TSH, 3RD Generation    <0.01 mIU/L (0.50 - 4.30 mIU/L)
T4, Free    1.8 (0.9-1.4 ng/dL)
T3, Total    316 (105-207 ng/dL)
TSI    more than 700 (140% baseline)
GGT    31 U/L (3 - 22 U/L)
AST    25 U/L (12 - 32 U/L)
ALT    26 U/L (8 - 30 U/L)

[Barb135]

It's been a long time since I've had trouble using the symbols for less or greater than but please try typing out the words instead of using the symbols and see if that helps.

[tsomshku]

THE BLOOD TEST RESULTS WERE CUT OFF AGAIN! WHY?

[Sarahjogs]

HI tsomshku,

I've had problems with test results getting cut off when I use the symbols for less than and greater than, everything in between gets deleted... I'm not sure this is your problem here, but  thought I'd mention it in case it is.  If there are symbols involved, I'd suggest trying to type them out and see if that fixes the problem.