High Thyroid Antibodies

[JT1963]

My 13 year old daughters Thyroid test - TSH                                     3.3mU/L        (0.40-4.00),
                                                                free Thyroxine (fT4)            15 pmol/L       (10-20),
                                                                free T3                                5.2 pmol/L     (2.8-6.8)
                                                               Anti-Thyroglobulin Ab           250      /mL   (<60)
                                                               Anti-Thyroid Peroxidase Ab  3200    /mL    (<60)

She is going for another test soon, Please tell me what you think is wrong with her.....

[goolarra]

Your daughter's FT3 and FT4 still look quite good.  Besides weight gain, does she have other hypo symptoms...cold intolerance, fatigue/drowsiness, etc?  Is your doctor addressing her low iron levels?  

I think I'd agree with your husband on this.  The elevated antibodies show that she has Hashi's.  Has your doctor discussed the pros and cons of starting treatment early with you?  A second opinion might help you sort it all out sooner.  Even without getting a second opinon, I don't hink I'd wait a whole year to test again...that might be appropriate for an adult than for a still-growing child.

[JT1963]

I have the latest test results for my daughter. Taken on 29th July.
Thyroid Antibodies - Peroxidase Ab      737      Units IU/ml Range (<6)
                           - Thyroglobulin Ab    65                                  (<4)

Free T4                  13.7  Units pmol/L  Range (9.0 - 19.0)
Free T3                    4.7                                (3.0 - 7.0)
TSH                         2.7                                (0.3 - 5.3)

Iron levels - Trans Sat is low 12 (20 -55)

The doctor just suggest repeating the test in 1 year.  What would you suggest?  My husband would like her to see a specialist.  My daughter seemed to grow very quickly in the last few years and she is over weight.

[goolarra]

The first test was more clearly hypo.  TSH was elevated above range, and FT4 was lower in the range than it is now.  So, it's looking like she has Hashi's.  As the antibodies attack the thyroid in the early stages of the disease, there are often swings in labs from hypo to hyper to "normal".  

There's a lot of debate as to when to start treating Hashi's.  Some doctors refuse to treat until labs have become clearly hypo and the person is symptomatic.  Others feel that treating earlier has advantages.  I'm sure you'll find plenty of reading material on the subject.  

Let us know how the next round of tests goes...

[JT1963]

Hi Goolarra,  Thank you for the reply.  The doctor is having the same tests run again.  My daughter has had a few Hypoglycemic episodes.  One was quiet bad, she did not know anyone, could not talk, had very bad headaches etc. She was taken to hospital in the Ambulance, they checked all blood sugar levels and they were all fine. My mother in law,3 of her sisters and a male cousin all have Thyroid problems.  
The 1st test.   My daughter had a series of test (all done at the same time) including a glucose tolerance with insulins test, this showed the insulin levels were mildly elevated, her iron saturation was low and her TSH was high at 6.2 mU/L (0.3-5.0)  Her free T4 was 11.6 pmol/L (9.0-19.0)  Comments on Collection suggest sub - clinical hypothyroidism.  Asked to repeat the test in 3 months.
She had another lot of test after this and I don't have the results, the doctor said the TSH had come down a bit, but she wanted the test repeated in a month.  They are the results that you have commented about.

[goolarra]

Although I'm not a doctor, I see that both your daughter's TPOab and TGab are elevated which indicates that she has autoimmune thyroid disease, either Hashimoto's thyroiditis (hypo) or Graves' disease (hyper).  Does she have either hypo or hyper symptoms?

At the moment, her TSH is slightly elevated.  AACE recommended several years ago that TSH range be changed to 0.3-3.0.  Your lab uses and old range (most do).  Elevated TSH indicates hypo.  However, your daughter's FT4 looks very good.  It's right in the middle of the range, which is the target for FT3.  FT3 also looks good.  It's in the upper half of the range.  My guess is that she's asymptomatic.  Why were the thyroid tests ordered?

Thyroid antibodies can be elevated for years or even decades before they do enough damage to the thyroid to cause symptoms.  On the other hand, they can go like gangbusters.  

Do you know what tests they are going to run next?  Has the doctor diagnosed a disease?