3rd psych hospitalization and TSH levels high and low...HELP!

[bnjboxer]

Not sure where to start, but have been reading these helpful posts about TSH levels on the forum.  My child has been admitted to the adolescent psych hospital for 3rd time, 1st time self admit, 2nd time had a 'plan' and told us, 3rd time- currently- my husband and I admitted them.  This has been over the span of 1.5 years.  Suffering from severe depression, diagnosed with Major Depressive Disorder with psychotic symptoms, and anxiety.

Every hospitalization there's a blood draw, which I've just recently inquired about and will post results below.  Unfortunately, the psych hospital doesn't ask for full TSH panel.  I took my adolescent to a neuronutritionist last week and finally had a full thyroid panel done, as well as everything else that could be causing these severe mood swings.  Had DNA tested, and pharmacogenetic testing.  My child has a reduced ability to methylate all B vitamins, Vitamin D and has a SNP in DNA for thyroid and celiac disease (as do I) among many others SNP's.

Also in Nov of 2012 had spinal fusion for Congenital Scoliosis caused by hemi-vertebra, had a severe scoliotic curve that was monitored since birth by doing yearly X-Rays and curve was beginning to affect lung and heart growth.  Has 2 titanium rods from cervical to lumbar spine.  About 6 mos after surgery began the downhill depressive slide.  Has been on Zoloft, Cymbalta, Wellbutrin, and now Paxil with Abilify and still not having relief from depressive symptoms.
Great grandmother had thrombocytopenia and took Thyroid med for underactive thyroid.

Our next step if this isn't rectified is to have our child in a residential facility.  Although it would be heartbreaking to do that, we just need them to be safe and stabilized.

all labs are fasting
Range :        Reference Range

Most recent full Thyroid panel- Feb 18, 2016
TSH 0.9: 0.5-4.9
Free T4 1.01: 0.79-1.95
Free T3 3.3: 2.3-4.2
Thyroid Peroxidase AB 1: 39
VLDL cholesterol 12: 5-40
LDL cholesterol 86: 0-109

Feb 18, 2016 (Neuronutritionist- full labs below from this draw)
TSH 0.9: 0.5-4.9

To sum up with TSH levels since that seems to have the most significant changes-

Feb 7, 2015 TSH 3.93: 0.45-4.5 (1st Hospitalization)
Feb 17, 2015 TSH 0.6: 0.5-4.9 (Release from 1st hospitalization- full thyroid panel was asked for by me but not completed- and I didn't really know what to ask for, I just knew something was terribly wrong with my usual happy, funny, energetic adolescent!)
Jan 12, 2016 TSH 4.42: 0.45-4.5 (2nd Hospitalization)
Feb 18, 2016 TSH 0.9: 0.5-4.9 (Neuronutrionist ordered labs with full thyroid panel)
Currently waiting for labs from 3rd hospitalization- and my child hasn't been released yet.


Most recent blood panel & urinalysis- Feb 18,2016:
ASO Titer <100: <200
DNASE B Antibody <86: 0-310
Vitamin B12 1108: 250-1100 (High- 3rd day on Vitamin B methylation tablets- so result is skewed)
Vitamin D, 25 OH   31: 20-100 pediatric <17 yrs (25-Hydroxyvitamin D Assay includes 25-Hydroxyvitamin D2 and D3)
Celiac panel
Gliadin AB IGG 5.1: <20 negative
Gliadin AB IGA 5.6: <20 negative
TTG IgG: 2.1: <6 negative
TTG IgA 0.5: <4 negative

Candida Albicans IGA 0.18: <0.89
Candida Albicans Ab,IGG 0.29: <0.89
Candida Albicans IGM 1.50: <0.89  (High- result of 1.0 or higher positive antibody, active infection)

Ferritin 12:        7-150
Iron Binding Capacity:
Iron Serum 149:      30-158
Unsaturated IBS 319:     155-300      (High)
Calculated Total IBS 468:    250-450    (High)
Calculated % Iron Sat 32:     20-50%
Glucose 79:       65-100
BUN 13:    4-20
Creatnine 0.66:    0.40-1.10
Sodium 138:   133-146

Urinalysis
Zinc 98:   150-1200   (Low)
Mercury 5.0
Potassium 3.8: 3.5-5.3
Chloride 102:  97-110
Carbon Dioxide 18L: 22-32L    (Low)
Calcium 9.8: 8.5-10.5
Protein 7.8: 6.3-8.2
Albumin 5.1: 3.7-5.2

Any insight would be appreciated!- I'm just stumped due to a lack of thyroid antibodies.  I was so sure that this was a thyroid problem due to the significant highs and lows of the TSH levels.

[gimel]

Anyone with emotional issues deserves to be thoroughly evaluated for possible thyroid problem.  You have already been given some good info.  I just wanted to add the words of an excellent thyroid doctor who stated, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."   This pattern seems to fit your child's test results.

Also, having adequate Vitamin D is very important for thyroid metabolism at the cellular level, so it is important that D is above 50.  One other possible issue is that with low ferritin, or high or low cortisol, there is a reported tendency  for T3 to "pool in the blood" rather than making it into body tissue.   Ferritin should be at least 100, but your child had a ferritin level of 12, which is terribly low.  

Of course supplementation for  Vitamin D and ferritin are in order.  I also  suggest that you need to discuss all this with the doctor and as part of that discussion request testing for Free T3, Reverse T3, and a diurnal saliva cortisol (free cortisol) panel of 4 tests.     These will help further with diagnosis.

[Lewly]

Please see a pediatric endocrinologist for your child. But celiac blood tests are a waste and they know it. Get a biopsy. I’m celiac no b no d and hashi now. Docs hate vitamin deficiency cause no money in it until your really bad off. Ask for b12 injections and script d. If they won’t give you d take no more than 10000 iu of d3 a day that’s the max...in a kid probably half. B12 you can get shots at cash only lab clinics normally for $20. Go gluten free. And take b complex too. And check with your pharmacist about celiac and those specific meds many are cut with gluten. Also some can make matters worse if you are celiac or anemic or have thyroid issues. Go with your gut and hunt out the best drs! It will take time! Celiacs and constant gluten even from meds makes you feel really depressed and crazy. I wish you well.

[Barb135]

There's nothing to suggest that your child is swinging to hyper, other than the swings in TSH and even that's not going hyper, but it would be good to go ahead and get the Thyroglobulin Antibodies as suggested by handsinclay in order to rule out Hashimoto's.  

A thyroid ultrasound would also be good, as some people have been diagnosed on the basis of an ultrasound with negative antibodies.  

All of that said, the labs lean more toward Central Hypothyroidism than Hashimoto's, in which case, you might want other pituitary tests performed to make sure no other body functions are being compromised, as well.  

[handsinclay]

I just wanted to add to what Barb and Kassie have said.

Want to offer you some hope....I too had 2 major depressions (with brief psychosis) before being diagnosed with hypothyroidism (Hashimoto's) 25 years ago.  Once I was on thyroid medicine, I felt a lot better.  Many articles have been written on the link between mental illness and thyroid disorders. Some protocols even suggest giving thyroid medicine to euthyroid depressed patients to potentiate the anti-depressants.

I see your son's TSH is going sig'ly up and down.  This is a hallmark sign of Hashimoto's.  When it starts out, the patient can fluctuate between being hyperthyroid and hypothyroid.  Both conditions can dramatically affect mood.   I see he has had the TPO antibody test that was normal.  There is another called one called anti-thyroglobulin antibody test.

And like Barb mentioned there other forms of hypothyroidism.  But all are highly treatable with T4 or T4 + T3 meds.

Then titrating the med(s) until symptoms improved and the Free T4 and Free T3 are in ranges described above.  

[kassieK22]

I forgot to mention that magnesium can cause stomach upset so be sure and research which type to use.

[kassieK22]

Hi bnj. I defer to others on interpreting the lab results but will describe the situation w/ my daughter and what has helped us. She was at Univ. and had uncontrollable crying , feeling depressed, etc. and eventually had to come home. She was largely vegetarian at the time and that seemed to exacerbate her symptoms. We put her on mostly grain free/legume free diet. She had improvement but not back to normal. She was low in D and B vitamins also. She supplements with those. The biggest gain seemed to come from starting magnesium. She claims a huge improvement (lives at Univ. again) with some problems when she backslides with diet. She was borderline on TSH with a level of 2.99 where 3.0 is considered clinical so not on any meds. Magnesium deficiency appears to be widespread and perhaps that will help with your child's mood swings etc. My daughter reported huge mood swings were her worst symptom before we changed diet and added supplements.  Also look up the list of anti-thyroid vegetables/foods as these make her feel much worse. I hope and pray you find some solutions to these things. We are still muddling along to improve  my daughter's energy level and stamina.

[Barb135]

Typically, when one is hypothyroid, FT4 and FT3 are low or low normal and TSH is high and when one is hyperthyroid, FT4 and FT3 are high, while TSH is very low...

Your child's Free T4 is very low in its range, indicating hypothyroidism...The TSH is what many doctors would consider "pristine" and, unfortunately, that's what most of them use to determine hypo or hyperthyroidism...  The problem with TSH is that it's very volatile and is affected by many things, other than thyroid hormones and can fluctuate by as much as 75% over the course of a day, so the fact that your child has has only TSH tests done is quite unhelpful, especially, if those tests were done at different times of the day.  TSH tends to be highest in the morning.  

Rule of thumb (where most of us feel best) is for Free T4 to be about mid range.  Your child's Free T4 is only at 19% of its range.  Rule of thumb for Free T3 is upper half of its range and your child's Free T3 is at 53%, so that's good, but since the Free T4 is so low, we'll expect Free T3 to be following suit very soon, because most of the Free T3 in the body is converted from Free T4.

Most hypothyroidism is caused by the autoimmune condition called Hashimoto's, but as I noted, that would marked by high TSH and low Free T4.  Since your child's TSH is also very low, I think you should talk to the doctors and have them central central hypothyroidism.  Central hypothyroidism is problem with the hypothalamus/pituitary axis in the brain, where the thyroid actually works correctly, but it doesn't get adequate stimulation (TSH) to produce enough hormones.

Central hypothyroidism is treated with replacement thyroid hormones, just like any other hypothyroidism and I think it would be in your child's best interest to be started on thyroid hormones.

Since the vitamin D level is also very low in its range, it's necessary to correct that deficiency as well.  Vitamin D deficiency can cause a lot of hypo-like symptoms, including depression and it's also linked to immune function.

Your child's ferritin level is also way too low.  Ferritin is the iron storage hormone and iron is necessary for proper thyroid synthesis.  Even though serum iron level is at the top of the range, there is none in storage.  Is your child taking an iron supplement?   Iron is necessary for the conversion of Free T4 to the active Free T3.

It appears that the celiac panel is all negative and your child does not have celiac.

I also notice that the urine zinc level is low; I'm not absolutely positive of the significance of that; however, I might suggest that you try to get a micro-nutrient test done on your child to make sure there are no other nutritional deficiencies that need to be dealt with.