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Low TSH (0.010) in 14 yr old girl
Hello!
I am new to this and I am hoping that someone else out there has an idea of what might be going on with my daughter. She is 14 years old, has been experiencing difficulty sleeping, nervousness, slight hand tremors that come and go, weight loss, loss of appetite, irregular periods. Her pediatrician did blood work and the only concerning value was her TSH, which was .010. The pediatrician sent us to a Pediatric Endocrinologist who in turn ordered more blood work which the results are;
TSI <89%
T4 Free, direct 2.1 (ref range 1.0-2.4)
TSH <0.010 (ref range 0.5-4.3)
Thyroglobulin AB 24 (ref range 0-20)
Thyroid Peroxidase AB 15 (ref range 0-34)
I had to pick the lab results up directly from the lab as the pediatric endo had still not gotten back to us as of today, 5/5, about the labs which were drawn on 4/23 and according to the lab paperwork were completed by 4/30. He did say when he saw her on the 23 that he was evaluating her for early Hashimotos or Graves. Any ideas what the labs say about her condition? Thanks!!
I am new to this and I am hoping that someone else out there has an idea of what might be going on with my daughter. She is 14 years old, has been experiencing difficulty sleeping, nervousness, slight hand tremors that come and go, weight loss, loss of appetite, irregular periods. Her pediatrician did blood work and the only concerning value was her TSH, which was .010. The pediatrician sent us to a Pediatric Endocrinologist who in turn ordered more blood work which the results are;
TSI <89%
T4 Free, direct 2.1 (ref range 1.0-2.4)
TSH <0.010 (ref range 0.5-4.3)
Thyroglobulin AB 24 (ref range 0-20)
Thyroid Peroxidase AB 15 (ref range 0-34)
I had to pick the lab results up directly from the lab as the pediatric endo had still not gotten back to us as of today, 5/5, about the labs which were drawn on 4/23 and according to the lab paperwork were completed by 4/30. He did say when he saw her on the 23 that he was evaluating her for early Hashimotos or Graves. Any ideas what the labs say about her condition? Thanks!!
Hashimoto's thyroiditis at this age is quite rare! I would look for second opinion (especially with low TPO antibodies per blood test)
My cousin's daughter was diagnosed with "virus" but it turned out to be a tooth eruption!
Your daughter may have different type of thyroiditis; many of them are not chronic and last about 3 months
My cousin's daughter was diagnosed with "virus" but it turned out to be a tooth eruption!
Your daughter may have different type of thyroiditis; many of them are not chronic and last about 3 months
Good Afternoon,
I just got done talking with her Endo and he has diagnosed her with Hashimoto's.
She is in a hyper phase right now, which he doesn't treat except for heart palpitations which have not yet been too big of a problem for her. So, he says the next stage is to just wait until her thyroid is destroyed at which time he will start treatment. She will have to do labs every three months or so, or sooner if she starts feeling bad...but that's it just wait... Which is a little frustrating, I must admit!
Anyone have any advice on what she will be in for...having Hashimoto's? Will she lead a relatively normal life? Anything she should do differently to improve her quality of life etc....? Thanks!
I just got done talking with her Endo and he has diagnosed her with Hashimoto's.
She is in a hyper phase right now, which he doesn't treat except for heart palpitations which have not yet been too big of a problem for her. So, he says the next stage is to just wait until her thyroid is destroyed at which time he will start treatment. She will have to do labs every three months or so, or sooner if she starts feeling bad...but that's it just wait... Which is a little frustrating, I must admit!
Anyone have any advice on what she will be in for...having Hashimoto's? Will she lead a relatively normal life? Anything she should do differently to improve her quality of life etc....? Thanks!
Ok, thank you 898.
A thyroid US with Doppler flow does sound like a good start! She does have dry eyes, but we do live in Las Vegas and she does wear contacts...so not sure if that is a good indicator for her. She has been having some allergies, but nothing major...and no circles or bags under her eyes...I haven't checked for Bruit...I can when she gets home from school... Thanks!
A thyroid US with Doppler flow does sound like a good start! She does have dry eyes, but we do live in Las Vegas and she does wear contacts...so not sure if that is a good indicator for her. She has been having some allergies, but nothing major...and no circles or bags under her eyes...I haven't checked for Bruit...I can when she gets home from school... Thanks!
Thank you Barb.
Yes he did say that early Hashimoto's may have periods of hyper in the early stage and that is why he was adding it to his list of what she may have. If he were to start her on anti-thyroid meds for her hyper stage, what happens when she goes hypo? .(.if she does have Hashimotos) How often will they need to test her levels? I have yet to hear back from the Doc about anything so this forum has been really wonderful for gaining some insight!
Yes he did say that early Hashimoto's may have periods of hyper in the early stage and that is why he was adding it to his list of what she may have. If he were to start her on anti-thyroid meds for her hyper stage, what happens when she goes hypo? .(.if she does have Hashimotos) How often will they need to test her levels? I have yet to hear back from the Doc about anything so this forum has been really wonderful for gaining some insight!
NO radio-iodine test please!
She may need to have thyroid ultrasound with Doppler flow
High flow in entire gland means Grave's while patches of increased flow can be positive for thyroid inflammation.
Any recent upper respiratory infections?
bags under eyes? dry eyese? Bruit (pulse on neck midline?
She may need to have thyroid ultrasound with Doppler flow
High flow in entire gland means Grave's while patches of increased flow can be positive for thyroid inflammation.
Any recent upper respiratory infections?
bags under eyes? dry eyese? Bruit (pulse on neck midline?
COMMUNITY LEADER
It's possible that her antibodies just haven't ramped up enough yet to be elevated enough for a definitive diagnosis.
Hashimoto's can often be characterized by periods of hyper in the early stages. The stages can last for a while, or can come and go relatively quickly.
Even if there's not a definite diagnosis, her doctor should still start her on anti-thyroid med.
Also, next time blood work is done, insist that Free T3 be done, along with the Free T4. Free T3 is the hormone that correlates with symptoms.
Hashimoto's can often be characterized by periods of hyper in the early stages. The stages can last for a while, or can come and go relatively quickly.
Even if there's not a definite diagnosis, her doctor should still start her on anti-thyroid med.
Also, next time blood work is done, insist that Free T3 be done, along with the Free T4. Free T3 is the hormone that correlates with symptoms.
Thank you!
Yes her TSI was at 89% as you pointed out previously. The lab work stated that a TSI of >=140% was definitive for Graves. So I am not sure where that leaves us on a diagnosis for Graves...or anything else yet
We were of course hoping for a definitive diagnosis of something, ASAP, so we can get on with a treatment, whatever it might be... I will be interested to talk with her Endo to see what his plan is for further sleuthing. Thanks again for your help!
Yes her TSI was at 89% as you pointed out previously. The lab work stated that a TSI of >=140% was definitive for Graves. So I am not sure where that leaves us on a diagnosis for Graves...or anything else yet
We were of course hoping for a definitive diagnosis of something, ASAP, so we can get on with a treatment, whatever it might be... I will be interested to talk with her Endo to see what his plan is for further sleuthing. Thanks again for your help!
First line TSI < 89%
Actually three concerns with a low TSH like that.
Graves disease: where antibodies stimulate the thyroid to produce excess hormones. TSI is Thyroid Stimulating Immunoglobulin.
Hot Nodule: A benign thyroid tumor that secretes thyroid hormones. If the doctor orders a A radioactive iodine uptake (RAIU) test, that's what he's looking for.
Thyroiditis: Thyroid inflammation, similar to graves but resolves over a few months.
A study I read seems to show that antibody tests more reliable for graves than hashimoto's. But neither is the end all be all.
Also any test that shows an abnormal result should be redone, just in case.
Actually three concerns with a low TSH like that.
Graves disease: where antibodies stimulate the thyroid to produce excess hormones. TSI is Thyroid Stimulating Immunoglobulin.
Hot Nodule: A benign thyroid tumor that secretes thyroid hormones. If the doctor orders a A radioactive iodine uptake (RAIU) test, that's what he's looking for.
Thyroiditis: Thyroid inflammation, similar to graves but resolves over a few months.
A study I read seems to show that antibody tests more reliable for graves than hashimoto's. But neither is the end all be all.
Also any test that shows an abnormal result should be redone, just in case.
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