What's a normal tsh for a 3 year old male ?

[Jlcole51099]

I have a 3 year old who had intermittent puffy hands last year. It hasnt happened much lately but it did this morning early while he was asleep. His tsh was a 5.19 which is close to the high end of normal ln the range they used which is 5.33. But I've also been told this could be subclinical hypothyroidism ?

[gimel]

Subclinical hypothyroidism is just a category they use for patients who do not meet their requirements for treatment.  The only patients identified for treatment by TSH are those with overt hypothyroidism.  All other types are basically ignored.  It is unfortunate that doctors rely almost totally on a test for TSH, because it has only a weak correlation with the actual thyroid hormones, and a negligible correlation with the most important indicator of thyroid status: signs/symptoms typical of hypothyroidism.  

I know it is difficult to evaluate for symptoms with a 3 year old, but see if there are any others you can identify.  Also, you should get tests for the actual thyroid hormones: Free T4 and Free T3.  IF the doctor resists, you should insist on those and don't take no for an answer.  When that info is available, please post results and reference ranges shown on the lab report and we will be happy to help interpret further.  

Also, if you want to better understand about all this, and be better prepared for further doctor visits, click on my name and then on my personal page, scroll down to my Journal.  There you will find the following link to a paper I co-authored.

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

[Jlcole51099]

He has other symptoms. He intermittently gets fatigued. Seems to have temperature sensitivities on both ends. His ferritin dipped down to a 5.2 last year while his hemoglobin barely went out of range. His hematocrit was high last year and now that's slightly low. Ferritin is only now at a 23 and hes been on an iron rich diet and supplements since august last year, they want it to be a 45. He has chronic eczema and seems to have cyclical flares where his whole body gets angry. It then goes to his face and it's so bizarre that he can legitimately rub his eye because its runny or bothering him and he will get a dang splotchy face from his own hand when hes maybe only had sweat on his hand or something.

He gets puffy under eyes/bags intermittently. Hes been tested for allergies. All negative. Celiacs negative. The puffy hands seems to be directly related to cold. They are just white and tight, puffy. His runny eyes seem to be related to humidity or just a warmer day even not humid.

He has spurts of decent irritability. Not just normal toddler irritability but relatively not himself. His eosinophils are high off and on (again no allergies with the testing). He drinks pediasure because he had wonky growth for a while and his PA before he was even 2 was considering blood work for genetic testing but his allergist (also immunologist) who manages his non allergic eczema (weird I know but we love him so much) said he didnt see any genetic markers for him when his growth went wonky again. It was attributed to a poor diet, which I repeatedly said he has never had. Only when not feeling well which is normal for most humans I think. Hes never made it past the 16th ish percentile for BMI and this is the first time in his life hes stayed in the double digits. Hes been as low as the 6th. Hes a tiny little peanut. Hes always pale and has been for over a year and even still when his iron issues are improving....


If I think of anything else I'll add to it but that's about what I can thing of right now. Lol

He has so many "quirks". He sees his allergist in a week ish and since he was so close to the high end I was going to ask him if hed recheck his tsh and also do the cascade I believe it's called that you're referring to, because hes having some similar issues and they are trying to nail down exactly what it is but so far we have found out only what it is not, really.

[gimel]

Important to understand that the standard test used by most all doctors, for  TSH, has very limited usefulness in diagnosing hypothyroidism.   The best test is for Free T3, which is the biologically active thyroid hormone used by all the cells in the body, and causes the metabolic effect needed.  Free T4 is also important to test, since T4 is a prohormone for that converts to T3.  In addition, since his TSH was on the high side, I suggest testing for Thyroid Peroxidase antibodies (TPO ab) and if negative, then test Thyroglobulin antibodies (TG ab).  In addition, I suggest testing for Vitamin D and B12.  You have already tested for ferritin and it was very low.  In adults it needs to be at least 100.  Not sure about kids.  

Also, hypothyroidism typically results in low body temperature.  When you test his temperature, what do you typically find it to be?

[Jlcole51099]

His pediatrician said shed like him ideally to have his ferritin at a 45. It was 23 6 months ago and we are over a year in to this. I feel like that's a slow rise but I guess I am not sure.

Oddly enough he tends to run lower often and rarely has fevers even when I'll. Hes ran as low as 96.7 while actively sick (some type of viral infection per the ped. Negative for covid, parvo19, strep) but she landed on presumed parvovirus anyways. Now he just kind of baseline/cyclically has a cold like presentation (chronic rhinitis, now).

[Jlcole51099]

Assumed*

I just requested new labs because he is due. I asked for a tsh with a cascade this time instead of just the tsh. He will have to do a cbc and his iron panel as well. I can ask for the others too, his new pediatrician seems much more open to doing more labs as long as hes getting them done anyways. His last would tell me "his b12 is fine" but hes never actually ever had that checked in his life.

His allergist (he has no actual allergies, just irritant based stuff he manages very well and eczema) and his new pediatrician sort of entertained and asked about reynauds in regards to his hand circulation and the temperature relation I noticed. It does run in our family but if it's that it would absolutely have an atypical presentation which isnt impossible.

He just had a bath that was on the chillier side per his demands and refusal to allow me to warm it up... very pale hands with just a tad of puffiness again. That is now certainly temperature related I'm thinking. I've not seen it linked to anything other than cold.

[Jlcole51099]

Hes also back down to the 3rd percentile for height. But his bmi is seemingly okay for now, until the next visit itll be his height maybe went higher and now his bmi is very low again. He has a growth curve that literally zig Zags and I've been told "it kind of curves, he has growth spurts".

They are legitimately supposed to develop their own curve and thats been drilled in to me at every well check with both children. The curve. Now not having one is whatever?

I'm determined to figure out what this is regardless of how trivial it may potentially be, because it sure is something a bit off for such a little kid.

[gimel]

Please be sure to insist on testing him for the actual thyroid hormones, Free T4 and Free T3.  Don't take no for an answer.  Very important to know.   After the doctor approves I would even confirm with the lab person drawing blood that those are to be tested.  You'd be surprised how often they operate on auto pilot and don't check those.