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Thyroid test, to believe it or not?
Hi everybody,
My little 4 1/2 year old daughter had some blood teststs done in July and another one in September. The reason for the test was an exsess body hair, legs, arms, back but none in the androgenic areas. The July Thyroid test results were TSH=1.9 ,FT4=13.4 ,FT3= 5.6 . The doc said all was OK. The second test in September came out as TSH=0.16 , FT4=13.6 , FT3=6 . We haven't see the doc yet.
It is my suspicion that somehow she is making a bit more FT3, just enough in exsess to alter the the body hair normal cycles of growth, regretion and rest.
The FT4 and FT3 do not look too much different but the TSH is way out of line on the second test. I would like to point out that as she is only 4 and a half, she is really expected to have higher TSH, maybe in the region of 2 to 3. She is not exactly a typical Hyper.., but I can say that she tolerates cold a lot better than her brother and night time the blanket is allways off.
From researching I got idea that the FT4/ FT3 should be around 2.5 or slightly more. Ideal should be 2.5 . Her's is, the first one 2.39 and the second 2.26 , indicating she is converting a bit too much or is she?
I agree that by just looking at the reference ranges you can't always say if one has problematic thyroid or TSH (pituitary). Everybody is different to extent and Thyroid hormone values could be at different spot for everyone, slight variation up or down within the ref range and we have a problem.
I would like to hear your opinion as I am desperately hoping to resolve the original symptom.
PS. My thyroid seems OK, but my birth family have history of thyroid problems, hyper and hypo.
Thanks for taking the time to read this.
My little 4 1/2 year old daughter had some blood teststs done in July and another one in September. The reason for the test was an exsess body hair, legs, arms, back but none in the androgenic areas. The July Thyroid test results were TSH=1.9 ,FT4=13.4 ,FT3= 5.6 . The doc said all was OK. The second test in September came out as TSH=0.16 , FT4=13.6 , FT3=6 . We haven't see the doc yet.
It is my suspicion that somehow she is making a bit more FT3, just enough in exsess to alter the the body hair normal cycles of growth, regretion and rest.
The FT4 and FT3 do not look too much different but the TSH is way out of line on the second test. I would like to point out that as she is only 4 and a half, she is really expected to have higher TSH, maybe in the region of 2 to 3. She is not exactly a typical Hyper.., but I can say that she tolerates cold a lot better than her brother and night time the blanket is allways off.
From researching I got idea that the FT4/ FT3 should be around 2.5 or slightly more. Ideal should be 2.5 . Her's is, the first one 2.39 and the second 2.26 , indicating she is converting a bit too much or is she?
I agree that by just looking at the reference ranges you can't always say if one has problematic thyroid or TSH (pituitary). Everybody is different to extent and Thyroid hormone values could be at different spot for everyone, slight variation up or down within the ref range and we have a problem.
I would like to hear your opinion as I am desperately hoping to resolve the original symptom.
PS. My thyroid seems OK, but my birth family have history of thyroid problems, hyper and hypo.
Thanks for taking the time to read this.
I have to say that I'm still a little uncomfortable with the ranges on your daughter's two FT3 tests. If the ranges are to be believed (the second as corrected to 4.28 to 7.23), she went from 8% of range on the first test to 58% on the second. That's a huge jump. However, that jump is compatable with the rapid decrease in TSH. Interestingly, FT4 was quite stable through all this.
To answer one of yout original questions on whether she converts too much T4 to T3. I would say definitely not. At 8%, she's barely in range, and at 58%, she's still well within (even a little on the low side) of the upper half of range that most of us feel well in.
I see I'm flirting with the 11:00 am PDT that MH is shutting down for maintenance, so I'll post and comment further later.
To answer one of yout original questions on whether she converts too much T4 to T3. I would say definitely not. At 8%, she's barely in range, and at 58%, she's still well within (even a little on the low side) of the upper half of range that most of us feel well in.
I see I'm flirting with the 11:00 am PDT that MH is shutting down for maintenance, so I'll post and comment further later.
Thank you "Barb135"
On the second test I have put down "questionable range" due to the lack of knowledge of the lab that children often have different ranges than adults. As I already mentioned I only phoned in to question the TSH and FT3 with their chief hospital Biochemist Scientist. Only then I was given the different ranges that I have included as "corrected to", the rest is still questioable. From my research FSH should be exactly at 2.3, often quoted as the median of the range. SHBG is usually higher for children, but yet again who am I to argue with the lab that was probably responsible for hundrends of wrong diagnoses based on their unupdated ranges. I can not comment, what the paediatric endos relying fully on the labs reports would say about this. As far as I am concerned every good endo should know where the values should be, if not from medical schol then atleast from experience. After all they study to become endos for more than 10 years. Just my opinion.
Lastly I agree with you on the other points that it might not be just or at all the thyroid. From my research I have come accross a lot of cases where the docs would treat a child for hypothyroidism or hyper and their primary symptom of increased body hair gets resolved. It is not explaned fully or understood why those body hair folicles sometimes would shut down on severe hypo or hyper patients and sometimes a problem with more than normal body hair gets resolved when the Thyroid hormones get back where they need to be.
I have come across, quote: "In research studies it has been shown that hair follicles express thyroid hormone receptors and they can respond with increased hair growth when exposed to the thyroid derived hormone triiodothyronine (T3)." and " However, occasionally there are reports of people with hypothyroidism or hyperthyroidism experiencing hypertrichosis - an excess of hair growth. This might be expected in people with mild hyperthyroidism, where a modest increase in thyroid hormones may stimulate the hair follicles into increased growth but not be so high as to be toxic for the cells."
For those who might be in the same bandwagon or fall into it in the future here is the link:http://www.keratin.com/ab/ab011.shtml
Even though the following is a bit extreme but still usefull to know is the following link: http://www.nature.com/jp/journal/v26/n4/full/7211461a.html
Due to my births family of thyroid disorders and I forgot to mention my wife's side family too, I feel there might be a strong possibility that we may be having a case of mild or subclinical hyperthyroidism where the FT3 is just a bit higher but still in range. It is a difficult one and I do not know where to beging to get some indication if this is the case. Most endos would just send you away, lets hope I get a good one that is willing to think outside the constrains imposed by old fashioned believes.
Thanks again for your time to put down your opinion and also research on my account.
On the second test I have put down "questionable range" due to the lack of knowledge of the lab that children often have different ranges than adults. As I already mentioned I only phoned in to question the TSH and FT3 with their chief hospital Biochemist Scientist. Only then I was given the different ranges that I have included as "corrected to", the rest is still questioable. From my research FSH should be exactly at 2.3, often quoted as the median of the range. SHBG is usually higher for children, but yet again who am I to argue with the lab that was probably responsible for hundrends of wrong diagnoses based on their unupdated ranges. I can not comment, what the paediatric endos relying fully on the labs reports would say about this. As far as I am concerned every good endo should know where the values should be, if not from medical schol then atleast from experience. After all they study to become endos for more than 10 years. Just my opinion.
Lastly I agree with you on the other points that it might not be just or at all the thyroid. From my research I have come accross a lot of cases where the docs would treat a child for hypothyroidism or hyper and their primary symptom of increased body hair gets resolved. It is not explaned fully or understood why those body hair folicles sometimes would shut down on severe hypo or hyper patients and sometimes a problem with more than normal body hair gets resolved when the Thyroid hormones get back where they need to be.
I have come across, quote: "In research studies it has been shown that hair follicles express thyroid hormone receptors and they can respond with increased hair growth when exposed to the thyroid derived hormone triiodothyronine (T3)." and " However, occasionally there are reports of people with hypothyroidism or hyperthyroidism experiencing hypertrichosis - an excess of hair growth. This might be expected in people with mild hyperthyroidism, where a modest increase in thyroid hormones may stimulate the hair follicles into increased growth but not be so high as to be toxic for the cells."
For those who might be in the same bandwagon or fall into it in the future here is the link:http://www.keratin.com/ab/ab011.shtml
Even though the following is a bit extreme but still usefull to know is the following link: http://www.nature.com/jp/journal/v26/n4/full/7211461a.html
Due to my births family of thyroid disorders and I forgot to mention my wife's side family too, I feel there might be a strong possibility that we may be having a case of mild or subclinical hyperthyroidism where the FT3 is just a bit higher but still in range. It is a difficult one and I do not know where to beging to get some indication if this is the case. Most endos would just send you away, lets hope I get a good one that is willing to think outside the constrains imposed by old fashioned believes.
Thanks again for your time to put down your opinion and also research on my account.
COMMUNITY LEADER
Since you seem very distrustful of the lab that did the analysis, maybe you could try to get the tests done at a different lab?
The second set of tests was done in Sept, which would be close to 6 weeks ago, so assuming that you'd want to keep a close eye on the situation, it would be about time to retest to see where all of your daughter's levels are now. If possible, this should be done at a lab you trust. You might even want to talk to the lab prior in order to insure quality.
You mentioned that both your and your wife's family have a history of thyroid disease. Have either you or your wife been diagnosed with a thyroid issue? Has the hypertrichosis showed up in any other family members with thyroid disease?
The second set of tests was done in Sept, which would be close to 6 weeks ago, so assuming that you'd want to keep a close eye on the situation, it would be about time to retest to see where all of your daughter's levels are now. If possible, this should be done at a lab you trust. You might even want to talk to the lab prior in order to insure quality.
You mentioned that both your and your wife's family have a history of thyroid disease. Have either you or your wife been diagnosed with a thyroid issue? Has the hypertrichosis showed up in any other family members with thyroid disease?
I agree that a third set of labs wouldn't hurt. I'd have a discussion with the lab beforehand to make sure they have ranges adjusted for age and that those ranges get on the lab report that goes to the doctor.
"As far as I am concerned every good endo should know where the values should be, if not from medical schol then atleast from experience. After all they study to become endos for more than 10 years." Unfortunately, it's not that simple since the values that "should be" are very individual for all of us. Most people have to have levels adjusted to fairly high in the ranges; I'm quite comfortable barely in the lower end of the ranges. Add to that that different labs, using different methods, have different "normal" populations, and range becomes even more illusive.
I have to say that were I convinced that this was a thyroid problem, I really wouldn't know how to suggest you go about treating it. FT4 is a little on the low side in both labs. FT3 (still questionable, in my opinion) varied from 8% to 58% of range. Yet, you feel that her symptoms are hyper, which is not supported in those labs. I really wouldn't know whether to suggest treatment for hypo or hyper. I feel that the results are not definitive enough to medicate (at this time).
I believe gimel suggested above that you have an ultrasound, and I'd agree with that to rule out the possibility of a hyperfunctioning nodule. Hyperfunctioning nodules put out T3 independent of the influence of TSH. T3 is produced in spurts, so FT3 levels can vary wildly. Has anyone in either of your families ever been diagnosed with Plummer's Disease?
"As far as I am concerned every good endo should know where the values should be, if not from medical schol then atleast from experience. After all they study to become endos for more than 10 years." Unfortunately, it's not that simple since the values that "should be" are very individual for all of us. Most people have to have levels adjusted to fairly high in the ranges; I'm quite comfortable barely in the lower end of the ranges. Add to that that different labs, using different methods, have different "normal" populations, and range becomes even more illusive.
I have to say that were I convinced that this was a thyroid problem, I really wouldn't know how to suggest you go about treating it. FT4 is a little on the low side in both labs. FT3 (still questionable, in my opinion) varied from 8% to 58% of range. Yet, you feel that her symptoms are hyper, which is not supported in those labs. I really wouldn't know whether to suggest treatment for hypo or hyper. I feel that the results are not definitive enough to medicate (at this time).
I believe gimel suggested above that you have an ultrasound, and I'd agree with that to rule out the possibility of a hyperfunctioning nodule. Hyperfunctioning nodules put out T3 independent of the influence of TSH. T3 is produced in spurts, so FT3 levels can vary wildly. Has anyone in either of your families ever been diagnosed with Plummer's Disease?
The first test was a 12h fasting one the second was a normal one with a breakfast. I just wonder it that somehow could have pushed the TSH so low down from 1.9 to 0.16 . FT4 and FT3 did not move so much though. Risking to sound even crazy, it crossed my mind that the second test TSH value could have been a human typing error, just puting the decimal point in the wrong place. If it was 1.6, then maybe would have made sence. I know what you might be thinking, - "paranoia".
COMMUNITY LEADER
TSH is variable for a variety of reasons (this is why TSH is useless as a diagnostic), so without follow up tests to see where your daughter is now, you won't know. I would doubt that the result is a typo, but anything's possible.
Thyroid blood work should always be done in the same manner - in other words, if it's done once fasting, it should always be done fasting; and it should always be done near the same time of day
I really think you need to take your daughter to a different lab, for the same tests.
Thyroid blood work should always be done in the same manner - in other words, if it's done once fasting, it should always be done fasting; and it should always be done near the same time of day
I really think you need to take your daughter to a different lab, for the same tests.
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