I got my daughter's test results done through Healthcheck USA and I'm not sure what to make of them. She is 17 years old and has been battling weight issues for years. She is currently 232 lbs at 5'8". She also has "Pre-Diabetes", with hyperinsulinemia. She is also on birth control pills (don't ask!)Here are the results of the thyroid tests:
Anti Thyroglobulin AB <20 Range <40
Antithyroid Peroxidase 13 Range <35
FT4 1.1 Range .6 - 2.0 (Mid point is 1.3)
FT3 3.1 Range 2.3 - 4.2 (Mid point is 3.25)
TT4 9.5 Range 4.7 - 13.3
TT3 122 Range 79 - 149
TSH(3rd Generation) 2.98 Range .7 - 5.7
HbA1c 6.0 Range <6.0
Does that mean that she has Hashimoto's, since her antibodies are detectable? Could the weight cause these results to be messed up? I'm kind of at a loss, since my PCP thinks I'm a thyroid whacko. I need to get my daughter to my endo (who is GREAT), but I have to get my PCP to give me a referral.
Any ideas, anyone? Could these just be messed up because of the weight? I would be a mess with a TSH of 2.98, but does her age make that different? I notice that under 20 always ends up in a different category on the lab slips.
My, you have a lot going on...it is so hard when it is your child isn't it! Tell your PCP..."Just to put a poor mother's mind to rest, give me the referal" if he still refuses, write a letter to your insurance telling them that your doctor is refusing to give a referal and you strongly object...etc....others here, I heard have done things like this... I think with that TSH she is at least due a referal! Let's bump for the other quesitons...anyone?
Normally with Hashi's you find extremely high Antibodies. Me, for instance were 2700 and 980 for my antibody numbers respectively which is more indicative of Hashi's. If she is under the lab range, its probably not Hashi's. Her thyroid numbers look OK, assuming they can fluctuate a little from day to day and week to week. Everything is normal.
I would however, be worried about that A1C test. I am fat and my doctor specifically told me he wanted my A1C under 5 and thankfully, due to my hypo I have low blood sugar, not diabetes and my number was 4.8.
6 A1C is high for her age. Losing weight will significantly change that number. The A1C test is a snapshot of the last 3 months average glucose stores and that number is too high for someone her age. I would even be willing to say that her "pre-diabetes" might be closer to "real diabetes" and should be checked more thoroughly by an Endo with the 3 hour glucose test and maybe an insulin blood test. I not a doctor of course, but if it were my son or daughter, that number would be the one that concerns me for right this second. Messed up blood sugar can throw everything else off. Does diabetes run in your family? Have you ever purchased a blood glucose monitor? If so, what are her fasting numbers like? In normal people they are usually 82-94 typically. People that are over 125 on a 12 hour fast are considered to have full blown diabetes. Now they consider "pre-diabetes" between 110 and 124, but in all practicality, fasting sugar in perfectly normal people would not be that high. I would not want my sugar over 92 on a fast if I could help it. Look into it. I bought the Freestyle Flash monitor. Its great and literally uses a pinprick worth of blood from the forearm so its totally painless. I test all the time.
Thank you for your replies. Yes, Diabetes runs in my family. In fact, I have full blown Type 2 Diabetes. Both she and I went for a 3 hour GTT in August, 2004. My 2 hour glucose was 227. Her's was 140. But her insulin was VERY high (I believe her fasting was 11). She started out with a high result and her 2 hour and 3 hour insulin were high. I'm sorry I don't have her results with me. Her HbA1c was 5.4 in February.
She was on my "diabetic diet" from August to Feb and lost 9 lbs (224 -> 215). But then she wasn't following the diet anymore and gained back 17 in 2 months. I have been testing her blood with my monitor for the last week and 1/2 since she's been back home and it seems to be doing OK for now. Her fasting glucose this morning was 83, and her post-prandial is usually below 100. Her HbA1c was mainly because she has been out of the house for two months and has had a steady diet of McDonald's value meal food.
Because the doctor knew this and also knew that her fasting and post-prandial numbers were not indicative of full blown Diabetes, he said she has progressed from hyperinsulinemia to Pre-Diabetes. With proper diet and exercise, they believe that she can get it back down. She has to go back on August 1st to find out if the diet and exercise have worked.
I know you've heard it before but it would seem a lifestyle change is called for before diabetes and other issues come into play. McDonald's each day for a while or any other stuff she might be eating that's no good is not going to help the cause. It needs to be a change from the heart and full circle....like a re-birth of sorts for her to get the benefits she probably desires but its got to come from her.
I had a little thing in my head a while ago that made things interesting. I dropped about 40 pounds while being TOTALLY HYPO which is extremely difficult to do. If I were normal, it would have probably been closer to 90 pounds lost. Anyway, I took the challenge of losing weight and trying to get healthy as "something to do". I know it sounds almost rediculous but mentally when I put the weight loss challenge in my head as almost a hobby and not something "I had to do" it made me change. I put it into perspective with other things that I wanted to work for, like studying for a final back in college or being the best parent I could be...I made it a challenge where the goal was not to necessarily lose weight, but to push myself to do it...it sounds like similar goals, but they are quite different. I hate "having to" do something and failed before I even started. By just tweaking my mentality a little, I was able to lose weight because losing weight was not the goal, sticking to my long term plan was.
Everyone is different and at my still girthy size I am no one to give advice, but I hate to see people so young with problems they should be dealing with when they are 50, not 17. Some kind of really active hobby and a little pep in the mentality might be exactly what the doctor ordered. Goals really help people stay focused. Its common sense but without a solid plan, there can be no significant action. A good talk with her and a plan of action might actually be something she will look forward to each day and all it takes is one tiny bit of positive progress and before you know it her whole attitude might be different. I know for me when those first 10 or 15 pounds came off I went from a depressed slug to invincible with a general feeling of accomplishment and a little extra pep in my step and it only took a little bit of work. That little bit of progress helped pull me out my "K-Hole" as I call it which was a depressed, ugly state of mind.
I have actually been working with her for the past week and a half to help her realize that the goal is to be healthy and not to lose weight. By being healthy, she will normally lose weight. She is having a very rough year and it's hard to get through to her sometimes, though.
As far as "Some kind of really active hobby and a little pep in the mentality might be exactly what the doctor ordered. ", that is EXACTLY what her doctor ordered. It makes me sad as well, especially since people do not treat you well when you are overweight. I used to weigh 243 (though I'm 6'1"), and I'm down to 180 now. I tried to not think of my new eating habits and exercise routine as a "diet". That really kills the fun of it and makes it feel like job. But thinking of it as "getting healthy" really helped me a lot. It was frustrating to lose it so slowly when it seemed like I gained it so quickly, but overall, it took about 8 months to lose the weight. And I am happy that I can be more active without feeling like I'm dying. Of course, they had started me on Synthroid at the same time that I found out I was Diabetic, so that helped to lose the weight, too.
First, you've been a terrific role model for your daughter with the weight loss & wise counselling.
Your DD's TSH is a little higher than the current AACE recommendations. Recent studies show that 95% of the population has a TSH between 0.3 and 2.5. Your DD's TSH is just outside that range.
Finding a doc who would supervise your DD on a therapeutic trial of low-dose thyroid hormone, while also working with her on insulin issues, would be neat.
In our town, most labs & docs are NOT YET following the new standards. Your DD's T3 & T4 are in range. So, it might not be easy to find a doc who will work her on thyroid issues. But, you could try.
Is it possible that the BCPs are influencing weight, mood, or other issues? Might a slightly diff Rx be helpful?
The blood sugar issues are something that most docs will grab onto & try to fix first. If your DD can get tight control over her sugars with a low glycemic index diet & exercise, perhaps she'll have greater success finding a doc to help her with thyroid concerns.
Might your DD enjoy/ be motivated by a peer-based support group for weight & insulin management issues? Available in many communities ...
One final thought: if DD is still being seen by a ped., she might do better with an Int. Med. or Endocrinology doc.
I wanted to add this: with what looks like a path towards diabetes, this is my doctor's feeling and my family history backs this up.
Here's the theory: untreated and undertreated hypothyroidism will turn a woman into a diabetic heart patient. This is true of my mother who knowingly did not treat her thyroid disease for the last 30 years. The result? A triple bypass at the age of 53. Poorly controlled diabetes. High cholesterol and triglycerides. Both indicators of thyroid disease by the way. Last October she died one week before her 64th birthday as a result of diabetes complications, just 3 weeks after having her leg amputated.
A Low glycemic diet will be important, but if she needs thyroid treatment, getting the proper medication will help her feel better and feel more like doing something about it. I know it did for me.