My 13 year old has been having problems with diarrhea for the past month. The ped finally ran both stool and blood work. It was mostly normal. The only things that stood out were thyroid tests and she felt that those were normal, too. Are they? I really don't fully understand the complex thyroid issues. I saw on here that vitiligo can be related.. Teen doesn't have it, but his dad does. Teen is so pale that one might not see it on him anyway! He is fatigued, but he is a teen who stays up late doing homework.
LOW: T4, Total of 5.5, range 5.6 - 14.9
HIGH: T3, Uptake of 37, range 22 - 35
T4, Free calculated 2.0, range 1.4 - 3.8
TSH, 3rd gen 2.03, range .50 - 4.3
Is this normal? Who should we see next?? Gastro or endocrinologist??
I would pursue the thyroid angle further and get some more testing done. Endos aren't always the best-- but for a pediatric case it might be the right choice. Just be aware that many endos are lab freaks and if your results fall within "normal" range some will dismiss a patient. Despite the "normal range" your son's TSH is high for someone his age and his free T4 is only at 25% of its range when it needs to be up over 50% for most healthy people. Make sure you ask for these tests as they will be the most helpful:
TPO and TG antibodies
I would also ask for the full battery of tests for celiac disease including the antibodies as this very often accompanies thyroid disease and the chronic diarrhea is indicitive of it.
Thanks. I will print your suggestions to bring to the ped tomorrow. I think that will be the fastest way to get more testing done (specialists are much less likely to take us on a Sunday if even within a week or more). Then I will seek a specialist. They did run a celiac panel with the result <3, range of <5 for negative. I don't see the other tests that you mentioned. If there are other ideas or input, I am grateful. This is new territory for us.
OK, new labs. TSH is higher. Looking for more input. Made an appointment in two weeks with a pediatric endo at a nearby hospital (practice was recommended).
TSH: 3.0, range .50-4.3
T4, Free: 1.0, range .9-1.4
T4, Total: 6.6, range 5.6-14.9
T3 Uptake: 35, range 22-35%
T4, Free, Calculated: 2.3, range 1.4-3.8
T3, Free: 425, range 335-480
Vit. B12, Serum: 287, range 260-935 * note here that this may be part of the 10% of patients in this range who experience neuropsychiatric and hematologic abnormalities due to occult B12 deficiency
Thyroid Peroxidase AB: <10, range <35
Thyroglobulin AB: <20, range <20
TBG: 15.1, range 13.8-28.2
Tanner Stage IV: 13.2-25.0
Vitamin D, 25 OH, Total: 16L, range 20-100
Vitamin D, 25 OH D3: 16
Vitamin D, 23 OH D2: <4
Vitamin D deficiency is clear. What else should I understand from this?? He is sleeping excessively and spending massive amounts of time in the bathroom. He spent nearly 3 hours last night with diarrhea. I had to keep him home from school and he has been sleeping all day. I don't know if he even ate anything. I thought he was at the table having breakfast and he was already back in bed.
He also currently has both fungal and bacterial skin infections. One being treated with a cream and the other with oral antibiotics. These are seemingly unrelated to the other issues, though clearly his immunity is down.
His B12 is very low, should be up around 600 or higher in adults, not sure about kids and of course the D is really low.
Of all those thyroid labs I would focus on the TSH, free T3 (FT3) and free T4 (FT4). Not sure what the difference between "calculated free T4" and simply FT4 is but the FT4 is the one we look at of the two. His FT4 is very low, just 20% of range and his FT3 is somewhat higher at 62%-- but most of us need this higher to feel good, up nearer the top of range. I would say he's pretty hypo based on these labs and that TSH is climbing. He doesn't have discernable antibodies for Hashimoto's at this time.
They didn't run a ferritin level on him did they? I'm not sure how the diarrhea ties into all this as it's usually not a big hypo symptom but everyone is different and some have it as well but usually with Hashi's and the hyper swings.
I know he was screened for Celiac but just to make sure all the possible tests were run, did they do all of these:
IgA anti-gliadin antibodies
IgG anti-gliadin antibodies
IgA anti-endomysial antibodies
Tissue transglutaminase antibody (IgA and IgG in questionable cases)
Total IgA antibodies
HLA DQ2 and DQ8 genotyping for celiac disease (used occasionally to detect genetic suspectibility).
Intestinal biopsy (rarely needed if gluten antibodies are positive)
If any of these are positive it's recommended that a gluten elimination diet be followed. Many doctors consider elevated anti-gliadin antibodies in the absence of a positive intestinal biopsy showing damage to be "false positives." That means the test looks positive but really isn't significant. There is some disagreement about this and I would at least take another look at his testing just to be sure.
I will go over your suggestions with the doctor. A friend has been to an endo in our area (she traveled across many states to see him with her son), so I am going to try his office tomorrow to see if we can get in sooner. She and her son both have celiac and he has growth issues. I know that this particular doc's child has celiac, so I am betting he knows how to look for it carefully. I just found out today that my MIL is hypothyroid and her sister is hyperthyroid. MIL says she has been on synthroid for 20 years. My husband didn't know either.
Endo gave him 600,000 units of vitamin D to get his level up. He sent us over to gi. Lots more labs and now a possible Crohns diagnosis. Going for scoping on Thursday. I guess I am off to another list..