I had posted previous about my 11 year old daughter and strange lab results. As I learn more about Thyroid Tests the more frustrated I'm getting with her Dr's.
Symptoms: She is an 11 year female does well in school not ADHD she is in the 18% - 19% for height and weight, has symptoms: Excessive sweating on the hands and feet, thicker arm hair, Irritable, sensitive (cries about EVERYTHING), Anxiety, very low pain tolerance, recent changes in vision one "Lazy Eye" - This eye is also slightly larger than the other, IBS, Frequent Bowel movements (3x/day), headaches, and shortness of breath. Thyroid does NOT appear to be enlarged.
Labs from ped endo aug 2011:
TSH: 3.53 ( .4 - 5.0 ),
FT4: 0.51 (1.1 -2.0) - Measured via Equilibrium Dialysis
Total T3: 166 (83 - 213),
Total T4: 15 (5.0 - 11.0),
thyroglobulin antibody was negative
thyroglobulin normal 22.8
Test results from our local Clinic Nov 2012:
Elevated FT4 1.89 (.58 - 1.64 ng/dl)
Normal FT3 4.02 (2.50 - 3.90 pg/mL)
Normal TSH 2.03; (.34 - 5.60 mIu/mL)
Thyroid binding globulin was normal at 21 (13-30)
Sorry for the lab re-post just wanted all the information together. In my last post it was suggested that I have her TSI and TPO also tested. The nurse called me back today and informed me that they DID run these tests back in June 2011:
TSI: 83 (<123)
TPO: .4 (0 - 9.0)
From my research I'm gathering that ANY TSI present suggests Hyper. They want to run a test on her for Thyroid Hormone Resistance. However I'm not sure now that this is needed. I think it would be hands down Hyper, but because the TSH isn't surpressed they want to call her thyroid function "normal", and suggested that we stop testing her thyroid.
So do I proceed with the test for THR, or is this the time to find a new Dr. for her and start over? Is it possible that the TSI present is blocking something that is preventing the TSH from being surpressed?
I don't have all the answers, but here's a few comments.
1. The lab results (TSH and FT4) are very different from Aug 2011 to Nov 2012, so the TSI and TPO numbers from June 2011 are irrelevant today. They should be repeated.
2. The Nov 2012 labs for TSH and FT3 fall right on the 50th percentile for young people with normal thyroids, so I would agree those values are normal.
3. The 50th percentile for FT4 is 1.18 to 1.24, so her FT4 in Nov 2012 of 1.89 is around 60% above normal. The Total T4 reading of 15 in Aug 2011 is twice normal.
4. I don't know for sure what this doc meant by "testing for thyroid hormone resistance", but it would definitely be a good idea to test for Reverse T3 (RT3). RT3 blocks the action of FT3, so even if your FT3 in the blood is good it cannot act as normal in the cells and results in the person being hypo. RT3 will go high if FT4 is high, which she has.
5. Might be an idea to go back to the endo..
I'm afraid that's about all I can contribute.
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4. The Dr. is wanting to test for Thyroid Hormone Resistance due to the elevated FT4 and Normal TSH. THR can present this way. He did mention that even if she tested postitive for this that he thinks no treatment would be recommended, but he would consult with a Dr. out of Chicago for recommendation.
5. Back to the Endo - I'm agreeing but think it might be time for a change of Drs. And "start over; per say" We have been working with a local Pediatrician who has been consulting with a peds endo 7 hours away. Twice they have sent us all the way over there. The labs from Aug 2011 were from the first trip out there. No followup was recommended, so we didn't do anything more - and didn't have the lab results till just last week. Fall 2012 She had some new symptoms come up (IBS and Lazy eye). Our local Dr. tested the Thyroid again (labs from Nov 2012) - Sent us back to the Peds Endo Dec 2012 - They did no additional lab work and sent us home with the info on testing for THR.
I'm thinking of taking her to an adult endo (we don't have an peds endo close by) instead of this whole pediatrician consulting with the peds endo thing.
Graves' and hyperT are more complicated subjects than I'm totally comfortable with. But I do know your daughter's thyroid situation is NOT "normal". That level of TSI always is a positive marker for Graves'.
The TRH test might be a good thing. But you also should ask for a blocking TRab test. If she has proportionately more blocking antibodies than stimulating ones (TSI), that could be the reason her TSH is still in normal range. Blocking ABs keep TSH from rising even in conjunction with elevated T4 and/or T3.
I don't know enough to say what doctor would be best for her, but I urge you not to accept a "normal" thyroid status conclusion, because there's definitely something going on.
__________________ "We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses." Abraham Lincoln
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