Hi, My daughter was found to have TSH of 6.1 mU/l and liver function of 503 (Serum alkaline phosphatase)
She now has to have further blood tests and is seeing a peadatrician in the next few weeks.
I'm unsure what I should be asking or trying to establish as I'm not quite sure what her results indicate. Her level of Free T4 was within normal limits.
Can anyone give me advise on what I should be asking when we have our appointment.
Thank you
Thank you for your reply m, our gp seemed to want to brush it off, he said we may never have known about it if they hadn't run blood tests as I felt she wasn't getting over viral symptoms, tiredness etc. He tried to say it could be post viral and may be fine by time of next blood tests. I have pushed to be referred.
The hospital have asked him to arrange more blood work than he originally requested and I have to pick up more forms.
I'm so confused but trying to learn quickly for my daughter so we find out the correct information.
Doctors are apt to 'brush' off blood tests but hypothyroidism can affect her badly if she's not treated optimally and in the UK, adults find it very difficult, thus we have a lot of members on this forum. She might not be aware of symptoms she has as I doubt children can explain but she might just be fine on a dose with no problems. Dose will have to be increased until all symptoms are relieved.
I shall give you a link of symptoms and am sure children could have similar, such as fatigue as thyroid hormones run our whole metabolism from head to toe. There are two main thyroid hormones, T4 and T3. Also known as Levothyroxine and Liothyronine. She should have thyroid antibodies checked because if she has antiodies it is an Autoimmune Thyroid Disease and prescriptions is the same, except the antibodies attack the gland and wax and wane, sometime more and sometimes less until she is completely hypothyroid.
thyroiduk.org.uk/tuk/about_...
The usual prescribed replacement hormone is levothyroxine only and it should convert to T3. We have to be on sufficient T4 to convert and we all convert differently.
T3 is the only active hormone and is required in the billions of receptor cells in our bodies, the brain contains the most and heart next as well as everything else.
academic.oup.com/jcem/artic...
There is also natural dessicated thyroid hormones (the original ones before levothyroxine was introduced). They were first made in 1892 and in various forms up until today's which is in tablet form. It contains all of the hormones a healthy gland would produce but in the UK, they have withdrawn this product as the authorities prefer levothyroxine. Members source it themselves.
I'm sorry your six year old has hypothyroidism. Hopefully she will be referred to a good Endocrinologist.
When she is due a blood test for thyroid hormones, it should be at the very earliest possible, fasting (she can drink water) as this helps keep the TSH at its highest as doctors are apt to adjust according to the TSH alone. If she is on thyroid hormones she should take thyroid hormones after the blood test. Also get her B12, Vit D, iron, ferritin and folate checked too.
Usually we take thyroid hormones on a fasting stomach with one glass of water and wait about an hour before eating but I assume she could eat a little earlier than an adult. (I am not medically qualified and have hypothyroidism).
Always get a print-out from the doctor, with the ranges. These are important as labs differ in their ranges and it makes it easier to respond. Adult reference ranges don't apply to children and I'll give a link which may be helpful:-
academic.oup.com/jcem/artic...
Other members who have children affected will respond.
A virus can also cause raised ALP so that needs to be retested at a later date.
You may find this article helpful in understanding the basics of thyroid function :
Thank you for the replies. We are going on Friday for the follow up blood tests, and to see paediatrician on 3rd of May. I'm hoping it has been post viral and the results have normalised.
My daughter has been very tired for a long time, she just takes herself off to bed even if we have people over or she falls asleep when we are out visiting and it's approaching her bedtime. It's hard to know what's 'normal' behaviour and what is extreme tiredness, I do know she is the only child in company who falls asleep like this. She also suffers extremes of moods, and is very easily upset. I'm not sure if that's related. But on the other hand she is tall and normal weight for height.
I think I will know more after the blood tests have been run.
Im not sure she will be able to have the bloods done in a fasted state as she is very hungry first thing in morning and the tests will be around 10.30 am, should that be ok, the doctor hasn't suggested fasted bloods?
Well, you can't make her fast that long, that's for sure.
Doctors really know very little about the thyroid and thyroid function testing. They will tell patients that timing is unimportant, for example. And yet TSH has a circadian rhythm, and between the highest and lowest level in a period of 24 hours there could be a big difference - the difference between getting a diagnosis and not getting one.
Another reason for timing being so important for TSH testing is that doctors use it to decide on dose. So if TSH is 2.5 in the middle of the afternoon and 4.0 first thing in the morning, then they are unlikely to raise dose of Levo based on a result of 2.5, but might be persuaded (if you are lucky) if the result was 4.0.
If the doctor is undecided about raising/maintaining/lowering dose based on TSH, then he/she might consider the Free T4 level (if you are lucky and if the test has been done - it often isn't).
A low Free T4 might persuade the doctor to raise a dose when he/she isn't sure about the TSH. This is why, when people are on Levo, they are told on here not to take levo for 24 hours before testing.
(In my opinion) there is some doubt about the need for fasting before a test. I've seen the evidence for it, and it is very poor. But some blood tests (unconnected with thyroid) do need to be fasted for. So on that basis I always fast just in case I have to do one of these other blood tests. It means I keep circumstances as similar as possible from one test to the next. But if I had a blood test done after about 9.30am I would always eat. I'm not a masochist.
Paper on TSH, thyroid hormones and the circadian rhythm (see graphs on page 2) :
reboundhealth.com/cms/image...
Paper on fasting before testing - please note that I'm not saying fasting has no effect on TSH. I'm just saying that this paper doesn't prove it one way or the other because it was very poorly designed.
ncbi.nlm.nih.gov/pmc/articl...
I'm really glad you said that.
I appreciate that there are times when we need all the planets to align and get the right results (fasting may help in getting a diagnosis, no one wants low meds reduced further etc) but unless you are so scrupulously dedicated that you want all your bloods to be taken under virtually identical conditions, for many of us it just doesn't matter that much.
It depends on what kind of a challenge fasting presents. If you can always get a 7am appt at your surgery down the street, and you're home by 7:30 for breakfast it seems sensible to do it, but in some cases it is more trouble than it's worth.
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