I wish to discuss my 16 year old brother's lab results. Myself, I'm 27 and I've had low B12 and Vitamin Deficiency that I'm treating, and take 100mg Synthroid.
I've seen a similar pattern with my brother, and interestingly my mother's recent labs. There seems to be a genetic, familial link.
TSH 1.79 (0.47 - 3.41)
Free T4 12.2 (10.2-17.3)
Vitamin D 22 (75-150)
Ferritin 20 (28-186)
B12 200 (180-655)
Glucose Fasting 5.8 (3.3-5.5)
While I need to get his antibodies and Free T3 tested, suffice to say these results already paint the picture. The Free T4 is 28% in range and TSH should be lower. I will need to convince the doctor to start him on medication, he eats decent and exercises 4 times a week yet has those vitamin deficiencies. I've always wonder what my levels were at his age and wouldn't be surprised if I was walking around with deficiencies most of my life too (only difference is that my Ferritin in past few years has remained in mid range). I really wonder what genetic cause is that me, my brother and mother have. We all have "slightly high normal" TSH with, I assume T4/T3 in bottom third-quarter quadrant.
I do wonder if there is some other gene going around here that affects the digestive system, leading to malabsorption and that effects the thyroid. Really a chicken or egg game here.
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Andyb1205
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Also why are there not peer reviewed scientific articles that look at the theory that T4 and T3 should be prioritized before TSH, and more importantly, the importance of where in the range the T4/T3. It seems like T4/T3 in bottom half, moreso bottom third of range, greatly affects quality of life. Many articles on this theory can be found but not in the peer reviewed journals.
What is clear is that there is some genetic mutation running in my family. It could be a metabolic disorder that results in malabsorption and that means the thyroid is undernourished and hence affected. Or some genetic mutation affecting the TSH signal. I mean, TSH works for many people, but not all, why is that? Because the thyroid is a complex disease requiring years of further study?
Acording to Hippocrates all diseases start in the gut and he was the father of medicine so we havent come on hugely have we?! 80% of immune system is in the gut.
Do you all have Hashimotos? Have you had your thyroid antibodies tested? You may benefit hugely from all being gluten and Casein free.
He really needs to get his vitamin D, ferritin and B12 addressed asap.
What about folate?
His blood sugars are fairly high too, has he been checked for diabetes?
My TPOab and TGab antibodies are in range but exist (low antibodies can exist in normal population, could also be significant, I need to do an ultrasound). My mother has not checked her antibodies.
I need to request the doctor to test my brother's antibodies. Have not checked for diabetes yet, he only saw the doctor for first time last week to get bloodwork. We are seeing the doctor this Friday.
To be honest, he was feeling depressed in the beginning, but he is a very strong kid. He is coming to accept that he will need help but is not worried, he's rather planning to get disciplined and have a serious approach to his health. He is young and will get the help he needs but yes he is confused.
The lab here does not run folate tests unfortunately.
I would suggest he gets tested for coeliac if he hasn't been already. It seems he is not absorbing nutrients from his food properly. I wouldn't assume it's a thyroid problem from those results. For a young man on a healthy diet his ferritin and B12 levels are dreadful. Has his doctor suggested any further investigations?
He only saw the doc for first time last week, will see him this Friday to discuss the results. I will get him tested for celiac as well for sure. I should add, he has been on an unhealthy diet for years but he had began exercising a few months ago and is eating decent now. But yes for a meat eater who gets his dairy products his iron and B12 is very low.
Myself, I've had celiac test done a few years ago and also last year, negative. While I was found to have Vitamin D deficiency last year, few years ago my B12 was 400 but I didn't drink much milk for couple years and last year B12 was 200. But I've never had such a low iron at least in past few years.
I can see a certain hereditary gene in myself, my mother, my brother. My two theories right now are, the one I lean towards, thyroid problem leading to malabsorption, or something else affecting malabsorption where in return the lack of nourishment for thyroid can explain T4 (my case T4/T3, haven't tested my brother's T3 yet) in bottom third of range. I should add, I see many similarities between me and him (I felt weaker, slower and more tired than others my age as well since I was young).
A few years ago my TSH (in range 0.30 - 5.50) had reached 5.30, then fell to 4.20, and before Synthroid last year was 2.5 then 2.2 after 100mg Synthroid. It's sort of a chicken or egg scenario, what came first. The thyroid problem or the malabsorption.
Crossing my fingers for tomorrow. I mean, if I don't have low iron like my mother and brother, perhaps they have malabsorption problems while I don't? But still same root cause, possibly thyroid? Let's see, I will request for us all to see a gastroenterologist.
I can get him to do celiac test and intrinsic factor for B12 soon but while we wait in the waiting list to see a gastroenterologist specialist, should I have the Doctor start my brother on 25mg Synthroid right away? No doubt he will be put on supplements by the doc for iron vitamin D and B.
In my personal case I remember how getting my vitamins up for 3 months only to add in Synthroid after was a waste of time.
Can central hypothyroidism run in families? Me, my brother and mother's TSH can all be characterized as "slightly elevated" in "high-normal range." While T4 for me and my brother is low-normal. Haven't checked the mother's T4 but wouldn't be surprised. Central hypothyroidism can have low, normal or slightly elevated TSH while T4 is in low-normal range.
I have checked my LSH and FH which were found to be in range. Same for my mother...
Just Google high homocysteine.....the info is all out there. Some of us make too much and a clue is low b12 of unknown cause......the b12 is low due to it being used up to clear the homocysteine from the body. It can cause blood clots and this is when doctors take it seriously and test for it. For my family knowing we have it has been a life changer. For me after my underactive thyroid being blamed for my symptoms of exhaustion and spending a fortune on private doctors I feel alive for the first time in years........it was me who discovered it after a gene test but my enidocrinologist is working with me on clearing it as he admits its new science to him and he is learning too
What I'm thinking is how would I know if it's central hypothyroidism (which makes far more sense) or mild hypothyroidism, because of lack of antibodies? I had thought about being in early stage of hypothyroidism, but my mom is 51 years old and this is her TSH in past few years (while also having barely in range B12 and iron deficiency for years on, she's never maintained consistency supplementing the iron though now she's trying). Never had T4/T3 or antibodies tested.
2014 TSH 1.93 (0.30 - 5.50)
Early 2015 2.59 (0.30 - 5.50)
Late 2015 2.0 (0.27 - 4.2)
2016 3.54 (0.32 - 5.04)
2017 3.82 (0.32 - 5.04)
Mine:
2013 5.30 (0.30 - 5.50)
2014 4.20 (0.30 - 5.50) T4/T3 in bottom third and quarter quadrant respectively
Late 2014-2016 suppressed (0.02 then 0.01) was on 125mg Erfa
Late 2014 saw T4/T3 rise above half of range, but went back to almost pre-treatment range in 2016 (bottom third quadrant for T4/T3). Didn't do labs in 2 years, only got refills. 2016 diagnosed with barely in range B12 (200, compared to 400 2 years before, tbh didn't drink much dairy or eat well, was depressed) and Vitamin D deficiency. Erfa probably became less efficient because of nutritional deficiencies.
Early 2016, taken off Erfa to "stabilize thyroid" (horrible decision by doctor) to check levels. Three months later, no medication:
Late 2016 TSH 2.50 (0.32 - 5.04)
*began Synthroid treatment from 25mg, upping by 25mg and now at 100mg.
Latest test done mid 2017: TSH 2.19 (0.32 - 5.04)
From before and after Synthroid, T4/T3 gone from 31%/32% in range to 38%/37%.
Someone had told me that because my TSH had once gone as high as 5.30 I can't be central hypothyroid, but science suggests TSH can be low, normal, OR slightly elevated. The point is, no direct linear relation with T4 and T3 levels. T4/T3 has remained in bottom third quadrant from 5.50 TSH, to 4.20, to 2.50. *all these numbers were without any medication, 2013, 2014, and now 2017.
What I know 100% is that there's a genetic familial link. And I am now leaning towards central hypothyroidism. Makes most sense.
I should add, when my TSH hit 5.30 (0.30 - 5.50) I had my first and worst breakout of tonsillitis. In fact that is what prompted me to get tested in the first place.
So I went in there to ask the doctor to give my brother a full thyroid test to include T3 and TPOab, even said I'm willing to pay. He refused, said who is the doctor here, said his numbers are fine and that I shouldn't try to confuse him. Said he started me on trial of medication hesitantly (refer to my lab numbers above) because I kept asking him but to keep my brother out of it.
Didn't even ask my brother about how he feels, no going into the history or talking about how we need to find the cause of these deficiencies. No referral to gastroenterologist. Didn't want to test intrinsic factor for B12, didn't even mention B12 (which is barely in range).
He did give my brother a prescription of Vitamin D 50,000 IU weekly for 8 weeks and 300mg ferrous fumarate (I will get my brother to take it with Vitamin C 1,000mg). And my brother did a blood test for celiac disease today, waiting for results. He said that because it rains a lot in Canada it's common to have Vitamin D deficiency... lol.
I apologize for the long posts but I do not want my brother to suffer as I have my whole life, he's only 16, going through puberty and body is growing. No better time to be aided with thyroid hormones. I'll check his vitamins again in 2 months and if I need to will doctor shop for him. Will also request doctor to at least refer him to a gastroenterologist at the very least.
I think you will struggle to get the doctor to prescribe anything based on those labs results . I can see your concern , and those labs would not be enough to satisfy me , but you really need more conclusive evidence of a thyroid issue . the t4 is low but in range , it may wel be dipping in and out of range of there is hashi's antibodies . I would explore further , a full text with T3 and antibodies , and possibly a thyroid monitoring test from medichecks every couple of months for a while so that you can get a clearer picture of movement in the levels over a wider period of time , if you have reason to be concerned that there really is an issue that needs to be picked up.
I think you're if you have reason , it is worth the effort to get sufficient evidence yourself , the NHS won't do it , and being undiagnosed is hell . Some of us spent many years in such hell.
If I try out some walk in clinic to give my brother full thyroid panel, this doctor might get mad. I need him to refer my brother to a gastroenterologist and a psychiatrist (ADHD runs in the family). Probably best I do that, wait a couple months, and then ask him to run the full panel again.
I'm just surprised that the doc wasn't worried about what the root cause of the malabsorption is.
They will not do anything if the tsh is below usually ten , and if the t4 is in range as well , they will say all is well . I would use the finger prick test from medichecks .com . The antibodies will tell you a lot , if they are high , even if the hormone levels are in range , then there is something going on.
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