Please can I have your advise, my daughter hashimotos with goitre, and the sick kids don’t feel that they need to start treatment till her tsh is over 10.
I feel that they are making a massive mistake as she shows signs of hypothyroidism.
I have attached her thyroid results.
Thanks
Can't view results as too small on phone but if TSH is above range with antibodies for Hashimotos and symptoms then I think you're right, she needs to start treatment with thyroid meds. She's only 14 so her brain is still developing and needs enough thyroid hormone.
Sorry I replied but not sure I did so in the correct box.
Her tsh was 4.7 July, then 4.8 Aug, then 3.8 Oct, then 5.5 Aug mu/l range 0.5-4.2
Tpo >1000
Thanks
Without viewing lab range I can't say whether TSH is over range or not. However, fluctuating results are typical of Hashimotos and as she has antibodies it seems worth suggesting a trial of Levothyroxine to you GP. You should also get vitamin levels tested. Vitamin B12, folate, ferritin and vitamin D as all need be sufficient for thyroid to function well. Could you ask for referral to paediatric endocrinology?
All TSH results are above range Nanaedake
And all FreeT4 are low in range (10-18) with 3 @ 12 and 11 six weeks ago.
She has already seen a paediatric doctor at the sick kids, that was only cause I insisted on an appointment. She’s felt they results didn’t warrant a consultants input
Chaca
I can't see TPOs on the list above.
Vitamin D is 45 with no comment. And Ferritin is LOW.
Creatinine is HIGH at 68 (31-67)
Chaca,
Read Dr. Toft's comments about the pragmatism of prescribing Levothyroxine in the presence of positive antibodies in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.
If her GP still won't prescribe Levothyroxine until TSH is >10 I would take her to another GP in the practice or change practice.
That was the endocrinologist at the sick kids. Which said no treatment unless it’s showing a trend or she wants rid of her goitre
Chaca,
It is showing a trend of rising TSH which means thyroid function is declining. If your daughter is symptomatic tell the paediatrician she wants Levothyroxine to ease symptoms and reduce her goitre.
Hashimoto's is even more serious for children than it is for adults. In children, the FT3 level which guides their health is 20% higher on average than when they become adult (around 18-20). FT3 was not measured and is essential to find how far it has dropped. FT4 is very low-normal and together with the TSH is suggesting hypothyroid problems.
For more information, type into Google: Hashimoto syndrome in children. When this page come up, click onto Endocrineweb which gives a comprehensive discussion.
Thank you
Chaca
I've just noticed that her B12 is very low - at the bottom of the range :
Aug 2017
B12 - 223 (200 - 1100)
I would query this.
You might also like to look up treatment of Vitamin D Deficiency in Children NICE guidlines. Your GP is supposed to advise if level 25 - 50. As this is regared as "insufficient " and treated in Adiluts. OR refer to specialist if any symptoms (outlined in the guidelines).
She has been on iron tablets for a couple of months. I give her d3 3000 spray and I give her b12 spray as the Doctors didn’t want to do anything about them
What did doctors say about her raised Creatinine and Bilirubin? Probably nothing.
What is her diet like is there a good fibre intake. Does she like Porridge,Bananas? Would she take Fybogels each day to boost her fibre intake naturally? Would also help with any constipation problems caused by iron pills and/or being Hypo . Water intake must be increased though.
They didn’t, yes she eats bananas. What does it mean having high levels of them?
If you Google search you'll find the various reasons. But they're not very high. Don't get me wrong, I'm not medically qualified so can't really comment and could be different causes. Mine were much higher so they thought I had fatty liver. They would have said caused by alcohol but I don't drink. I think they were a bit stumped. When I had abdo Ultrasound liver looked ok. However I'd had Hypothyroid Blood results that I wasn't aware of and had been unwell. They should have seen these in Gastroenterology if they'd looked. All my Liver Function Tests returned to normal. I believe that increasing fibre intake should help. Porridge every day is a good idea.
You could ask a different GP about them and see if they need testing again sometime. You could Ask if it's because of her Thyroid function and the fact that it's obviously struggling??
Her vitamin D is low, so needs to supplement to bring up to around 100nmol
Vitamin D mouth spray at 1000iu strength may be enough to improve her levels
Retesting after 2-3 months.
. vitamindtest.org.uk £28
Important to test ferritin, B12 and folate too. Ask GP to do so
Does she experience heavy periods? Good reason to test ferritin if she does
Private tests are available if GP unhelpful
thyroiduk.org.uk/tuk/testin...
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.
All thyroid tests should be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results
Link about antibodies
thyroiduk.org.uk/tuk/about_...
Link about thyroid blood tests
thyroiduk.org/tuk/testing/t...
Print this list of symptoms off, tick all that apply and take to GP
thyroiduk.org/tuk/about_the...
Hashimoto's affects the gut and leads to low vitamin levels
Low vitamin levels stop Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
thyroidpharmacist.com/artic...
thyroidpharmacist.com/artic...
amymyersmd.com/2017/02/3-im...
chriskresser.com/the-gluten...
Good advice from everyone here Chaca, sorry was working today so couldn't respond.
Thanks everyone 
Sorry, just noticed her ferritin is dire, also B12 extremely low
See SeasideSusie detailed vitamin advice
healthunlocked.com/thyroidu...
High bilirubin is linked to Gilbert's syndrome
But could just be high due to Hashimoto's
I would push for testing for coeliac before trying strictly gluten free diet even if coeliac test is negative
been checked for coeliac, but came back negative. Is Gilbert’s syndrome past on, as I have that too, I’ve got her on b12 and vit d sprays she is also on iron tablets. She has been on iron tablets for a while now, there not moving it fast as she is only taking one. She is suppose to try to take 2.
You say checked for coeliac, was that endoscopy?
Blood test is unreliable
But getting a 14 year old to try strictly gluten free diet might be hard
Yes Gilbert’s syndrome is inherited
There is some research that Gilbert’s is also perhaps linked to gluten intolerance too
Can you get her to try liver once a week
Or hide it in shepherd pie. Or chilli etc
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