Adolescence and Hypothyroidism

[Tristy]

My 12 year old nephew has been feeling very tired, has headaches, a sore throat and feeling nauseous for the last 3 weeks. He had a full blood count done which was normal but his thyroid result was abnormal. The T4 was 12.4 (12.7-20).

The doctor said it could be low if he is fighting an infection and wants to re-test in 6 weeks time. He has had a glandular fever test and that was negative.

Myself, my mother and my sister all have Hypothyroidism. Should the doctor be waiting 6 weeks and re-testing or treating him straight away? He is very lethargic and has been on podgy side for a while. He’s a very bright kid and it’s not nice seeing him go through this. Any advice would be appreciated.

Ps My sister didn’t get a printout of the full results, she is going back for that. She does know that the TSH was in range though.

[shaws Administrator]

For goodness sake - a T4 of 12.4 - which is below range. Goodness knows what his T3 is.

I think a Full Thyroid Function Test may be worthwhile rather than let a child suffer on for another six weeks.

Can he get a private test which would be easier . I'll give a link and I think it is awful that a child has to wait so long to be diagnosed especially as hypo is within the family.

I am aware you will know the best way to get an optimum from the tests. ie. fasting(he can drink water) etc. Being home pin-prick tests he should be well hydrated a couple of days before and hands/arms warm.

This is a list of labs. Medichecks usually have an 'offer' of some sorts ever wednesday.

He needs, TSH, T4, T3, Free T4, Free T3 and thyroid antibodies. Regardless of the others if he has antibodies he should definitely be diagnosed as hashi's/hypo.

thyroiduk.org.uk/tuk/testin...

[Tristy in reply to shaws]

Hi Shaws, thank you so much for your reply. You have confirmed what I was thinking. I agree, he shouldn’t be left another 6 weeks like that.

[shaws Administrator in reply to Tristy]

It's bad enough for adults, never mind a child to cope with hormone deficiencies.

[Tristy in reply to shaws]

Exactly.

[shaws Administrator]

TSH - in range doesn't really give us much information, i.e. we don't really want 'in range' we want a TSH of around 1.

TSH up to 10 (in the UK) is acceptable to doctors which most seem to think is o.k. In other countries if it is above 3+ people will be diagnosed along with symptoms.

[Tristy in reply to shaws]

Thanks Shaws, I just hope once we get the full thyroid results the doctor doesn’t still want to wait 6 weeks to retest in case it’s an infection causing it! Ridiculous.

[MaisieGray]

Yes it is perfectly reasonable to wait 6 weeks and retest in any case, and there's also a possibility that he is in the hypothyroid stage of either post-viral or post-bacterial thyroiditis.

[Tristy in reply to MaisieGray]

Thanks for your reply MaisieGray. He had some swabs taken on his throat and they came back negative for bacteria. I don’t know if that has any bearing on your reply?

[MaisieGray in reply to Tristy]

Well it can be post-viral as well a post-bacterial, so testing only for bacteria, wouldn't impact on any virus present or past.

A 2009 study of this topic stated that "Although the search for a viral cause is usually unrewarding, it appears that the thyroid could respond with thyroiditis after invasion by a variety of different viruses and that no single agent is likely to be causative in the syndrome of subacute thyroiditis......" and concluded "Identifying etiological infections in human disease is difficult. Besides the fact that organ tissue is not always available for direct study, the interpretation of virological data must be cautious. The presence of antibodies directed towards a virus does not prove that this pathogen is responsible for the disease, especially when the agent is common in the general population. On the other hand, the absence of viral markers at the onset of the disease does not refute the viral hypothesis. Indeed the triggering infection can take place many years previously. A triggering virus can be cleared from the body without any virological trace except the presence of specific antibodies..... "

[MaisieGray in reply to MaisieGray]

I forgot to add that like post-partum Thyroiditis for instance, both post-viral and post-bacterial Thyroiditis can be self-limiting (and treatment should be regularly monitored to ensure that it is still necessary); or in some cases can cause permanent hypothyroidism.

[Tristy in reply to MaisieGray]

Thanks MaisieGray.

[SlowDragon Administrator]

He needs both TPO and TG thyroid antibodies tested, plus vitamin D, folate, ferritin and B12.

Low vitamin levels can cause significant symptoms.

This time of year, likely to have very low vitamin D

But it's standard practice to wait and retest thyroid levels several weeks after first test.

One of my relatives had high TSH test, after a virus/infection. Retesting several weeks later Thyroid blood tests were all back well within range.

Obviously because of family connections to autoimmune disease, arranged full testing privately to check for antibodies, (result was negative) and tested vitamin levels too. Very low vitamin D, now supplements regularly to maintain at optimal levels

[Tristy in reply to SlowDragon]

Thanks for your help SlowDragon, as always.

[SlowDragon Administrator in reply to Tristy]

Vitamin D is actually not a vitamin, but a very important hormone

Teenagers, especially boys often seem to be deficient

[Tristy in reply to SlowDragon]

Thanks SlowDragon, great help.