Hello, I am new to Health Unlocked & my first post & need some urgent advice as expecting to speak to my daughters consultant tomorrow...
My daughter has been experiencing a number of symptoms over the last 3-4 years, extreme fatigue, very tearful, all over body aches, cold, periods of being unwell with no obvious causes. She has had a number of blood tests recently, the latest results below.
Latest Results:
TSH 6.31 (range 0.27-4.2)
Free T4 14 (range 12-22)
TPO 1300+ (range 0-60)
Also low in Vitamin D & abnormal gastric cell antibodies (I haven’t got a print out yet & not sure if the precise number of exact name, apologies).
My daughter’s paediatrician has been in contact with specialists at Great Ormond Street Hospital, who have advised me today no treatment necessary & re-test In 6 weeks. I am not sure the point of these repeated blood tests, she has had 3 since June.
She is very symptomatic - extreme fatigue to the point of tears, all over body aches, cold. Given her blood tests surely a trial of Levothyroxine should be given? They have said that she is at an increased risk of thyroid disease but her results do not ‘necessarily’ indicate thyroid disease at this moment in time. The doctors just seem to look at the blood tests & not listen to symptoms at all.
Any advice? I have argued my point & the paediatrician will go back to the specialists to discuss symptoms & if any further action needed. I am starting to feel desperation as my daughters symptoms does impact on her on a daily basis.
Thank you.
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If that is her first raised TSH result then it's normal to repeat the test after a couple of months or so because TSH can be raised due to non-thyroidal illness so they will want to rule this out.
However, it would seem that her very high TPO antibodies do seriously suggest autoimmune thyroid disease (Hashimoto's) but I suppose they have to follow protocol.
If her next TSH test comes back raised then you can push for her to be treated with Levo, using the following information if necessary (bearing in mind that I only assume it's the same for children as it is for adults):
Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist, says in his article in Pulse magazine (the magazine for doctors):
Question 2 asks:
I often see patients who have an elevated TSH but normal T4. How should I be managing them?
Answer:
The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.
But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune thyroid disease - the patient should be considered to have the mildest form of hypothyroidism.
In the absence of symptoms, some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow up.
Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 2 to show your doctor.
In the meantime, here is some general information about Hashi's, again bear in mind that this is not specifically targetted at children but is general information given to members here who are, in the main, adults:
Hashi's is where the immune system attacks the thyroid and gradually destroys it, this can cause fluctuations in symptoms and test results.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Gluten/thyroid connection: chriskresser.com/the-gluten...
stopthethyroidmadness.com/h...
stopthethyroidmadness.com/h...
hypothyroidmom.com/hashimot...
thyroiduk.org.uk/tuk/about_...
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies and it's important to test
Vit D
B12
Folate
Ferritin
and address any problems there.
Thank you so much for this information. Very very helpful.
My daughter has had 1 prior raised TSH (above 5), on retest it had gone down to just under 5, this was enough for the GP to dismiss any further thyroid issue. On the 3rd test it was 6.31, I feel that this demonstrates a thyroid issue, especially paired with symptoms.
I think the over range, under range, over range TSH is due to Hashi's fluctuations and she should now be prescribed Levo. Persuading a doctor to do this might be tricky.
Had there ever been a time when FT4 has been below range with a raised TSH?
I do not believe so.... I haven’t got copies of her results to look back on. I will request from GP tomorrow.
A useful link for finding out the Recommended Daily Intake of selenium for different age groups is this one :
nootriment.com/selenium-rda/
And for safety and adverse effects :
nootriment.com/selenium-sid...