Hello,
I have just received my 6 year old daughters results after her Levo was increased to 50mcg 5 weeks ago.
TSH - 0.7 (0.6-4.16)
FT4 - 25.8 (10-20)
FT3 - 7 (5.7-7.4)
Her TSH has gone way down from 31, 5 weeks ago. However her T4 and T3 are even a little higher/above range.
Please can i have your thoughts? Is she getting too much hormone now? Is she converting ok? Thank you
Possibly a little too much now. It may be that her thyroid has erratic sectretion rather than being on too high a dose. Perhaps they should monitor again in a month or two. You can't really judge conversion when fT4 is high because it reflects the wrong sort of conversion ('type-1 deiodinase').
Ok, in relation to your last advice regarding the unusual results, possible RTH etc do you think this could still be the case? Thank you
I'd forgotten the previous post. I'd also overlooked an alternative explanation. Sorry.
The TSH reference intervals for this and the previous blood test are different. This means they were different assays, blood tests done on different machines with different reagents. This is fine. However, the TSH blood test is an 'immunoassay'. In simple terms (all that I understand) they use antibodies, usually from a mouse, to detect the minute traces of TSH that exist. Occasionally a patient will have similar antibodies and this messes up the test. The solution is to use a different assay which usually makes use of different antibodies.
The conclusion is that the previous TSH blood test was invalid due to probable antibody interference. Hence the weird results. This assay is probably correct and indicates she is perhaps on a touch too much hormone. Her symptoms still need to be followed up but the blood test picture is clearer.
Did your daughter have a gap of 24 hours between her last dose of levo and the test and take it afterwards?
No, her paediatrician said not to?
We always recommend getting blood test early morning and not taking levothyroxine until after blood test
It may not make a difference to Ft4 for jimh111 ....but it does for some other patients
Ok but what do you think is happening based on her those results please? Thanks
Suggest you wait and retest again in another 6 weeks
Ft3 isn’t over range
How much was she increased up from?
Are vitamins optimal?
How does she seem in herself
But T4 is - Is this a worry? Too much hormone?
Vitamin levels within range though B12 and Folate above.
She ok but not 100% and her hair loss continues ......
The trouble with hair loss that it takes a long time to resolve and I think once your daughter has been on a established dose for a while it will stop. I have suffered from hair loss twice and the one time it fell out for 2 years because my levels weren't right for me. Is the hair loss upsetting your daughter? If it is please reassure her that it will grow back but it might take some time. Many times I have been in tears when my hair was falling out in the hundreds and I was ashamed to leave the house because of my balding head. I used to wear woolly hats in the winter and a large straw hat in the summer to hide my scalp. Eventually I had some hair extensions put in to make my hair look thicker. I do sympathize with your daughter because it is horrible when you can't stop your hair from falling out.
Im sorry to hear that. So tough!
Yes its really hard. Im scared for when she notices as she loves her hair and for a shy 6 year old who already has little confidence, its heartbreaking x
I have longish hair but I had a couple of inches taken off and it did make it look thicker. Hopefully this will soon stop and she won't notice. xx
What were her most recent results and ranges for vitamin D, folate, ferritin and B12
Has endo or GP done coeliac blood test
B12 - 1511 (200-900)
Serum Folate - 24 (2-17)
Zinc - 13.4 (9.8-19)
Ferritin - 52 (15-250)
Total Vit D - 81 (75-200)
Coeliac negative. She is on gluten free diet now though.
See if you can give her some liver once a week (Can hide it in Spag Bol or Shep pie) or liver pate ... or red meat ....help improve slightly low ferritin
Showing my age now ...but when I was growing up we always had liver casserole once a week - a really cheap and nutritious meal ......liver with bacon and mushrooms in sauce made of Heinz tomato Soup, quick to make and delicious
Seems rare that young families eat any offal these days
I've no idea whether it makes a significant difference for me, I've never done an experiment! Thyroxine has a seven day half-life which means it stores around 10.6 days worth of levothyroxine. Thus an hour or two after taking your daily dose you will have about 10% more thyroxine in your blood than just before taking the tablet. So the effect on fT4 is small, around 10% which is not much given daily variations in fT4 and the limited accuracy of the assay. You can see it in Figure 1 of this study by Saravanan wvrtaal.files.wordpress.com... . Ignore the TSH graph, the variation is due to the circadian pattern of TSH secretion.
It is better to take your levothyroxine about 12 hours before the blood test but if you don't the margin of error is small and can be ignored. The result is about 5% above average if the blood is taken shortly after taking the tablet and about 5% below average if the tablet is taken just after the blood test.
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