Results for daughter

[Dolphin40]

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

[jimh111]

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').

[Dolphin40 in reply to jimh111]

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

[jimh111 in reply to Dolphin40]

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.

[Dolphin40 in reply to jimh111]

Is it not strange her T4 and T3 are high when she is hypothyroid?

[shaws]

Did your daughter have a gap of 24 hours between her last dose of levo and the test and take it afterwards?

[Dolphin40 in reply to shaws]

No, her paediatrician said not to?

[SlowDragon Administrator in reply to Dolphin40]

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

[Dolphin40 in reply to SlowDragon]

Ok but what do you think is happening based on her those results please? Thanks

[SlowDragon Administrator in reply to Dolphin40]

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

[Dolphin40 in reply to SlowDragon]

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 ......

[SlowDragon Administrator in reply to Dolphin40]

What were her most recent results and ranges for vitamin D, folate, ferritin and B12

Has endo or GP done coeliac blood test

[Dolphin40 in reply to SlowDragon]

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.

[SlowDragon Administrator in reply to Dolphin40]

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

[jimh111 in reply to SlowDragon]

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.

[jimh111 in reply to shaws]

Five or six hours is enough, even if the gap is less the long half-life of levothyroxine means the effect is small.

[Dolphin40]

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