URGENT ADVICE NEEDED for child

[h4nz05]

Long story short, my son has been vomiting in the morning for nearly a year and a half. He is getting worse. After a battle with the GP, they agreed to do some bloods. They claim this thyroid result is normal and typical variation. I am waiting a call back from the GP. Please advise is this normal? What should I be asking for if not.

[helvella Administrator Thyroid UK]

Sorry that my response has to be a question.

Are those the paediatric ranges appropriate to son's age? Or the default adult ones?

And what age is he?

[h4nz05 in reply to helvella]

He is 12. How would I know what ranges they used?

[helvella Administrator Thyroid UK in reply to h4nz05]

Look for your local laboratory on the internet. Most have a web page. They often publish their information there. If not, ring them up and ask. It is a perfectly normal, acceptable thing to do.

If you cannot identify the laboratory - some cities have several - ask your GP surgery. Though sometimes several laboratories act as a group with the same details for all of them. (Sorry to suggest that - but if it isn't on the print, and not obvious from location, it does make it more difficult.)

[h4nz05 in reply to helvella]

It's Salisbury nhs lab. It says "ThyroidAppropriate thyroid function tests will be undertaken based on the information given by the "tick box" system found on the blue request form and adequate clinical information."

[helvella Administrator Thyroid UK in reply to h4nz05]

Their pathology handbook is here:

mg.salisbury.nhs.uk/media/2...

Looks like they don't have age bands for FT4 but do for FT3. With an FT4 significantly over the top of the reference interval, I think they should have done an FT3 as well - automatically.

But the lab's FT4 range is not the same as you posted in earlier. Something wrong!

FT4 and FT3 details

[helvella Administrator Thyroid UK in reply to helvella]

Adding the details for TSH (as can only add one image in a single reply).

TSH ranges

[SeasideSusie Remembering]

h4nz05

What other tests/investigations have they done? Presumably if he's been vomiting for a yer and a half you've taken him to see the GP before now and other investigations have been done?

[h4nz05 in reply to SeasideSusie]

I've taken him several times. They just give him anti sickness tablets, tell me it's anxiety and there is nothing they can do. He isn't growing, or doing it very slowly. He gets shake, hot in the face etc. We've paid for hypnotherapy etc but it's getting worse. I've just had results back from a York test that say cows milk sensitivity.

They've done routine bloods, only thing out of range was neutrophil count which was below 2.0*10^9/L [2.2 - 8.0]. They told me they were doing coeliac test but I don't think they did. I need to submit one for hpylori.

[SeasideSusie Remembering in reply to h4nz05]

If he is vomiting every day then it needs investigation. Anti-sickness tablets aren't the answer, they may calm the symptoms down but it's not getting to the root of the problem.

Does something trigger the vomiting, eg certain foods or drink?

Is it possibly something to do with school - does he vomit every day, only school days, not in the school holidays, etc. Is it bullying perhaps, or doesn't like school or a particular teacher maybe.

Even if it turns out to be anxiety he needs other things ruling out.

I don't know what investigations are appropriate but they should be checking for blockage in the digestive system, all I can think of at the moment are

endoscopy

ultrasound

ct scan

You could try cutting out dairy and see if it makes a difference, try some dairy alternatives (he may or may not like them) but if you are going to do this be very strict and cut out ALL dairy (check labels).

Has he been referred to a paediatrician or any of these tests?

If he isn't growing it would seem that he's not absorbing nutrients. Ask for key nutrients to be tested - Vit D, B12, Folate, Ferritin.

If no further tests have been done it would seem that his GP is being rather negligent. Stand your ground, insist on a referral and further investigation.

[Polski in reply to h4nz05]

Take this seriously. Cut out ALL dairy - milk , cheese, butter, yoghurt, and ANYTHING which includes 'milk' in the list of ingredients (including sheep's and goat's milk), (beware margarine, 'coconut butter' should be OK). The results could be immediate and remarkable. If not keep it up for at least two weeks, before deciding that is not the problem. If it does produce a change, follow the non-dairy diet absolutely strictly for at least six months, and then add a little dairy back in very slowly, preferably only on one day in four (ie days 1, 5, 9 etc). This could go a long way to solving your problem.

[h4nz05 in reply to Polski]

This is my plan. Just got back from shopping and have bought a heap of dairy free alternatives. Fingers 🤞

[Polski in reply to h4nz05]

If excluding milk doesn't work then make sure they've done the coeliac test. A genuine allergy to wheat or gluten would not show up on the Food Intolerance Yorktest you've done, as allergies need testing differently. You could just try excluding wheat, and then gluten, if excluding milk doesn't solve it, but the coeliac test will produce a more conclusive result if it is done before you try excluding wheat or gluten.

[h4nz05 in reply to Polski]

Thanks. The gp I spoke to said that the celiac test has been requested but may take a few weeks to come back as they do them in batches.

[RedApple Administrator]

h4nz05, Has your son lost weight over the time he's been vomitting? The well over range FT4 could suggest hyperthyroidism, but the GP won't recognise that possibility because they only look at the TSH which is in range.

'CONCLUSION

Although weight loss is always an important clue to make diagnosis of hyperthyroidism, it should be noted that hyperthyroidism patients can have unexplained vomiting, and that hyperthyroidism may coexist with peptic ulcer in rare cases. Therefore, awareness of such atypical presentations of hyperthyroidism may help to make a correct diagnosis. ncbi.nlm.nih.gov/pmc/articl...

[h4nz05 in reply to RedApple]

Sorry I thought I had replied to this. I'm not sure if he has lost weight, but he certainly hasn't grown at all - he is still in the same clothes he was in at the start of y6 and he is going into y8.

When I spoke to the GP yesterday he said exactly that - because the TSH is in range, then the variation in the free T4 is irrelevant because it changes drastically over the course of a day.

[helvella Administrator Thyroid UK]

Have been looking around and found the link below (and several other references). I do appreciate the timing that you have posted doesn't exactly match with this information. Nonetheless, it might be worth a read - even if only to exclude it. Remember that perfect matches between generalised descriptions and actual cases are unusual - most are approximate.

Symptoms & Causes of Cyclic Vomiting Syndrome

niddk.nih.gov/health-inform...

There is an NHS page on it as well but it is much shorter:

nhs.uk/conditions/cyclical-...

[h4nz05 in reply to helvella]

Thanks, I've read this several times but he isn't really violently sick or incredibly unwell for long. He generally feels unwell for 1-2hrs max and is only usually sick once, maybe twice.

[SlowDragon Administrator]

GP must test vitamin D, calcium, magnesium, folate, ferritin, iron, B12

Also Thyroid antibodies and coeliac blood test

Come back with new post once you get results

[h4nz05 in reply to SlowDragon]

When we see the pediatrician I will ask for the others. We are waiting on results for coeliac test.

[RoboTh]

I'd push for a referral to gastro enterology. My daughter had reflux and was under their care for a long time. Ended up on ppi, anti sickness and antibiotics for gastric emptying. She's grown out of it all now. So worrying for you I understand x my daughter had scopes, barium meal I think I was, tested for allergies and also turned out to be fructose intolerant.

[h4nz05 in reply to RoboTh]

Thanks. My youngest son had a barium swallow test as a baby because he had severe reflux. We have trialled omeprazole for my middle son who is being sick with no luck. I expect they may want to rule this out when we see the pediatrician though if the diet changes don't work.

[RoboTh in reply to h4nz05]

Just wondering does he have hypermobility anywhere In his body?

[h4nz05 in reply to RoboTh]

I expect so. I have hypermobility (was assessed for ED under the new criteria, but not diagnosed as not heart issue - would have been under the old criteria) and my other son does. He has always had painful hips and achy legs, more so when unwell, but I have never had him assessed. He walks on tip toes all the time and used to have to go in the pushchair until around 4 when unwell as he couldn't manage walking.

[kushami36 in reply to h4nz05]

If all else comes back normal, you could try looking at autonomic dysfunction simply because it often crops up alongside hypermobility.

[RoboTh in reply to h4nz05]

Isn't that strange that I asked. I have a feeling the hypermobility affects the ligaments in the stomach. My daughter had some issues with feet hips, gait etc along with stomach issues. Vomited daily for years and was in the 9th percentile for weight

[helvella Administrator Thyroid UK in reply to RoboTh]

I posted this a while back - which could be of interest:

All in the Mind - hypermobility, ADHD, Tourette's

healthunlocked.com/thyroidu...