My daughter recently had a spate of viral and bacterial infections and has been left with fatigue which when worse manifests physically as a sore throat, sinusitis pain and feeling sick. It has been getting better (3 months since first infection now and 2 months since peak of fatigue) but has not gone completely (going to school but not managing after school activities) so I asked the GP to do some bloods and because I have Hashimotos they included a thyroid panel. TSH came back high. T4 normal. Oesinophil levels also high, whatever that means. They plan to repeat bloods in 3-6 months. My questions are:
- Could this be something I need to be pushing for more/sooner tests for, or is it normal to have a high TSH post infection at her age and should settle down as she continues to recover?
- I was going to ask that they include thyroid antibodies next bloods, T3 (if they do it!), B12, Coeliac test and anything else?
- If bloods come back again with high TSH do I ask to try medication or is it not good to treat subclinical hypothyroidism in children? I feel so lost!
- Can anyone suggest any good supplements to try? I am doing probiotics, prebiotics, omega oils, and a complete multi-vitamin. I read somewhere that CoQ10 might also be good but I am not sure.
- What else can I do?!
Results:
Serum Vit D3 - 81 nmol/L (50-174)
TSH - 5.82 mu/L (0.6-4.84)
T4 - 15.7 pmol/L (12.5-21.5)
Ferritin - 90 ug/L (7-140)
Oesinophil 0.8 (0.1-0.4)
Bone profile, HbA1c, liver function, renal profile, full blood count (except for oesinophils) - all look really normal
Thank you so much for reading this.
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Rokko
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Oesinophils are part of the white blood cell count. Raised oesinophils can mean that the immune system is fighting an infection (eg viral, bacterial, fungal) or experiencing an allergic reaction. They can also be raised in the presence of an autoimmune disease.
It sounds like your daughter could have Post Viral Fatigue and this could just be temporary hence repeating bloods.
Could this be something I need to be pushing for more/sooner tests for, or is it normal to have a high TSH post infection at her age and should settle down as she continues to recover?
I would push for 3 months rather than 6 months.
TSH can be raised in non-thyroidal illness which is why we advise here that regular thyroid testing should not be done whilst suffering an acute illness/infection and to wait for a few weeks after the infection has cleared before doing normal thyroid tests.
I was going to ask that they include thyroid antibodies next bloods, T3 (if they do it!), B12, Coeliac test and anything else?
I think testing antibodies is a good idea. Only TPO antibodies will be tested in primary care. T3 unlikely to be done, lab will decide even if GP requests it. It's generally only done when TSH is below range and FT4 high as they'd be looking for overactive thyroid.
Certainly ask for key vitamins - Vit D, B12, folate, and a full iron panel (not just ferritin) - no guarantee that you'll get them but you can try. If you want to do them privately then Blue Horizon is the only private testing company that will test under 18s.
If bloods come back again with high TSH do I ask to try medication or is it not good to treat subclinical hypothyroidism in children? I feel so lost!
I think that's really a case of we can't say much at this stage, get full testing in 3 months and post results here for further comment.
Can anyone suggest any good supplements to try? I am doing probiotics, prebiotics, omega oils, and a complete multi-vitamin. I read somewhere that CoQ10 might also be good but I am not sure.
Multivitamins aren't recommended here for many reasons. They tend to contain too little of anything to help low levels/deficiencies, they're mainly made for the "worried well". They often contain the cheapest/least absorbable of active ingredients, include too many of them which shouldn't be taken at the same time, eg Vit C and B12 should be taken 2 hours apart; calcium shouldn't be taken at the same time as iron, magnesium or zinc; calcium should be tested and only supplemented if deficient; iodine should be tested and only supplemented if deficient and then under the supervision of an experienced practioner; iron must be at least 2 hours away from anything else as it affects their absorption.
If it’s any consolation/comfort I was worried sick about my 18 year old this time last year, exhausted anxiety jittery with exam season in front of her. First TSH came back 4.1, 3 months later after A Levels and interailing TSH1.6. It’s absolutely right to jump on it. Now at Uni burning the candle at both ends. What we did discover was Vit D was on the floor and B12 was very low. Those are improving with supplements and she is in a better place. She had massive doses of freshers flu but is learning to pace herself. It sounds like you are doing all the right things. Sending Mamma hugs 🌱🦋🌱
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