My son is 7 years old and he doesn't seem to be growing enough, at least in the last year or so. I am suspecting he could be Hypothyroid because of my genes (Hashimoto's and Type 1 diabetes), so we did some blood work:
hGH - 0,27 ng/mL (0,05 - 11,00)
IGF-I - 74,93 ng/mL (18,00 - 307,00)
TSH - 3,574 ฮผUI/mL (0,6700 - 4,1600)
FT4 - 1,05 ng/dL (0,86 - 1,40)
Anti TPO - 57,6 UI/mL (< 60,0)
iPTH - 33,1 pg/mL (18,5 - 88,0)
Total Calcium - 9,2 mg/dL (9,1 - 10,3)
Phosphorus - 5,5 mg/dL (3,0 - 5,4)
His weight is 20 kg, whereas the average for his age is 24/25 kg. And his height is 121 cm. Endo said his labs are ok (nothing outside the range) and we should wait and see. But I think she is wrong. To me, he looks hypothyroid. Even the iPTH suggests this. I read that low PTH might be because of low Magnesium, which is a consequence of low thyroid function. Endo said that she believes this could be a lab error! I cannot believe this!
Please share your thought on this ๐๐๐
Thank you! โค๏ธโค๏ธโค๏ธ
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danielatudorela
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His HGH is very low and that would affect his growth.
His FT4 is only 35.19% which is low - although are these ranges specific for his age group?
And, if his FT4 is low, then his FT3 is probably lower. And, you need good levels of T3 for the pituitary to make HGH. That is assuming he doesn't have a pituitary problem, which he could have. So it's a pity his FT3 wasn't tested to get a clearer picture.
Then again, although not over-range, his antibodies are high, so he more than likely has Hashi's.
But, of course, he could have Hashi's and a pituitary problem.
The endo is not looking at the whole picture. She's only looking at individual results and seeing them in-range, concludes that everything is fine. But, she's not looking at them in conjunction with each other. Hormones are all interconnected, and levels should correspond. His TSH is high in-range (technically hypo but the NHS likes to wait until it gets to 10!) but low compared to his FT4. But I don't suppose she knows enough about any of this to be able to pick out the anomalies.
Like you, I would not be satisfied that all is well and would be looking for a second opinion - preferably from an endo that knows something about pituitaries.
Were the blood draws the exact same time of day for both tests?
I see below that helvella has asked the same question I asked above: Are the ranges specific for his age group?
FT3 - 4,76 pg/mL (3,30 - 4,80) 97.33%
FT4 - 1,13 ng/dL (0,86 - 1,40) 50.00%
So, his TSH has dropped, which is understandable because his FT4 has risen.
What is no causing confusion is his FT3 which is very high! I keep checking the percentage to make sure I haven't made a mistake. Such a pity that it wasn't done the first time! Honestly, they just haven't got a clue!
So, normally, the FT3 percentage would be just slightly lower than the FT4, and both would be around the 50% mark. The fact that the FT4 has risen for no obvious reason, and the FT3 is so high, would suggest to me a Hashi's 'hyper' flare sometime between the two blood tests.
His antibodies have reduced but are still pretty high in-range. The change in level doesn't mean much because antibodies fluctuate all the time and some Hashi's people never even have over-range antibodies.
But, the pituitary still has a question mark hanging over it because now, his TSH is too high for his FT3 level. But, that could just be because it hasn't had time to fully catch up yet. It moves more slowly than the thyroid hormone levels.
Were the blood draws the exact same time of day for both tests? - The first blood draw was done at 8.00 and the second at 10.30.
Are the ranges specific for his age group? - Presumably yes, because in my results, the ref. ranges are different (we went to the same lab). And is it even possible to provide a reference range without it being calculated for one's age and sex? Anyways, I will call them tomorrow and ask ๐
For the pituitary - are any other tests that we can make before we find a good doctor?
I have been listening to Dr. Eric Berg today about possible causes of growth deficiency in adolescents:
Low HGH:
- zinc deficiency (he is on carnivore, there is very low chance he is zinc deficient)
- starvation (he eats plenty of animal products, can't be this)
- lack of protein (he eats mainly protein)
- lack of sleep (he sleeps at least 10-11 hours per day)
- smoking, caffeine, obesity (non of these are applicable to him)
- lack of D vitamin (could be an issue, he has low calcium and I did not give D vitamin supplements)
Low IGF1 (my son's IGF1 is also quite low):
- fatty liver (not applicable)
Thyroid gland:
- iodine deficiency (could be in his case)
It seems plausible a potential Hashi flareup with hyper-hypo...And the pituitary...
The first blood draw was done at 8.00 and the second at 10.30.
OK, so that could account for the difference in the TSH. So, we can't really compare those.
And is it even possible to provide a reference range without it being calculated for one's age and sex?
Yes, absolutely it is, given the way ranges are 'calculated'. They're just based on the general population mostly.
Low IGF1 (my son's IGF1 is also quite low):
- fatty liver (not applicable)
No, I have low IGF1 but I don't have fatty liver.
Another cause of low IGF1 is low vit A. And if he doesn't eat any vegetables then he could very well be low in vit A (sorry, if my assumption is wrong but I know nothing about the carnivore diet).
IGF1 levels are supposed to reflect HGH levels. But, in my experience, they don't always.
Low HGH can be caused by low FT3, but obviously that's not his case.
As to other tests for the pituitary, has he had his cortisol or his ATCH tested? ATCH is a pituitary hormone that controls the production of cortisol by the adrenals.
I did not know that 2 hours difference in the blood draw might have a totally different TSH and make it impossible to rely on for comparison...
On vitamin A I think he should be fine, because he eats full fat dairy.
Low HGH can be caused by low FT3, but obviously that's not his case. - But what if his high FT3 is a consequence of Hashi flareup? Could he still have low HGH in case of fluctuating FT3?
As to other tests for the pituitary, has he had his cortisol or his ATCH tested? - no, never. This was his 1st and 2nd lifetime blood draw he actually feels like a little hero, because I told him he was so brave and did not cry at all ๐ Should we test only cortisol first and see if we need ATCH? Will serum cortisol work?
In case of Hashi, would it help for diagnosis to test again TSH, FT3, FT4 and antibodies every week? I do not want to spend too much time waiting. His weight is of a 5 year old, we already lost 2 years of growth ๐๐
But what if his high FT3 is a consequence of Hashi flareup? Could he still have low HGH in case of fluctuating FT3?
Yes, I it could. Which is just one of the reasons FT3 should be tested every time. We have no idea what his normal FT3 is or why it's high right now. So, all we can do is guess.
Will serum cortisol work?
I'm not sure how accurate serum cortisol is, but it would be a start, yes. But do check about ranges. I'm not sure if children have different levels of cortisol.
In case of Hashi, would it help for diagnosis to test again TSH, FT3, FT4 and antibodies every week?
I'm not sure testing every week would help. You're not likely to see much change in the TSH from week to week - assuming it's always done at the same time of day - because it moves so slowly. And there's no way he's going to get any sort of diagnosis with his TSH as it is, and that's all they tend to look at.
But once a month, maybe. But, even so, just proving that he has Hashi's is not going to get him any sort of treatment until his TSH goes much higher.
Besides, there's no guarantee that treating with thyroid hormone replacement is going to help with his growth. If there is a problem with the pituitary itself, even good levels of T3 are not going to increase his HGH. And, to be honest, I cannot understand why they haven't just put him on HGH injections already. And, I think that would be what I would be pushing for, being the most important issue at the moment. The thyroid can wait a while until that is sorted.
Yes, the lab said that the ref. range is for his age and gender.
I cannot understand why they haven't just put him on HGH injections already. - Endo said that his deficiency is 0.8. And they only consider intervention when the deficiency is 2.0 (Again, conventional medicine waits until it gets extreme and dreadful ๐ฑ)
Greygoose, you have a feeling that it could be a pituitary problem as well. Can you explain to me why you think so? Mainly because his TSH is not appropriate his T4 and T3 level (too low compared to his low T4 and too high compared to his high T3)? Or is it something else?
I initially thought he is hypothyroid because he had very similar symptoms to me - under eye puffiness in the morning that would go away by evening (this occurs every 2-3 days), waking up tired, mild headache. When he is tired it doesn't happen everyday and not all day long, rather in episodes. My husband says if it was his thyroid, he would probably have symptoms permanently, but he does not, only once in 2-4 days ( I did not count)...
Yesterday, when he had the blood draw, he had eye puffiness and was tired. I thought - great, probably his test results will show over/under the range. But it wasn't the case. But I really have no clue how fast we have symptoms after a certain spike/fall in hormones...
Yes, the lab said that the ref. range is for his age and gender.
In that case, his FT4 and TSH are too low - the TSH being low in comparison to the FT4 (pituitary) - and his antibodies are high enough to make the idea of Hashi's a probability.
Endo said that his deficiency is 0.8. And they only consider intervention when the deficiency is 2.0
That sounds like a load of codswallop to me. His growth is obviously affected. But you can bet your life that that 'rule' is based on money rather than patient wellfare! HGH injections are hideously expensive.
I think it's a pituitary problem because of the low TSH, yes. But also because of the low HGH.
I initially thought he is hypothyroid because he had very similar symptoms to me
The symptoms will be the same whatever the cause of low thyroid, whether it's due to the thyroid being slowly destroyed or the pituitary not producing enough TSH to stimulate the thyroid. Low T3 is low T3 and will cause symptoms.
I don't mean any disrespect to your son but I had a hypothyroid dog - probably Hashi's. And I knew he was hypo because he had the same symptoms as me - not that I'm a dog, but I recogniised a problem in him. Two vets told me I was being rediculous and refused to even test him. But, it turned out I was right. He was very hypo. Always trust your instincts!
My husband says if it was his thyroid, he would probably have symptoms permanently, but he does not, only once in 2-4 days ( I did not count)...
I don't mean to be rude but does your husband have a thyroid problem? What makes him think that? Does he not know that hypothyroidism is different for everybody? No two hypos will ever follow exactly the same path. And we all have good days and bad days. Plus the fact that he also looks to have Hashi's - although probably in the early stages - so his thyroid hormone levels will probably vary from day to day. My apologies to your husband but I disagree.
I thought - great, probably his test results will show over/under the range. But it wasn't the case. But I really have no clue how fast we have symptoms after a certain spike/fall in hormones...
No-one has a clue about that. It's all totally unpredictable.
I agree with greygoose. I think the "almost near the mark" of the antibodies is really concerning, along with a very very borderline TSH and T4. I hate these "normal limits" because they grade "normal" over very large populations and some of the people in those populations may be hypothyroid and not know it. As well as, one can be very hypothyroid for you and have a TSH that is "within normal limits" but close to the edge of those normal limits and not normal for you. I would definitely look further with your kid.
Vitamin D is also related to calcium too, so if your son hasn't had a vitamin D test then perhaps you could ask for that to be done, along with other nutrients - vitamin B12, folate, and an iron panel.
For many blood tests there are specific paediatric reference intervals (ranges).
Sometimes they are only slightly different from adult reference intervals - but some are substantially different.
Please double-check that the reference intervals you have are the proper reference intervals for his age. It is all too common for the doctors involved to miss this issue. And I'm not convinced that labs always put the right reference intervals on printouts of results!
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he actually feels like a little hero, because I told him he was so brave and did not cry at all ๐
Should we test only cortisol first and see if we need ATCH? Will serum cortisol work?
19 year old son, blood results. Only taking 75mcg levothyroxine but results show high T3?
Help Needed Please- Full Bloodwork with T3
