# new need help understanding these results



## Jlgsmom (Feb 11, 2013)

Right around puberty I knew something wasn't right with my daughter. Suddenly she just couldn't control her weight. She was and is very active, dance and the gym plus is very cautious with her diet since she is a ballerina and was required to maintain a certain body weight. She had most of the hypo symptoms plus some unusual hair growth which made me think she had PCOS. We went the Endocrinologist and everything was "normal". Still struggling we went to a dermatologist and gynecologist and in an attempt to treat her symptoms, she went on birth control pill. Long story short, a year and a half later she now has been diagnosed with hypothyroidism by the first endocrinologist. I'm hoping if I put her lab values if someone could tell us if we are on the right track. I really want to know if there is some other testing that should be done. I don't want to leave anything to chance and we are both ready for her to feel normal. She has been taking Synthroid 112 mcg for about 15 days. I greatly appreciate any input.

8/29/2011 TSH 1.490 (0.450-4.500)

Free T4 1.14 (0.93-1.60)

4/19/2012 TSH 0.919 (0.450-4.500)

Free T4 not tested

1/07/13 TSH 0.293 (0.450-4.500) low

Free T4 1.04 (0.93-1.60)

Free T3 1.8 (2.3-5.0) low

2/6/2013 TSH 0.881 (0.450-4.500)

Free T4 0.87 (0.93-1.60) low

Free T3 1.4 (2.3-5.0) low

Thyroid Peroxidase AB 7 (0-26)

Antithyroglobulin AB <20 (0-40)

Lipid panel = high cholesterol


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## Lovlkn (Dec 20, 2009)

> 8/29/2011
> TSH 1.490 (0.450-4.500)
> Free T4 1.14 (0.93-1.60) *mid range 1.265*
> 
> ...


She started 15 days from the 2/6 labs?

Your daughters lab results are severely hypo - I want to point out her TSH - she likely has stimulating and blocking antibodies.

It will be very important for you to insist on FT-4 and FT-3 tests every time she has labs and ONLY dose by those - TSH is useless for adjusting doses, lags 6 weeks, and can be affected by stimulating and blocking antibodies. Has anyone run a TSI antibody test?

Goal is mid range to 3/4 range for both Free's tests.


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## Octavia (Aug 1, 2011)

Lovlkn, your 2nd to last sentence cut off...I assume you were asking if she's had TSI antibodies tested?


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## Jlgsmom (Feb 11, 2013)

Thank you so much for responding! Yes, the Synthroid was started after her 2/6/13 labs. We didn’t see the Endocrinologist until the next week which was when she started the medication. It was the Gynecologist that ran the labs in January, she is the only Doctor we have seen that listened and believed the issues my daughter was having and made an attempt to help her. Even though she had gained weight she wasn’t overweight which meant she didn’t have a problem in their eyes. I told her Dermatologist in December that her hair was falling out and it was noticeably thinner, so much so I had to have the drains cleaned out. She said it was the birth control pill and sent us on our way. When I called for her refills in January for the bcp I told them what happened with the Dermatologist and they immediately ran the blood work, finding the first “flagged” abnormal values. She then had to refer us back out to the Endocrinologist. Unfortunately we didn’t have much choice of the Endocrinologist because we were forced to see a pediatric since the other Endocrinologist in this area would not see her since she is not 17 yet. As soon as I knew we were going back to see her I called and faxed all the labs we had had to date and told her if she wanted anymore testing to order it immediately so that we would have the results for our appointment, those were the 2/6/13 labs. We didn’t get a how, or why, just that there is a problem and take this medication. She did tell us the TSH test didn’t work for her. Thank you for putting those mid ranges up. I see from the very start her Free T4 was below the mid range. I guess it was normal but I feel like maybe she should have at least retested in a few months to see if those numbers changed. It scares me to think what could have happened if the GYN had not ordered those labs. My daughter is exhausted all the time, feels like a block of ice, goes to the bathroom once a week, not to mention the hair falling out, changing texture, brittle and breaking off, plus the brittle slightly yellow finger nails, weight issues and generally pale skin. Since the medication she actually perspired during a workout, has moments she’s not so frozen and is using the bathroom more. She has not had the TSI test. We go back in March, I plan to demand the TSH, Free T4, Free T3 and the lipid panel. Should I also demand TSI test?


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## Lovlkn (Dec 20, 2009)

I would push for the TSI test - the reason why is her TSH is not as high as it should have been for the low Free T-3 and Free T-4.

While you do not want to dose by TSH - having the TSH your daughter did tells me something is going on other than simple hypothyroid aka hashimoto's and also her TPO isn't as high as I would expect it to be for her showing such hypo Free's.

The high cholesterol is due to being in a hypo state.

When they palpitate her thyroid have they said anything regarding size or feeling any abnormalities? You might want to ask about a sonogram to find out why her thyroid is not functioning properly.


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## lexi731 (Dec 6, 2012)

Jlgsmom said:


> She has been taking Synthroid 112 mcg for about 15 days.


Did she start at that dose? That seems really high to me.


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## jenny v (May 6, 2012)

112 mcg of Synthroid seems like a really high starting dose to me, too. I have Hashi's and am only on 75mcg currently, which has been built up over the years from a starting dose of 25 mcg.

I would definitely request a TSI test and an ultrasound, too. Her TSH is really odd in comparison to her Frees.


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## StormFinch (Nov 16, 2012)

You might also want to have her pituitary and hypothalamus checked just to be on the safe side. What little information I've seen on low Frees combined with a low TSH suggests possible problems in one of those areas.

I'm really sorry she's having to go through this at this stage of her life. Dealing with puberty is tough enough on it's own without having the extra stress of another hormone problem thrown in.


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## Andros (Aug 26, 2009)

Jlgsmom said:


> Thank you so much for responding! Yes, the Synthroid was started after her 2/6/13 labs. We didn't see the Endocrinologist until the next week which was when she started the medication. It was the Gynecologist that ran the labs in January, she is the only Doctor we have seen that listened and believed the issues my daughter was having and made an attempt to help her. Even though she had gained weight she wasn't overweight which meant she didn't have a problem in their eyes. I told her Dermatologist in December that her hair was falling out and it was noticeably thinner, so much so I had to have the drains cleaned out. She said it was the birth control pill and sent us on our way. When I called for her refills in January for the bcp I told them what happened with the Dermatologist and they immediately ran the blood work, finding the first "flagged" abnormal values. She then had to refer us back out to the Endocrinologist. Unfortunately we didn't have much choice of the Endocrinologist because we were forced to see a pediatric since the other Endocrinologist in this area would not see her since she is not 17 yet. As soon as I knew we were going back to see her I called and faxed all the labs we had had to date and told her if she wanted anymore testing to order it immediately so that we would have the results for our appointment, those were the 2/6/13 labs. We didn't get a how, or why, just that there is a problem and take this medication. She did tell us the TSH test didn't work for her. Thank you for putting those mid ranges up. I see from the very start her Free T4 was below the mid range. I guess it was normal but I feel like maybe she should have at least retested in a few months to see if those numbers changed. It scares me to think what could have happened if the GYN had not ordered those labs. My daughter is exhausted all the time, feels like a block of ice, goes to the bathroom once a week, not to mention the hair falling out, changing texture, brittle and breaking off, plus the brittle slightly yellow finger nails, weight issues and generally pale skin. Since the medication she actually perspired during a workout, has moments she's not so frozen and is using the bathroom more. She has not had the TSI test. We go back in March, I plan to demand the TSH, Free T4, Free T3 and the lipid panel. Should I also demand TSI test?












In addition to what others have said, please get your daughter an ultra-sound of the thyroid as well.

And here is a list of labs for you which may or may not be helpful.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.

Negative test results means that the autoantibodies are not present in the blood at the time of testing and may indicate that symptoms are due to a cause other than autoimmune. However, a certain percentage of people who have autoimmune thyroid disease do not have autoantibodies. If it is suspected that the autoantibodies may develop over time, as may happen with some autoimmune disorders, then repeat testing may be done at a later date.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

I hate it when children are unwell; I think we all have a soft spot for the youngsters!


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## Jlgsmom (Feb 11, 2013)

The Dr. did do a physical exam, felt around on her neck. She said everything felt normal, it did not appear to be swollen or enlarged.

Also, yes my daughter did start at 112 mcg Synthroid. We had an 8am appointment and my daughter had fasted just because she is so accustomed now to going to the Dr. and having blood drawn so she actually took her first dose of Synthroid at the dr. office. They had given us a 6 week supply so we wouldn't have to fill a prescription if it ended up being the wrong dose. She is 15, about 5'6 and 135 pounds right now.

Thank you all for responding and trying to help me! I'm compiling a list of questions and tests I want to talk to the Dr. about! It sounds like I really need to push the Dr. to find out why this is happening, not to just treat it. I'm a bit obsessive compulsive when it comes to my child. She is having her blood drawn March 20 th , and we have an appointment for March 26 th . I'll be reading everything I can on this board until then, this time I'm going in armed with information, thank you all so much!


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