# 13 yr old "normal"? labs



## ncmom (May 13, 2015)

I am looking for some opinions... my gut tells me something is wrong - but I don't know what

This has been a long process -

about 3-4 years ago, my then 9-10 year old son began putting on a lot of weight (despite eating well, limiting sweets, etc) . The pediatrician just kept saying "don't worry about it, he'll grow into it" ...the weight kept increasing, & height began slowing down (my other 3 kids are SUPER thin). I finally got her to run a thyroid test (I have hypothyroid myself) - which she said was normal. I asked to see the numbers - his THS was 4.75. I took him to my endocrinologist who felt he was probably low and started him on a low dose of thyroid. He was then transferred to a pediatric endocrinologist who took him off and said "he's fine - just put him on a diet". Even though we saw the nutritionist in his office (with a complete printout of everything he ate for 2 weeks) and she said " I don't see anything to change" and the Pediatrician was saying do NOT put him on a diet or restrict his calories (he was already eating less than what the charts said a boy of his age should eat)

So currently - he is now just about to turn 14, still quite overweight, tired all the time, voice is hoarse all the time, dry skin...

We saw the pediatric endo a week ago. His height growth was good this year, he did gain quite a bit of weight, but his BMI went down, so that's good. The Dr didn't feel his hoarseness is related to thyroid and referred him to ENT to have them take a look (we have an appointment tomorrow). I asked to have repeat thyroid testing done. (he said pediatric TSH ranges are different than adult)

Here are his numbers:

THS 3.72 (0.34-5.60)

T4 free 0.71 (0.61 - 1.12)

Thyroid Peroxidase Ab 8 (0-26)

Antithyroglobin Ab <1.0 (0.0 - 0.9)

The Dr's office called today and said his labs are all normal - does everything look good to you all? Any thought on anything else that maybe I should look at? I just feel something is off ....

Thanks for any thoughs!


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## Andros (Aug 26, 2009)

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
(Copy and paste into your browser)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/
(Copy and paste into your browser)

They are not normal. You son should have none of the antibodies; period!

He needs an ultra-sound; presence of antibodies and hoarse voice dictate that. FREE T3 needs to be run also.

I hate to disagree w/ the doctor ............................but???

Feeling very bad for your son; it's hard enough to be a teener! He has a good mom, though and w/maybe some help from us you will get to the bottom of this.

Welcome!


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## Lovlkn (Dec 20, 2009)

You are being a GOOD MOM!!!

Keep fighting for your kid and keep looking for a doctor who will treat him properly.

The ENT should do an ultrasound.

Free T-4 and Free T-3 will tell you what hormones are in the blood and are best for dosing purposes. Your son's FT-4 is bottom of range, he is hypo. 3/4 of range is goal. I agree that a FT-3 needs to be ordered.

Hopefully your ENT will order some new labs. If not we have a site we could recommend and you can have them run for $59.


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## ncmom (May 13, 2015)

THANK YOU!

Just to know that someone else doesn't think I'm crazy is helpful. For years my gut has told me something was wrong.

I am in the process of getting a new endo myself (mine retired & I'm not happy with the one who took over his practice - she missed thyroid cancer in a friend of mine!) I have an appointment next month with a highly recommended one - she doesn't treat kids, but the person making my appointment said it cant hurt to ask her - so I will at least run some stuff by her ....

I had asked my son to run a FULL thyroid panel - guess I needed to specifically say "run the free T3 as well" ...

heading to ENT shortly, hopefully he can shed some light...


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## ncmom (May 13, 2015)

so, just got back from ENT - he put a scope down his throat, said the vocal chords looked good, but there is swelling at the larynx this, combined with the constant throat clearing & hoarseness, indicates acid reflux - gave him an RX return in 6 weeks.

He did really feel his neck (seemed thorough - had him swallow and all) and said he didn't feel anything...

He is actually also endocrine surgeon (has removed a number of thyroids - and his father is a pediatric endo) - he said he felt my son's endo was a good dr.

I do feel better about the hoarseness now, and will inquire with his endo for clarification as to why he feels they are all "normal"


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## Andros (Aug 26, 2009)

You just have to get your son an ultra-sound! Did you ask the doctor about that?

God bless; I am very concerned as I know you are.

Hugs,


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## ncmom (May 13, 2015)

ok - so after looking at all the labs, I sent a message to the pediatric endo - this is what I sent - and the reply I received:

----- Message -----from me

I know someone in the office told us that all X's labs were "normal" (they said we were sent a letter but for some reason we didn't receive it.)
So I just wanted to get a little clarification on his results - to go with everything I've read or been told by others  I just need to make sure that I understand it all.....

TSH - 3.72 I see it is in normal range - what is the "optimal" level for teen boys? I understand that is may be higher than adults?

Free T4 - 0.71 I see that it is within the range, but that it is at the very low end - what is the optimal level? I've been told that it should be in the 50-75% of the range?

Free T3 - I don't see any results for this - was this not ordered?

Thyroid Antibiodies:

Thyroid Peroxidase Ab 8 I see that is within the range and at the low end - again, what is optimal? I've been told you don't want ANY antibodies present, but also understand that sometimes the antibodies can show up without symptoms - and will sometimes lead to Hashimotos in the future, but not always (X's grandmother has it, & I'm being tested next month)

Antithyroglobulin Ab < 1.0 not exactly sure what this means since it doesn't give the exact decimal and the range is 0.0 - 0.9 - does that just mean that there are some antibodies present, just not over 1? and again, is it "normal" to have any present?

When X saw the ENT Dr last Friday he asked it an ultrasound had been done? 
He said his vocal chords looked good & started him on an acid reflux med to see if that helps his hoarseness.

Thanks in advance - just doing my due diligence to make sure I have a complete understanding.

Reply from Dr - -

Hi xxxxx-

X's TSH and Free T4 were both normal. The optimal ranges for these tests are defined by the reference ranges provided. I did not order a T3 as this is not useful except in the setting of hyperthyroidism. X's thyroid antibodies are normal (not elevated). This confirms he does not have autoimmune hypothyroidism as they would be expected to be elevated in the setting of autoimmune hypothyroidism. I hope this helps clarify things. If you would like to discuss further I'm happy to schedule some time for you to come in and discuss in person.

------------

so basically - "everything is normal" ANYTHING within range is "optimal"


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## ncmom (May 13, 2015)

Just wanted to post an update on my son..

We FINALLY got him in to a new endocrinologist (the same one I now see) end of Sept. (my husband took him since I was out of town - Dr ordered all these labs without having to be asked! 

here are his lab results:

TSH 5.71 (range 0.45-4.5)

Free T4 1.31 (range 0.93 - 1.6)

Free T3 3.8 (range 2.3 - 5.0)

TPO Ab <6 (range 0-26)

Thyroglobuin Antibody <1 (range 0.0-0.9)

Cortisol 17.8 (range 2.3-19.4)

Ferritin 38 (range 16-124)

vitamin D 15.7 (range 30-100)

vitamin B12 392 (range 211-946)

CBC - everything in normal limits

CMP - most things in normal limits, except:

Glucose, serum 114 (range 65-99)

HGB A1c 5.8% (range 4.8-5.6%)

ultra sound was done:

RIGHT LOBE:

ant-post: 0.98cm

transv: 1.44cm

sag: 4.53cm

volume: 3.3ml

echotexture: homogeneous

other: normal blood flow

LEFT LOBE:

ant-post: 1.07cm

transv: 1.22cm

sag: 4.52cm

volume:3.2ml

echotexture:homogeneous

other:normal blood flow

ISTHMUS THICKNESS

ist ap th: .32cm

FREE TEXT: no enlarged lymph nodes visualized

handwritten on the results was: ultrasound shows normal tissue with normal thyroid and right is minimally enlarged

He was started on levothyroxine and vitamin D - will be seen again in December

SO glad I finally got him to a Dr that actually ran all the tests, including ultrasound - and am finally being taken serious on something I've been questioning for years (on a side note - with definitive laboratory proof of hypothyroid, the pediatrician now had NO problem ordering a battery of tests I requested for 2 of my other kids - still waiting for the antibody results, but looks like my older son may be hypER thyroid..)


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## Octavia (Aug 1, 2011)

Super! Glad you trusted your "mother instinct."

Any thoughts about the blood glucose? That's a little concerning.


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## ncmom (May 13, 2015)

yea - I was wondering about the glucose as well - the Dr did mention that is was high and to "try to watch sugar and refined carbohydrate intake" and she will keep an eye on it...


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