# 3 year old, what does this mean?



## jackandsamayasmom (Jul 11, 2012)

TSH 1.87 (.64 to 4)
TT4 6.5 (7.8 to 15.5)
FT4 1.6 (1.0-2.8)

Hi! I am new to this group and not even sure if I should be here. My 3 year old little girl has FPIES (Food Protein-Induced Enterocolitis Syndrome), which is food allergy of the gut. As she is getting older things are getting more complicated when in most children they have begun to resolve by 3. Her docs agree that it looks a lot like auto-immune, but aren't big testers. I recently asked for thyroid tests after talking to a mom who's 3 year old was recently diagnosed with Graves. It all sounded so familiar and matched so much of what we are seeing! So, blood was drawn Friday. Here's the symptoms we have been seeing. After her reactions we see an illness (often terrible canker sores or hand foot and mouth disease). She has periods of erratic behavior following reactions (mood swings, uncharacteristic tantruming) and she won't sleep. She has been having spells for a year where she says her nose is burning. She is seeming to have an "off" thermometer- sometimes hot or cold when she shouldn't be. She has had periods where her brush is full of hair each time we brush it. She has had beau's lines on her hands and feet after a reaction. She doesn't seem to have the normal stamina of a 3 year old. Any ideas of what we are dealing with? Does a low TT4 and a normal FT4 mean she has some other issue besides thyroid? Or is it just her weird and nothing to worry about? I feel so lost. I just want her to feel well! If you've stayed with me this long, thank you!!! Any thoughts are welcome!


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## jackandsamayasmom (Jul 11, 2012)

I forgot to mention that we are still waiting on a couple of tests. Antibody and T3, I think?


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## Andros (Aug 26, 2009)

jackandsamayasmom said:


> I forgot to mention that we are still waiting on a couple of tests. Antibody and T3, I think?


I hope you are waiting on some of the tests listed below and also the FREE T3 rather than the T3. Free is unbound available for cellular uptake.

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. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

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/

What a shame your precious little one is so ill.

You may find the link below helpful; there will be an index on your left so you can bypass all the neonatal stuff if you like.
http://www.thyroidmanager.org/chapt...d-gland-in-infancy-childhood-and-adolescence/


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## jackandsamayasmom (Jul 11, 2012)

Thanks for your reply. These tests were ordered at my request (though all I knew to ask was for blood tests for Graves/Hashimotos). The tests were ordered by her allergist. Do these results warrant a trip to another specialist? Endocrynologist?

I know we are waiting on 3 more tests, so all the ones you mentioned couldn't have been done. Do her results indicate we should do these tests to keep digging or are the standard?

I am sorry for all of the questions. This not knowing what is going on has raised my anxiety!


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## joplin1975 (Jul 21, 2011)

Wow, that's a lot for a kiddo to be dealing with -- the poor little bug!

So, those free t4 and free t3 tests that Andros is referring to are really, really important. The total t4 and total t3 aren't really that helpful. The frees tells us how much her body has available to use. In most cases, you want those numbers to fall at mid-range to higher...

So just on the numbers posted below, while her TSH looks ok, her free t4 is a little on the low side. Will be waiting anxiously on the free t3 result.

To complicate the situation, those antibodies can skew the results of the frees tests...so those results will be informative.

I would wait until all the results come back before calling a specialist, but if the antibodies are high/abnormal, I'd be prepared to ask her pediatrician for an ultrasound of the thyroid.


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## Andros (Aug 26, 2009)

jackandsamayasmom said:


> Thanks for your reply. These tests were ordered at my request (though all I knew to ask was for blood tests for Graves/Hashimotos). The tests were ordered by her allergist. Do these results warrant a trip to another specialist? Endocrynologist?
> 
> I know we are waiting on 3 more tests, so all the ones you mentioned couldn't have been done. Do her results indicate we should do these tests to keep digging or are the standard?
> 
> I am sorry for all of the questions. This not knowing what is going on has raised my anxiety!


When anything is wrong w/our "wee ones" ; anxiety is through the roof. They can't tell us so it makes it pretty rough.

Let's wait and see what tests were done and take it from there. If you would like, when you get the results, please post them here with the ranges.

The only question to be sorry for is the one you did not ask! LOL!


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## CA-Lynn (Apr 29, 2010)

If it was my kid, I would find a good medical school and get the benefit of all the specialists' opinions, rather than keep taking the poor darling in for tests to different doctors. I know you have a diagnosis, but medical schools are more "Up" on all the correlations to other diseases and will know to test for same.

Poor kid. Age 3 is a tough time to be dealing with all of this, so maybe better to get the diagnostics done in one fellswoop?

You have to deal with this gently for the child's sake. My earliest memory is at age 2 and a half when I had my tonsils out. I have a VERY detailed memory of it all, confirmed by my mother.


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## jackandsamayasmom (Jul 11, 2012)

This is all tremendously helpful. I am beginning to understand, at least a little. This is all so complex! You've given me enough info to help me relax a little. I am glad to know we may not need a specialist! I will post back when we get the rest of the results. It has been almost a week now and the lab technician seemed to indicate it wouldn't take that long. I can't thank you all enough for helping me understand these tests. You are doing a great thing!


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## Andros (Aug 26, 2009)

jackandsamayasmom said:


> This is all tremendously helpful. I am beginning to understand, at least a little. This is all so complex! You've given me enough info to help me relax a little. I am glad to know we may not need a specialist! I will post back when we get the rest of the results. It has been almost a week now and the lab technician seemed to indicate it wouldn't take that long. I can't thank you all enough for helping me understand these tests. You are doing a great thing!


You are so very welcome!!! Most of us here are just "passing it forward!"


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## jackandsamayasmom (Jul 11, 2012)

I just confirmed that the remaining two tests we are waiting on are TPOAb and PTH. Hopefully that will be enough to tell us something. The allergist seems to think everything is good enough so far.


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## Andros (Aug 26, 2009)

jackandsamayasmom said:


> I just confirmed that the remaining two tests we are waiting on are TPOAb and PTH. Hopefully that will be enough to tell us something. The allergist seems to think everything is good enough so far.


I don't know much about the PTH but I do about the TPO Ab.

Everyone should have a little TPO but not TPO Ab.

Anti-microsomal Antibodies- TPO Ab
Negative test is normal; you should not have any of these antibodies. And the healthy person does have a low titer of TPO.
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

Alternative NamesThyroid antimicrosomal antibody; Antimicrosomal antibody; Microsomal antibody; Thyroid peroxidase antibody; TPOAb

This antibody, historically referred to as the anti-microsomal antibody, is established as a sensitive tool for the detection of early subclinical autoimmune thyroid diseases, follow up of the response to immunotherapy and identification of at-risk cases for autoimmune thyroid diseases [8].

We will all be anxious for the test results and ranges.


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## jackandsamayasmom (Jul 11, 2012)

OK, results are in! I will repaste all of them here so you can see them together at once.

TSH 1.87 (.64 to 4)
TT4 6.5 (7.8 to 15.5)
FT4 1.6 (1.0-2.8)
Thyroid peroxidase antibody 7.7 (5-33)
PTH related peptide <1.9 (0-4)

So they say it is normal to have antibodies. That they are within range. Are we completely in the clear here and should look elsewhere for an issue that is causing her symptoms?


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## jackandsamayasmom (Jul 11, 2012)

Bumping for answers! Andros? This is a really low number of antibodies. Are we in the clear? Should we just watch? Any ideas where to go from here? Our doctors aren't very interested in pursuing her symptoms because her weight is stable and she seems healthy. I don't even know what the next step would be. Functional Med doc?


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## Octavia (Aug 1, 2011)

I agree that those antibodies are very low, but they're there. I don't think it's cause for alarm, but it is probably worth watching.

You may find this information more helpful:

http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test


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## joplin1975 (Jul 21, 2011)

I think you're in a situation where you'll have to watch it, but there's no need to pull any alarm bells quite yet.

I think her Free T4 is on the lower side and there are antibodies there, although not much. It's hard to say if those are causing her symptoms...my gut would say probably not, but who really knows.

I do think you'll have to make sure to watch her as she ages, particularly when she hits puberty.


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## jackandsamayasmom (Jul 11, 2012)

Thanks! That's what I was thinking! I appreciate everyone's thoughts! Hopefully she is just being 3. Time will tell, I suppose. She isn't in any kind of a dangerous health situation. I just want to be sure we aren't being passive in her care.


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## Andros (Aug 26, 2009)

jackandsamayasmom said:


> OK, results are in! I will repaste all of them here so you can see them together at once.
> 
> TSH 1.87 (.64 to 4)
> TT4 6.5 (7.8 to 15.5)
> ...


Your daughter's FT4 and TT4 are both in the basement. Something "is" wrong and the healthy person should not have any TPO Ab.

Anti-microsomal Antibodies- TPO Ab
Negative test is normal; you should not have any of these antibodies. And the healthy person does have a low titer of TPO.
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

Alternative NamesThyroid antimicrosomal antibody; Antimicrosomal antibody; Microsomal antibody; Thyroid peroxidase antibody; TPOAb

This antibody, historically referred to as the anti-microsomal antibody, is established as a sensitive tool for the detection of early subclinical autoimmune thyroid diseases, follow up of the response to immunotherapy and identification of at-risk cases for autoimmune thyroid diseases [8].

http://www.biomedcentral.com/1471-5945/6/3

I would push on this and if necessary get a pediatric endo.

http://www.thyroidmanager.org/chapt...d-gland-in-infancy-childhood-and-adolescence/


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## jackandsamayasmom (Jul 11, 2012)

Andros said:


> Your daughter's FT4 and TT4 are both in the basement. Something "is" wrong and the healthy person should not have any TPO Ab.
> 
> Anti-microsomal Antibodies- TPO Ab
> Negative test is normal; you should not have any of these antibodies. And the healthy person does have a low titer of TPO.
> ...


OK, so got any ideas where I start here? Pediatrician and Allergist say this is a done deal. We are in Cincinnati OH and it looks like all of the ped. endocrinologists here seem to specialize in diabetes and obesity. How do I find someone to take us seriously?


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