What Could It Be?

[tncook58]

8yo female with mostly normal blood work (Lymphocyte Relative % 60, everything else is within range - though some are JUST normal). Her AST was700 and ALT 1100 last week, but seem to be trending down. Her TSH was elevated, but is now normal. Thyroglobulin was 9.9. Her thyroid was quite enlarged at one point, no nodules were present, but is now appearing to be normal. She had multiple enlarged cervical lymph nodes (2+cm) when thyroid was enlarged, no new imaging has been done to see if they have changed in size.

Symptoms include chronic fatigue, chronic leg pain (right, lower), chronic headaches, frequent nose bleeds, frequent c/o sore throat, SOB (no wheezing), c/o being cold, mouth ulcers, decrease in appetite, severe constipation.
STRONG family history of cancer and thyroid disorders.

[Ken_PA]

Some thoughts.

Let's think about her liver enzymes. Has she had any antithyroid medication (or any medication) that's raising them so much? If not, has she had the blood test for CK (creatine kinase)? If that's high, then her leg pain might be from some one-sided muscle damage. Di she bump that leg; or alternatively, was she very active during a period of hypothyroidism so then that resulted in muscle damage?

For her frequent nose bleeds: since her platelets are normal, we'd next think of the clotting proteins being low, which are made in the liver -  so that can alternatively tie in her highly elevated AST and ALT with decreased liver function which results in decreased clotting proteins.


I assume the doc ran thyroid tests for T3 and T4 and those were normal.

[Ken_PA]

Hi, I'm sorry to hear she's having such a rough time. With all of that going on, her nodes are probably just reacting -- it's likely not-cancer.

Children's nodes are usually more reactive and grow relatively larger than for adults. They can be reacting to some infection. Lymphocytes usually go high because of some virus. Also possible is some immune dysfunction, especially with the thyroid involved but that's out of my sphere so I don't really know. Sorry.

But there do seem to be lots of powerful immune system biochemicals going around in her system which are causing a lot of the effects.

If her nodes enlarged almost overnight, then that's also a good sign of being reactive and not-cancer. If they stay enlarged for a very long time, you can ask for an ultrasound --- and make sure that it looks for not just size but also for "internal architecture"..

[tncook58]

Thank you for the response!
Her WBC came back today low instead of within range, with still high lymphocyte % and low neutrophil %, but everything else was normal minus the liver enzymes which are still trending down. Because she was SOB and c/o of chronic lower leg pain for so long, her doc did order a chest and leg xray, but we are still waiting for the radiologist to read and release that information. We did agree to wait on following up with a neck ultrasound based on the results of these tests, but not being able to feel anything severely abnormal from her external neck has relieved some stressors for me.

[tncook58]

Oh, and manual nRBC of 1 was included, but I am not certain how relevant that is.