8 yr old daughter High TSH level 5.31

[Spencer_mom1]

Hello:

Need your help to help educate me before Pedis Endo Appt tomorrow.
TSH: 5.31
T3, Free: 3.5
T4, Free: 1.1
Thyroglobulin abs value <1
Thyroid Peroxidase abs value <1

[gimel]

TSH being over range is frequently an indication of primary hypothyroidism, due to autoimmune system disorder causing antibodies to be produced to attack and eventually destroy the thyroid gland.   When this is happening the gland produces diminishing amounts of thyroid hormone, which then causes the pituitary to produce increasing amounts of TSH to attempt to stimulate the thyroid gland to produce more thyroid.    However the tests for TPO ab and TG ab were negative for autoimmune thyroiditis.  Your daughter's Free T4 of 1.1 is about 40% of its range, while her Free T3 of 3.5 is only about 13% of its range, which is lower than optimal for many.    

Usually the best way to assess a person for the possibility of hypothyroidism is first to evaluate for symptoms that occur more frequently with hypothyroidism.   I know it is difficult to find out about symptoms from an 8 year old, but with the exception of anxiety, the ones you listed don't seem to fit with hypothyroidism.    And precocious puberty due to hypothyroidism is reported to be rare.  

So in view of all this I expect that it will be difficult for a doctor to diagnose as hypothyroidism.  I do think that the relatively low Free T3 with normal FT4  is worth a followup test for both Free T3 and a Reverse T3, just to put that to rest.   Sorry I have nothing further to suggest right now.  Hopefully the pediatric Endo will be an excellent one.  Please let us know what transpires.  

[Spencer_mom1]

Thank you for helping me having a broader understanding. I will follow up after Pedi Endo appt this afternoon.

[gimel]

Lab tests and associated calculated reference ranges vary from lab to lab.  So Lab test results must always be compared to reference ranges.  Even though she is not an adult, did the lab show any reference ranges for those tests?

[Spencer_mom1]

TSH: 5.31 - Range: 0.50-4.30 1-19 years old
T3, Free: 3.5 - Range: 3.3-4.8
T4, Free: 1.1 - Range 0.9-1.4
Thyroglobulin abs value <1 - Std Range <1
Thyroid Peroxidase abs value <1 - Std Range <9

[gimel]

Why  was your daughter tested for thyroid?  If it was based on her having symptoms, please tell us about those.  Also, if any were shown, please post the reference ranges on the lab report for those tests.

[Spencer_mom1]

Early onset of puperty, hard time falling a sleep, anxiety, and severe mood swings. I have worked with a team of doctors to pin point a treatment plan to help me daughter. This has been a six month journey. She has been treated by a therapy for the past year.  She recommended cognitive testing to rule out behavior and academic delays to a physiatrist, which lead to lab test that revealed TSH level high, to Pedi Neuro w brain MRI. All stemmed from severe mood swing, struggles with peer relationships and hallucinations of a girl/ a boy in our home. Wow, this feels so overwhelming typing this.