Any pediatrician or endocrinologist here?or a.o know abtTSH

amother

Tue, Oct 20 2020, 1:23 am

anonymrs wrote:

Yes it's a concern. You need a complete thyroid panel consisting of these tests- TSH, free t3, free t4, reverse t3, thyroperoxidase (TPO), and thyroglobulin antibodies.

curious what's your background? medical or experience with yourself or your child? I already asked my dr about it and he said it's no problem. how do I go about it if he doesn't think it's a problem? I can't just tell him to write me a lab slip...

nanny24/7

Tue, Oct 20 2020, 6:41 am

Yes the other markers were normal. And we had no symptoms. Synthroid medication once a day. Labs every few months to recheck. No side effects. Had to increase dose slightly just once in years, based on labs results.
I don't know if for life lol.
But it's such a none issue that's so common I wouldn't care.
Thyroid is hugely important especially for kids or teens as it's involved in the growth process too.
Small inconvenience in the bigger picture.
And I wouldn't wait and worry on what pediatrician thinks. Every month in a child's growth and development counts.

imasinger

Tue, Oct 20 2020, 7:23 am

This thread isn't so much about endocrinology as it is about self advocacy with regard to medical professionals.

OP, here's how to do it.

Call the pediatrician, and say, "I'd like a second opinion about DS from a pediatric endocrinologist. I'm still concerned that recent unexplained behavior changes may be connected to this high level. Can you help us with the referral, and signing off on the insurance?"

Doctors know they are fallible. They actually often appreciate your pushing back if you have concerns.

Frankly, if this one doesn't give you the referral, I'd start looking for a new pediatrician. But I'll bet you'll get it without any trouble.

amother

Gray

Tue, Oct 20 2020, 7:27 am

Definitely get a second opinion. My son had a high tsh and no other markers (tsh was over 9) and he was immidiately put on synthroid. Maybe with your son's numbers it's more of a keep an eye on it situation, but at the very least, it warrants some further investigation, and if your doctor is not doing that, find someone else to consult with. I will say though, thyroid issues are pretty simple to treat and also kids can outgrow them. Mine did.

PinkFridge

Tue, Oct 20 2020, 9:43 am

imasinger wrote:

It's about both. Because when it comes to endocrinology, you need to be really proactive. I don't know why doctors are so crummy when it comes to thyroid. There are good ones, but you need to find them.

OP, I have no medical background. I am a liberal arts type. I got good grades in science but with a LOT of hard work. But what I know is ABC. Starting with

DOCTORS SHOULD NOT GO BY TSH ALONE.

I don't know too much about pediatric endocrinology. Acceptable ranges are different but the principle is the same: TSH is a useful screening tool, to a point, and should never be the primary determinant for medication dosing, whether hypo or hyper. It's important to know how much thyroid hormone is actually circulating and that is achieved by testing BOTH the T4 and T3 hormones.

You see, the first and worst level of incompetence is going by TSH alone.
The next, and lesser level, is by testing T4 but not T3.

https://www.endocrineweb.com/t.....4-tsh
This looks like it might be useful. The book, The Thyroid Solution by Dr. Ridha Arem, is a classic and IIRC really explained te T4 T3 connection well.

PinkFridge

Tue, Oct 20 2020, 9:46 am

I just want to add, YES, OP go for further testing.
I get my blood work done at the hospital lab by dr.'s connected to. I sometimes have a longer wait. (I always get blood work BEFORE the appointment, something good to do if your son is diagnosed and sees his doctor on a regular basis.) The results are posted in the portal and I get a notification right away. Having full access to the results and ranges is really helpful.

amother

Amethyst

Tue, Oct 20 2020, 9:56 am

Pediatric NP here.

A child can have an extremely high TSH and still have normal or almost normal t4 because the body compensates. TSH is released by the pituitary and stimulates the thyroid gland to produce thyroid hormone (t3 and t4). If the thyroid gland isn't functioning properly, it takes more and more TSH to get it to produce thyroid hormone. (As my professor explained it, TSH is knocking on the door of the thyroid gland and if the thyroid gland doesn't respond, it will keep pounding louder and louder.) Eventually though the thyroid gland gives out and can't produce anymore.

Usually with a TSH that's slightly out of range we repeat the test anywhere from a few weeks to a few months later, along with thyroid antibodies. There's something called "transient thyroiditis" where the TSH might be slightly elevated for a short time but then goes back to normal.

I would recommend seeing endo just for peace of mind, although I don't think they would automatically treat unless there were other factors. It really depends on the whole picture and what other symptoms are there.

amother

Ginger

Tue, Oct 20 2020, 10:05 am

I would not consider seeing an endo going behind peds back. And many specialists don’t follow up with the pediatrician and it’s up to you to bridge that gap.

You can always send the pediatrician an email saying something like - hi Dr so & so just wanted to let you know we’ll be seeing Dr so & so from peds endo to f/u on the ___. I’ll keep you posted on the results.
Or after the visit giving an update. If you want you can even add how you wanted to calm down those mommy nerves & make sure all is alright Wink

ETA my child sees doctors in about 10 specialties (and some specialties we have seen 2-3-4 docs in different hospitals/states) no one gets offended as long as the dialogue is open.

amother

Tue, Oct 20 2020, 11:22 am

nanny24/7 wrote:

Thank you!

amother

Tue, Oct 20 2020, 11:23 am

amother [ Amethyst ] wrote:

Thanks for your reply! Do you recommend the endo now or first getting the labs to see if the endo is necessary?

amother

Tue, Oct 20 2020, 11:25 am

imasinger wrote:

PinkFridge

Tue, Oct 20 2020, 12:36 pm

amother [ Amethyst ] wrote:

Normal or almost normal ,I.e. low or just below normal? Is it compensating by selfllessly converting to T3 leaving barely no T4 which means that supplementing might be in order?
Where does T3 fit into your picture? It's sounding like less than optimal monitoring.

amother

Mistyrose

Tue, Oct 20 2020, 12:37 pm

amother [ Amethyst ] wrote:

Ty for those explanations. Not OP but my daughter had blood test done. TSH was normal but T4 was slightly high.
She also tested positive for CMV.
Should I be concerned? What does it mean when only T4 is high? (we do have to repeat test in a couple of months!)

PinkFridge

Tue, Oct 20 2020, 12:38 pm

amother [ Mistyrose ] wrote:

T4 was high? That could indicate hyperthyroidism.