Pediatric Thyroid Reference Ranges

4/3/2017

This question comes up a lot online: "What are the optimal reference ranges for thyroid hormone labs in children?" I hope this post serves to help parents and physicians understand optimal reference ranges for children versus reference ranges reported on actual lab results. This is an important topic as thyroid hormone is crucial for brain and global development of infants and children.

Unfortunately, there are no national or international standards for reference ranges that labs use. This has resulted in sometimes huge variations in reference ranges used by different labs. Ultimately, a well-studied physician should have their own reference ranges that they use when evaluating labs.

The six most important labs to obtain when assessing thyroid function, regardless of the age of the patient, are:

TSH
free T4
free T3
reverse T3
TPO
TgAb

There are others but these are values that assess direct thyroid hormone status. The other labs that are pertinent to thyroid hormone function are CBC, ferritin, zinc, copper and vitamin D. I'll start by reviewing in very simple terms the thyroid hormone cascade.

Image 1

TSH (thyroid stimulating hormone) is secreted from the pituitary gland. It's released into the blood stream where it travels to the thyroid gland. TSH docks with receptors on the thyroid gland, triggering the gland to secrete T4 (thyroxine) hormone. It also secretes some T3 (triiodothyronine) hormone. T4 and T3 are secreted in an 11:1 ratio (Snyder, 2012) from the thyroid gland in humans. T4 hormone travels from the thyroid gland back to the pituitary gland as well as throughout the whole body. The pituitary gland responds to levels of T4 in the blood by lowering TSH that is secreted, but not too much. A negative feedback loop is created that results in a stable release of TSH from the pituitary and T4 from the thyroid gland. T4 that travels througout the rest of the body must be converted to T3 hormone at the cellular level. T3 hormone is active thyroid hormone that every cell of the body is dependent upon to function. T4 converting to T3 hormone occurs when one iodine atom is removed from T4 to result in T3 hormone.

This removal of iodine is accomplished by deiodinase enzymes (D1, D2 and D3 in Image 2). There are several forms of this enzyme. One form removes the iodine that results in active T3 hormone and and another form removes an iodine that results in inactive thyroid hormone called reverse T3. This is the body's system of "deciding" on a cellular level how much energy is needed in any given moment. When too much reverse T3 is generated compared to active T3 this results in hypothyroidism that goes by several names, Euthyroid Sick Syndrome or Non-thyroidal Illness Syndrome. (Lee, 2016; DeGroot, 2015)

Image 2. http://deiodinase.org/

The most important message to take away from this is that the thyroid hormone process within the body is complicated and involves many steps that include proper pituitary function, thyroid gland function, deiodinase enzyme function, cell receptors and thyroid hormone receptors within each cell of the body. A problem in any of these steps can result in hypothyroidism.

Given the negative feedback loop that occurs between TSH and T4, endocrinologists have been using TSH levels only to assess the health of the very complicated thyroid hormone process for their patients. This has resulted in many patients who still experience symptoms of hypothyroidism but are told by their doctor that they don't have hypothyroidism. The result of this for an adult is often continued fatigue, depression, weight gain, dry skin and many other symptoms. Given the critical role thyroid hormone plays in childhood development at key stages that can't be revisited, this same incomplete assessment can result in irreversible lack of optimal brain development. For a thorough review of the important role thyroid hormone plays in brain development please read "Thyroid Hormones in Brain Development and Function" by Juan Bernal, M.D. Ph.D.

As it turns out several studies do exist supporting that the current practice of using TSH only to assess thyroid hormone function is missing a lot of patients with hypothyroidism, including children. One such study was conducted in 2005 by researchers at Athens University School of Medicine (Koutras, 2005). They tested TSH, T4 and T3 levels in 85 patients with hypothyrodism who were taking T4-only medication. They found that these patients had lower T3 levels compared to normal, non-hypothyroid subjects. They concluded that hypothyroid patients may benefit from co-administration of T3 and T4 medication. They also concluded, "TSH levels used to monitor substitution, mostly regulated by intracellular T3 in the pituitary, may not be such a good indicator of adequate thyroid hormone action in all tissues. " In 2015 a team of physicians collaborated to write "Homeostatic Control of the Thyroid–Pituitary Axis: Perspectives for Diagnosis and Treatment". They suggest that the use of TSH be "scaled back" and highlight the importance of T3 hormone levels.

The most important work being done to support the need to use more in-depth labs and assessment when testing patients for hypothyroidism is Dr. Antonio Bianco. The website for his lab is Deiodinase.org. His lab is doing extensive and valuable work investigating the important role that local cellular control of thyroid hormone plays in the thyroid status of patients. This website contains a wealth of knowledge regarding deiodinase enzymes and I highly recommend Endocrinologists start studying his work.

Although the role TSH levels play in thyroid hormone assessment should be downplayed, an optimal reference range should still be discussed. Many functional medical doctors agree that an optimal reference range for a test result is quite different than reference ranges that have been established by labs. These reference ranges may be capturing lab values for patients with undiagnosed pathology. The optimal reference range for TSH is generally accepted to be 1.0-2.5 mIU/L. In 2015 the American Association of Clinical Chemistry published "Thyroid-Stimulating Hormone" in which they state:

Although there is a consensus that the lower limit of the euthyroid reference interval for TSH should be 0.2–0.4 mIU/L, experts disagree about the appropriate upper limit. In 2002, researchers published an analysis of thyroid function test results from a large survey of individuals representative of the U.S. population (3). The study revealed that within a small standard error the mean TSH level in the general population is approximately 1.5 mIU/L. This finding prompted organizations to call for lowering the upper limit of the normal TSH reference range. The National Academy of Clinical Biochemistry recommended 4 mIU/L, while the American Association of Clinical Endocrinologists set the upper limit at 3 mIU/L, and other groups went as low as 2.5 mIU/L

As well, researchers in the UK refer to a normal TSH as <2 mIU/L in "Pitfalls in the measurement and interpretation of thyroid function test".

The optimal reference range for TSH in newborns, infants and children varies from those of adults. In addition, there are definite differences in optimal free T4 and free T3 levels in children. The most comprehensive anaylsis of thyroid hormone tests of pediatric patients was done in 2008 (Kapelari, 2008). Researchers analyzed medical records of 414 patients. Patients were grouped into age ranges of 1 day to 1 month, 1 – 12 months, and 1 – 5, 6 – 10, 11 – 14, and 15 – 18 years, respectively. They state in their conclusion, "Our results corroborate those of previous studies showing that thyroid hormone levels change markedly during childhood, and that adult reference intervals are not universally applicable to children." The images below are graphs from this study displaying their findings. The darkest black line in the graphs represents the 50th percentile (median) lab result.

Image 3. Reference intervals for TSH of all age groups

Image 4. Reference intervals for free T4 for all age groups

Image 5. The central 95% range for free T3 in females of all age groups

Image 6. The central 95% range for free T3 in males of all age groups

The conversion of pmol/L to pg/mL, the unit of measurement most often used in the US for free T3, uses the conversion factor of 1.536. The pmol/L number is divided by 1.536 to get pg/mL. The conversion of pmol/L to ng/dL, the unit of measurement most often used in the US for free T4, uses the conversion factor of 12.9. The pmol/L number is divided by 12.9 to get ng/dL.

The results from Kapelari's study are converted to US units of measurement and summarized in Table 1.

Table 1. Results from "Pediatric reference intervals for thyroid hormone levels from birth to adulthood: a retrospective study" converted to US units of measurement.

A reference range for reverse T3 in infants and children has not yet been established nor has it adequately been studied. However, some studies do exist. Researchers at UCLA studied levels of T4, T3 and reverse T3 in neonates from 1-30 days old. They found that "high serum rT3 concentration in the newborn becomes comparable to that in the normal adult by 9-11 days of neonatal life." (Chopra, 1975) The same dramatic decrease in reverse T3 in newborns was reported by Dr. Brown and Feingold in 2010 as seen in Image 7. (Brown, 2010) A striking increase in T3 levels after birth was noted by both studies as well. Reference range for reverse T3 in adults has been established to be 10-24 ng/dL. (Endocrine Society Laboratory Reference Ranges) Unfortunately, until further studies are conducted the only information available today regarding reverse T3 in infants is to use that of adults.

Image 7. Source: Shiri B. Feingold, Rosalind S. Brown, Neonatal Thyroid Function, NeoReviews Nov 2010, 11 (11).

It's of utmost importance to assess signs and symptoms of hypothyroidism in infants and children in addition to lab results when determining their thyroid hormone status and whether thyroid hormone supplementation is warranted or not. Those signs and symptoms include:

Dull look
Puffy face
Thick, protruding tongue
Choking episodes
Constipation
Dry, brittle hair
Jaundice
Low muscle tone (floppy infant)
Low hairline
Poor feeding
Short height
Sleepiness
Sluggishness
Slow growth
Hoarse-sounding cry or voice
Short arms and legs
Very large soft spots on the skull (fontanelles)
Wide hands with short fingers

Thyroid antibodies should always be checked when assessing thyroid status given the high prevalence of autoimmune induced hypothyroidism. Naturally, these antibodies ideally should be as low as possible. Once again reference ranges vary widely from lab to lab. The Endocrine Society has determined the reference range for thyroid antibodies to be:

TPO (Thyroperoxidase) - < 2.0 IU/mL
TgAb (Thyroglobulin antibodies) - < 4.0 IU/mL

Functional medical physicians are also taught that TPO up to 15 IU/mL is normal. Reversing autoimmune hypothyroidism and lowering these antibodies is possible. The treatment for doing so is outside the scope of this article. I highly recommend working with a physician who is trained in treating the root cause of autoimmunity if you or a loved one has elevated thyroid antibodies.

In short, hypothyroidism should not be missed in any infant or child given the important role thyroid hormone plays in the health and development of children. Signs and symptoms should never be ignored and a complete and thorough check of all thyroid hormone levels should be conducted.

**Please do not write comments that include your child's specific lab values asking for medical advise. We will not be able to give medical advise based on lab values alone and cannot give medical advise in this format. These comments will not be approved for posting. Feel free to contact the office to make an appointment if you would like our help.

46 Comments

Tasha

6/23/2017 05:04:21 pm

Hello! Thank you for this article. So the optimal reference ranges in children is the last table showing the 25-75th percentiles of each of the thyroid hormones by age group, correct? If this is correct, my 12 year old son is at the 25th percentile for his FT4, but his FT3 is far below the 25th percentile. The lab's reference range for FT3 is 3.74-6.87 pmol/L and my son's FT3 was 3.91, but his doctor said he was fine! I know he is still within the reference range, but I question if it's optimal. He has acne quite badly, his hands and feet get quite cold and his memory isn't very good. Should I seek out a second opinion? Thanks!

Erica Peirson

6/23/2017 10:11:24 pm

If your son's free T3 is 3.91 pmol/L that converts to 2.54 pg/mL. That is quite low. Ideally you would also get a reverse T3 to see if that's elevated. I highly recommend a second opinion. Hopefully you can work with a physician who understands underlying causes of hypothyroidism and doesn't simply recommend thyroid hormone replacement. No one is JUST hypothyroid.

Tasha

6/23/2017 11:34:41 pm

Dr. Erica, thanks so much for your reply! Are you able to do consults over Skype for international patients (we live in Canada)?

Erica Peirson

8/16/2017 10:44:14 am

Tasha, We have many international patients and several from Canada. Please contact our office if you have any questions about how to proceed with making an appointment so we can help you.

Lisa

7/15/2017 05:52:27 am

My daughters lab results are free t4 .84 and tsh .59. I am not sure how to understand her findings?

Pilu

8/1/2017 06:14:22 am

Dr Erica, thanks for this nice article. I would like to consult you for my son who has down syndrome. I am based out of Bangalore, India. My apologies to post the question here but the nutrients or vitamins that you will prescribe for my son after the appointment be delivered to India if I order through natural partners.

Erica Peirson

8/16/2017 10:43:15 am

We have many international patients. Please contact our office for more information about how to proceed with making an appointment so we can help.

Casey

8/16/2017 07:48:40 am

Hi Dr. Pierson, Great article and very informative. My14 year old son was recently diagnosed with growth hormone deficiency and in 4 months has done great on treatment. His Free T4 and TSH before treatment was .8 and 1.4 respectively. A month and a half into treatment his Free T4 was .7 and TSH 1.27. He was tested again at 3 months and he was .7 and 1.7. Our doctor is concerned that the Free T4 is persistently low and prescribed 50mcg of synthroid out of concern for secondary hypothyroidism seems like the pituitary isn't responding. We are doing labs again after 6 weeks on synthroid including Free T4, TSH, TPO and TgAb. Just would like your thoughts? Thanks!

Erica Peirson

8/16/2017 10:41:44 am

As a general rule, it's also important to monitor free T3 and reverse T3 in order to get a more complete picture of thyroid hormone function. Synthroid (T4-only) medication doesn't work for every child is there is a problem with conversion of T4 to T3 hormone.

Casey

8/17/2017 05:31:08 pm

Thank you. I will push to test the Free T3 and reverse T3. In the past they have said that Free t3 does not give us significant information. Thanks again!

Verna Dry

8/21/2017 07:09:20 pm

My grandson has ONH. Everything I have read says they have a high percentage of endocrine issues. His Free T4 is .95 and his IGF is 100 and his TSH is 4.24. To me that seems to high but the doctor thinks we should continue to monitor. Even though he is active he is over weight. He takes Vyvanse as he has problems sitting still. Your thoughts are appreciated

Erica Peirson

8/29/2017 08:52:49 pm

ONH could be secondary to a nutritional deficiency. A TSH of 4.24 is slightly high but it's never wise to make a judgement about thyroid hormone status on TSH alone. Other labs, history and physical area also taken into account when determining what treatment approach to take. I wouldn't "continue to monitor". That's basically doing nothing. I would assess more complete labs to determine underlying cause and make sure your son is in optimal health in all areas.

Erica Peirson

4/5/2018 08:42:47 am

Here is a study to support the importance of B12 and folate to optic nerve function. ONH is often thought to be caused by genetics but it's important for physicians to not miss other potentially treatable root causes.

https://www.ncbi.nlm.nih.gov/m/pubmed/25345287/

Liza link

10/8/2017 11:04:19 pm

Hi,

My daughter is 14 years old, female, her TSH reads at 0.52 and T4 at 9.77. is she slightly hyperthyroidism as i have seen in other websites that at her age TSH normal is 0.7.Please let me know . thanks

Erica Peirson

10/9/2017 08:51:50 am

This is difficult to answer given so little information. Assessing thyroid function based on a TSH alone is not recommended. Signs and symptoms must also be taken into account in addition to free T3 and reverse T3 levels. The T4 level you gave does not include a unit of measurement, nor does it include if it's total or free T4, which makes it also difficult to assess.

Melisa

10/14/2017 08:56:05 pm

My 10 year old daughter's thyroperoxidase AB SER-ACNC was 26 & her TSH was 9.36. Her T4 was 1.1. We visited with a pediatric endo and she only discussed the thyroid part and put her on synthroid. When I asked her about the autoimmune part of her diagnosis, she said she had Hashimoto's Disease and if she was going to to choose a autoimmune disease to have, that would be the one. I left feeling completely lost. My daughter has a full list of symptoms and feels terrible every day. What type of doctor do we need to find to help find the root cause of what is causing it? She didn't want to discuss that and just said she would have it for the rest of her life. Do we need to see a naturepath doctor or another endo? Thank you!

Molly

10/15/2017 10:41:18 pm

My daughter is 7 years old and is prone to extreme fluctuations in mood, symptoms of ADHD (although negative diagnosis), constantly tired no matter how much she sleeps, but hyper at the same time and constipation. She has had these symptoms since she was under 2 years old. She has had her thyroid tested twice and both were within normal range. When she was 4, she had a Free T4 of 1.1 ng/dL and a TSH of 2.62. When she was 6, she had a TSH of 2.26, FT4 1.37 ng/dL, FT3 3.9 pg/mL and TPO of 11 IU/mL. All of these are within normal ranges as well. I'm wondering if it is worth pursuing thyroid issues or if these tests are clearly negative, despite the symptoms.

Erica Peirson

10/16/2017 09:03:12 am

Lab results can not be reviewed here on this blog post. In order to assess the thyroid status of a patient a lot more is needed than just a TSH and free T4 level. It's also important to keep in mind that no patient is ONLY experiencing hypothyroidism. There is always an underlying cause that must be addressed as well. This requires a full history, physical exam and often more labs to be done. Signs and symptoms of hypothyroidism mirror other conditions and nutrient deficiencies as well. Working with a physician who is trained to recognize these things is key. We work with families all over the world. Please contact the office or read on our website about how to make a new patient appointment if you would like our help.

Amanda

11/13/2017 08:18:37 am

Dr. Piersen,

My daughter who is 4, has been overweight her whole life, has skin issues, and chronic constipation. Her TSH result was 4.46 and the doctor is saying that this is just outside the normal range, and that she likely doesn't need treatment. We eat extremely clean, and are an active family (she does gymnastics, dance, swimming, and soccer). Would you push for a specialist? I'm just feeling like things shouldn't be so hard. :(

Erica Peirson

11/13/2017 09:29:38 am

You should definitely push to get more help given her symptoms. Naturally we can help, but you might be able to find someone on the "Find a physician" list at Thyroidchange.org or Thyroiddoctors.com. Find someone who is willing to help with underlying cause, not just writing a prescription for thyroid hormone. No one is JUST hypothyroid. Good luck!

Dee

1/25/2018 01:39:18 pm

Hello. My son is 3 months old and currently has a TSH of 0.02, T4 of 22.3 and T3 at 5.58. His paediatrician is saying his Thyroid function is now hyper upon treatment with natural dedicated Thyroid. Shortly after birth upon getting a diagnosis for T21, his TSH was 8.8.. He is doing great and I'm now being told I need to stop medication. Should I receive a second opinion?

Erica Peirson

1/25/2018 01:50:30 pm

It's important to get the proper labs. Working with a physician who knows to order free T3, free T4 and reverse T3 in addition to TSH is very important. It's especially important to get a reverse T3 for an infant with T21 too. There are other labs that can give a functionally trained physician clues that a patient is experiencing hypothyroidism as well. Also, working with someone who has a lot of experience with dosing is key as well.

Please read Dr. Peirsons research poster presentation about reverse T3 in infants and children with Down syndrome here:

http://www.peirsoncenter.com/uploads/6/0/5/5/6055321/peirson_poster.jpg

Mary

2/8/2018 07:50:26 am

My 11 yr old daughter just got her labs back... TSH is 8.067 her thyroglobulin antibody is 39 and her thyroid peroxidase is >900.. I havent been able to reach her Dr. What does this mean? I know it not good.

Erica Peirson

2/8/2018 08:49:29 am

The lab results you've shown here indicate that your daughter has Hashimoto's thyroiditis. This is an autoimmune condition that is the number one cause of hypothyroidism. I suggest working with a physician who will not just treat with thyroid hormone replacement medication but will also treat the underlying, root cause for her autoimmune condition. Most conventional endocrinologists don't do this as they are not trained that this is even possible. There is a lot of information online about how this is possible. I also suggest purchasing the book "Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause" by Izabella Wentz PharmD.

Mary

2/8/2018 09:35:19 am

I was told it was the opposite... Hyperthyroidism or Graves Disease. What could be the underlying cause?

Erica Peirson

2/8/2018 10:40:50 am

You were given incorrect information. These results clearly indicate HYPOthyroidism and Hashimoto's. I recommend you work with a knowledgeable physician. There are many possible underlying causes for autoimmune conditions. The book I recommended as well as the website for the author are good starting points. We help patients all over the US and can help as well. Please contact the office if you would like to make an appointment.

https://thyroidpharmacist.com/

Brandalyn Romero

3/27/2018 04:04:32 pm

My daughter has been having crazy mood swings, bloody noses, dizzy spells and near fainting with vomiting. She has an enlarged thyroid with a borderline tsh. Her antithyroglobulin results were 2.4 and the reference range for normal on it say 0.0 to 0.9 with 2.4 being high. They said that they wanted to wait 6 months and see what happens and that she was completely fine. I'm wondering if I should get a second opinion? One doctor said oh that's not good and they second doctor called and said she's fine everything is normal They'll check her antibodies again in 6 months. She's constantly tired, moody, and almost daily migraines.

Erica Peirson

3/27/2018 08:56:22 pm

It's likely your daughter needs more of a work up than just checking thyroid hormone. There are many things that can cause the symptoms you describe. I recommend you work with a knowledgeable doctor who is experienced in uncovering the root cause of symptoms like gastrointestinal dysbiosis, malabsorption, nutrient deficiencies, food sensitivities, etc. Feel free to contact our office if you would like to make an appointment with us.

Ana

5/18/2018 11:26:44 am

Hi Dr. Peirson,

My daughter was diagnosed by her Pediatrician with Failure to Thrive at 9 months old. She will be turning 1 yr in a week and she hasn't grown in height, weight or head circumference since she was 9 mos old. From 6-9 mos old she grew very little. She still fits into 6-9 mos clothes. She has always been easily irritable, constantly waking during the night, frequently wanting to eat (goes crazy when she sees food), poops right after she eats, she's always sweating. I suspect she may have hyperthyroidism. I breastfed since she was born up until she was 10 months old. I, myself, have hypothyroidism... Hashimoto's and I was taking 100 mcgs of Levothyroxine. I found out 2 months ago that my FT4's were elevated and my new Endo reduced my Levo to 88 mcgs. Thats when I stopped breastfeeding. Once I stopped breastfeeding she guzzles her bottles in 2 min and wants to eat ferociously.

Her Pediatric Endo tested her TSH and FT4. TSH was 2.740 (range 0.246- 4.849 uIU/ml). FT4 was 1.42 (range 0.87- 1.83 ng/dL). I requested for her FT3 to be tested but was denied by both her Pediatrician and Pediatric Endo saying it was not necessary since TSH and FT4 were in range.

Erica Peirson

5/18/2018 11:57:27 am

I'm sorry to hear your daughter is struggling. There are issues outside of hypothyroidism that can cause failure to thrive. However, getting a complete picture of how her body is processing thyroid hormone is important. Perhaps if you share this article and information it may help.

https://naturalwellnesschoices.blogspot.com/2009/11/hypothyroidism-and-limitations-of-blood.html

You might also gain more insight from reading our blog post about growth:

http://www.peirsoncenter.com/articles/top-six-factors-impacting-growth-in-children

Kasey

6/6/2018 09:59:47 pm

Hi Dr. Peirson,
I just has my 11 year old daughter tested for hypothyroidism, the TSH levels were 3.044. PCP said it’s within the normal range and she just needs to exercise and see a nutritionist. She is a very active child and does get called fat at school:( she’s already 5’2” 150 pounds, she has a bigger build. I was the same way growing up. I’m at a loss of what to do because she cries when the kids call her mean names :( so looking at Table 1, she should be 1.6 - 2.8? For the 25th to 75th percentile is that correct? Any advice would be greatly appreciated! Thank you!

Erica Peirson

6/7/2018 08:12:02 am

Thyroid hormone function within the body cannot be assessed by TSH alone. Please read the full blog post. Unfortunately, we also cannot give any medical advice over a blog comment.

There are many other factors to weight gain in children including, but not limited to, glucose metabolism. Many doctor's will simply tell patients to exercise more and eat less when there's more that can be done. I recommend you find a Naturopathic physician or functional medicine practitioner in your area to help you do more in-depth testing, diet assessment, history, etc to figure out how best to help her.

Alaa Craddock

6/13/2018 08:01:25 am

My 8 year old has TSH 23.00, free T4 0.73 and Thyroid peroxidase AB 209. But she can't get an appointment with an endocrinologist until Aug 3 (her blood tests were in May). Her pediatrician has given us a levothyroxine RX in the meantime... do you see any issue with waiting two months to be seen by an endocrinologist? I'm wondering whether we should we look for a more distant clinic that can see her sooner.

Erica Peirson

6/13/2018 08:36:10 am

The prescription for Levothyroxine will definitely help her, but labs to check that her dose is adequate should be done 6-8 weeks after starting the medication. Hopefully labs will be dome before you see the endocrinologist. Also, the conventional endocrinologist that you'll be seeing will likely only manage her dose of Levothyroxine to maintain her TSH in an optimal range. Given that your daughter has elevated antibodies, which is Hashimoto's Thyroiditis, she needs more than just T4 thyroid medication. There are many underlying causes of Hashimoto's, which is an autoimmune disease. Your conventional endocrinologist will probably tell you that it's not treatable, but it actually is. I recommend you start by taking a look at the book "Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause" by Izabella Wentz, PharmD. She has a website as well that has a lot of helpful information.

https://thyroidpharmacist.com/

We can also help if you would like to make an appointment with us.

Brittney Stephens

11/2/2018 10:26:41 am

My daughter has Down Syndrome and her TSH for thyroid is 6.2. An endocrinologist reviewed her labs and said it’s okay for now but to recheck in 4 months. I’m wondering if she should be on medication. She is 8 months old.

Erica Peirson

11/2/2018 11:54:01 am

It's a good thing that your endocrinologist at least wants to check it soon and not let it go for longer than 4 months. The best way to determine the need for thyroid medication is to combine lab results with a thorough assessment of symptoms. You can use our Thyroid Questionnaire as a guide to symptoms. Do not simply accept symptoms of hypothyroidism as "normal" for Down syndrome.

http://www.peirsoncenter.com/uploads/6/0/5/5/6055321/pcc_thyroid_questionnaire.pdf

Jessie Gallagher

11/16/2018 11:24:15 am

So my 7 year old son in the last 2 years has gained over 40lbs! His PCP is acting like this is normal for them to “pudge” up as she says. I requested his thyroid to be checked as he is VERY active. They seem to only have tested FT4=1 and TSH=2.08, she said everything was normal, but found this post and thought I’d check for some more information. I’m an RN and I just have a gut feeling that something more is going on with him. Thank you.

Erica E Peirson

11/19/2018 07:53:59 am

Reasons other than hypothyroidism can cause weight gain, but it is very important to run all thyroid labs to get a full assessment. A lipid panel will provide some information about metabolism as well and should be run in a child with unexplained weight gain. Another important reason for weight gain is impaired glucose metabolism. Optimal metabolism of glucose requires more than just insulin. B vitamins and magnesium play a critical role in glucose metabolism. Consider seeing a Naturopathic or functional medical doctor who understands the role vitamins play in fat metabolism.

fuadaziz link

11/25/2018 03:54:10 am

Is there hope of recovery when the disease is discovered on the 45th day of the child?

Erica Peirson

12/18/2018 10:30:10 pm

Absolutely. The brain does heal. With the right support your child can, potentially, do very well.

Doris Malone

12/18/2018 07:28:50 pm

My 14 year daughter has a TSH of -0.007 , T4 16.36 T3 36. They are treating her for hyper thyroid but her ATP were over 6000. Now the pediatric endro has stopped her anti thyroid meds and only left her on beta blocker for the racing heart and BP. She is anxious, mood swings , hot flashes. Doctor is retesting on the 26th because he doesn’t understand the high TPO as it runs in our family; we have Hashimoto’s 3 generations. And he is also doing an ultrasound. My question; can she be in hyperthyroidism before underactive as I was ? The doctors missed mine 25 years ago and I had a small TIA and still stuff from panic attacks. Something I pray my daughter doesn’t have to suffer with.

Erica Peirson

12/18/2018 10:34:13 pm

Her TSI (thyroid stimulating immunoglobulins) should also be tested. As well, she should be seen by a functional medical doctor who can help with the underlying cause for the autoimmune reaction and potential nutrient deficiencies that can cause hyperthyroidism as well as nutrient deficiencies that can be caused by it. Hypo- and hyperthyroid patients need to be seen holistically and be treated for more than just their thyroid condition. There is ALWAYS something else going on.

Jennifer R. Goehring

2/18/2020 03:05:27 pm

Hello! Thank you for this helpful information. My 16 year old son is having difficulties and although we have had some blood work done, we are seeking a second opinion. His TSH came back at 5.010, total T4 7.8, and T3 1.17. They didnt do a free T4 or Free T3 and I didnt see ranges for the Total T's in your article. Would you have more information on this? Our current doctor said he was fine but looking at my once energetic teen, he is not fine. Pale skin, lethargic, bad acne, dry hair, and finds it difficult to concentrate. He has missed so much school and feels awful all the time. Just wanted to get your opinion and advice before our second opinion doctors appt in March. Thank ypu so very much!
Jennifer

Laura Suermann

2/20/2020 07:59:26 am

My 15 year old daughter is very lethargic, and I've had her TSH, T3 and T4 tested along with antibodies and rT3. the only one that comes back elevated is rT3. So, they tell me her thyroid is working ok...however, I myself have high rT3 and very high antibodies, so I would like to get her reevaluated. Can you provide more information on how to contact your office and set up a consult? Thanks.!

Stephen Barksfield

3/4/2021 09:03:03 am

Hi, thank you for the helpful article, My son has Type 1 Diabetes and has also been diagnosed with Auto-immune hypothyroidism. He is taking Levothyroxine daily. His growth rate is slow (Height 9-25th centile, weight just below 50th centile). Free T4 14.9 pmol/L, TSH 3.85 munit/L, Free T3 4.7 pmol/L. I am concerned here in the UK that we are not looking at the other complexities and that Levothyroxine alone will not provide the treatment he needs. He is 13.55 years old. My son is very sporty and his slow growth and size may put him at a disadvantage over the coming years (compared with his peers). I am interested in your opinion, is there anything else we should be looking at with regard to holistic treatment? Many thanks for any information that you can provide.

Exhausted link

3/10/2022 09:49:21 am

My 16 yr old daughter has been struggling with multiple symptoms. It started with 'body tremor',' panic attacks', mood swings, recently brain fog and muscle weakness on her rt calf and cannot walk for some time.
Her labs: (3/09) T4 .8.ng/dl TSH 1.12 (it was .83 in Dec).
T3 146 (Dec)
Dr. states her labs are fine, and they keep referring her to BH. I am super concerned that different symptoms keep trickling in an we don't know how to help her.

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Pediatric Thyroid Reference Ranges

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Dr. Erica Peirson

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Dr. Erica Peirson

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Pediatric Thyroid Reference Ranges