Thyroid, vitamin D and iron questions

[egoldber]

A few weeks ago we had bloodwork done for older DD.

Her vitamin D came back slightly low, at 28 when the range on the lab report is 30-100. The doctor recommended a supplement and to get her outside a lot this summer, but was otherwise not terribly concerned. She already takes 800 IU daily-ish :o but probably not the highest quality in the world (Lil Critters).

She also had thyroid testing done. All her results were normal, but I wanted to check in with the thyroid experts here. :) I tried reading some of the thyroid threads, but they made me :dizzy:

T4 total - 8.5 (range: 4.5 - 12.0)
T3 uptake - 29.2% (range: 27.8 - 40.7
T4, free, calculated - 2.5 (range: 1.6 - 3.7)
TSH - 2.4 (range: 0.5 - 4.3)

Also, her iron was 29, at the very low end of the normal range (27-164). And I am wondering if getting that higher could help make her feel better.

I am wondering if anyone has any thoughts on these numbers. I would appreciate any input. Her doctor is only mildly concerned about the vitamin D.

[sariana]

I don't know anything about thyroid numbers but have low vitamin D myself. A few weeks ago mine came back at 26. This surprised me, as I am fair-skinned, live in SoCal, and spend at least a few hours a week outdoors without sunscreen. I walk DS to and from school every day (~30 minutes total) and also walk around our lake 2-3 times a week for at least an hour, usually closer to 1.5 hours. So I would think my D would be okay. I also drink a lot of milk.

My doctor recommended 2,000 IU of D a day, which I started right away. I need to get back to the lab to be retested.

I think it is quite possible that low iron levels could make your DD feel not quite on top of things. My DC tend to have low iron levels, as well. Both were preemies and took iron for a couple of years. Now we just use Flintstones (the kind with the most iron, which ironically is NOT the kind labeled With Iron).

[tiapam]

are there specific symptoms you are concerned about? did you get the lab ranges? they can vary slightly from lab to lab. her TSH might be considered a bit too high which would make her hypo (underactive). there is at least one poster here who does not feel well over 2. ten years out from permanent treatment i am still trying to get back to my old self. i suspect that i will wind up somewhere closer to 2 and under.

if you even think your kid(s) has a thyroid problem, it is worth researching yourself so you know about the signs and ins and outs of testing. i have to admit, i have thought from some of your previous posts that your older DD might have a thyroid problem. can't remember about your younger DD, but i seem to remember she is a handful, so could be the opposite of your older DD. also have to say that it is your posts about your family of origin that make me think it needs to be ruled out. some of what yuo have posted about kind of sounds familiar to me, kwim?

this might be helpful:

http://thyroid.about.com/cs/testsforthyroid/ht/interpretresult.htm

you should probably ask for the antibodies test as per #12 on that list.

also just want to add that many docs think the TSH is gold standard of tests. they say it should show an imbalance earlier than the other thyroid blood tests. but then many of them don't treat someone with a high TSH! so they say this test is sensitive, and gives early warning and then ignore or pooh pooh the early warning!

i don't mean to overstep, i just feel very strongly that with all the thyroid disease going undiagnosed in adults i have to believe the numbers are even higher for undiagnosed children.

[egoldber]

Well the things we see with older DD are.....

anxiety (diagnosed mild generalized anxiety disorder)
impulse control
sensitivity to foods and textures
low muscle tone (not diagnosed, but lower normal, gross and fine)
allergies
asthma

I will update the above results with lab ranges.

[Indianamom2]

Beth, glad you got some testing done.

We *just* got done with a follow-up meeting about DD with our dev. pedi yesterday and went over all these same results.

Her opinion, FWIW, is that iron levels need to be "at least 50" for optimal memory and brain function. 30 is acceptable, but not ideal. DD's iron is low as well (very similar to your DD's level, actually) and she has prescribed iron supplements for her).

Vitamin D is also something that our dev. pedi is adamant about. She wants it to be much higher. DD's level was 8, which she was horrified about. She put DD on 1,000 IU's of D3 every day, which we had accidentally doubled (I thought my tablets were 1,000, but they are 2,000) Either way, she needed the D desperately. We're also trying to make a concerted effort to get her in the sun a little more (but the weather is NOT cooperating). I believe that the doctor wants her level to be at least 50 again. This takes a while to go up though.

As for TSH, I'm no expert there, but to give you some perspective, when DD's levels came back, her TSH the first time was 7.5 and the second time was 5.7 or so. Since her T3 and T4 levels were normal, she is just treating her with kelp (idodine) supplements to see if that helps get her TSH levels down. We retest this week, so I'll let you know if we learn more. 2.4 sounds fairly close to normal, but I think the newer "ideal" range is 1-2, so it might be something to recheck in a few months to see if it fluctuates wildly.

Hope that helps a little.

[tiapam]

what are her hair, skin, eyes and nails like? do hair and nails seem to grow abnormally fast or slow? does she have tons of hair or hardly any? is it falling out? what are her usual sleep habits? is she hard to wake up or does she have trouble sleeping? what about appetite, weight and BMs? constipation can be a sign of hypo.

is she on any meds that could be affecting her test results? i would google any meds with the term thyroid and see if anything comes up. i don't trust docs to keep up on that.

take a look at this, particularly about subclinical hypothyroidism:

http://en.wikipedia.org/wiki/Hypothyroidism

yes i know it's wikipedia but i think it is pretty clearly written. i'll just paste a very important part for the benefit of everyone:

Early hypothyroidism is often asymptomatic and can have very mild symptoms. Subclinical hypothyroidism is a state of normal thyroid hormone (http://en.wikipedia.org/wiki/Thyroid_hormone) levels, thyroxine (http://en.wikipedia.org/wiki/Thyroxine) (T4) and triiodothyronine (http://en.wikipedia.org/wiki/Triiodothyronine) (T3), with mild elevation of thyrotropin, thyroid-stimulating hormone (http://en.wikipedia.org/wiki/Thyroid-stimulating_hormone) (TSH). With higher TSH levels and low free T4 levels, symptoms become more readily apparent in clinical (or overt) hypothyroidism.


that sounds like the test results she just got.



IIWY, I would also get her cholesterol tested as there is some evidence that high cholesterol and low thyroid often go together. not sure if that would be true of kids or not, but i think it is worth looking into. this is basically looking for puzzle pieces, so you can def rule thyroid in or out.

after years of doing research on this, i feel there is a lot the medical community does not know and a lot they choose to ignore. and that is from researching my adult onset, treatment and aftermath. now that i have been researching it in children for my own kids' sake, i can see that the same thing goes on in kids, probably worse.

finally, if you don't get much help from any peds you go to, then i would seek out an integrative doctor. this website is also awesome and has good tips for finding a doc:

http://www.stopthethyroidmadness.com/

HTH.

[chlobo]

I agree with the previous posters.

Her vit D is very low. I have heard that 50 is optimal as well. My DD was very low but responded very well to supplementation, although I was doing a higher dose.

I've heard 50 for iron as well.

As far as the hypothyroidism goes, I found a link to symptoms from Children's Hospital in Boston:

http://www.childrenshospital.org/az/Site1135/mainpageS1135P1.html

What are the symptoms of hypothyroidism in children?

The symptoms of hypothyroidism in children are different than in adults. Each child may experience symptoms differently, and often the symptoms are not seen at all. This is why all infants should be screened for low thyroid.

Symptoms in newborns (neonatal hypothyroidism) may include:

jaundice (yellowing of the skin, eyes, and mucous membranes)
hoarse cry
poor appetite
umbilical hernia (navel protrudes out)
constipation
slow bone growth


Childhood (juvenile hypothyroidism):

slow growth, sometimes resulting in abnormally short limbs
delayed tooth development


Adolescents (adolescent hypothyroidism):
slow growth
delayed puberty
hoarse voice
slow speech
droopy eyelids
puffy and swollen face
hair loss
dry skin
slow pulse
weight gain

[essnce629]

I like this site for info on vitamin D dosage:

http://www.vitamindcouncil.org/about-vitamin-d/how-to-get-your-vitamin-d/vitamin-d-supplementation/

For healthy kids it says to give 1000 IU for every 25lbs of body weight. DS1 is 60lbs so I give him one drop of Carlson vitamin D (2000IU) every day and he gets an additional 80IU in his multivitamin and another 200IU in his calcium supplement. It sounds like she needs more vitamin D and the Carlson drops are great. They are completely tasteless (they're in coconut oil) and you can put them directly on her tongue or on food.

We get ours from Vitacost: http://www.vitacost.com/Carlson-Vitamin-D-Drops

[egoldber]

She really doesn't have any of those symptoms.

They did cholesterol testing and her levels are excellent.

I think I am going to give her 1000 IU vitamin D and ask her ped at her well check about re-testing.

The iron does not surprise me because she rarely eats meat (it's a texture thing for her).

What kind of iron supplementation do you do for kids? How much?

[MommyAllison]

When DS was low on iron, we tried the iron supplements the ped recommended, but they were very hard on his stomach (crying w/stomach pain after a dose, couldn't sleep). We switched to Floradix, which he *loved*, and his iron level came up very quickly. He was much younger than your DD, but I know lots of pregnant women who've used Floradix with good results too, so I'd check into it. Some people don't like the taste and mix with orange juice - DS loved the taste and just took it plain.

[niccig]

I think I'm the poster tiapam is thinking about for TSH over 2. Through trial and error since my surgery, we've worked out I'm best around 1.5 If I get to 2 I do start to get symptoms. Because I had thyroid surgery and then bounced from hypo to hyper while working out medications, I was able to really track my symptoms and where I feel best. I don't think everyone gets to have that experience without sudden loss of TSH from losing the gland.

My endo. says most people feel best between 1-2 TSH.

I'm not sure how it is with children.

It could be something to watch.

[trales]

my vit d is low, 18 . my doc likes to see it above 50. I have found differences with the supplements. I tend to keep levels up with only the prescription Lind. when it drops below 50 I know it. I have been doing 50,000 IU once a week 3 months to keep it just below50.

as for the thyroid, it is hard to tell. You could see a pedi endocrine if you are worried. but I would be more concerned with the vit D and Iron.

[tiapam]

ok, been doing more research and IMO she should have had a free T3 test also.

got that idea from stopthethyroidmadness.com and the last post on this page:

http://forums.realthyroidhelp.com/viewtopic.php?f=8&t=13

this looks like a good resource for parents. it has a children's forum.

it suggests there is even a different range for developing bodies for this test. that makes total sense to me and i have often wondered if kids should have a different ref range for all thyroid tests because their bodies are undergoing rapid change. there is also some stuff on ferritin and iron there. i am not saying she has a thyroid problem, but if that stuff is coming up in a thyroid forum there is a reason.

your DD's behavioral/emotional symptoms to me are the ones that could be the most indicative of thyroid. and that is from experience. imo, the symptoms you get depend on the body and mind you have at the time of onset. so an olympic athlete might present with more of the mental and emotional symptoms first and take forever to get any noticeable physical symptoms. a basically healthy kid could present the same way. just a theory of mine, but i feel like it's based on common sense - you get hit where you are most vulnerable first. and your body changes just a little bit every day - just like the normal developmental changes of childhood, so it makes the undesirable changes a bit hard to spot.

HTH. If you have thyroid disease on either side of the family, I would def take this possibility seriously.

Sorry to harp on this. I have an adult sister who i believe is hypo and has been since childhood, maybe even birth. my mom did take her to the doctor at least once looking for some answers, but nothing was diagnosed. i don't know much about it but can look back on her childhood and see something was really off. at almost 40 YO now we cannot even get her to go to a doctor or get a lab test. it's very sad, she has not really lived a full life, kwim?

[egoldber]

The question of meds interfering is a good one. She is on SEVERAL meds right now: allergy meds, asthma meds, and also an SSRI. These tests were to look for issues that might be causing/exacerbating the anxiety she is experiencing.

The SSRI that she is currently on really seems to be helping her tremendously, so I am less inclined to see thyroid or other issues driving that. But there are other concerns that could be thyroid/iron/D3 related that I am concerned about.

Starting June 1 we plan to wean her off of several of her allergy and asthma meds, so I am hoping we can get a clearer picture at that point.

[JTsMom]

Did they check any other levels? I know zinc and some of the B vitamins sometimes help with ADHD symptoms. Gena is a good one to ask about that stuff.

[egoldber]

Yes, they ran basically every panel there is. All her B vitamins look good. I don't specifically recall zinc (I don't have the paper with me today), but it may have been in there.

The only ones that concerned me were the vitamin D and iron.

I only asked about the thyroid here because I know those results are really hard to interpret and there is some disagreement.

[bubbaray]

Starting June 1 we plan to wean her off of several of her allergy and asthma meds, so I am hoping we can get a clearer picture at that point.

I'm curious about this -- are you wanting to wean her off those because they might be contributing? What issues do the doc's think the allergy/asthma meds are contributing to??

My DD#1 is on allergy meds (Aerius) and asthma meds (Symbicort). I think the Symbicort (changed to that from Pulmicort last month) caused some mild behavioral changes at first, but they seem to be settling down. I've never noticed a change with Aerius. Then again, she's been on allergy/asthma meds for so long, I woudln't really know what behavior is from them and what is just her personality, KWIM? This is her peak season for both allergies and asthma, so I'm quite petrified to change anything.

Hope you find solutions!

[egoldber]

Older DD's peak season is mid April to early May.

Currently she takes....

Zyrtec (once a day)
Advair 100 disk (twice day)
Alvesco 80 mcg (twice a day)
Prozac (once a day)

She was using Veramyst (nasal spray) until about 2 weeks ago.

Per the allergist, we are to wean her off the Alvesco starting June 1.

I would also like to take her off the Zyrtec and see how she does. She's been on the Zyrtec for about 18 months now.

She definitely has always reacted strongly and oddly to meds. I would like to get her off the Alvesco and Zyrtec if we can.

[bubbaray]

That is interesting that they would want to wean her off Alvesco and not the Advair. I guess, whatever works, right?

[egoldber]

Well she has been on Advair now for almost 2 years. We added the Alvesco a few months ago because she was flaring post an illness in January. Then they decided to keep her on it through the allergy season. We can step her up to the next dose of Advair, but she reacts behaviorally to that, so we prefer to add the Alvesco vs. using the Advair 250.

[bubbaray]

Just a thought -- I've been told (for myself and DD#1) that its the rescue med in Advair/Symbicort/Ventolin that can cause the behavioral changes. I'm not saying *I* agree with this, b/c Flovent has no rescue med and it caused huge behavioral changes in DD#1. But, I'm just passing that along.

FWIW, I have also been told that Alvesco is a mild steroid, but it works better than the more "potent" steroids because of *how* it works (don't ask me the pharmacology, it makes my head spin!). I know that for me personally, Alvesco works for maintenance, but as soon as I'm in trouble, its not strong enough. Hence my change to Symbicort 200 last month (HUGE difference for my breathing!).

Would they/you be willing to try Alvesco instead of the Advair? I was told by the asthma clinic here that they are having great success with Alvesco. DD#1's asthma dr wasn't willing to try it with her because she was needing Pulmicort 200 3x/d to maintain (so he switched her to symbicort 100 2x/d and it seems to be working). I am rather hopeful that we might switch her to Alvesco at some point. He seems unimpressed by it and prefers the more "established" drugs, but the other asthma dr there seems to like Alvesco. None of the asthma drs I've encountered here (pediatric or adult) seem much impressed by Advair. The GPs do prescribe it, though.

I will say that asthma med changes make me very nervous. Sigh.

[egoldber]

My office also said that they are seeing great success with kids with behavioral issues on Alvesco. I honestly had not thought about keeping her on Alvesco vs Advair. Hmm. Maybe I will call and see what they think.

She reacts behaviorally to Pulmicort (demon child) even though it does not have the rescue med. She does not react to Flovent, but Flovent alone was not enough for her. I have a feeling they will not want to take her off the combo med until she has been stable for awhile.

And currently we are actually not seeing any behavior issues other than minor ones. Things are very improved. But the sheer number of meds she is on really makes me nervous.

[tiapam]

She definitely has always reacted strongly and oddly to meds. I would like to get her off the Alvesco and Zyrtec if we can.

IMO strong reactions are probably related to metabolism or are autoimmune. Both of which are linked to thyroid. Also, re asthma you might want to read this:

http://thyroid.about.com/library/derry/bl10.htm

IMO it is pretty compelling. This is not the only site i have found linking asthma and the thyroid. Imagine if your DD could get off all her asthma meds simply by getting a thyroid supplement!

as you can see i feel very strongly about this. i hate to think of anyone, but especially a child, not getting the help they need in this area of health. While peds are watching it or trying something or not catching it at all, their little bodies are developing without the proper amount of hormone.