Q. Suffering from subclinical hyperthyroidism with anxiety and palpitations.
Dear Doctor, I am trying to figure out what is wrong with my 15 year old daughter. Her symptoms have developed most significantly over the past few months, and include depression, weakness, constant light-headedness, shortness of breath (even when sitting still), difficulty taking a deep breath (causes pain), episodes where breathing becomes especially difficult, a complete lack of energy, continual exhaustion, continual muscle soreness (especially in the calves), cold hands and feet (to the point of turning blue), intolerance to cold and heat especially, episodes of a racing heartbeat, and episodes of anxiety and disorientation. At first our focus was on her was depression but now our focus is shifting toward her problems with physical activity and breathing, especially as she has now come to the point where she can no longer participate in any sports. We have seen a psychiatrist for her depression who discovered the MTHFR Mutation, which has since been addressed with a megadose of methyl folate. After three weeks on the medication there has been no improvement. Her paediatrician tested her for asthma and the results were negative. We have put her on various vitamin B supplements and have made sure she is getting proper nutrition and rest. Again, nothing has helped. Other labwork, as well as some of her symptoms, has made us consider her thyroid. The thyroid results are as follows:  TSH: 0.059 ulU/ml. AntioTPO-Ab: 84.9 IU/mL. Anti-Thyroglobulin: 134 IU/mL. Total T3: 130 ng/dL. T4: 10.5 ug/dL. Other labs that were out of the normal range are as follows:  - Ferritin: 31 ng/mL (her other iron results were normal). - Differential (Audo Diff) Neutrophils: 66%. In spite of a low TSH we have been told that as long as the T4 level is within normal range there is no need for attention with the thyroid. Yet, I canno help but keep coming back to the thyroid and wonder if this is not where we should focus our efforts. Any thoughts please?
Hi, It is really sad to know about your daughter. 1. As a matter of fact your daughter seems to have acute thyroiditis. Though the thyroid profile has not shown full blown thyrotoxic state, she has subclinical hyperthyroidism with TSH being suppressed. Since how long has she been like this? Thyroiditis might take 8-12 weeks to settle. How old are the reports? Thyroiditis might leave the patient hypothyroid. 2. Secondly she is 15, puberty is another phase of major hormonal and emotional change over. How are her periods? Has she put on weight? or lost some? You have supplemented with multivitamins, please see if B12 upto 1500 mcg is being given and Vitamin D 1000 IU daily or 60,000 IU once a week is going. Also supplement her with calcium and magnesium and check these levels as well. Treat her with Propranolol 10mg twice a day to beat the anxiety and palpitations. Get back to an endocrinologist online -->