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?