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Stomach pain, gas and bloating every morning and vomiting. Have lump on thyroid and elevated WBC. Suggest?

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Practicing since : 2001
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Son is 22 has free thyroxine level of 4.9 and t3 of 38 tsh 0.41 and t4 total is 13.0 his glucose is 133 prolactin 59 and cortisol taken at 6:30 in eve was 61.1 he has been ill most of the last 2 and a half years has had every test for gastroenterology all come back negative and normal his symptoms are severe stomach pain gas and bloating every morning and cycles monthly vomiting and ends up in Er this has been ongoing for almost 3 years started with flu in 2010 he has a endocrinologist appt soon what do you think these recent blood tests suggest? He does have a lump on his thyroid you can feel and was seen on MRI 2 years ago and was told not to worry.but I am worried,please help.
I forgot to add he has a high WBC count of 24.7 this is always elevated like this when he gets really ill.
Posted Fri, 31 May 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 15 hours later
It would be helpful to see normal ranges for the lab test results you have shared regarding your son. For example, the prolactin appears elevated but it may well be within range for the lab in question. Was this test performed fasting? How much does your son weigh?

Cortisol levels tend to drop in the late afternoon and evenings as the day progresses.

Regarding the thyroid nodule, the vast majority are benign. More information is available on WWW.WWWW.WW
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Follow-up: Stomach pain, gas and bloating every morning and vomiting. Have lump on thyroid and elevated WBC. Suggest? 9 minutes later
Ok normal level for prolactin lab values are
2-18 NG/ML his is 59.
Cortisol 4pm 2.4 to12.8 his is 61.1 at 6pm he had not eaten for a day
Also t4 4.5-12.1 his is 13 free thyroxine is 4.9 normal 1.4 -4.5
WBC is 24.7 range is 4.5 -11.0 son is 510 and weighs 165
Answered by Dr. Shehzad Topiwala 1 hour later
this is a complex scenario. The prolactin needs to be rechecked. I also recommend an IGF1 blood test. The thyroid function tests like Total T4, Total T3, Free T4, T3 resin uptake and TSH should also be repeated.
The white count is also elevated. This requires independent assessment

Based on physical examination findings and clinical suspicion by an endocrinologist, it may be necessary to consider checking the 'midnight salivary cortisol'

A thyroid ultrasound is recommended as well
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