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Child with a very small height. All blood work done. What are the findings. Thyroid or kidney?

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Posted on Thu, 30 May 2013
Question: My 20 month old went to an endocrinologist because she is under the 3% in height. Because of her short stature, the Endocrinoligist did numberous blood work. Of this bloodwork, many areas were either high or low. The high/low is the following:
BUN/Creatinine Ratio: High: 120 (Normal Range 9 - 25)
Creatinine, Serum: Low: .15 (Normal Range .19 - .42)
Carbon Dioxide, Total: Low: 18 (Normal Range 20 - 32)
Albumin, Serum: High: 4.5 (Normal Range 3.4 - 4.2)
Lymphs (Absolute): High: 6.5 (Normal Range 1.2 - 5.2
Monocytes (Absolute): High: 1.1 (Normal Range .2 - .8)
TSH: High: 7.1 (Normal Range .6 - 5.5)
Prealbumin: Low: 10 (Normal Range 20-40)
Does this indicate a thyroid problem? And a kidney problem? What is the relation of the lab results as to her short stature? What is the solution to this? Would she take synthroid? My 5 year-old daughter also saw an endocronoligist at the same time for the same (short stature) issue. I am still waiting for the results.
Thanks so much! XXXXXXX
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Answered by Dr. Anantharaman (6 hours later)
Iam a qualified endocrinologist and try to answer your doubts one by one.
At first I would like to say that many children whose height is less than 3rd percentile would be entirely normal it is just that they are normally short I.e their genetic potential for growth is less. So it is important to interpret a childs growth in the context of the parents and siblings heights.I need to know your and the childs fathers height and also your elder childs height .since you are saying that your elder child also had a similar issue at 20 months the short stature seems familial to me.
Regarding the tests the creatinine may be low because of a low muscle or lean mass which is part and parcel of her short stature. There doesnt appear to be a kidney probleThe ratio of ureaand creatinine is high because the creatinine is low.The TSH is high but she requires a repeat testing and usuallyyour endocrine will ask for an anti TPO before initiating on thyroid hormone this is done to identify autoimmune thyroid disease . Only after this ccan we say that there is a thyroid issue. The co2 concentration can be low very commonly due to fast breathing or crying when the blood is drawn.your endocrinologist will be the best person to decide wheyher synthyroid is required and the dose.
Please do write back to me with any clarifications
Regards
anantharaman r
DM endocrinology
Consultant endocrinologist
Bangalore
India

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Anantharaman

Endocrinologist

Practicing since :2002

Answered : 52 Questions

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Child with a very small height. All blood work done. What are the findings. Thyroid or kidney?

Iam a qualified endocrinologist and try to answer your doubts one by one.
At first I would like to say that many children whose height is less than 3rd percentile would be entirely normal it is just that they are normally short I.e their genetic potential for growth is less. So it is important to interpret a childs growth in the context of the parents and siblings heights.I need to know your and the childs fathers height and also your elder childs height .since you are saying that your elder child also had a similar issue at 20 months the short stature seems familial to me.
Regarding the tests the creatinine may be low because of a low muscle or lean mass which is part and parcel of her short stature. There doesnt appear to be a kidney probleThe ratio of ureaand creatinine is high because the creatinine is low.The TSH is high but she requires a repeat testing and usuallyyour endocrine will ask for an anti TPO before initiating on thyroid hormone this is done to identify autoimmune thyroid disease . Only after this ccan we say that there is a thyroid issue. The co2 concentration can be low very commonly due to fast breathing or crying when the blood is drawn.your endocrinologist will be the best person to decide wheyher synthyroid is required and the dose.
Please do write back to me with any clarifications
Regards
anantharaman r
DM endocrinology
Consultant endocrinologist
Bangalore
India