A 12 years old boy with no significant past medical history complained of difficulty in sleeping at night and feeling fa

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A 12 years old boy with no significant past medical history
complained of difficulty in sleeping at night and feeling fatigue
often. Because of those symptoms, he has also experienced a decline
in grades at school. His weight, height, and Body Mass Index showed
normal to his age. His pulse pressure was little big higher than
normal. His parents said that both his grandfathers have a family
history for thyroid disease. Doctor ordered thyroid panel including
TSH, Free T4, T3, Anti-TSH receptor antibodies, and Antithyroid
peroxidase antibodies. CBC and differential WBC were normal
The lab results for the tests follow:
Tests
Results
Reference Range
Thyroid-stimulating hormone (TSH)
0.18 mU/L
0.45-4.12 mU/L
Free thyroxine (FT4)
2.97 ng/dL
0.73-1.77 ng/dL
Total triiodothyronine pediatric (T3)
298.00 ng/dL
123-211 ng/dL
Thyroxine (T4)
16.5 mcg/dL
5.0-12.0 mcg/dL
Antithyroid peroxidase antibodies
1855 IU/ml
Negative <60 IU/mL Positive >100 IU/mL
Antithyroglobulin antibodies
987 IU/mL
Negative <60 IU/mL Positive >100 IU/mL
Anti-TSH receptor antibodies
59.1 %
Negative <16 %
ranges from 80-100%