Hello – We are fellow patients, not docs, but here are a few thoughts…
Having below normal TSH but normal T3/T4 is referred to as “subclinical hyperthyroidism”. The treatment is usually “watch and wait” unless the patient is having hypER symptoms. Since your son *does* appear to be symptomatic, whether to pursue further testing (and treatment) would be a decision for you, your son, and his doctor.
The family history is definitely a red flag for Graves’, but there can be other causes as well for hyperthyroidism, including inflammation in the thyroid and overactive thyroid nodules.
The antibody testing (TSI or TRAb) would be useful in getting a definitive diagnosis of Graves’, but then you would still be left in the same quandary – do you treat someone with subclinical disease who is having symptoms…or do you watch and wait to see if the condition progresses to “overt” hyperthyroidism? Since all three treatment options have risks, this is definitely not a decision that you want to jump into.
That’s good that you received a referral to an endo. I’m sure the doc’s office did not intend to be insulting – deliberately ingesting excess thyroid hormone (or taking supplements with excess iodine) is something that they would want to rule out before putting your son through further testing and possible treatment.
Wishing you and your family all the best!
