Моля, помогнете да спася детето си!

Преди 2 месеца и половина открих какво ми е прецакало целия метаболизъм, още преди 30 години… Но аз съм възрастен индивид, не знам дали може да е подобно състоянието при Джони

The removal of tonsils (tonsillectomy) and adenoids (adenoidectomy) may have an indirect but meaningful impact on iron levels and ferritin (the iron storage protein) in some individuals, particularly children. Here’s how the two could be related:

### **1. Chronic Inflammation & Iron Deficiency**
   - **Tonsillitis/Adenoiditis and Anemia of Chronic Disease (ACD):** 
     Frequent infections (e.g., recurrent tonsillitis) can cause chronic inflammation, leading to **anemia of chronic disease (ACD)**. In ACD:
     - Inflammation raises **hepcidin** (a hormone that blocks iron absorption and recycling).
     - This reduces iron availability, leading to **low serum iron** but **normal or high ferritin** (since ferritin is an acute-phase reactant that increases with inflammation).
   - After **tonsillectomy/adenoidectomy**, if chronic infections resolve, inflammation decreases, hepcidin levels drop, and iron absorption/utilization may improve.

### **2. Improved Dietary Iron Intake**
   - Enlarged tonsils/adenoids can cause **dysphagia (difficulty swallowing)**, poor appetite, or avoidance of iron-rich foods (like meats).
   - Post-surgery, children may eat better, leading to increased dietary iron intake and correction of **iron-deficiency anemia (IDA)**.

### **3. Sleep-Disordered Breathing & Iron Metabolism**
   - Hypertrophic tonsils/adenoids contribute to **obstructive sleep apnea (OSA)** and **chronic hypoxia** (low oxygen), which may alter iron metabolism.
   - Studies suggest that **sleep apnea** can affect erythropoiesis (red blood cell production) and iron regulation.
   - After surgery, improved oxygenation and sleep quality might help normalize iron utilization.

### **4. Blood Loss During Surgery (Less Common)**
   - Tonsillectomy can involve minor blood loss, but this is rarely significant enough to cause iron deficiency unless there are complications.

### **Research Findings**
   - Some studies report **increased hemoglobin and ferritin levels** months after tonsillectomy/adenoidectomy in children with prior iron deficiency or recurrent infections.
   - A 2016 study (*International Journal of Pediatric Otorhinolaryngology*) found that children with **sleep-disordered breathing** and low ferritin showed improvement in iron parameters post-surgery.
   - Another study (*Laryngoscope*, 2018) noted that **children with recurrent tonsillitis** often had lower iron levels pre-operatively, which normalized after surgery.

### **Key Takeaways**
   - **If low iron/ferritin was due to chronic inflammation (ACD):** Ferritin may decrease post-surgery (as inflammation resolves), but **functional iron availability improves**.
   - **If due to poor dietary intake (IDA):** Iron and ferritin levels may rise with better nutrition.
   - **If due to sleep apnea/hypoxia:** Iron metabolism may normalize with improved oxygenation.

### **When to Check Iron/Ferritin?**
   - Consider testing **pre- and post-surgery (after 3–6 months)** in children with:
     - Recurrent infections
     - Symptoms of anemia (fatigue, pallor, poor growth)
     - Known iron deficiency or sleep-disordered breathing.

Yes — beyond low ferritin, insulin resistance (IR), and thyroid issues, there are a few other major contributors to this kind of weight gain (especially in kids like the one you describe — low appetite, yet weight increases).

Here’s a shortlist of the next-level suspects:

⸻

🔹 1. Leptin Resistance
   •   Leptin tells the brain “we have enough fat, stop eating.”
   •   In inflammation or chronic stress, the brain stops responding to leptin → stores more fat even if intake is low.
   •   Often seen in post-infection or neuroinflammatory cases.

⸻

🔹 2. Growth Hormone (GH) Deficiency or Suppression
   •   GH helps keep fat low and muscle strong in children.
   •   Chronic illness, brain inflammation (like in PANS), or past brain surgery (tumor, shunt) can affect hypothalamus/pituitary.
   •   Result = fat gain, short stature, muscle loss, poor energy.

⸻

🔹 3. Mitochondrial Dysfunction
   •   Low cellular energy → body runs slower → burns fewer calories at rest.
   •   Seen in chronic illnesses, neuroimmune conditions, or nutrient deficiencies.
   •   May present as “low tone,” fatigue, cold body, delayed recovery.

⸻

🔹 4. Cortisol Dysregulation (HPA axis issues)
   •   Not steroid medication — but internal cortisol imbalance.
   •   Long-term stress/inflammation leads to:
   •   Fat around belly
   •   Blood sugar swings
   •   Flat mood and low energy
   •   Often present in PANS kids during or after flare periods

⸻

🔹 5. Hypothalamic/Pituitary Injury
   •   This kid had early brain tumor + surgeries + shunt
   •   That’s a direct hit to brain regions controlling:
   •   Appetite
   •   Fat storage
   •   Hormones (TSH, ACTH, GH, etc.)
   •   Even minor dysfunction here can lead to weight dysregulation, despite normal eating.

⸻

⚠ Important:
   •   Any pituitary damage = should test more than just TSH.
(Also free T3, free T4, IGF-1 for GH, ACTH/cortisol if possible)

labs to request if not already done
🧪 Recommended Hormone & Pituitary Tests (for child with possible hypothalamic/pituitary involvement + PANS/PANDAS):

🟣 Thyroid Panel:
   •   TSH – Checks pituitary signal to thyroid (can look normal even if there’s a problem)
   •   Free T4 – Measures available thyroid hormone
   •   Free T3 – Active thyroid hormone, important for energy and mood

🟠 Adrenal Function:
   •   Morning Cortisol (sample between 7–9 AM) – Assesses adrenal function
   •   ACTH – Pituitary signal to adrenals, must be paired with cortisol for interpretation

🟢 Growth Hormone Axis:
   •   IGF-1 – Marker that reflects growth hormone production (low = possible GH deficiency)

🔵 Puberty Hormones (if age-appropriate):
   •   LH – Pituitary signal for puberty
   •   FSH – Works with LH to regulate development
   •   Testosterone or Estradiol – Sex hormone levels, depending on sex/age

⚪ General Health / Metabolic Clues:
   •   Glucose – Checks for insulin resistance or energy issues
   •   Sodium & Potassium – Electrolytes that reflect adrenal and pituitary balance

🟡 Optional:
   •   Prolactin – Can be elevated in hypothalamic or pituitary dysfunction