Hypertyroidism/Graves' disease in my 8 year old

[babypodof4]

OK - this is kind of a long set up but here it goes.

2 1/2 years ago my daughter and a terrible immunological reaction to a vaccination.  This caused initial severe developmental regression that took about a year to get her back up to her "normal" age (she was almost 5 when this happened).  As her development improved, her psychological behavior deteriorated, as well as a major increase in agitation and impassivity.  Eventually she was diagnosed with high functioning autism as well as ADD/ADHD.  We started her on medication (in early 2013).  It was also noted at this time that she had elevated fasting blood sugar levels, but her A1C was high end of normal.

We have been doing meds since then with some benefits (for the ADD/ADHD).  Well, we switched doctors about a month ago and during that initial test the doctor noted her BP and heart rate were elevated (140 beats per minute).  Doctor told me to watch her heart rate over the next month.  I did, we never saw a heart rate below 130 so back to the MD we went.  We looked at her history from our old doctor and it was noted that her heart rate hasn't been normal since we started the ADD/ADHD medications in 2013.  It was at that point where our new PCP looked at her wt and height - ht wise she went from below the 5th to the 50 percentile (pretty big height jump), but it was noted that she lost 5 pounds at that point (and has very little gain since then).  The doctor decided to do testing of her thyroid before we sent her off to the cardiologist (to rule out all underlying causes of the tachicardia)  Well, we got the tests back today.  TSH less than .1, Free t3 was almost 8 and t4 was almost 3.  Platelets are high as well.  Now we get to see a pediatric endocranologist on Monday and there is already talk of Graves disease.

I'll admit - I am scared as heck.  First - at this point I believe that immunological issue she had at almost five probably is what caused her thyroid to do this - which means that she has probably had some level of hyperthyroidism for three years that we just never caught.  From what I have been reading - all of these ADD/ADHD like symptoms could be caused by her thyroid.  Does this mean that once we get this under control that this will improve?  Or does it mean that since this has been going on for three years, and at the age she was at, that she is permanently damaged?  She is very bright intellectually, it is just behavioral outbursts, impulsivity, agitation, hyperactivity, and social interactions that are her issues.

Plus, what are we looking at as far as treatment?  I have been reading out anti-thyroid medications- but some of teh side effects sound terrible (liver damage leading to death).  It sounds like she is too young for the radioactive treatment.  What can I expect at that appointment on Monday?  Will her cardiac symptoms improve once we get control of this?  Anyone else have something similar happen to their child, and how did they respond to treatment.

Any advice or guidance would be appreciated.

[goolarra]

Great!  That sounds good.  She can't make any guarantees, but I agree with her that I bet you'll see a remarkable change.  Best of luck!

[babypodof4]

Saw endo today.  She diagnosed her with Graves' disease.  Still have to do a neck ultrasound, and more blood work in three months to check all labs and that TSI level.  She said pretty much everything she has experienced these last three years can be attributed to this, and she things that once we get her hormones where they should be that all her ADD/ADHD symptoms should go away (should - but she is not 100% sure).  We start the anti-thyroid meds tonight.  

Thank you again!

[goolarra]

That's a pretty high FT3, but children run higher FT3 and FT4 than adults.  You might check with the lab to make sure they used an age adjusted range.

The specialist will probably order a TSI (thyroid stimulating immunoglobulin) test to confirm a Graves' diagnosis.  It's a simple blood test.  

Good luck with the specialist, and let me know how it went if you have a chance.

[babypodof4]

The highest her FT3 should have been was 3.8, and hers was almost 8.  Thank you so much for everything you posted.  I am looking forward to seeing the specialist on Monday.  

[goolarra]

Those symptoms could very well be caused by hyperthyroidism.  If you correct the hyperthyroidism, symptoms should improve.  I think age is in her favor regarding permanent damager.  

All drugs come with warnings that will scare you to death.  By and large, I think ATMs are relatively safe, at least in the short term, which will buy you some time.

Cardiac symptoms should improve.  What's the reference range on her FT3?  FT3 can have a profound effect on HR.