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Children with Thyroid disease/ familial history
Hi, I posted these questions over at the thyroid discussion forum. I haven't gottten a response yet. I wasn't aware of this forum. If any one can help me with my concerns, questions I would greatly be apprecaitive.
High TPO number, low ulta tsh number, high nomal T4 number - Is this hypothyroid?
I am a mom who has a history of Graves disease, 11yrs. I have a family history of Grave's & Hashi's. Some with one or the other and some with both. The question is in regard to two of my children. I have 5 children total that will be seen and followed by an endo. The two in question were seen this week. Doc sais they have Hashimoto's. They are 9 and he also said they were precocious puberty. I can post what test results I have if asked and needed. My main concern is that we are missing something here. Thanks of you can help!
High TPO number, low ulta tsh number, high nomal T4 number - Is this hypothyroid?
I am a mom who has a history of Graves disease, 11yrs. I have a family history of Grave's & Hashi's. Some with one or the other and some with both. The question is in regard to two of my children. I have 5 children total that will be seen and followed by an endo. The two in question were seen this week. Doc sais they have Hashimoto's. They are 9 and he also said they were precocious puberty. I can post what test results I have if asked and needed. My main concern is that we are missing something here. Thanks of you can help!
MEDICAL PROFESSIONAL
The labs are consistent with euthyroid state-normal thyroid function and positive antibodies, they both have it and we can call it Hashimoto's but do not require treatment as far as I can see on paper, the puberty is separate and you are very well read, severe hypothyroid can lead to high tsh that cross reacts with LH receptors stimulating puberty-VanWyck Grumbach syndrome.
So a free T4 NOT a Total T4 is needed to completely feel that we are fine, but the tsh is normal making me think that the free T4 is fine as well.
The early adrenarche(acne, hair etc) is related to premature adrenarche, seen in many many premies who have some evidence of insulin resistance, having hypoglycemia as babies, being small and having gone through alot these babies develop very robust stress responses and also become insulin resistant per se in the fact that they may make a little higher insulin levels that stimulate the adrenal glands to make earlier than normal androgens as well as the fact that the adrenal matured a little earlier.
The breast is a different story, twins are telling us they are acting alike due to some annoyingly early but more than likely benign reasons-since both have this, their pituitary has pulsed early.
So here is the dilemma, they are already having menses so I would consider treatment with Lupron if you want to keep puberty asleep a little longer till age 10 perhaps, preserving the bone development so that their growth is not compromised,
a pediatric endocrinologist is the person you should work with, I may not treat with thyroid but I am not their doctor and also I would consider labs and a bone age and discuss an mri of the pituitary and discuss lupron treatment versus letting them be(most 8 year old girls however are not ready for menses)
So hope this helps, also remember you having autoimmune thyroid, makes it very likely they develop antibodies but they may not necessarily get thyroid disease per se but need monitoring every 6 months for thyroid(every 4 months if early puberty monitoring)
So a free T4 NOT a Total T4 is needed to completely feel that we are fine, but the tsh is normal making me think that the free T4 is fine as well.
The early adrenarche(acne, hair etc) is related to premature adrenarche, seen in many many premies who have some evidence of insulin resistance, having hypoglycemia as babies, being small and having gone through alot these babies develop very robust stress responses and also become insulin resistant per se in the fact that they may make a little higher insulin levels that stimulate the adrenal glands to make earlier than normal androgens as well as the fact that the adrenal matured a little earlier.
The breast is a different story, twins are telling us they are acting alike due to some annoyingly early but more than likely benign reasons-since both have this, their pituitary has pulsed early.
So here is the dilemma, they are already having menses so I would consider treatment with Lupron if you want to keep puberty asleep a little longer till age 10 perhaps, preserving the bone development so that their growth is not compromised,
a pediatric endocrinologist is the person you should work with, I may not treat with thyroid but I am not their doctor and also I would consider labs and a bone age and discuss an mri of the pituitary and discuss lupron treatment versus letting them be(most 8 year old girls however are not ready for menses)
So hope this helps, also remember you having autoimmune thyroid, makes it very likely they develop antibodies but they may not necessarily get thyroid disease per se but need monitoring every 6 months for thyroid(every 4 months if early puberty monitoring)
Here are their numbers.
Child A:
TPO - 127
T4 - 7.7
Ultra TSH - 1.74
TG - 0.1
TGAB - 78.5
Anti thyroglobulin AB - 71.7
TSI - 9
Child B:
TPO - 112.6
T4 -7.6
Ultra TSH - 1.44
TG - 0.2
TGAB - 36.5
Anti thyroglobulin Ab - 37.3
TSI - 7
Normal reference ranges stated for these numbers are:
TPO (0.0 - 9.0)
T4 (6.1 - 12.2)
Ulra TSH (0.34 - 5.60)
TG (0.0 - 35.0)
TGAB (0.0 - 4.0)
Anti thuroglobulin Ab (0.0 - 4.0)
TSI ( - < 10)
Both children in question are girls. They are set of 9yr old female identical twins from a set of triplets. They were born 2 months early with a stay in NICU of 8 weeks. Growth has been normal with no delays in physical or mental development. At 71/2 Child A had acne, since then has become severe. Child B began acne at 8. Both girls started breast development after acne and at 8 and 6 months followed shortly by pubic hair and body odor. Child A had first period 2 months ago. As I stated above there is a strong family history of thyroid disease. Both children also have had issues with hypoglycemia. Both girls are tall in stature for their age and are thin built. When I took them to see the doctor this week Child B was acting weak and sluggish and some what uninterested. The doctor said from what he observed both girls are precocious puberty. He questioned if there might be an issue with diabetes. And based on the thyroid findings diagnosed them with Hashimoto's. He thinks that the sluggish behaviour exhibited is a symptom of their thyroid disease and has prescribed a low dose of 50mcg of levo. He said they present with "subclinical symptoms" and that this levo will help with their energy levels. I haven't started either girl on the medication because I prefer to understand exactly why. From what I can see their T4 and TSH numbers are within range but their antibodies are high. From what I have studied Hashimoto's and precocious puberty do not go hand in hand. What I read was in fact in very rare severe hypothyroidism do you see then precocious puberty. As I can see by their numbers this is not the case. I am concerned that their sluggish behaviour is due to an underlying undiagnosed condition and I don't want to aggravate it if it does exist. Whatever it may be. My second concern is that by giving them additional T4 it may make them become hyper. Also the doctor said that they didn't have any antibodies for Grave's. However from my understanding TPO can be used for diagnosing both diseases. Can some one please help me with my concerns? I will be seeing the endo with two other children this coming week and will be bringing up these issues to him. I would like to know if my concern are worth validating and arguing about or if I shoud blindly follow along. As you can tell I don't take lightly putting my children on any medication. Thank you if you can help!
Child A:
TPO - 127
T4 - 7.7
Ultra TSH - 1.74
TG - 0.1
TGAB - 78.5
Anti thyroglobulin AB - 71.7
TSI - 9
Child B:
TPO - 112.6
T4 -7.6
Ultra TSH - 1.44
TG - 0.2
TGAB - 36.5
Anti thyroglobulin Ab - 37.3
TSI - 7
Normal reference ranges stated for these numbers are:
TPO (0.0 - 9.0)
T4 (6.1 - 12.2)
Ulra TSH (0.34 - 5.60)
TG (0.0 - 35.0)
TGAB (0.0 - 4.0)
Anti thuroglobulin Ab (0.0 - 4.0)
TSI ( - < 10)
Both children in question are girls. They are set of 9yr old female identical twins from a set of triplets. They were born 2 months early with a stay in NICU of 8 weeks. Growth has been normal with no delays in physical or mental development. At 71/2 Child A had acne, since then has become severe. Child B began acne at 8. Both girls started breast development after acne and at 8 and 6 months followed shortly by pubic hair and body odor. Child A had first period 2 months ago. As I stated above there is a strong family history of thyroid disease. Both children also have had issues with hypoglycemia. Both girls are tall in stature for their age and are thin built. When I took them to see the doctor this week Child B was acting weak and sluggish and some what uninterested. The doctor said from what he observed both girls are precocious puberty. He questioned if there might be an issue with diabetes. And based on the thyroid findings diagnosed them with Hashimoto's. He thinks that the sluggish behaviour exhibited is a symptom of their thyroid disease and has prescribed a low dose of 50mcg of levo. He said they present with "subclinical symptoms" and that this levo will help with their energy levels. I haven't started either girl on the medication because I prefer to understand exactly why. From what I can see their T4 and TSH numbers are within range but their antibodies are high. From what I have studied Hashimoto's and precocious puberty do not go hand in hand. What I read was in fact in very rare severe hypothyroidism do you see then precocious puberty. As I can see by their numbers this is not the case. I am concerned that their sluggish behaviour is due to an underlying undiagnosed condition and I don't want to aggravate it if it does exist. Whatever it may be. My second concern is that by giving them additional T4 it may make them become hyper. Also the doctor said that they didn't have any antibodies for Grave's. However from my understanding TPO can be used for diagnosing both diseases. Can some one please help me with my concerns? I will be seeing the endo with two other children this coming week and will be bringing up these issues to him. I would like to know if my concern are worth validating and arguing about or if I shoud blindly follow along. As you can tell I don't take lightly putting my children on any medication. Thank you if you can help!
Better wait for the doctors response (from this forum) but I can say that the doctor is right about Hashi (positive TPO) but TPO are not so high and TSH look normal, you must ask the doctor to run free T4 before starting medication and also ask for free T3, those are more accurate. About Graves, TSI is bellow the reference range at this point.
Just remember one thing, what about anemia? I would check that too...
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