Tests for goitre or hyperthyroidism

[Adam10]

My 11-year old stepdaughter has a goitre (swelling) in the front of her neck by her thyroid. Her endocrinologist in the Philippines has prescribed Tapdin methimazole 20 mg daily which she has taken on and off (not continuously) for 4 months. Her blood tests for FT4 during January to March 2017 were 96, 32, 15 pmol/L (range 9-22). Her neck swelling remains

Her symptoms have been sore throat, difficulty swallowing, high heart beat, difficulty sleeping. These symptoms have mostly stopped recently.

She is having further blood tests tomorrow. What other tests should she have? eg TSH FT3 reverse FT3 etc.

Any comments or suggestions much appreciated.

[Clutter]

Adam10,

Your daghter needs to take the medication DAILY not sporadically for it to re-regulate her thyroid gland. If the goitre doesn't shrink surgery may be considered if the goitre is very larg or is impacting your daughter's breathing or swallowing. Many hyperthyroid patients are able to wean off Methimazole after 12-18 months but remission is permanent in less than 50% of patients who have Graves disease.

Ask your daughter's doctor to check TSH, FT4 and FT3 and if antibodies haven't previously been checked thyroid stimulating immunoglobin (TSI) and/or thyroid receptor antibodies (TRab).

[Adam10 in reply to Clutter]

Thank you Clutter. Very helpful as ever. Does it sound like my stepdaughter has Graves' disease?

What are the blood results that indicate Graves' disease?

We are reminding the daughter to take the methimazole every morning without fail. Does methimazole have to be taken on an empty stomach (like T4) and 30-40 minutes before taking food?

I will ask the clinic to test for TSH, FT3, TSI and TRab. If they test for TSI and TRab Is there any need to test for TG and TPO (i.e. Antibodies)?

[Clutter in reply to Adam10]

Adam100,

She needs the antibody testing, TSI or TRab, to determine whether her hyperthyroidism is autoimmune ie due to Graves. I don't think there is necessity to test Tg and TPO too.

thyroiduk.org.uk/tuk/about_...

Ask the clinic to test TSH, FT4 and FT3 in addition to TSI and/or TRab.

You'll have to read the Methimazole patient information leaflet to see whether it needs to be taken on an empty stomach or not.

[Silver_Fairy]

She needs to take her medication as she has a fast heart rate and is in danger of damage to her heart.

You mention a sore throat? You need to get her WBC tested ( read medicine leaflet) Your GP should have warned you of this.

[Adam10 in reply to Silver_Fairy]

Thank you Silver Fairy. Yes I am impressing upon her to take her medicine without fail. Her symptoms are easing so we hope she might be one of the lucky 50%.

[Silver_Fairy in reply to Adam10]

Also make sure you check her levels regularly at least every 8 weeks, as she may easily become hypO. Her last result looks low, has the GP suggested lowering the dose?

[Adam10]

Thanks Silver Fairy. Will do