Children with hypothyroidism

[MaddyT]

Hi, I am a newbie. Is hypothyroidism usually found in children. I suspect my 8 year old daughter has it. Thankyou

TSH 10.6 (0.27 - 4.20 mIU/L)

Free T4 9.3 (12.0 - 22.0 pmol/L)

Free T3 3.0 (3.1 - 6.8 pmol/L)

[ITYFIALMCTT]

Babies can be born with a form of hypothyroidism.

And, yes, it's possible for children to be evaluated and diagnosed with hypothyroidism.

thyroiduk.org.uk/tuk/get_in...

[MaddyT in reply to ITYFIALMCTT]

Thankyou. She had her thyroid tested some time ago and no treatment has been confirmed yet

[ITYFIALMCTT in reply to MaddyT]

Do you know the results and their reference ranges? Can you share them so that members might be able to comment, please?

[MaddyT in reply to ITYFIALMCTT]

TSH 10.6 (0.27 - 4.20 mIU/L)

Free T4 9.3 (12.0 - 22.0 pmol/L)

Free T3 3.0 (3.1 - 6.8 pmol/L)

[ITYFIALMCTT in reply to MaddyT]

It would help other people to comment if you can edit these into your initial post so that it's easier to read as it would be good if more members see them and it can be hard when it's buried in the comments.

However, I'm just stating something that you already know when I say that those results are clear indication of hypothyroidism. Your daughter's TSH is over range plus her FT4 and FT3 are below their ranges.

Is your GP referring your daughter to an endo. - is this the delay?

Did she have any vitamin and mineral levels tested?

[MaddyT in reply to ITYFIALMCTT]

They have been put into the post now, GP is not referring her to endo

[ITYFIALMCTT in reply to MaddyT]

Sorry for all the questions, but has the GP given a reason for not starting her on treatment for hypothyroidism?

[MaddyT in reply to ITYFIALMCTT]

Thankyou there is no reason, I plan to speak to GP about this tomorrow

[MaddyT in reply to ITYFIALMCTT]

Ferritin 14 (30 - 400 ug/L)

Folate 2.0 (2.5 - 19.5 ug/L)

Vitamin B12 147 (180 - 900 pg/L)

Total 25 OH vitamin D 23.3 (<25 nmol/L deficient)

[ITYFIALMCTT in reply to MaddyT]

Again, no surprise to you but all of those are deficient. Nothing's been prescribed?

I don't know if SeasideSusie knows if there are special ways of correcting those deficiencies in children - but in adults, you'd be looking at:

possible infusions to correct the iron deficiency if other results are in line with the below range ferritin or at least iron supplements;

loading doses of vitamin D;

investigation of that low vitamin B12 - e.g., rule out Coeliac's Disease, H Pylori, Intrinsic Factors etc. but she should also be considered for B12 injections;

folate level is below the range, but she should not start folic acid supplementation until she's been evaluated for the B12 deficiency causes.

[MaddyT in reply to ITYFIALMCTT]

Thankyou no I will be speaking to GP about this tomorrow as well and ask why these have been ignored

[ITYFIALMCTT in reply to MaddyT]

If you scroll down here, you can read what SeasideSusie discusses for an *adult* with similar levels to your daughter:

healthunlocked.com/thyroidu...

Your daughter must be so tired and out of sorts!

[MaddyT in reply to ITYFIALMCTT]

Thankyou yes she is, she has symptoms like tiredness, puffy eyes, aching everywhere, dry skin, dry eyes, outer border of eyebrows thinning and she has gained an awful amount of weight within the past 3 months, about 6 extra kg

[SeasideSusie Remembering in reply to MaddyT]

MaddyT I'm afraid I don't know if there is anything different about treating deficiencies in children but your daughter has some very serious ones there i.e.

Below range ferritin, possibly indicating iron deficiency anaemia so she needs a full blood count and iron panel.

She is folate and B12 deficient so I would post on the Pernicous Anaemia Society for further advice healthunlocked.com/pasoc

She is Vit D deficient.

All need addressing urgently. Insist your GP does something about them with urgent referrals if necessary.

[MaddyT in reply to SeasideSusie]

Thankyou she had complete blood count and iron panel which showed

Red blood cell count 4.44 (3.80 - 5.80)

White cell count 7.12 (4.00 - 11.00)

MCV 77.2 fL (80 - 98)

MCHC 376 (310 - 350)

MCH 28.2 (28 - 32)

Haemoglobin estimation 116 (115 - 150)

Haematocrit 0.400 (0.370 - 0.470)

Platelets 250 (150 - 500)

Iron 5.4 (6.0 - 26.0)

Transferrin saturation 12 % (12 - 45)

[ITYFIALMCTT in reply to MaddyT]

Her iron is below the range and her transferrin saturation is one the floor - so it looks like your daughter has iron anaemia. T

here start to be crossovers with iron anaemia, folate deficiency/anaemia, and the low B12 which makes sense of some of the other results (like the MCV and MCHC).

Your daughter is in need of some careful management to rectify her deficiencies.

[SeasideSusie Remembering in reply to MaddyT]

MCV 77.2 fL (80 - 98)

MCHC 376 (310 - 350)

Iron 5.4 (6.0 - 26.0)

Haemoglobin estimation 116 (115 - 150)

You need a very serious discussion with her GP tomorrow, your poor daughter must be feeling dreadful. Normally I would suggest seeing a different GP and with levels as serious as these being ignored I would suggest considering making a formal complaint against the GP. That is, of course, your decision to make.

[MaddyT in reply to SeasideSusie]

Yes absolutely will do something about this. She has symptoms like tiredness, puffy eyes, aching everywhere, dry skin, dry eyes, outer border of eyebrows thinning and she has gained an awful amount of weight within the past 3 months, about 6 extra kg

[SeasideSusie Remembering in reply to MaddyT]

Poor girl

Please let us know how it goes tomorrow.

[MaddyT in reply to SeasideSusie]

Thankyou yes I will

[Clutter in reply to MaddyT]

MaddyT,

Your GP should investigate whether B12 and folate deficiency is due to pernicious anaemia. B12 injections should be initiated 48 hours prior to 5mg folic acid daily. Post your daughter's vitamin and mineral results on healthunlocked.com/pasoc for advice as they are the experts on B12 deficiency and folate deficiency.

Ferritin is deficient which can indicate iron deficiency anaemia. GP should check full iron panel and full blood count.

VitD is severely deficient. Your GP should refer to local guidelines or the NICE CKS recommendations for treating vitamin D deficient children cks.nice.org.uk/vitamin-d-d...

VitD and iron (if prescribed) should be taken 4 hours away from Levothyroxine.

[MaddyT in reply to Clutter]

Thankyou she had complete blood count and iron panel which showed

Red blood cell count 4.44 (3.80 - 5.80)

White cell count 7.12 (4.00 - 11.00)

MCV 77.2 fL (80 - 98)

MCHC 376 (310 - 350)

MCH 28.2 (28 - 32)

Haemoglobin estimation 116 (115 - 150)

Haematocrit 0.400 (0.370 - 0.470)

Platelets 250 (150 - 500)

Iron 5.4 (6.0 - 26.0)

Transferrin saturation 12 % (12 - 45)

This indicates anaemia?

[Clutter in reply to MaddyT]

MaddyT,

MCV and iron are below range, transferrin sat. is bottom of range and haemoglobin bottom of range which indicates iron deficiency anaemia.

GP will probably prescribe 3 x 210mg Ferrous Fumarate. She should take each tablet with 1,000mg vitamin C to aid absorption and minimise constipation.

[ITYFIALMCTT]

One hospital's guidelines for treating vitamin D deficiency in children (scroll down to the Treatment Dose table): rnoh.nhs.uk/our-services/ch...

ETA: Specific NICE treatment guideline (similar to the above treatment table, 6000IU per day for 8-12 weeks): cks.nice.org.uk/vitamin-d-d...

"Prescribe oral high-dose vitamin D treatment, followed by daily supplemental doses.

The doses currently advised in the British National Formulary (BNF) for Children are:

...

Age 6 months-12 years: 6,000 IU daily for 8-12 weeks.

...

These may need to be changed depending on the availability of other vitamin D preparations and evidence of alternative dosing regimens."

[MaddyT in reply to ITYFIALMCTT]

Thankyou for this, will take to appointment when I can get one

[ITYFIALMCTT]

GOSH on treating iron anaemia in children: gosh.nhs.uk/medical-informa...

[ITYFIALMCTT]

PASOC on B12 deficiency and children: pernicious-anaemia-society....

[Reginacrz]

Hypothyroidism in children can lead to stunted growth if left unresolved for too long. Your doctor should have been doing something about this as soon as these results were confirmed. This is another aspect of thyroid disorders that is out of the realm of the general knowledge general practitioners have.

I wouldn't leave it to them. I recommend asking for an endo referral ASAP or taking these results to A&E if you can't get it.

[eeng]

If your daughter has trouble swallowing pills, get her to practice with sweets of a similar size to the pills she needs to take. Then she knows that if she doesn't manage to swallow them it won't taste horrible. Once she is a pro at swallowing sweets she should do OK with pills. I would recommend something small and smooth like tic-tacs to begin with. Smarties are about the same size as ibruprofen.

[helvella Administrator in reply to eeng]

eeng,

The Patient Information Leaflets for most, possibly all, UK levothyroxine tablets say something like I quote below (that is from Actavis). This gives one possibility for avoiding any difficulty in swallowing the tablets.

Giving these tablets to children:

The dose for children depends on their age, weight and the condition being treated. Your child will be monitored to make sure he/she gets the right dose. You should give them their medicine at least half an hour before breakfast or their first meal of the day. If necessary, the tablets can be dissolved in 10-15ml of water and given with some more liquid (5-10ml). The dissolved tablets should be taken straight away. Do not keep the solution to give to your child later.

medicines.org.uk/emc/medici...