Daughter hypothyroid

Hi I have just registered and my 10 year old daughter has been diagnosed with hypothyroidism, this was found a mont ago. She is on a dose of 25mcg Levothyroxine a day and her latest bloods are

TSH 6.2 mIU/L (0.2 - 4.2)

Free T4 11.3 pmol/L (12 - 22)

Free T3 3.3 pmol/L (3.10 - 6.80)

She has lost her appetite, has headaches, her hands and feet are very cold and she has dry skin all over her face. She is also more pale than normal and the front of her neck looks swollen.

Any advice appreciated.

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Tanya_C,

Your daughter is undermedicated on 25mcg as TSH is still high and FT4 is below range. Dose is usually increased in 25mcg increments and 6 week intervals until TSH is between 1-2 with FT4 higher in range. The high TSH flogging her thyroid gland may be inflamming it and causing it to swell. When she is optimally dosed the swelling may subside.

Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for a Levothyroxine dose increase to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. Symptoms may lag behind good biochemistry by several months.

Your daughter should have a follow up thyroid test 6-8 weeks after adjusting dose. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

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

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Also experiment in the future with taking the T4 at bedtime. It works much better for a lot of people. some people struggle sleeping, but it needs to be tried because taking thyroid meds at bedtime fits in better with when we actually make the thyroid hormones, which is when we go to sleep.

It may not be something to look into at the moment as really you want to get onto the correct dosage. 25mcg is certainly to low. But in the future certainly worth a go.

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For full evaluation she ideally needs TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

Do you know if she has High antibodies. This means cause is Hashimoto's also called autoimmune thyroid disease.

It's very common to have low vitamin levels, especially with Hashimoto's.

See if you can get Antibodies and vitamin testing from GP.

Low vitamins stop thyroid hormones working

Dose needs increasing slowly, until TSH is low in range and FT4 towards top of range.

As a young child she should be referred to endocrinologist specialising in paediatrics

Private tests are available

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

Link about antibodies

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

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Print this list of symptoms off, tick all that apply and take to GP

thyroiduk.org/tuk/about_the...

Link about taking Levothyroxine at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits your daughter best to make sure to only get that one at each prescription.

For adults the general advice is that thyroid tests should be done as early as possible in morning and fasting and if taking Levo don't take it in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

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TPO antibody 574 IU/mL (<34)

TG antibody 695.3 IU/mL (<115)

TSH 88.3 mIU/L (0.2 - 4.2)

Free T4 12.5 pmol/L (12 - 22)

Free T3 3.6 pmol/L (3.1 - 6.8)

GP said not clinically significant

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Ferritin 11 ug/L (30 - 400)

Folate 2.1 ug/L (4.6 - 18.7)

Vitamin B12 177 pg/L (190 - 900)

Vitamin D total 22.4 nmol/L (<25 severe vitamin D deficiency)

Red blood cell count 4.40 (3.80 - 5.80)

White cell count 7.12 (4.00 - 11.00)

MCV 80.5 fL (83 - 98)

MCHC 386 (310 - 350)

MCH 28.2 (28 - 32)

Haemoglobin estimation 113 (115 - 150)

Haematocrit 0.40 (0.37 - 0.47)

Platelets 248 (150 - 400)

Iron 5.4 umol/L (6.0 - 26.0)

Transferrin saturation 12 % (12 - 45)

Should she be given anything?

Thanks again

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