Thyroid diseases

[Clarkey140]

Hi my daughter is 18 now and had been diagnosed with Hasimotos thyroid disease a couple of years ago, we were under the hospital for paediatrics because she was 16 at the time. She had regular bloods took levithyroxine and then we were told that her thyroid had repaired itself which is unusual, the endocrinologist advises to stop the thyroxine . Six months on my daughter had symptoms again of hypo thyroidism so had her bloods checked again and her tsh levels are really high again so she is again on levothyroxine 50 mcg. Please can anyone shed some light on this condition for me as I don’t understand how one minute it’s a problem then it’s ok and now it’s returned again thanks in advance

[jimh111]

Hashimoto's thyroiditis in children is not always lifelong it can get better whereas in adults once you have Hashimoto's with a high TSH it tends to progress (except in postpartum thyroiditis which may be temporary). This study endocrineconnections.com/co... found that about a third of children with Hashimoto's thyroiditis recovered. Those with a TSH > 10 tended not to recover. I've mentioned this study because it addresses your question. It is not a great study, it's not easy to read and most important they only looked at TSH and not at how the patients were doing, whether they were clinically hypothyroid.

The short answer is that sometimes children with Hashimoto's thyroiditis recover and sometimes they don't. The higher their TSH the less likely they are to recover. The only way to find out is to stop the levothyroxine for a while and see what happens.

It may be a few years off but it's worth mentioning that if she becomes pregnant or is planning a pregnancy it is important to keep her TSH below 2.5.

[SlowDragon Administrator]

So she should have her bloods retested 6-8 weeks after each dose increase. Dose should be increased in 25mcg steps until TSH is under 2

All thyroid tests should ideally 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. (Patient to patient tip, GP will be unaware)

It's common to have low vitamin levels. Has she had vitamin D, folate, ferritin and B12 tested?

Hashimoto's affects the gut and often leads to low stomach acid and then low vitamin levels

Low vitamin levels can affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

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Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

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

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased