Living Well With Hypothyroidism – Part 3
After isotope scan of thyroid of a child with probable diagnosis of hypothyroidism and following conversation with the parents, management with thyroxine (T4) is initiated at the first visit and previous to the plasma thyroid stimulating hormone (TSH) and T4 results are identified. Some doctors have used an initial amount lower than that suggested by the American Academy of Pediatrics in their guidelines on screening for congenital hypothyroidism.
Since in some countries an appropriate presentation of T4 as suspension/solution is not obtainable, parents are trained to provide a pill crushed in some beverage using a teaspoon. They are asked to replicate the dose if the child vomits or regurgitates the medication. The baby is seen for a second time following two weeks to assess the pretreatment biochemical data and talk about their meaning with the parents.
As a general rule, the first TSH results are evidently anomalous and the amount of T4 in blood are according with the findings on the isotope scan, confirming suspicions that the previous diagnosis of congenital hypothyroidism is accurate and that permanent therapy will be required. Sometimes there are false positive screening tests, in such cases the pretreatment levels of TSH and T4 will be absolutely normal and the parents can be free from worry that additional medication and hospital follow up are not necessary.
Occasionally, a soft augment in levels of TSH with normal concentration of T4 are established and this can produce significant nervousness, mainly if family sense that there is doubt as to whether or not their baby requests to be treated. These results can happen in a baby with some of the following problems: a) a partial deficiency in the production of T4; b) a big ectopic gland; c) a small normally located gland.
Those defects can keep the levels of T4 in blood within the standard range even with augmented TSH effects, and in such cases some doctors have frequently initiated medication with T4 owing to the danger of future thyroid malfunction with progressive onset of hypothyroidism. High levels of TSH in blood have also been described in a small number of families where it seems to be a hereditary trait. Extensive study does not clarify the reason of the atypical TSH levels and a pragmatic choice has to be made as to whether therapy is required. Doctors have a propensity to maintain those cases under evaluation, inspecting development and thyroid function for up to three years to corroborate that signs and symptoms of evident hypothyroidism do not develop.
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Return to Losing Weight With Hypothyroidism
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