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Children's Health

Thyroid in kids

04/15/2009

Question:

My daughter is 10 and is overweight. She recently had a thyroid test. When it was done a year ago her TSH was 2.07 and T4 Free was 2.3. When it was run a month ago her TSH was .01 and her T4 Free was 2.4. Her pediatrician was so concerned he referred us to an endocrinologist. They were puzzled as well since she doesn`t exhibit classic hyperthyroid symptoms.

THey redid the bloodwork. This time her TSH was "less than .01", T4 was 11.1 and her T4 Free 2.1.

She has been a bit fatigued and came home today saying she is jittery/having trouble relaxing during school in the mornings and is shakey when she goes to the restroom.

They nurse at the doc office said to just wait 6 months and repeat the tests but I am concerned. they keep saying it could be "a couple other things" but don`t wish to elaborate.

What could this be? Is it a reason to be concerned? Does she need a scan of her neck and/or head (for the pituitary)?

Any input is most appreciated.

Answer:

Thank you very much for the question.  I am glad to hear that your pediatrician referred you to an endocrinologist. Judging from the test results that you have shared - an undetectable TSH and high-normal T4 - it appears as though your daughter has hyperthyroidism.  Most cases (about 90%) of hyperthyroidism in children are caused by Graves' Disease.  The diagnosis can be made by testing for a thyroid stimulating antibody.  If that test is negative, then it would be worthwhile having your physician explore other potential causes, such as: thyroiditis, a solitary thyroid nodule or a multinodular goiter.  Your pediatrician and endocrinologist can certainly guide that evaluation.

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Response by:

Stephen E Wilson, MD, MSc Stephen E Wilson, MD, MSc
Assistant Professor of Clinical Medicine
College of Medicine
University of Cincinnati