Treatment of borderline hypothyroid one year old

Our one year old son was recently diagnosed as hypothyroid by a ped endo.  His Total T4 is low (4.1), Free T4 normal (1.3), TSH high (6.09), and TBG low (.8).  He had a normal infant thyroid screening.  He is in an early intervention program and has some physical and cognitive developmental delay (evaluated at 9 mos development).  He has been seen by a ped neurologist who didn't have any serious concerns over his neurological condition.  He has always been a quiet baby who makes cautious eye contact.  Slow to roll over and not very physically active.  We have always felt there is something not quite right, but nothing seriously wrong.  A mild, acquired hypothyroidism may explain a lot of the things we have seen.  The ped endo has recommended 37.5 mcg Synthroid as treatment.  Our primary pediatrician is unsure if this is necessary due to the borderline thyroid panel results.  We will be getting a second opinion from another ped endo.

Is there a risk in administering Synthroid in a borderline case?  Is the recommended treatment consistent with his thyroid panel results?  Can Synthroid be discontinued if the second opinion indicates it is not necessary?  Are the risks of not medicating a borderline hypothyroid infant with documented delay greater than the risks of medicating if it is not absolutely necessary?  This has been a long and difficult road in pinpointing our sons problem, if in fact he has one.  Obviously we have many questions and hope we are getting closer to the answers.  I know you may not be able to answer these questions, but thanks for any insight.

[Kevin Kennedy, Ph.D.]

I won't attempt to address the question of your son's medical condition. Our Forum focuses on emotional, psychological, behavioral, developmental matters.

[mrich]

I have a 7.5 year old recently diagnosed with borderline hypothyrodism.  He sounds much like your child as an infant and we continued with him barely making milestones and ultimately getting the ADHD/LD/sensory integration dysfunction diagnosis and the list goes on.  They do not know why he is hypothyroid all the auto immune tests came back negative, but I wonder if it is responsible for where he is today looking back he has had symptoms going back to birth.  If he had been caught at a year perhaps we would be in a different boat. Also if you try medication you still track his blood work every 1-2 months.  It takes several months often times for the blood work and the symptoms of hypothyrodism to change, but the medication can always be adjusted. From personal experience Hypothyrodism is not the exciting thing for endocrinologists (they like diabetes)to treat so you need to make sure you have a doctor has time to focus on your sons case.  In regards to you pediatrician not thinking it is necessary to take meds from the time my son was 3 until 7 I asked 3 different pediatricians if they thought he could have a thyroid problem they all said no. So I would agree with your endo, but do not give up on finding out why his body is not producing enough T4.