6 year old w/ Hashimoto's - more symptoms

[aam73]

Thank you for all the helpful info with my last question.  We have a follow-up appt w/ our ped. in about 2 weeks and an appt with a ped endo from Children's on Feb. 6.  However, there are a few things that are still worrying me.  My daughter still has a marble size lymph node on the back of her neck and now has a lump on her forehead the size of a quarter.  I noticed the lump about a week ago (it looks like she bumped her head), but it is slightly bigger now.  She is still tired and irritable, her coloring is pale-grayish and some nights the circles under her eyes look almost like bruises.  Our friends and family continue to ask about her, because they think she doesn't look well.  She also has had a few more night sweats..I go to turn off her lamp if she fell asleep reading and she and her sheets are soaking wet.  Should I take her to the dr. sooner or just wait for the scheduled appts?

[aam73]

We had our appt. with Dr. Kaplowitz.  He was very nice and informative.  He explained to us what is exactly going on with our daughter's thyroid, which I really appreciated.  He said he probably wouldn't have medicated her right away, but it is appropriate also.  He wants to keep her on the levothyroxin for 1 year (with a level check at 6 months) and then try to take her off for a month and test her again.  Hopefully, she won't need the meds indefinitely, but that way we can find out.  Thanks again..you have been a huge comfort while waiting to see him.

[Deanna L Aftab Guy, MD]

Ha! but I am not as published as Paul!! -good luck

[aam73]

Thanks again for all of your help.  If you were near DC, I would be trying to get an appt with you!

[Deanna L Aftab Guy, MD]

good guy, posts on the listserve for peds endo. very knowledgeable and I am sure he is very nice, you are in excellent hands and yes, he is well published!!!

[aam73]

It is Dr. Paul Kaplowitz at Children's in DC.

[Deanna L Aftab Guy, MD]

do not be freaked about publications, I wrote several papers first author and several textbook chapters trust me, I am not very intimidating!!! As the division chief he got his job because he is academic, pressure to publish and often asked to keep on publishing, that is good. If he is a good clinician that is the key. Often they work with a nurse practitioner who you  may see at your second visit, they tend to have much more time and teach well, our NP is amazing and is my right arm but I do spend time teaching cause I like it and am not spending alot of time in the lab anymore or writing papers-too many kids and so little time :) What is his name?

[aam73]

Thank you for your response.  I think I'm just a little anxious and slightly intimidated.  I looked up and read several of the ped endo papers and he seems incredibly knowledgable and l look forward to learning as much as I can from him.

[Deanna L Aftab Guy, MD]

give the person a chance, often by phone I think one thing then seeing a child change my mind, also with two sets of labs pre and post treatment they may be convinced that this is the right thing. Sometimes the chief is so busy they need a minute to think, our poor division chief sees less patients but is much much smarter than we are :) I respect him immensely and many times there are a few ways of treating a problem with good outcomes.
Stay on treatment till you see the boss :)

[aam73]

Hi again.  You have been so helpful...I thought I would pose one more question.  We returned to the pediatrician after labs and found that my daughter's TSH had dropped to 2.6 and her thyroid looks slightly less enlarged.  She also seems to look better and have more energy.  We scheduled an appt. with a ped. endo at Children's b/c we wanted a dr. associated with a children's hospital.  Our pediatrician informed us that the ped. endo. we are scheduled to see was the 2nd who got back to him for consult after he had already prescribed the levothyroxin for our daughter and this ped. endo. said he would not precribe anything and told ped. to watch for changes.  I'm worried about our appt with this ped endo... he is chief of the dept and very well published.  I just want to be prepared for what he may suggest for treatment (or lack of).  Is it appropriate for her to be taking meds...what would you recommend if she were your patient?  Thanks so much for your time.  

[Deanna L Aftab Guy, MD]

so all of your labs-repeated a bunch :) show to me that the tsh is slightly higher than we like, the free T4 is in good range and the thyroid antibodies are positive confirming Hashimoto's.
I would tend to increase her thyroid dose slightly if she were my patient, but now it has been a whole month, did they change her dose on 12/10? if so then repeat labs this month are needed. If not then repeat labs are still warranted.
Hope this helps, again don't think the lymph node or bump on head are related to thyroid though.

[aam73]

Sorry, I don't know why it posted so many times.

[aam73]

Her levels were checked on 12/10 (TSH=7.88,T4=7.87,freeT4=1.13,Anti-thyro eia=492,thyroglobin=<.2)  She was started on 50 mcg levothyroxine on 12/17.  She is scheduled to have a recheck on 1/17 and follow-up with ped. a few days later.  Eval. by ped. endo. on 2/6.
I guess I am worried because she really looks sick and the lymph node and bump on her forehead have happened since we saw the doctor.

[aam73]

Her levels were checked on 12/10 (TSH=7.88,T4=7.87,freeT4=1.13,Anti-thyro eia=492,thyroglobin=<.2)  She was started on 50 mcg levothyroxine on 12/17.  She is scheduled to have a recheck on 1/17 and follow-up with ped. a few days later.  Eval. by ped. endo. on 2/6.
I guess I am worried because she really looks sick and the lymph node and bump on her forehead have happened since we saw the doctor.

[aam73]

Her levels were checked on 12/10 (TSH=7.88,T4=7.87,freeT4=1.13,Anti-thyro eia=492,thyroglobin=<.2)  She was started on 50 mcg levothyroxine on 12/17.  She is scheduled to have a recheck on 1/17 and follow-up with ped. a few days later.  Eval. by ped. endo. on 2/6.
I guess I am worried because she really looks sick and the lymph node and bump on her forehead have happened since we saw the doctor.

[aam73]

Her levels were checked on 12/10 (TSH=7.88,T4=7.87,freeT4=1.13,Anti-thyro eia=492,thyroglobin=<.2)  She was started on 50 mcg levothyroxine on 12/17.  She is scheduled to have a recheck on 1/17 and follow-up with ped. a few days later.  Eval. by ped. endo. on 2/6.
I guess I am worried because she really looks sick and the lymph node and bump on her forehead have happened since we saw the doctor.

[aam73]

Her levels were checked on 12/10 (TSH=7.88,T4=7.87,freeT4=1.13,Anti-thyro eia=492,thyroglobin=<.2)  She was started on 50 mcg levothyroxine on 12/17.  She is scheduled to have a recheck on 1/17 and follow-up with ped. a few days later.  Eval. by ped. endo. on 2/6.
I guess I am worried because she really looks sick and the lymph node and bump on her forehead have happened since we saw the doctor.

[Deanna L Aftab Guy, MD]

I don't think that the node on the back of her neck is related to her thyroid problem. The night sweats may be due to elevated thyroid, when was her last level checked and when is her next one to be checked.