9 Month Old

[diazmommy]

We have been having some concerns about our 9 month old's development............I went to the hospital and got his medical records and was confused and concerned about something.  He has a TSH done the day he was born at the hospital.  T4 normal THS (high-32)  normal range on the printout was .52-16.0).  

He also has the newborn screenings done as required by GA and that was the next day.  The report says within normal limits for Congenital Hypothyroidism.  

I have Hashimoto's. My TSH levels were okay during pregnancy and anitbodies were not a high level that the Dr. said would harm baby.

What about the discrepancy above and should we be concerned.  My little boy acts "zoned" sometimes and he is also sick with ear infections, etc.  But I am concerned about the above..............any advice. THANKS!

[Deanna L Aftab Guy, MD]

So newborn screening is done for this purpose to rule out low thyroid issues prior to concerns, an elevated tsh is suspicious of low thyroid but also the physiology of the baby's pituitary is as such, at birth the pituitary has a surge of tsh to get the gland going, sometime the newborn screen is done earlier than 48 hours or if the baby is a little premature the surge happens a little later, so an elevated tsh may be found in these two situations when indeed the baby's thyroid is fine, a repeat is indicated and more than likely was done (I hope)
So the test done the next day were ok, these may look at either T4 or free T4 or TSH depending on the state.
If you have Hashimoto's this does not increase the risk of congenital hypothyroid but does increase the risk later in his life of having autoimmune hypothyroidism.
In regards to whether he could have thyroid issues now, I would look at his overall development, if he is low thyroid his length would be low on the curve, his weight would be higher and he would be the best behaved kid in the nursery, never crying much, sleeping all the time.
If he is getting repeat ear infections there are so many more common reasons, allergies, repeat exposure to viruses and bacterial infections and anatomically prone ear canals and eustachian tubes.
The "zoned" symptoms can be addressed with your ped. Is he constipated, dry skin, feeding issues, lethargic? Then a workup is indicated.
So my hunch is that his thyroid is fine and if needed your ped can test, tsh and free t4 are all that are indicated for now if he or she feels it is needed at all.
Hope this reassures you

[cisco123]

Thanks!  He does seems short and he is overweight, despite the fact the Dr. tells us that he is eating a normal amount.  We did go in to have levels checked just to be sure and this is what came back:  

Thyroxine  L 8.4      range (8.8-16.5)
Thyroid Hormone Binding RAT  39    range (32-48)
Free T4 Estimate   L8.2   (8.8-16.5)
TSH  2.713   range (0.55-7.1

The lows above concern me..........but is this really considered low and should I be worried.  

[diazmommy]

Sorry first was from husband but wanted to make sure you saw my name:)    Thanks!  He does seems short and he is overweight, despite the fact the Dr. tells us that he is eating a normal amount.  We did go in to have levels checked just to be sure and this is what came back:  

Thyroxine  L 8.4      range (8.8-16.5)
Thyroid Hormone Binding RAT  39    range (32-48)
Free T4 Estimate   L8.2   (8.8-16.5)
TSH  2.713   range (0.55-7.1

The lows above concern me..........but is this really considered low and should I be worried.  

[Deanna L Aftab Guy, MD]

every lab is different, he has a normal tsh, I am looking at the free T4 range and this is different than the lab I use, I am thinking that the free T4 is an estimate rather than a measurement from another test. So with a normal tsh we are good and not to worry about slight variation from the norm essentially these are good numbers, I would ask you doc at some point if it is necessary to repeat it in a few months, but the tsh should be 3rd generation and free T4 needs to be measured