Pediatric Endocrinology Expert Forum
Hashimoto's Disease
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Questions in the Pediatric Endocrinology forum are answered by Dr. Deanna L Aftab Guy. Topics covered include adrenal problems, diabetes insipidus, menstrual irregularities, obesity, parathyroid abnormalities, pituitary abnormalities, puberty concerns, rapid growth, rickets and bone disease, short stature, and thyroid.

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Hashimoto's Disease

My 11 year old daughter was just diagnosed with Hashimoto's. We were having her checked for constipation and several month later, this was the diagnonsis. Not what I expected!!!  I have several questions...
How common is this in her age? What are the long term effects? Should I get a second opinion? How will this "derail" her development? What can I do to keep her as healthy as possible?

She is very active but has been very sluggish lately. The doctor immediately put her on 50mg of Synthroid. Will she become active again?

Thank you
Stacy

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She has a very common problem, fortunately it is treatable. Hashimoto's is an autoimmune thyroid disorder that runs in families or can occur spontaneously, the body basically makes antibodies that attack the thyroid gland and prevent it from working properly. To confirm it the thyroid functions need to include thyroid antibodies along with tsh and free T4, sometimes the gland is enlarged but never should it be tender or reddened under the skin.
In some patients initially the gland will be overactive and we call this Hashitoxicosis, this will resolve and can be treated briefly with medications is needed, in most the gland becomes underactive and this is demonstrated based on an elevated tsh and a low or normal free T4, if the t4 is low she is hypothyroid, if the t4 is normal she has compensated or subclinical hypothyroidism and warrants treatment anyway as she needs to grow properly.
With treatment she should be fine, if she just started treatment with synthroid she needs her level rechecked about a month later to see if she needs adjustment.
She is at risk of having other autoimmune disorders but this is not very common but important to know, these include diabetes, vitiligo (lack of skin color), celiac disease, adrenal problems etc.
So as she is treated be sure her doc is following her for any symptoms that may raise suspicion.
She should see a pediatric endocrinologist at least once a year along with  her pediatrician, I would ask for only one of them to be in charge of her thyroid as too many cooks in the kitchen....
Not to worry about her age or development, I bet with treatment she will improve her energy and hopefully improve her symptoms regarding constipation. Some girls may develop puberty as they are treated, not cause it causes this but it was delayed in showing up due to the untreated hypothyroidism.
Keep us updated, hope this helps.
4 Comments
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Thank you for your quick reply. You have set my mind at ease, somewhat. You mention the gland should never be tender. What if it is? Alexa has complained of tenderness in that area. I mention it to the doc today, but quickly went into another discussion and forgot to go back to the tenderness.

Thanks
Stacy
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310293_tn?1274743373
Sometimes we worry about thyroiditis or an inflammation to the gland due to a viral or bacterial infection, if this is the case then antiinflammatories are helpful and or antibiotics depending on the cause. Monitor her, if you note one more mom's daughter on this forum also has Hashimoto's, very very common. Be sure that they are rechecking her levels in a month after starting treatment and if possible be sure she is seen by a pediatric endocrinologist as there are other things to monitor and that is all we do.
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