Pediatric Endocrinology Expert Forum
Newborn Low normal T4 High TSH
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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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Newborn Low normal T4 High TSH

Ultra Urgent
Dear Dr D. Aaftlab,
I have a nephew who is a baby boy. He is 37 days old. His T4 = 7.4 (Normal lab range = 7-14 ug/dl), TSH = 28.5 (Normal lab range = 0.5-6.0 ulU/ml). His current weight = 6.6 lb and his armpit temperature = 97.7 F. He is breastfed. He was born at the very beginning of the 9th month and at the end of 8th  gestation. When he was 2 days old developed mild jaundice Total Bilrubin 11.9 at 6th day (normal lab range 0.2 -1), 11.6 at 16th day, 13.1 at 22nd day weight at this date was 5.5 lb,  moved from breastfeeding to Formula (prebiomil) for 5 days, 7.45 at 27th day weight increased to 6.4 lb.  at the 36th day Here are the final test results: weight 6.6 lb, T4, TSH and Temp mentioned aboved were of this final day. In addition to RBC = 2.8 (lab normal range 4.5 -5.5 C/ul), Hemoglobine = 9.0 (lab 13-16 G/dl), Hematocrit = 27 (lab 38-53 %), Reticulocytes = 1% (lab 0.5 -1.5 %) and coobas direct = negative. infant's blood group = O+, Mother's = O-, Father's = B+. First child, no previous bleedings, miscarriage. The endocrinologist prescribed yesterday daily 12.5 mcg anhydrous thyoxine sodium. We haven't given the baby anything yet.  We don't trust the doctors around here. They are quick on medications and don't care about patients. I am very worried that once an external hormone given to the body it will deny the gland   wither and the medication necessarily will be for life. In addition to problems of hormone adjustment. It won't ever be like body producing its own hormone. But I am also very concerned that I might be doing the wrong thing by not giving the medicine risking the child to underdevelop and get brain damage and retardation especially at this critical age. My question is, please inform me with latest approaches and what decision should I take and had there been any possible brain damage already in this period of time.
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Firstly PLEASE do not post anything urgent on this site, the physicians and specialist volunteer their time doing these postings in between very very busy practices in which we are already on call. So any urgent questions have to be between parents and their doctors
Next, where are they located, treatment with thyroid will not hurt this baby, a tsh that is elevated needs to be correlated with a free T4, repeat will help and the results can be available that same day, talk with his parents as I am sure they are on top of this. Delayed treatment CAN hurt so do not withhold any medication that the doctors feel is needed especially thyroid which is critical for not only brain growth but also metabolism as a whole, some babies with low thyroid have jaundice but the bilirubin was not too high to be alarmed at all.
No you should be fine in regards to any damage , it is the babies with big time need who have no replacement that we get concerned about long term problems with development.
Have the parents talk directly themselves with their doctor, starting the medication and following labs is the best bet, if they find he can be weaned off then fine and if he needs it then he will do well.
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