Pediatric Hyperthyroid

[sxheet]

My daughter is 4 yr.s old. She just had blood work done last Thursday 1/17/08. Friday we learned that her 'T3 & T4" levels were very high.  The doctor informed us that she may have a hyperthyroid disorder and he reffered us to Texas Childrens.  Our Dr. did not have much advice for us because he had never seen this in a child so young.  She is very much underweight.  She has only gained 2 lbs in the past 10 months, but she has gotten a little bit taller.  Her heart beat is fast and she is very, very, hyper I guess you could say!!  She has got so much energy that she can just go, go, go, all day.  She is also very irritable at any moments notice, but very happy at others.  Her attention span is about 3 seconds. We have searched all over the web and we are having a hard time finding any info about hyperthyroid in toddlers....It is either in infants or adults.  I am very nervous about this, because the Dr. said that this could be life threatening and then we haven't heard anything from Texas Children's about an appointment.  I am just curious if anyone can tell me how bad this really is as we can't really find anything other than the symptoms.
Thank you!

[Deanna L Aftab Guy, MD]

You probably need to have this cleared up in the next few days! She may or may not have hyperthyroid, call your pediatrician today if you still have not heard about the endo, they need to call the endo directly, the one on call to get advice.
If she is hyperthyroid, then it can be a few things, yes she is young but it doesn't rule it out.
She could have elevated thyroid levels but no or little response at the receptors, this is called thyroid hormone resistance, rare but I have 2 patients with this, the levels are high but the patient does not have same symptoms as someone who is fully responsive to elevated levels.
There is Grave's Disease which is caused by an autoimmune response that actually turns on the thyroid gland and causes excessive amounts of thyroid to be released.
There is Hashimoto's thyroiditis which is also due to antibodies and these patients may present with elevated thyroid and then low thyroid or even normal thyroid levels.
So first start with Texas Children's, my partner Dr. Steelman just left Vanderbilt and went to Cook Children's in Texas, if you cannot get in to Texas Children's call that office and tell them I referred you, but work with your pediatrician first.
Please let us  know what happens and get this addressed soon

[sxheet]

Thank you for your response!!  I have actually already gone to Texas Children's and they were extremely great!!  I guess the fear of not knowing made me a little impatient!!  They have actually diagnosed her as having Grave's disease and we were given the option of radioactive iodine ablation or medication and we are kind of debating both, but leaning more towards the ablation. Any comments you have about that as well would be helpful!! You don't see much on the internet for either option for toddlers.... Thank you for all of your help!!
Sxheeth

[Deanna L Aftab Guy, MD]

You have time to decide, she more than likely will need medication and hopefully is on this right now. We as endocrinologist try to discourage radioablation under age 10 but honestly still have a few patients who need it and have had no problems, the literature is just not complete but the concern is radiation prior to puberty, if she can be managed on oral meds for at least a year then you have time to decide, but she will only be 5, by that time maybe you will learn more about both options. Sounds like you are in good hands. Glad to hear you are well cared for

[JS1960]

My daughter (16 y.o. now) was dx with Graves disease several years back and began Methmazole at that time.  We went thru one round for a year when she was taken off.  Within 8 mos she was back on the Methmazole.  We have just finished another year and her Ped. Endo said her levels are not good, even on the Methmazole.  She has been taking 1 10mg in the am and pm.  She admitted that she may be missing up to two doses per week (probably on the weekend when she spends the night with friends).  Our Dr. thinks it's time to consider ablation, but my daughter wants to give her thyroid more time to see if she can get back to normal  She understands the permanance of ablation.  My question is, how many rounds of the Methmazole should we go thru until we are sure her thyroid will not return to normal and the ablation is the only way to go?

Thanks

[chigirl29]

JS1960

I have had thyroid disease for a long while now, and I would not ablate my thyroid.  I think you should respect your daughter's decision.  Hope that helps some.

[Deanna L Aftab Guy, MD]

Work with your doctor, you are still the parent, remember informed consent. If it is Grave's Disease the methimazole will not cure her disease, it needs a permanent treatment ultimately, she has been on treatment for several years, there are significant side effects rare but important with the methimazole, these meds can cause problems with our white cell count and blood count, there is a true method to treating this problem and data to support things, you should talk with your doc and decide about surgery or radioablation, at age 16 the ablation is often suggested, she is pubertal and each treatment has its risks and benefits but ultimately this has to be handled, you may want to sit down with the pediatric surgeon and sit down with the endocrinologist and talk about the two options.

[jwells_red]

I had an overactive thyroid while preganant with my first child; the Dr.'s have mentioned Grave's Disease to me before, but I don't think I've ever been told straight out whether or not that's what I have. A few months after I gave birth to my daughter, I had the radioiodine treatment and only about two months later developed severe hypothyroidism (TSH was 100). I am now on Synthroid permanently. Lately I've been concerned about my daughter and whether or not she has a problem with her thyroid. When she puts her head back, it seems to me like her thyroid may be enlarged (goiter). She's only 22 mths, so I'm concerned about getting her tested; I'm assuming the only way is through blood work. She's not really underweight (about 26 lbs. or so), but is quite irritable at times, very happy at others, VERY energetic, but lies around like she's tired sometimes as well. She also eats quite frequently. This may just be normal for toddlers, I don't know... I agree with previous comments that it is very difficult to find info on hyperthyroidism in toddlers on the net, so I don't know if the effects are different in toddlers than in adults. Also, considering the possible side effects of radioiodine and such drugs as Novopranol (which I was on), would the removal of the thyroid be safer in the long run for such a young patient? I know I have to make an appointment for my daughter very soon, but I really don't know what I would do if it came back positive... I'm also pregnant again...

[jwells_red]

Sorry, I mistakingly said Novopranol instead of Propyl-Thyracil near the end there.

[Deanna L Aftab Guy, MD]

So you had hyperthyroidism, probably Graves Disease while pregnant and after delivery you had radioablation?
Your thyroid stimulating antibodies while pregnant can pass to the baby via the placenta and about 1-3 months after delivery we pediatricians watch these kids carefully for the overactive thyroid symptoms of neonatal graves(resolves once these antibodies pass, since they themselves are not making them).
She is now 22 months, I would say if you see a goiter, have her start with her pediatrician, they can get simple thyroid functions and if they see a goiter they can include thyroid antibodies, yes, it is a blood test but if it is negative it will result in some good sleep for many years on your part.
It is rare to have Graves at that age but it is being seen younger and younger-age 5 or 6 lately reported, usually these things happen during teen years, so if you had it she is at an increased chance but by no means guaranteed to have it.
Hope this helps. Congratulations on your pregnancy, now that you are ablated, take your thyroid medication and have your levels checked, also your antibody titer will be indicative of the likelihood that your next child may have neonatal graves, so make sure that your pediatrician and your obgyn always know that although you no longer have Graves that you did have Graves and that this is a baby that needs monitored closely for a little bit. Take care, get rest, eat well, take your folate and vitamins like your doc says to!

[jwells_red]

Thanks for your response! Yes, It was Graves; and yes, I had the radioablation--almost a year after delivery. One quick question, what did you mean by my 'antibody titer'? I've never heard that before. My OB/GYN (more reliable than my GP!!!!) is really good, and he is going to monitor me throughout the pregnancy. Thanks!

[Deanna L Aftab Guy, MD]

antibody titer should be determined by your endocrinologist but your obgyn can draw it. Some endocrinologist measure your thyroid stimulating antibodies to determine if they are still high even though you are "cured". this will make it more likely that your baby should be monitored closer for becoming hyperthyroid briefly by the antibodies passing via the placenta. If the "titer" is lower than it is less likely. Just another tool, not always used or necessary.

[jjbmat]

Hi, my daughter is 22month and 19lbs.  She has been hyper since the day she was born (at 5lb 12oz at 40 weeks).  She has also been a very irritable baby and is still a little Jeckle and Hyde.  She finally started sleeping through the night at 12 months and when I put her down for her nap or bedtime she bounces around in her bed for an hour before going to sleep even though she is very tired.  Her hair has not grown in much, she has bilateral kidney reflux and gets constipated very often regardless of the fact she eats a very healthy diet, lots of fibre rich fruits and vegetables, supplimented with psyllium fibre (which has helped) and doesn't even drink cow's milk.  I have asked her pediatrician if she thinks she may be hyperthyroid but she won't return my calls.  Any thoughts?

[Deanna L Aftab Guy, MD]

This is a question to ask in person at her well visit, it is very doubtful that she has hyperthyroid if her symptoms are chronic since birth, Hyperthyroid is very obvious, weight loss, racing heart, diarrhea, sudden change with worsening of symptoms in most children. I would make an appt if he is not returning calls as you need and ask him to evaluate if needed, if they do not suspect then labs may not be needed-they cause discomfort and added cost (up to $800 or more in most cases). so if they do not suspect it then do not insist but rather monitor her.

[sherribb]

A related discussion, 6 year old hyperthyroidism was started.