hypothyroid problem

[jd5]

I have hypothyroid problem.
I have a baby girl of  5 months old.
I checked my baby's THS when she was 7 days old. We re-examined her TSH after 4 months.

Age                       TSH                                    Reference range
7 days                   0.7 MIU/ml                            0-10 MIU/ml
4  months              4.43  MIU/ml                         0.5 - 6.0  MIU/ML



We never did her T3 and T4 as the TSH was normal.
Even though her TSH is normal,  i have following queries

1) TSH is increased in 3 months. is it OK?

2) Why there is a difference in the reference range?

3) Do we need to repeat her THS ? How frequently?

4) My TSH is high (7.25) from last 2 months. Before that it was normal.
I am regularly taking the medicine (100mcg).
Now I have incresed the dose (125 mcg)

My baby is only on breastmilk. is it harmfull to her?

[Deanna L Aftab Guy, MD]

yes, tsh surges in the first 2 days of life but can peak differently in newborns that are born prematurely, both those labs are normal and would give me no reason to check further, the screening tests in many states in the US done in newborns are only tsh as this is felt to be the best one screener and if this in turn is abnormal then a confirmatory free T4 and Total T4 is done, now we tend to get false positive newborn screens but its better than missing babies with thyroids that are under active,  in the false positive cases the tsh is a little elevated when the baby has their heel checked and it is usually when we catch the pituitary putting out its normal peak of tsh to get the gland awakened-usually due checking earlier than normal like in a child going home at 24 hours or possibly in a premie who peaks later and has higher levels at 2 days compared to a full term baby
So all that being said your child sounds just perfect!
there are different ranges for age and also for the lab where they are done, your tsh is elevated for most labs (usually above 5 but some up to mid 5's ), so increasing your dose from 100 to 125 is a good change that your doc recommended, remember we don't see a change to normal until about 4 weeks into the new dose so don't go crazy checking until that time has passed.
Breastmilk is just fine for the baby, in regards to thyroid medication in breast milk it is not toxic, everything practically passes into our breastmilk and it is secreted into the breast milk although most sources say in low quantities, the effects on the infant show mixed results but the majority of studies show that the level does not affect the infants thyroid and others stated that it was not enough to treat the baby if they were low thyroid, so my overall impression which I recommend you also obtain from your doc is you should be just fine to breastfeed while taking levothyroxine.

[neeli123]

A related discussion, Baby TSH level 20 was started.

[jd5]

Thanks a lot for the quick reply.