Hashimoto's thyroiditis

[idspirit]

Hi,
My daughter is almost 17 yrs old and having re-occuring symptoms of when she was in the 8 grade 13 yrs old.  The symptoms back then were: Sore throat, chronic tireness (where I could not wake her for school, she sleep close to 15 hours or more) headaches.  Then one day I noticed her neck was swollen, test were done and came back with a dx of hashimoto's,  abnormal antibodys with normal tsh and t4 at first nothing was done other then antibotics for possible viral. Waking her became worse, I finally found a Endocrinologist who placed her on synthroid which she was on for two yrs.  Then one test came back with a t4 level too high and she was removed off the synthroid.  Now she is complaining of the same symptoms, MD says that thyroid is swelling again but as before her tsh,t4 are normal.  They are giving her antiboitics again, no synthroid she is complaing of neck itching (new).  We no longer have a Endocrinologist out here so she is being tx by her pedicatric MD.  I guess my question is would it hurt her to be back on the synthroid and have it adjusted every so often.  I concerned as she is starting the same pattern and she can't keep having this up and down trips for the rest of her life!  Is it true that once dx with hasimotos that it does not go away its just managed? That evidentually the thryoid stops functioning?  Do you suggest finding a Endocrinologist to help her closes one to me would probably be in Portland, Or  or Washington.  Ours here in Idaho moved.  Thank you idspirit

[Deanna L Aftab Guy, MD]

I would NOT treat her with thyroid and antibiotics are not needed unless she has a documented bacterial infection, thyroiditis does not mean infected thyroid unless she has a separate suppurative thyroiditis-rarer and painful and does not keep recurring. The swelling of the thyroid is due to the antibody affect, treating with thyroid in the face of normal labs is not appropriate. I would have her thyroid functions checked every 6 months or so to be sure the gland does not fizz out as can happen in about 10-20% of our patients, also they can have intermittent episodes of exaggerated outpour of thyroid hormone that goes away, this is called Hashitoxicosis-alot like Graves but does not stay and does not usually need treatment if stable.
She needs an endocrinologist, at 17 find an adult endo, they are easier to find!

[idspirit]

Sorry about the bad English, one of these days I will check my letters before hitting send!  Anyway, I found my daughters from last year in Oct.
t4, free   1.26    tsh 3rd gen  1.17. No antibodies have been taken since she was 13.  Yesterday, levels showed t4 free  1.38 and tsh 3rd gen  0.46.  We are on a downward slope on the tsh levels, does hasitmotos go hypo to hyper back to hypo?
Thank you again
idspirit