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Pediatric Endocrinology (Expert Forum)
CH dosage regulation
Answered by
Deanna L Aftab Guy, MD - Short Stature, thyroid, Pituitary abnormalit, Puberty concerns, Rapid Growth, Adrenal problems, Parathyroid abnormal, Rickets and bone dis
Vanderbilt Children’s Hospital
Nashville - TN
Questions in the Pediatric Endocrinology forum are answered by Dr. Deanna L Aftab Guy, affiliated with Vanderbilt Children's Hospital. 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.
CH dosage regulation
by MrSam, Jun 13, 2008 05:32PM
Our newborn was diagnosed with CH. The first 2 borderline screeners (there was a retest) and the stalling of childrens public hospital urged me and my wife to take our baby for a blood test to a private lab where (TSH 8.9) (fT4 5.7) (fT3 1.45). Next day the screening in hospital showed (TSH 12.97) (fT4 11.9) (fT3 4.8).
Eventually we initiated treatment on 40th day after birth with 1x25 T4tabs a day One month later values from a molecular lab were fT4= 2.2 (0.6-2.0) fT3=4.13 (1.4-4.4) and TSH=0.783 (0.3-4.0), accordingly the pediatric endocrinologist of the hospital suggested reduction in terms of giving the dosage 5/7 days a week. Once more we desided to get another opinion. The new pediatric endocrinologist believed there is a high possibility of transient hypothyroidism (not that it matters) and suggested the continuation of dosage at 7/7 days with 25T4 tablets. The last blood test (same molecular lab) after a 2 week period showed the following values fT4= 1.99 (0.6-2.0) fT3=3.85 (1.4-4.4) and TSH=2.28 (0.3-4.0),
What should we do stay at 5/7 or go back to 7/7, we do not want out child to be either under or overmedicated.
Thank you.
Eventually we initiated treatment on 40th day after birth with 1x25 T4tabs a day One month later values from a molecular lab were fT4= 2.2 (0.6-2.0) fT3=4.13 (1.4-4.4) and TSH=0.783 (0.3-4.0), accordingly the pediatric endocrinologist of the hospital suggested reduction in terms of giving the dosage 5/7 days a week. Once more we desided to get another opinion. The new pediatric endocrinologist believed there is a high possibility of transient hypothyroidism (not that it matters) and suggested the continuation of dosage at 7/7 days with 25T4 tablets. The last blood test (same molecular lab) after a 2 week period showed the following values fT4= 1.99 (0.6-2.0) fT3=3.85 (1.4-4.4) and TSH=2.28 (0.3-4.0),
What should we do stay at 5/7 or go back to 7/7, we do not want out child to be either under or overmedicated.
Thank you.
Doctor's Answer
by Deanna L Aftab Guy, MD, Aug 03, 2008 05:31PM
, Aug 03, 2008 05:31PM
To: MrSam
I am confused, sounds like I agree with peds endo number one,
congenital hypothyroidism is important to treat fast, we all worry about growing brains! So in the first few weeks of life we have to decide about treatment, the tsh being a little elevated more than likely was the normal surge we see in the first few days of life, and the tsh was not so high that it worried me but if it were my child better error on the safe side and replace the hormone if is appears a little low. So now the repeat labs indeed show a little too much on board, you are down to 12.5 mcg daily, wait a month before checking labs and then reassess about changing dose or holding for 4 more weeks and repeat labs, my gut says you will not need treatment, those that need it for life usually have tsh at birth over 100-no real science, just something seen and understood by peds endos as typical.
So don't focus on dose for weight, it is based now on labs and how baby is doing, I bet you stop soon!
congenital hypothyroidism is important to treat fast, we all worry about growing brains! So in the first few weeks of life we have to decide about treatment, the tsh being a little elevated more than likely was the normal surge we see in the first few days of life, and the tsh was not so high that it worried me but if it were my child better error on the safe side and replace the hormone if is appears a little low. So now the repeat labs indeed show a little too much on board, you are down to 12.5 mcg daily, wait a month before checking labs and then reassess about changing dose or holding for 4 more weeks and repeat labs, my gut says you will not need treatment, those that need it for life usually have tsh at birth over 100-no real science, just something seen and understood by peds endos as typical.
So don't focus on dose for weight, it is based now on labs and how baby is doing, I bet you stop soon!
Member Comments (3)
by MrSam, Jul 27, 2008 04:29AM
Since our first post, dosage was reduced twice since initiation. At first dosage was 50 weight 3.5kg, now is 12.5 weight 7.5kg. What is going on?
by MrSam, Jul 27, 2008 04:30AM
correction initial dose was 25
