toddler thyroid ultrasound

[kristenb1120]

My son is 2 years old and was recently referred to a Pediatric Endocrinologist due to slow growth, frequent low grade fevers, and slow growth.  His pediatrician ran some basic thyroid levels where his T4 was slightly elevated and TSH was in the low normal range.  In talking with the endocrinologist, she expressed that she thought most likely it was lab errors that impacted his thyroid levels and did not really feel he has a thyroid condition. His basic thyroid levels came back in the normal range but we are waiting on the antibody levels to rule out Hashimotos.  In the meantime, she wants him to have an ultrasound of his thyroid because she said it was difficult to feel his thyroid and she wasn't sure if she felt it or how the size of his thyroid is.  Due to difficulties getting off work and financial issues, it will be very difficult to get the ultrasound done by the end of the year (when insurance changes).  Do you feel it is necessary for a thyroid ultrasound if the other labs come back in the normal range?  Could there be a problem with his thyroid size that would not result in abnormal thyroid levels?  Thanks for your help!

[kristenb1120]

Thank you so much for your response!  You confirmed that I was doing the right thing with my son.  I will continue to work with his diet and hopefully he will start to gain weight shortly but will continue to follow up with the pediatrician and the endocrinologist as needed (and will get the ultrasound if things don't improve soon).  I really appreciate your help!  

[Deanna L Aftab Guy, MD]

I see alot of kids with some mild abnormal thyroid and repeat is normal, lab is variable and you have to treat the kid, I have not examined your child but think that if the thyroid functions are normal that perhaps you can wait on the ultrasound, ESPECIALLY if you have financial concerns! It is often hard to find the thyroid in someone with normal thyroid functions. I usually cannot find it unless it is enlarged or unless the patient is very slim. So the slow growth can be many things and it sounds like you can work with your pediatrician and address diet etc. and if you find that your 2 yo is falling off the growth curve, readdress it with your pcp and ped endo