Avatar universal

Infant Hypohyroid

Hello Doctor,
My baby boy is 8.5 months old now(Born on June 22, 2013). When he was 3 months old, he was diagnosed with CHD(Coronary Heart Disease) - ALCAPA syndrome(Anomalous origin of the left coronary artery from the pulmonary artery). Because of which he underwent an open heart surgery at his 3rd month itself(Sept 23, 2013) for a coronary replacement. So far he is doing well by God's grace and is no longer on any kind of cardiac medication. To be specific, all his medications stopped by end of Oct, 2013. post his operation he was started on Thyronorm 50mcg daily as his thyroid levels were lower than normal.
Please find below the details of the tests done so far:-
Test done on Oct 19, 2013
TSH - 1.36 microIU/ml  (Reference Range - 0.55 - 7.1 microIU/ml)
            FT3 - 3.76 pg/ml             (Reference Range - 2.30 - 4.2 pg/ml)
            FT4 - 0.89 ng/dL             (Reference Range - 0.89 - 1.76 ng/dL

2.         Test done on Dec 26, 2013
TSH - 0.057microIU/ml  (Reference Range - 0.55 - 7.1 microIU/ml)
            FT3 - 5.21 pg/ml             (Reference Range - 2.30 - 4.2 pg/ml)
            FT4 - 1.99 ng/dL             (Reference Range - 0.89 - 1.76 ng/dL
Post the above tests, his medicine dosage was reduced to Thyronorm 50mcg 3 days per week and Thyronorm 25mcg 4 days per week.

3.         Test done on Mar 4, 2014
TSH - 0.015microIU/ml  (Reference Range - 0.55 - 7.1 microIU/ml)
            FT3 - 4.44 pg/ml             (Reference Range - 2.30 - 4.2 pg/ml)
            FT4 - 1.39 ng/dL             (Reference Range - 0.89 - 1.76 ng/dL
As of now, his dosage of medication remains unchanged(Thyronorm 50mcg 3 days per week and Thyronorm 25mcg 4 days per week.)
I would like to know, if his treatment is appropriate. We still do not know, if his thyroid problem is congenital or post operative effect. So my question remains, will he have to continue taking thyroid medicines throughout his life(If at all, we can comment  on it now).
His weight as on Feb 6, 2014 is 9.43 kg.
Looking forward to your kind suggestion.

Best Answer
Avatar universal
Let's look at his FT3 and FT4 instead of his TSH.  TSH often becomes almost useless once on meds.  

Between 12/26/13 and 3/4/14, his FT4 came down nicely from above range to right around midrange, which is perfect.  FT3 is still a little above range, but it's also dropped significantly in the same time period.  As we adjust meds, we often see a lag in FT3, i.e. FT4 will come down first, then FT3 will follow it down more slowly later.

Do you see any signs of hyperthyroidism (overmedication)?  Diarrhea, sensitivity to heat, insomnia, elevated BP and/or HR?  Is he gaining weight as expected?

Has he ever been tested for antibodies to see if this is autoimmune?  Hashimoto's thyroiditis, the most prevalent cause of hypothyroidism "runs in families" and is possibly hereditary, though that has not been proven.

I should mention that this is a patients' forum.  We are not doctors, just fellow patients, and we can only suggest ideas that you can discuss with your doctor.  
9 Responses
Sort by: Helpful Oldest Newest
Avatar universal
The antibody test is a simple blood test.

Weight gain is a symptom of hypothyroidism, so it's quite possible it's related.

Especially with his other health issues, your doctor would be the best one to recommend diet or to refer you to a dietician.
Helpful - 0
Avatar universal
What is the anti bodies test? Is it any kind of blood test?
Also, now my baby is 8.5 months old and weighs 10kg. My doctor says that his weight needs to be checked? Can his weight gain be due to thyroid issue?
Any diet to follow for him now ? Is there any specific symptom for this kind of thyroid problem?
Helpful - 0
Avatar universal
It doesn't always continue for life.  There are some conditions that cause transient hypothyroidism.  That's why I suggested testing for antibodies.  If his antibodies are not elevated, then he will have a reasonable chance of getting over this.  If they are elevated, then it's probably for life.  You can also wait and see if he does get better, as your doctor thinks he will.  You can test for antibodies at any time.  
Helpful - 0
Avatar universal
Thank you for your inputs. I have heard that once we start on thyroid medication it continues life long. Is it true? My baby's cardiologist still feels that his thyroid imbalance is transitional, and a side effect of his open heart surgery. I am hoping that he will be out this medication sooner or later.
What do you feel?
Helpful - 0
Avatar universal
I am the first in my family to have Hashi's.  It's not necessary to have a relative with it to develop it.  It's usually standard treatment to test for it in any case of thyroid dysfunction, whether there's a family history or not.  If he has Hashi's, you will know that he will have to be on thyroid meds all his life.

I think the dose he's on now looks reasonable.  His FT4 looks really good right now.  If you lower his dose, that would fall down too low in the range.  FT3 is still high.  I think it would be worthwhile to test again in another month and make sure it's continuing to fall.

I also notice that the reference ranges you posted for both FT3 and FT4 are pretty "standard" adult reference ranges.  Babies have higher reference ranges for both FT3 and FT4.  For example, I found FT4 reference range for 0-12 months of 1.3-2.8 and FT3 reference range of 1.5-6.0.

However, ranges are also specific to each lab.  It might be worthwhile to give your lab a call and ask for their own age adjusted ranges (they might not even know they have them).  Alternatively, you could ask your doctor about the reference ranges for babies.  He may be aware that babies run higher FT3 and FT4 than adults and is basing his meds decisions on that knowledge.

Helpful - 0
Avatar universal
Thanks for your suggestion. As I already discussed, he has undergone an open heart surgery on Sept 23rd, 2013. And at that point, his heart rate was higher than normal, which the doctors said will settle down eventually. I didn't observe any other symptoms in him.
And, neither me nor my husband has had any thyroid issues so there is no question of hereditary as well. now
So do you think he is on correct dose of medicines as of now ?
Helpful - 0
Avatar universal
Thanks alot. So do you think the dosage of the medicine should be decreased..?? please respond.
Helpful - 0
Avatar universal
TSH - 0.057microIU/ml
TSH - 0.015microIU/ml

Both of these are low, indicating meds are too high.

Free T3 is also high.
Helpful - 0
Have an Answer?

You are reading content posted in the Thyroid Disorders Community

Top Thyroid Answerers
649848 tn?1534633700
Avatar universal
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.