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Daughter Three Year Worried About Short Stature. Suggested Hypo Thyroid In Border. Started Medication. Confused?
Question: Hello Doctor, I am XXXXX. My daughter is 3 year 5 months old and Height is 91cm weight is 13.4 kg.When went for general checkup one and half year back, doctor suggest to consult endocrinologist when we worry about short stature. Basically family history also all are short, on avg gents are at 5.3 and ladies are at 4.11 feet.
1st endocrinologist suggested there seems hypo thyroid in border.So we started medicine.
After multiple visits the last doctor from apollo chennai said nothing to worry and no problem at all by seeing Anti microsomal Ab(TPO)-NEGATIVE. And asked to check a year later. And asked us to stop medicine .We have stopped medicine for almost 9 months. I am in confusion that am I in right direction?
I have given the complete medical history below in detail.
1ST DOCTOR
At the time of 1st checkup on 22-01-12 (one and half year ago)
T3-1.78
T4-7.10
TSH-5.29
Medication-Thyronorm 25 mg 1 tablet per day
2ND DOCTOR
At the time of 17-Apr-2-12
Total T3-1.3ng/ml
Total T4-10.2 ug/dl
TSH-0.4 ulu/ml
Medication-Thyronorm 25 mg 1/2 tablet per day
3RD DOCTOR
At the time of 5-8-2012
Free T4 – 1.4 ng/dl
TSH -2.1 ULU/ML
Medication-Thyronorm 25 mg 1 tablet per day
2ND visit At the time of 8-12-2012
Free T4 – 1.5 ng/dl
TSH -4.4 ULU/ML
4th DOCTOR
Stopped medicine for three months since 8-12-2012
After stopping medicine,At the time of 16-3-2012
TSH-3.4
Free T4 – 0.9 ng/dl
Anti microsomal Ab(TPO)-NEGATIVE
Anti Thyroglobulin Ab(TT)-NEGATIVE
ANTI-Thyroid ANTIBODIES: (ELISA)
1st endocrinologist suggested there seems hypo thyroid in border.So we started medicine.
After multiple visits the last doctor from apollo chennai said nothing to worry and no problem at all by seeing Anti microsomal Ab(TPO)-NEGATIVE. And asked to check a year later. And asked us to stop medicine .We have stopped medicine for almost 9 months. I am in confusion that am I in right direction?
I have given the complete medical history below in detail.
1ST DOCTOR
At the time of 1st checkup on 22-01-12 (one and half year ago)
T3-1.78
T4-7.10
TSH-5.29
Medication-Thyronorm 25 mg 1 tablet per day
2ND DOCTOR
At the time of 17-Apr-2-12
Total T3-1.3ng/ml
Total T4-10.2 ug/dl
TSH-0.4 ulu/ml
Medication-Thyronorm 25 mg 1/2 tablet per day
3RD DOCTOR
At the time of 5-8-2012
Free T4 – 1.4 ng/dl
TSH -2.1 ULU/ML
Medication-Thyronorm 25 mg 1 tablet per day
2ND visit At the time of 8-12-2012
Free T4 – 1.5 ng/dl
TSH -4.4 ULU/ML
4th DOCTOR
Stopped medicine for three months since 8-12-2012
After stopping medicine,At the time of 16-3-2012
TSH-3.4
Free T4 – 0.9 ng/dl
Anti microsomal Ab(TPO)-NEGATIVE
Anti Thyroglobulin Ab(TT)-NEGATIVE
ANTI-Thyroid ANTIBODIES: (ELISA)
Brief Answer:
Need to look for more symptoms of hypothyroidism.
Detailed Answer:
Dear XXXXXXX Hi, I understand your concern fully and your confusion still more. I will try to answer your query , let's see if I can clear your doubts.
1. Your first concern was short stature of your girl child when you first went to the doctor. That time your daughter was < 2 years if I am right. Usually we do not evaluate short stature below 2 years. If we talk of ICP (infancy, childhood and puberty) model, it is nutrition that plays major role in growth below 2 years. So we emphasize and reinforce the role of nutrition only at that age for growth and review growth every quarterly. Secondly you have stated that there is a familial short stature so it could be inherent as well.
2. Now when your daughter is 3 y 5 m, her height 91 cm, is normal and weight 13.4 kg is also normal both for age and height. What ever average height you have given for males and females in the family, though we require the exact height of father and mother (in cm), considering that, her height is supposed to be somewhere between 139 cm and 155 cm. As per her present height her final height will be around 155 cm i.e. she is growing on the best percentile for her familial height. To be more sure I need her Bone age, and her growth velocity i.e. her height monitored every 3 monthly.
3. Your second concern , that is whether to treat her for hypothyroidism or not. Now that is a bit tricky, looking into the various reports and looking at antibody status, I would suggest wait and watch over next 3 months. Watch her weight, her height and her bone age as well.
4. Look for other symptoms of hypothyroidism like, weight gain, loss of appetite, dull, lethargic attitude, constipation, irritable mood etc. then review her TSH and FT4 after 3 months and let us know. Also try to maintain one good lab for all reports.
Regards and all the best.
Need to look for more symptoms of hypothyroidism.
Detailed Answer:
Dear XXXXXXX Hi, I understand your concern fully and your confusion still more. I will try to answer your query , let's see if I can clear your doubts.
1. Your first concern was short stature of your girl child when you first went to the doctor. That time your daughter was < 2 years if I am right. Usually we do not evaluate short stature below 2 years. If we talk of ICP (infancy, childhood and puberty) model, it is nutrition that plays major role in growth below 2 years. So we emphasize and reinforce the role of nutrition only at that age for growth and review growth every quarterly. Secondly you have stated that there is a familial short stature so it could be inherent as well.
2. Now when your daughter is 3 y 5 m, her height 91 cm, is normal and weight 13.4 kg is also normal both for age and height. What ever average height you have given for males and females in the family, though we require the exact height of father and mother (in cm), considering that, her height is supposed to be somewhere between 139 cm and 155 cm. As per her present height her final height will be around 155 cm i.e. she is growing on the best percentile for her familial height. To be more sure I need her Bone age, and her growth velocity i.e. her height monitored every 3 monthly.
3. Your second concern , that is whether to treat her for hypothyroidism or not. Now that is a bit tricky, looking into the various reports and looking at antibody status, I would suggest wait and watch over next 3 months. Watch her weight, her height and her bone age as well.
4. Look for other symptoms of hypothyroidism like, weight gain, loss of appetite, dull, lethargic attitude, constipation, irritable mood etc. then review her TSH and FT4 after 3 months and let us know. Also try to maintain one good lab for all reports.
Regards and all the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much Madam.Happy to see your answer.To answer your question w.r.t growth velocity.. here is the details.
Feb 2012-77cm-11.4kg
April 2012-79.2cm-11.3kg
Aug 2012-84cm-12.1kg
Dec 2012-86cm-12kg
April 2013-89cm-12.4
Aug 2013-91-13.4
And also my height is 5.3 and wife's height 4.11
Bone Age test result are attached when we did at the time 2012 feb
Feb 2012-77cm-11.4kg
April 2012-79.2cm-11.3kg
Aug 2012-84cm-12.1kg
Dec 2012-86cm-12kg
April 2013-89cm-12.4
Aug 2013-91-13.4
And also my height is 5.3 and wife's height 4.11
Bone Age test result are attached when we did at the time 2012 feb
Brief Answer:
Growth velocity seems normal.
Detailed Answer:
Dear XXXXXXX growth velocity seems normal. MPH i.e. mid parental height is just what i calculated. Bone age is not in the report though it is a detailed X- XXXXXXX report.
Now if you can send me the photo of X- XXXXXXX left hand AP view and Date of birth of your daughter that would give me all details.
Things seem absolutely normal. Regards!
Growth velocity seems normal.
Detailed Answer:
Dear XXXXXXX growth velocity seems normal. MPH i.e. mid parental height is just what i calculated. Bone age is not in the report though it is a detailed X- XXXXXXX report.
Now if you can send me the photo of X- XXXXXXX left hand AP view and Date of birth of your daughter that would give me all details.
Things seem absolutely normal. Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Madam, I have attached teh X-ray AP view.And my daughter date of birth is 28-March-2010.
To added more details..actually all these started when we went for general checkup.By seeing here hand in short stature general physician suggested all the tests.At that time we started with X-ray hands and spine AP view and also did Urine MPS test.Met the specialist in rainbow hospital hyderabd with these result.He said everything is normal.And then we come back to general physician who suggested all these tests first.then genral physician suggeste dto XXXXXXX endocrynologist.From there all thyroid tests started as i explained in my first question.
Note-These X-rays are done at the age 1 year 10 months.
To added more details..actually all these started when we went for general checkup.By seeing here hand in short stature general physician suggested all the tests.At that time we started with X-ray hands and spine AP view and also did Urine MPS test.Met the specialist in rainbow hospital hyderabd with these result.He said everything is normal.And then we come back to general physician who suggested all these tests first.then genral physician suggeste dto XXXXXXX endocrynologist.From there all thyroid tests started as i explained in my first question.
Note-These X-rays are done at the age 1 year 10 months.
Brief Answer:
Seems normal for age.
Detailed Answer:
Dear XXXXXXX thanks for the update. Everything is really normal. As per her age I have plotted all her heights and found that she is following the same growth curve since 2 years of age. If she follows the same her final height will be around 155 cm. Keep a track of her growth quarterly and also her thyroid profile.
Regards!
Seems normal for age.
Detailed Answer:
Dear XXXXXXX thanks for the update. Everything is really normal. As per her age I have plotted all her heights and found that she is following the same growth curve since 2 years of age. If she follows the same her final height will be around 155 cm. Keep a track of her growth quarterly and also her thyroid profile.
Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much madam on behalf of my family and me.
Brief Answer:
you are welcome sir.
Detailed Answer:
Dear XXXXXXX you and your family is always welcome if they have any health related queries. Also, it is my pleasure if I could give you satisfactory replies to all your queries. Regards!
you are welcome sir.
Detailed Answer:
Dear XXXXXXX you and your family is always welcome if they have any health related queries. Also, it is my pleasure if I could give you satisfactory replies to all your queries. Regards!
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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