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What does this thyroid function test result indicate?

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Posted on Thu, 21 May 2015
Question: My daughter is digonised with thyroid problem at the age of 1 year 4 month and from that time she was on medication of thyroxin 0.25mg.
Last time on 20th July 2014 we had gone through some other tests and thyroid test and by looking at the reports our Doctor's has advised to stop the medication.
After that we had not taken any test and Recently I had taken again thyroid tests(FT3, FT4,TSH) and TPO for my daughter.
This time the reading came like this.
Free T3---4.10 Range(2.1---4.4)
Free T4----1.15 Range(0.82--1.57)
TSH -----11.95 Range(0.35--5.5)
TPO >1300.0h Range 0.0--60.0).

Now my daughter's age is 6 year 4 month and her weight is 30 kg and height is near to 122 cm.
I got shocked with the results and I am worried now.
Please advice me what I should do now.
How this problem can be cured?
What kind of problems she can get in future due to this problem
doctor
Answered by Dr. Ajish TP (30 minutes later)
Brief Answer:
Hashimotos's hypothyroidism- needs treatment

Detailed Answer:
Hi Mr XXXXXXX

Welcome to HCM. I have gone through the question and understand your concerns.

No need to worry. The results are showing Hypothyroidism due to autoimmune disease ( Hashimoto's hypothyroidism).

Her TSH is slightly elevated and thyroid hormones (T3&T4) are normal now. Thyroid auto antibodies are grossly elevated. This show that the high levels of antibodies are going to destroy her thyroid and make her hypothyroid.

She needs to be on replacement thyroxine. The starting dose can be 25 mcg per day. You can retest the thyroid function after 6 weeks and adjust the dose.

Hashimoto's hypothyroidism is the most common cause of hypothyroidism in XXXXXXX Most patients have antibodies (TPO) elevated like this. So don't get concerned about the high numbers. Treatment is not based on antibody levels, but based on TSH levels.

This is a hormone deficiency and treatment is hormone replacement (thyroxine). So if the treatment is adequate she won't develop any complications in future.

Hope I have answered your questions. If you have any further queries I will be happy to help you.

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajish TP (33 minutes later)
I have one doubt If we will continue with the dosage throxyin 25 mg and again her TSH level comes normal.

When these Thyroid auto antibodies will become normal or she will be permanently on medicine.In a nutshell for how long she will be on medication.

Another strong doubt if this level does not get cured how much time these antibodies will take it to destroy the thyroid.
because last time I have taken the test on 20th july 2014 and she is not on medication from that time.

If i understood you correctly she should take one dosage before food of thryoxin 25 mg
doctor
Answered by Dr. Ajish TP (32 minutes later)
Brief Answer:
See detailed answer

Detailed Answer:
Hi Mr XXXXXXX

The answers to your questions

1. Hashimoto's hypothyroidism cause permanent hypothyroidism in more than 90% of cases - has to be on life long medication.

2. We do antibodies only to find out the cause of hypothyroidism. So we usually won't repeat the antibody test while on treatment. Usally the levels won't come down with time.

3. At present the thyroid gland is only slightly damaged. XXXXXXX hypothyroidism can occur any time. The chance of developing severe hypothyroidism when antibodies are elevated is around 5% per year.

4. Once started on thyroxine the TSH will come to normal in 6 weeks time. After that the dose has to be adjusted to keep TSH between 0.5 to 3 miu/ml.

5. The starting dose I suggested was 25 mcg thyroxine, to be taken in morning empty stomach.

Hope I have answered your questions

Regards

Dr Ajish TP
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajish TP (35 hours later)
Hi Dr Ajish,

I am very satisfied with your response and now I got clarity about this problem.

I have one question only now.

As antibodies attacks on thyroid.
After giving the medicine will they not attack on thyroid>
Because antibodies will still be high.

This problem I am not able to understand.

doctor
Answered by Dr. Ajish TP (3 hours later)
Brief Answer:
It is a replacement therapy

Detailed Answer:
Hi Mr XXXXXXX

I will explain.

There are a group of disorders called auto immune disorders which include hashimoto's hypothyroidism, Type 1 diabetes, Rheumatic fever, SLE (lupus), rheumatoid arthritis etc . Our immune system is one which produce antibodies which are essential to protect us from infections. Here the immune systems is altered so that some antibodies are formed which is directed against our on body tissues rather than attacking bacteria.

We can stop this auto immune process by giving immuno suppressants like steroids, cyclophosphamide etc. But that is associated with major side effects and put you at risk of infections. This treatment will not completely suppress the antibodies. In diseases like hypothyroidism and type 1 diabetes, this is not justifiable, as replacing the hormones (thyroxine or insulin) is associated with less side effects and completely satisfy the hormone needs. But in diseases like SLE, Rheumatic fever, rheumatoid arthritis we need to suppress the antibodies at least to decrease the destruction caused by auto antibodies

In thyroid disease, we do antibodies to just find out the cause of thyroid disease. We are not targeting the antibodies. We are just replacing the thyroid hormones (Thyroxine) that was supposed to be produced by thyroid. So thyroxine (Thyronorm) treatment will not stop the antibodies attacking the thyroid. If the thyroid is more damaged we increase the dose of thyroxine to supply more hormones.


If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajish TP (1 hour later)
Sorry I am troubling you much but I am very much worried.
Now after medication her thyroid will not get more damaged one question?

Yesterday we visited one more Endocrinologist and he recommended us 50mcg tablet.
I don't want to say he is wrong but I want to know how this value gets prescribed and another thing If I start with 50 mcg will there be some problem?

Personally I feel I should go with 25 mcg as you recommended.
Please guide me, I don't want to play with my child's health.

If I start medicine as you recommended which tests I should repeat after 6 weeks and another thing how I can contact you .
Because I want a doctor who I can approach regularly.
doctor
Answered by Dr. Ajish TP (3 hours later)
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi Mr XXXXXXX

I understand your concerns.

Before answering your question let me clarify few facts about hypothyroidism.

1. This is a very common disease in XXXXXXX affecting around 10 -15% of females at any age after 3 years

2. More than 90 % of hypothyroidism is caused by hashimoto's disease.

3. 90-95% of Hashimoto's hypothyroidism is permanent - has to be on life long medications.5-10% may recover back to normal. Still you have to monitor TFT every 6 months in them.

4. Treatment is replacement of thyroid hormone. If your thyroid is producing 60% of hormones required for body now, we will replace remaining 40% of thyroid hormones as thyroxine (Thyronorm). If later in life the hormone production decrease to 30%, we replace 70%. So treatment is a REPLACEMENT of deficient hormone, NOT A CURE.

5. How much thyroxine is needed is based on TSH values. If TSH on treatment with thyroxine is between 0.4-3 miu/ml, the thyroid hormones in body (thyroxine produced by thyroid + thyroxine given as Thyronorm) is adequate.

6. If adequately replaced the disease wont affect growth, development, puberty, pregnancy or lifespan.

7. Thyroxine is similar to natural hormone - so less side effects

Now answers to your questions:

1. Whether you take thyroid medications or not the process of thyroid damage will continue - the rate we cannot predict. The chance of XXXXXXX hypothyroidism is around 5% per year.

2. The starting dose varies. 25 or 50 mcg is ok. The correct dose adjustment is based on the repeat TSH after 6 weeks, so initial dose doesn't matter. If TSH is more than 3 we increase dose, if less than 0.4 we decrease dose.


If you have any further questions, I will be happy to help.

I work in Silverline hospital , Kochi, XXXXXXX If you have any concerns while on follow up, you can ask "direct question" addressing my name in the query.

Regards

Dr Ajish TP

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ajish TP

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What does this thyroid function test result indicate?

Brief Answer: Hashimotos's hypothyroidism- needs treatment Detailed Answer: Hi Mr XXXXXXX Welcome to HCM. I have gone through the question and understand your concerns. No need to worry. The results are showing Hypothyroidism due to autoimmune disease ( Hashimoto's hypothyroidism). Her TSH is slightly elevated and thyroid hormones (T3&T4) are normal now. Thyroid auto antibodies are grossly elevated. This show that the high levels of antibodies are going to destroy her thyroid and make her hypothyroid. She needs to be on replacement thyroxine. The starting dose can be 25 mcg per day. You can retest the thyroid function after 6 weeks and adjust the dose. Hashimoto's hypothyroidism is the most common cause of hypothyroidism in XXXXXXX Most patients have antibodies (TPO) elevated like this. So don't get concerned about the high numbers. Treatment is not based on antibody levels, but based on TSH levels. This is a hormone deficiency and treatment is hormone replacement (thyroxine). So if the treatment is adequate she won't develop any complications in future. Hope I have answered your questions. If you have any further queries I will be happy to help you. Regards, Dr Ajish TP [MD,DM] Consultant Endocrinologist