From Roanoke, Virginia, USA:
I am very worried about my 10 year old daughter who is steadily gaining weight out of proportion to her height (Height: 56 inches; Weight: 188 pounds). She has generalized weight gain along with lots of abdominal obesity.
She was six weeks premature after I underwent 14 weeks of treatment for pre-term labor (terbutaline, mag sulfate, betamethasone), and I also had gestational diabetes which was thought to be aggravated by the pre-term labor drugs, and I have mild typeá2 diabetes now.
She remained in the fifth to tenth percentile for height and weight until age five, and then, when she started to school, she grew three and a half inches and gained 15 pounds in one year. The gain in height continued so that she is now around the fiftieth percentile I think, and her weight is off the chart. Does this initial weight gain associated with a small growth spurt in height sound like it can be blamed on diet and exercise?
By age seven and a half, she had acne on her face which comes and goes. At age eight and a half, she was seen by an endocrinologist who ran many tests and called them all "normal". Her bone age at that time was read as six years and 10 months (a one year, eight month delay), but he did not have an explanation for that.
At age nine, we saw another doctor who thought she had hypothyroidism, based on symptoms (temperature and a TSH around 3). I know this part is controversial, but the AACE stated in a 2000 press release that a TSH between three and five may represent a thyroid that is failing and more recently, a large study (NHANES III) which looked at about 17,000 people and eliminated anyone with hypothyroid symptoms, thyroid antibodies, etc., found that the mean TSH in that group was 1.5. She has been on thyroid medication and initially gained a few inches without gaining weight. However, within a short time she had some hyperthyroidism symptoms and her medicine was discontinued (by me).
A few months later, we traveled to another institution to see a highly recommended pediatric endocrinologist. I had hoped he would look at the big picture with a new set of eyes, but he spent most of the time lecturing me about the danger of thyroid treatment. Some repeat testing was done including a new bone age which showed she had basically caught up to her actual age. Thyroid tests were about the same and an insulin level was around 7 which was well within the normal range.
After being off of thyroid medication for about six months, she was fatigued, gaining weight faster, and moody/depressed to the point of refusing to go to school (She is normally a good student), so I decided to resume the thyroid medication under the care of the previous doctor, and her mood improved greatly over the next few weeks. She has remained on the medication for the past seven months. At one point when labs were checked her free T3 was a little high and free T4 was about midrange, so we decreased the dose a bit. Her morning cortisol level was also checked and was in the bottom of the reference range at around 6 (range: 4-22). However her insulin level when checked this time was 19 with a fasting blood sugar of 94 mg/dl [5.2 mmol/L]. By the way, there is also strong family history for both type 2 diabetes in my family and hypothyroidism on both sides of her family.
She is taking five dance classes per week which amounts to about four and a half hours of activity, although much of it is not aerobic. Does this all sound like just a diet and exercise problem? She has had multiple lab tests although no stimulation testing was thought necessary as baseline levels of things tested was with the reference range. Does this sound like either hypothyroidism or insulin resistance? Can treatment of hypothyroidism (including treatment with T3 containing drugs) causeinsulin resistance? Is weight gain associated with overeating accompanied by increased height percentile as well?
This is a very complicated problem, so it's difficult to answer your questions. This does not sound like thyroid disease so I am puzzled why you are treating your daughter with any thyroid hormones. I wonder about insulin resistance as well, but an insulin level fasting of 19 with a normal blood glucose level, it is not very convincing.
Does she have any evidence of early puberty/adrenarche or hairiness besides her acne? This could be a form of "/dictionary/m.htm#metabolic">metabolic syndrome, and her obesity could be part of this problem. You did not mention lipids or exactly which hormone levels were checked nor about her blood pressure. Most such obese youngsters who we see are clearly overeating so I would suggest strict calorie counts and especially watching fat calories and sugar calories as well as portions.
A good pediatric nutrition consultation would be valuable if you still do not see weight loss when calories are cut back. If she is watching more than an hour of television or spending the comparable time on the computer or video games, this should be restricted as well since this often promotes more activity and therefore calorie expenditure. You are wise to be so concerned about weight gain at such a young age since this is likely to lead to future diabetes and/or early heart disease/cardiovascular problems.
[Editor's comment: See Controversy Continues Over Treating Symptomatic People with Normal TSH Levels -- A Look at Weetman's July 2002 Commentary in Clinical Endocrinology. SS]
Original posting 7 Oct 2002
Posted to Diagnosis and Symptoms
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Last Updated: Tuesday April 06, 2010 15:09:38
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