December 14, 2009
Diagnosis and Symptoms, Thyroid
Question from Palmer, Alaska, USA:
My nine-year-old has Hashimoto’s thyroiditis, ADHD, and other health problems. She is 54.3 inches tall and currently weighs 85 pounds. This year, she started gaining weight for unknown reasons, mainly in the belly area and started complaining of lower abdominal belly aches. She has had ovarian cysts due to a congenital problem – potentially has been ruled out. This late summer, she was found to have the skin staining of insulin resistance, which was interesting because the doctors disregarded a very low fasting glucose (104 mg/dl [5.8 mmol/L]) in April when her thyroid numbers were bad. She has been seen for possible UTIs this summer but not diagnosed. After the discovery of the insulin discoloration, her latest fasting glucose, insulin, lipids and cholesterol were all normal and I was congratulated on working with my daughter on her diet and exercise (she has not gained any more weight and possibly lost a little). I was told she is very high risk for PCOS, diabetes, syndrome X, and heart disease and that my daughter needs to watch her carbohydrates/sugar and to increase her cardio exercise more. Other than that, the endocrinologist will only check her fasting glucose once or twice a year. If/when abnormal, we will go from there.
Based on what the doctor has said, it sounds as if my daughter will develop these problems eventually, but I was given no timeline. I am trying to work on the diet and exercise, but should her blood tests not be checked more frequently? Should I watch her glucose at home? Friends who are diabetic have suggested it. A lot of people on my mother’s side of the family have had type 2, but no type 1. It appears the doctor suspects type 2, but has not done antibody tests although I have read that type 1 and Hashimoto’s can co-exist.
What normally should be done in this type of a case? I have found that my daughter appears sensitive to carbohydrates. I overfed her carbohydrates one weekend and her mood swung from one end to the other and then she ended up with a stomachache. Since I have decreased her carbohydrates, her stomachaches and car sickness have decreased. What do you suggest?
Answer:
It is unlikely her mood swings are related to sugar levels but it would be easy to do a detailed profile of blood glucose levels, pre-food and one hour post-food to determine this, maybe for four or five days. And, whenever there is an obvious mood swing, add an extra glucose check.
If she is overweight with polycystic ovaries and acanthosis nigricans, then she is clearly in the high risk group for future diabetes or what could be called the pre-metabolic syndrome or pre-diabetes. The only thing that we know for sure is that increasing daily exercise and decreasing carbohydrate intake, as well as stopping the obesity, is key even if a difficult task. Turn off the television. Turn off the computer games. Stop any IMing, etc. Get her moving either outside or inside and not being sedentary. Make sure that the entire family eats in a healthy fashion, not just this one child being nagged. How much to monitor is not resolved but the real answer is “enough for you to know what is going on.” Lipids and blood pressure need to be monitored periodically, perhaps yearly, as we do.
Thyroid problems are not part of this but she might have type 1 diabetes with an overlay of type 2 from the family history you provided. If thyroid antibodies are positive, then she has Hashimoto’s thyroiditis by definition and I would wonder about pancreatic antibodies: islet cell antibodies, insulin antibodies, IA2 antibodies and GAD-65 antibodies are the ones we would check because of young age and Hashimoto’s; these would likely be negative in pure type 2 diabetes or metabolic syndrome that you are describing clinically. If positive for one or more, then one must consider type 1 and not just type 2 or the overlap syndromes (type 1.5 or “double diabetes” as some call it).
SB
