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May 27, 2004

Thyroid

Question from Las Vegas, Nevada, USA:

My 13 month old son, who falls low on the growth charts, had some blood work done and his TSH was slightly high although still within the norm, 3.9. He does not have any immune disorders as of yet, but his three year old brother has type 1 diabetes and his father has celiac disease so I'm concerned about other immune disorders, such as thyroid. We visited the endocrinologist who didn't seem concerned with his TSH value and said it was normal for his age. He does want to test him for celiac. Is a TSH of 3.9 okay for a 13 month old? Should I not ever worry again about it or should I periodically have him tested? Does he have any risk of developing thyroid problems given a score of 3.9?

Answer:

The TSH of 3.9 is within normal limits although a bit higher than some newer, tougher standards using the most sensitive assays for TSH. However, without a goiter and without any thyroid related symptoms, I would not do much of anything. One might screen with thyroid antibodies to see if this child has some autoimmune markers. Thyroglobulin antibody and thyroid peroxidase/microsomal antibody are the two most commonly used and available. If positive, this would indicate Hashimoto’s thyroiditis and would suggest closer follow-up, perhaps every four to six months instead of less frequently, if at all, if negative. Celiac, type 1 diabetes, thyroiditis, adrenalitis/Addison’s are all autoimmune disorders that commonly “run together” since they have common genetic tendencies from HLA immune sites. The more people in a close family who have the same genes and the more positive antibodies, the more others in the same family should be checked and periodically monitored.

SB