My eight year old daughter, who has had type 1 diabetes for two and half years, just had a T4 of 6.9 and a TSH of 6.8. I am concerned about these results and want another opinion as to what is going on.

It sounds like you have a wise diabetes team who are correctly monitoring thyroid problems since they are seen so commonly in association with type 1 diabetes. This sounds like very mild hypothyroidism, often caused by Hashimoto’s thyroiditis with positive thyroid antibodies on blood work, also very common.

If there is only mild increased TSH and normal T4, no goiter and no thyroid symptoms, sometimes this is merely closely watched to see if the pattern changes. With falling T4 or rising TSH — or symptoms or a goiter — then treatment with synthetic thyroxine (pills) would be recommended. Go back to your team and ask them some of these same questions so that you better understand what is going on, if things have changed or not and what their options are for you to consider. Also ask if tests for celiac disease (transglutaminase antibody) have been run.

SB