My eight-year-old son has type 1 diabetes. He recently had some laboratory tests done. His TSH was 5.02 mcIU/ml and his A1c was 8.7%. His doctor mentioned putting him on Synthroid, 50 mcg. Should he really be on this medication at such a young age? Does he really need Synthroid? Can this be put off for now?

His A1c is rather high so that current and future risks are also high. This is not related to the TSH usually.

A TSH of 5 is slightly elevated. With no goiter and no hypothyroid symptoms, high lipids, growth problems, then many specialists would recheck every three months to see if there were persistence, any pattern of deterioration (rising TSH and/or falling free T4 and/or falling total T4), etc. If positive thyroid antibodies, this also would suggest that likely hypothyroidism will worsen over time so it is better to treat without symptoms and just a chemical imbalance rather than see clinical problems develop. Synthroid treatment is rather easy and simple with virtually no side effects except if overdosage occurs. Usually, it is quite easy to balance the thyroid functions and make them all normal with some fairly predictable dose increases, which are needed with expected normal growth and pubertal development. We would usually suggest every four to six month routine follow-up thyroid blood work to confirm normal values on or off Synthroid treatment.

If there is hypothyroidism, and usually this is caused by Hashimoto’s thyroiditis, then it is also important to check for celiac disease, the third most common of the autoimmune disorders associated together. It is also important to check family history for pernicious anemia and adrenal insufficiency as these two can be associated, especially if others in the family also have the same patterns. Some suggest monitoring other family members with antibody screening as well, so all this should be discussed with your medical team.

SB