Secondary Hypothyroidism - Pediatric Oncall

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Question
My 1 year old has had hypothyroidism since she was 4 months old. She recently had thyroid tests run, the T4 was high but the Thyroid-stimulating hormone, and T3 were low. The Thyroid-stimulating hormone was very low and the T3 was just barely low. Even after treatment was initiated,she still had symptoms of hypothyroidism. What could these results mean? If she has been under treated or over treated what kind of outlook does that give her?
Answer
Since the Thyroid-stimulating hormone is low inspite of hypothyroidism, it is suggestive of Secondary hypothyroidism. Thus, the problem seems to be in the hypothalamus. For monitoring free T4 and free T3 would be more useful rather than T3 and T4. They should be kept in the higher normal range for her age. Back to All Questions

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