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Born Premature. Blood Group O+ve. Diagnosed Jaundice. Have High Levels Of TSH On Day 7. TSH On Day 22 After Taking Eltroxin. Suggestions?
Question: My daughter iis 24 days old. She was born 3 days premature from 37 weeks by normal delivery. During birth her weight was 2.560kgs and length of 48 cm . Her Apgar score was 8 and 9 at 1 min and 5 mins respectively. Her blood group is O+ and her G6PD is normal.
She was diagnosed with jaundice with TSB 16.84 mg/dl on day 5 of life. She was started on phototherapy which was continued for 24 hours. Her last TSB was 9.34. She tested for high levels of TSH on day 7 amounting to 13.31uIU/mL and FT4 to 22.64 pmol/L. Her other CBC parameters were normal. She was put on dose of 15mcg of Eltroxin (Thyroxin Sodium) .
She was again tested for TSH on day 22 after taking Eltroxin for 15 days . Her TSH levels had fallen to 2.75 mIU/ml and T3 being 2.02 ng/ml and T4 being 12.8ug/dL.
Please advise the following
1) How long is it required to take Eltroxin and is it a life long disease . The mothers family has a history of hyperthyroidism but neither parents of the baby have it.The doctor has advised us to continue the dose of Eltroxin for 3 months and monitor the TSH levels monthly. Please suggest the correct course of action
2) The baby is gaining weight consistently and had gained 600 gms in 20 days. Although the baby is active and is taking regular breast feed she passes stool many times daily amounting to 15 - 16 times . She also releases some stool when ever she passes gas which is about 15 - 20 times in a day. Lately she cries a lot when she passes the stool and it feel she is having a serious gas problem and stomach aches. Please suggest a remedy for this and is it somewhat related to hyperthyroidism or administration of Eltroxin. Please suggest is it normal for the baby to cry before passing stool.
3) Please suggest a remedy for gas and stomach pain. She doesn't have a stomach infection as her stool was tested and it gave negative results
She was diagnosed with jaundice with TSB 16.84 mg/dl on day 5 of life. She was started on phototherapy which was continued for 24 hours. Her last TSB was 9.34. She tested for high levels of TSH on day 7 amounting to 13.31uIU/mL and FT4 to 22.64 pmol/L. Her other CBC parameters were normal. She was put on dose of 15mcg of Eltroxin (Thyroxin Sodium) .
She was again tested for TSH on day 22 after taking Eltroxin for 15 days . Her TSH levels had fallen to 2.75 mIU/ml and T3 being 2.02 ng/ml and T4 being 12.8ug/dL.
Please advise the following
1) How long is it required to take Eltroxin and is it a life long disease . The mothers family has a history of hyperthyroidism but neither parents of the baby have it.The doctor has advised us to continue the dose of Eltroxin for 3 months and monitor the TSH levels monthly. Please suggest the correct course of action
2) The baby is gaining weight consistently and had gained 600 gms in 20 days. Although the baby is active and is taking regular breast feed she passes stool many times daily amounting to 15 - 16 times . She also releases some stool when ever she passes gas which is about 15 - 20 times in a day. Lately she cries a lot when she passes the stool and it feel she is having a serious gas problem and stomach aches. Please suggest a remedy for this and is it somewhat related to hyperthyroidism or administration of Eltroxin. Please suggest is it normal for the baby to cry before passing stool.
3) Please suggest a remedy for gas and stomach pain. She doesn't have a stomach infection as her stool was tested and it gave negative results
Hi
Thanks for writing this query. I went through the details with diligence and my answers to your questions are as follows:
1) Do not worry; the current dose of eltroxin is good enough for your kid as the TSH levels are already normal. Do repeat TSH monthly and continue eltroxib for 3 months as suggested. Most of the babies may not need life long eltroxin. But do recheck TSH monthly after your clinician decides to stop eltroxin.
If three TSH levels are normal after stopping eltroxin,you can safely not restart eltroxxin.
2)Frequent motions are normal in the first 45 days of life. As your kid is gaining weight adequately, there is no need to control this. This pattern of transitional stools will normalize in another 1 or 2 weeks.
3) Excess gas and crying before stools is associated with colic pain. You can give drops like colicaid, etc., which I do prescribe at 6 drops three times daily for 2 equator similar babies in my clinic. You can discuss with your pediatrician and ask for similar drops.
Do not worry , your baby is doing well. Let me know if you need clarifications.
All the best
Regards,
Dr. Arun.
Thanks for writing this query. I went through the details with diligence and my answers to your questions are as follows:
1) Do not worry; the current dose of eltroxin is good enough for your kid as the TSH levels are already normal. Do repeat TSH monthly and continue eltroxib for 3 months as suggested. Most of the babies may not need life long eltroxin. But do recheck TSH monthly after your clinician decides to stop eltroxin.
If three TSH levels are normal after stopping eltroxin,you can safely not restart eltroxxin.
2)Frequent motions are normal in the first 45 days of life. As your kid is gaining weight adequately, there is no need to control this. This pattern of transitional stools will normalize in another 1 or 2 weeks.
3) Excess gas and crying before stools is associated with colic pain. You can give drops like colicaid, etc., which I do prescribe at 6 drops three times daily for 2 equator similar babies in my clinic. You can discuss with your pediatrician and ask for similar drops.
Do not worry , your baby is doing well. Let me know if you need clarifications.
All the best
Regards,
Dr. Arun.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Doctor
Thank you for your informative and comprehensive reply. Please also clarify the following
1) With the initial levels of TSH being 13.31 was it required to start the dose of eltroxin.
2) Is her regular passing of stool and release of gas associated with intake of Eltroxin
3) is it possible she might be suffering from diarrhea, whilst her weight gain is due to Thyroid
4) Sometimes she becomes really inactive and sleeps continuously, not even waking for feed after 3-4 hours. If we forcefully try to feed then she takes little bit and goes to sleep again. Is it normal?. This phenomenon repeats for a day in a week. Is it normal .
Please advise
Thank you for your informative and comprehensive reply. Please also clarify the following
1) With the initial levels of TSH being 13.31 was it required to start the dose of eltroxin.
2) Is her regular passing of stool and release of gas associated with intake of Eltroxin
3) is it possible she might be suffering from diarrhea, whilst her weight gain is due to Thyroid
4) Sometimes she becomes really inactive and sleeps continuously, not even waking for feed after 3-4 hours. If we forcefully try to feed then she takes little bit and goes to sleep again. Is it normal?. This phenomenon repeats for a day in a week. Is it normal .
Please advise
Let me answer one by one
1) Tsh level above 10 at one week needs either recheck after a week or trial of eltroxin.
2) Eltroxin does increase intestinal movements, but you shouldn't worry as taking eltroxin is more important than others.
3) Transitional stools is normal at this age. Your baby is doing fine don't worry. This should settle in couple of weeks time.
4) Babies growth varies from day to day and so their demand and sleep pattern. What you described is absolutely normal.
Regards
Dr Arun
1) Tsh level above 10 at one week needs either recheck after a week or trial of eltroxin.
2) Eltroxin does increase intestinal movements, but you shouldn't worry as taking eltroxin is more important than others.
3) Transitional stools is normal at this age. Your baby is doing fine don't worry. This should settle in couple of weeks time.
4) Babies growth varies from day to day and so their demand and sleep pattern. What you described is absolutely normal.
Regards
Dr Arun
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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