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Does Thyronorm For Hyperthyroidism Should Be Taken Life Long?
Question: My question is that my daughter has been diagnosed by hyperthyroidism and is told to take thyronorm 125,mg daily for life. Does it need to be taken that long and are any side effects of that tablet. She is just 2 years 8 months. Will she be cured of this problem. Will her thyroid gland start functioning perfectly fine. Please answer me. Thanks
Brief Answer:
Hypothyroidism - depends on cause
Detailed Answer:
Hi,
Welcome to HCM. I have gone through your question and understand your concern
It is HYPOTHYROIDISM - for which thyronorm is used?
How long she is having hypothyroidism? What was the initial thyroid function reports? Did the doctor told you about the cause of hypothyroidism? What was the ultrasound thyroid reports?
The duration of treatment is till the thyroid gland start functioning on its own. So in conditions like congenital hypothyroidism (congenital absence of thyroid gland) or hashimoto's hypothyroidism (where thyroid gland is destroyed by antibodies), the medication has to be taken life long.
So usually the tests done are thyroid ultrasound in all cases and technitium scan & thyroid antibodies in selected cases.
If appropriately managed and followed up every 3 months with thyroid function reports, there wont be any side effects of this medication. Thyronorm is just a hormone replacement. It will not cure the disease or make her thyroid gland function normally. It just replace the thyroid hormones which was supposed to be produced in her thyroid gland.
Hope I have answered your query. If you have any further questions I will be happy to help.
With warm regards,
Dr Ajish TP (MD,DM)
Consultant Pediatric Endocrinologist.
Hypothyroidism - depends on cause
Detailed Answer:
Hi,
Welcome to HCM. I have gone through your question and understand your concern
It is HYPOTHYROIDISM - for which thyronorm is used?
How long she is having hypothyroidism? What was the initial thyroid function reports? Did the doctor told you about the cause of hypothyroidism? What was the ultrasound thyroid reports?
The duration of treatment is till the thyroid gland start functioning on its own. So in conditions like congenital hypothyroidism (congenital absence of thyroid gland) or hashimoto's hypothyroidism (where thyroid gland is destroyed by antibodies), the medication has to be taken life long.
So usually the tests done are thyroid ultrasound in all cases and technitium scan & thyroid antibodies in selected cases.
If appropriately managed and followed up every 3 months with thyroid function reports, there wont be any side effects of this medication. Thyronorm is just a hormone replacement. It will not cure the disease or make her thyroid gland function normally. It just replace the thyroid hormones which was supposed to be produced in her thyroid gland.
Hope I have answered your query. If you have any further questions I will be happy to help.
With warm regards,
Dr Ajish TP (MD,DM)
Consultant Pediatric Endocrinologist.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the answer. But still my question is not answered that her free t4 is showing high. What does that mean. Any cause to worry. Also her first she was diagnosed in march 2015. Her initial thyroid reports showed her brain signals TSH high and her thyroid gland T4 lower as it was not responding to the brain signals. Kindly help when will the thyroid gland start responding to the brain signals to produce thyroid hormone. Also what does free T4 test indicate in her case
Brief Answer:
Detailed answer
Detailed Answer:
Hi,
Welcome back.
Sorry, I couldn't find any mention of free T4 being high on the previous question.
The answers to your questions:
1. Thyronorm that she takes is actually T4. In her body her T4 will get converted to T3, so that her body gets enough thyroid hormones (free T3 and free T4). If the body have enough thyroid hormones, there is no need of further stimulation to thyroid (which is any way not working) and the thyroid stimulating hormone (TSH) will return to normal.
While on treatment the T4 can be high if the dose of thyronorm is high. But we also look at T3 and TSH and decide on reducing the dose. Upload the lab reports so that I can have a better idea of exact values of FT4, FT3 and TSH.
2. If TSH is high and T4 is low initially - that means her thyroid is not functioning properly (HYPOTHYROIDISM). The thyroid is not producing enough thyroid hormones even after stimulation from brain.
The cause of hypothyroidism we have to find out to say about the prognosis (like how long she has to be on replacement). The usual tests done are thyroid ultrasound in all cases and thyroid antibodies & uptake scan in selected situations. These tests will say whether her thyroid will function again normally. When - we cant predict.
3. thyroid hormones are T3 and T4. They are detected in 2 forms in blood total hormones and free hormones. Free hormones are more important in body.
Hope I could clear your doubts. If you need any further clarifications I will be happy to help you.
Wishing her early recovery.
Regards
Dr Ajish TP
Detailed answer
Detailed Answer:
Hi,
Welcome back.
Sorry, I couldn't find any mention of free T4 being high on the previous question.
The answers to your questions:
1. Thyronorm that she takes is actually T4. In her body her T4 will get converted to T3, so that her body gets enough thyroid hormones (free T3 and free T4). If the body have enough thyroid hormones, there is no need of further stimulation to thyroid (which is any way not working) and the thyroid stimulating hormone (TSH) will return to normal.
While on treatment the T4 can be high if the dose of thyronorm is high. But we also look at T3 and TSH and decide on reducing the dose. Upload the lab reports so that I can have a better idea of exact values of FT4, FT3 and TSH.
2. If TSH is high and T4 is low initially - that means her thyroid is not functioning properly (HYPOTHYROIDISM). The thyroid is not producing enough thyroid hormones even after stimulation from brain.
The cause of hypothyroidism we have to find out to say about the prognosis (like how long she has to be on replacement). The usual tests done are thyroid ultrasound in all cases and thyroid antibodies & uptake scan in selected situations. These tests will say whether her thyroid will function again normally. When - we cant predict.
3. thyroid hormones are T3 and T4. They are detected in 2 forms in blood total hormones and free hormones. Free hormones are more important in body.
Hope I could clear your doubts. If you need any further clarifications I will be happy to help you.
Wishing her early recovery.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your answer. I will give you the details of her report from the first time she was diagnosed in April 2015. This will give you better clarity to help me.
First report on 2nd April 2015 T4 - 6.06 and TSH - 10.26 H. 1st May 2015 T4 - 13.19 ( 5.1 - 14.1 ), TSH - 0.492 ( 0.70 - 5.90 ), 31st May 2015 T4 - 13.44 ( 5.1 - 14.1 ) TSH - 0.089 ( 0.70 - 5.90 ) and 28th XXXXXXX 2015 FREE T4 - 2.01 ( 0.93 - 1.70 ) and TSH - 2.01 ( 0.70 - 4.20)
I have provided all her report details on thyroid. Please explain to me in layman language whether she will be cured of this problem. From the report what do you think is the cause of this ailment and how will it be cured.
First report on 2nd April 2015 T4 - 6.06 and TSH - 10.26 H. 1st May 2015 T4 - 13.19 ( 5.1 - 14.1 ), TSH - 0.492 ( 0.70 - 5.90 ), 31st May 2015 T4 - 13.44 ( 5.1 - 14.1 ) TSH - 0.089 ( 0.70 - 5.90 ) and 28th XXXXXXX 2015 FREE T4 - 2.01 ( 0.93 - 1.70 ) and TSH - 2.01 ( 0.70 - 4.20)
I have provided all her report details on thyroid. Please explain to me in layman language whether she will be cured of this problem. From the report what do you think is the cause of this ailment and how will it be cured.
Brief Answer:
The reports are not bad
Detailed Answer:
Hi,
Welcome back. Sorry being more technical.
Please forget what ever I have discussed in last 2 answers. I could only explain from the details provided by you. Now as I got the thyroid function reports, it is more clear. The reports are not bad. What is the dose of thyronorm she is on - in 1st question you have written it as 125,mg - is it 125 microgram (mcg) of thyronorm? Is she on the same dose from beginning?
I think the doctor you showed had over exaggerated things.
1. Your child's thyroid is responding to brain signals and is producing thyroid hormones.
2. Now she is over treated with thyronorm - 125 mcg for a TSH of 10 is a high dose. Usually we start high dose like this when TSH is more than 50. I would have started her initially on a dose of 25 mcg.
3. She need not be on life long medications.
4. We can decrease the medications and consider stopping it after 3 years
If you look at her first report on April 2, 2015 : her T4 ( thyroid hormone) is normal, but TSH is slightly high. This means there is a slight reduction in thyroid hormone production, and her brain is producing signals (TSH) to improve it and with increased brain signals the thyroid is producing enough T4. So her thyroid is responding to brain signals. We will still treat the child at this situation because a slight reduction in T4 can affect brain development, height etc.
But after treatment the T4 is always high and TSH is low. So after 1 month the dose should have been reduced to keep the T4 and TSH in normal range.
Most of these kid's thyroid function tests will return to normal after 3 years. Brain development after 3 years is not dependant on thyroid hormones. So after 3 years we will stop the thyronorm and see if her thyroid function is normal. If the TSH is less than 10 and T4 is normal we won't restart the medications.
I think this will clear the doubts.
So no need to worry. She will be alright. Her thyroid gland will function normally after an age and no life long medications are needed.
Regards
Dr Ajish TP
The reports are not bad
Detailed Answer:
Hi,
Welcome back. Sorry being more technical.
Please forget what ever I have discussed in last 2 answers. I could only explain from the details provided by you. Now as I got the thyroid function reports, it is more clear. The reports are not bad. What is the dose of thyronorm she is on - in 1st question you have written it as 125,mg - is it 125 microgram (mcg) of thyronorm? Is she on the same dose from beginning?
I think the doctor you showed had over exaggerated things.
1. Your child's thyroid is responding to brain signals and is producing thyroid hormones.
2. Now she is over treated with thyronorm - 125 mcg for a TSH of 10 is a high dose. Usually we start high dose like this when TSH is more than 50. I would have started her initially on a dose of 25 mcg.
3. She need not be on life long medications.
4. We can decrease the medications and consider stopping it after 3 years
If you look at her first report on April 2, 2015 : her T4 ( thyroid hormone) is normal, but TSH is slightly high. This means there is a slight reduction in thyroid hormone production, and her brain is producing signals (TSH) to improve it and with increased brain signals the thyroid is producing enough T4. So her thyroid is responding to brain signals. We will still treat the child at this situation because a slight reduction in T4 can affect brain development, height etc.
But after treatment the T4 is always high and TSH is low. So after 1 month the dose should have been reduced to keep the T4 and TSH in normal range.
Most of these kid's thyroid function tests will return to normal after 3 years. Brain development after 3 years is not dependant on thyroid hormones. So after 3 years we will stop the thyronorm and see if her thyroid function is normal. If the TSH is less than 10 and T4 is normal we won't restart the medications.
I think this will clear the doubts.
So no need to worry. She will be alright. Her thyroid gland will function normally after an age and no life long medications are needed.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thanks doctor for your answer. I am now better able to understand her problem of thyroid. My baby XXXXXXX was first diagnosed in March 2015 when she was 2 and half years old. She was told to be given 125 MCG of thyronorm 2 tablets a day. Later now after giving her regularly two tablets of 125 mcg each for now 3 months continuously. Now in last month XXXXXXX 2015 after reviewing her report of FREE T4 her dosage was reduced to one tablet a day from 17th XXXXXXX 2015. I want to know since she has already taken 2 tablets of 125 MCG per day from continuous three months, wouls that affect little XXXXXXX in anyway. Now that I know, how much of the dose of thyronorm I need to give her. She had been detected first from nephritic syndrome in march 2015, then after doing further test she was diagnosed with this hypothyroism. She has always been a very active baby. Hence none of the symptoms of hypothyroidism match her even now. I want to know whether she got this thyroid problem because of nephrotic syndrome. If no what is the cause of her thyroid problem because at birth everything was normal. Her birth weight was 2.7 kgs . Kindly help me understand in layman language. I am a concerned mother
Brief Answer:
Need to reduce the dose
Detailed Answer:
Hi,
Welcome back.
Is she under treatment with an endocrinologist? If not please consult an endocrinologist atleast once.
I am surprised that she was started on thyronorm 125 mcg two tablets initially, considering her TSH was only slightly raised. At 2 1/2 years the usual dose of even severe hypothyroidism is 8 mcg per kg - 100 mcg if she is 13 kg. While she was on 250 mcg per day. Any how this medication is not of any serious side effects.
Nephrotic syndrome is rarely seen with hypothyroidism- not a common association. Both are different diseases, one won't lead to another.
Now what needs to be done is to decrease the thyronorm dose gradually by 25 mcg every 4-6 weeks by testing the free T4 and TSH. While decreasing the dose the TSH has to be below 5 miu/ml.
You can do an ultrasound thyroid to get a clue for the cause of hypothyroidism.
I think you should consult a good endocrinologist or Pediatrician with experience in treating thyroid problems
Regards
Dr Ajish TP
Need to reduce the dose
Detailed Answer:
Hi,
Welcome back.
Is she under treatment with an endocrinologist? If not please consult an endocrinologist atleast once.
I am surprised that she was started on thyronorm 125 mcg two tablets initially, considering her TSH was only slightly raised. At 2 1/2 years the usual dose of even severe hypothyroidism is 8 mcg per kg - 100 mcg if she is 13 kg. While she was on 250 mcg per day. Any how this medication is not of any serious side effects.
Nephrotic syndrome is rarely seen with hypothyroidism- not a common association. Both are different diseases, one won't lead to another.
Now what needs to be done is to decrease the thyronorm dose gradually by 25 mcg every 4-6 weeks by testing the free T4 and TSH. While decreasing the dose the TSH has to be below 5 miu/ml.
You can do an ultrasound thyroid to get a clue for the cause of hypothyroidism.
I think you should consult a good endocrinologist or Pediatrician with experience in treating thyroid problems
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks doctor for your answer. The tablet which I am Giving her is 1 tablet of 125 MCG , how do I reduce the dosage by giving her half the tablet or 3/4 of the tablet. Please help me how to reduce the dosage by 5 MCG after 1 month ie 4 weeks. Doctor you said that her thyroid will start functioning at the age of 3 years. Doctor now she is 2 . 9 years so after 3 months I can stop her medicine. Please advice me.
Brief Answer:
Either buy new tablet or reduce the days
Detailed Answer:
Hi,
You can either buy new tablets of 50 mcg and take 2 tablets a day for 1 month, 1 1/2 tablets next month and 1 tablet after that.
Or else you can decrease the number of days of medications in a week. You can take 125 mcg 5 days a week x 1 month, 3 days a week ( alternate days) next month and 2 days a week after that.
You can stop thyronorm after 3 months and check if her thyroid gland has recovered and functioning normally.
Hope the information was useful.
Regards
Dr Ajish TP
Either buy new tablet or reduce the days
Detailed Answer:
Hi,
You can either buy new tablets of 50 mcg and take 2 tablets a day for 1 month, 1 1/2 tablets next month and 1 tablet after that.
Or else you can decrease the number of days of medications in a week. You can take 125 mcg 5 days a week x 1 month, 3 days a week ( alternate days) next month and 2 days a week after that.
You can stop thyronorm after 3 months and check if her thyroid gland has recovered and functioning normally.
Hope the information was useful.
Regards
Dr Ajish TP
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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