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HomeAnswersEndocrinologyhypothyroidismWhat causes high TSH in a child with diabetes & Hashimoto's?

Can hypothyroidism be the reason for high TSH and normal T3 and T4 levels?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Shaikh Sadaf

Medically reviewed by

iCliniq medical review team

Published At July 7, 2022
Reviewed AtOctober 8, 2023

Patient's Query

Hello doctor,

My 8-year-old son was diagnosed with type 1 diabetes at the age of three years. He also has Hashimoto's thyroiditis. His blood results show TSH is 49 mIU/mL and T4 is 1.1 micrograms per deciliter. He is currently using Humalog insulin and tablet Levothyroxine. What is the reason for his high TSH levels? Also, what are the normal levels of thyroxine?

Kindly suggest.

Answered by Dr. Shaikh Sadaf

Hello,

Welcome to icliniq.com.

I understand your concern and would be happy to help. I have reviewed the attached reports (attachment removed to protect the patient's identity). The following are some of the causes of high TSH (thyroid-stimulating hormone):

1. It could be a part of his thyroid disease progression.

2. It could be due to poor absorption of the medicine from the gut. There should be a gap of at least one hour after the morning dose before taking the breakfast. Milk products in breakfast can prevent absorption of thyroid medication.

3. There can be an autoimmune condition called celiac disease associated with type 1 diabetes and Hashimoto's thyroiditis, preventing the absorption of thyroid medication. So you have to get assessed for it by a pediatrician.

4. This test should be done while the child is on an empty stomach; it is better to get it repeated after overnight fasting of eight hours

5. It could be a laboratory error as T4 (thyroxine) is normal and not low.

I would like to know the current dose and the child's weight to assess if the dose is appropriate.

I hope this helps.

Thank you.

Patient's Query

Hello doctor,

Thank you for the response.

Can he have absorption problems despite having a normal T4 level?

Answered by Dr. Shaikh Sadaf

Hello,

Welcome back to icliniq.com.

I appreciate your concern for your child. Understanding the thyroid test results is a bit complex. When the thyroid gland becomes inefficient during the progression of hypothyroidism, the TSH becomes elevated even though T3 (triiodothyronine) and T4 (thyroxine) are within the normal range. This rise in TSH represents the pituitary gland's response to a drop in circulating thyroid hormone; it is usually the first indication of thyroid gland failure or inadequate thyroid medication replacement.

I hope this helps.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shaikh Sadaf
Dr. Shaikh Sadaf

Endocrinology

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