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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18458
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My 15 yr old daughter was diagnosed with hashimotos disease

Resolved Question:

My 15 yr old daughter was diagnosed with hashimotos disease following a sezuire like collapse in oct 2103. Assessed by neurology initially , EEG showed some minor changes but not definitive of any particular type of epilepsy. She was very symptomatic of thyroid under activity and after bloods TSH was 8.9 and anti TPO antibodies 124. She is on eltroxin 50 mgs. However she continues to feel very unwell. Her haemoglobin is 9 and ferritin 11. She has constant daily headaches with weekly migrane attacks. She is on iron supplements and my GP started her on amitryptilline 10 mgs od since yesterday. She is extremely fatigued and barely functions in school. In fact she is out of school at the moment and is sleeping for long periods. She also has a hiatus hernia as a side issue since she was 9 years old.
Could there be another issue causing her general malaise and should she be seen by an endocrinologist ? She is really struggling and I would have expected her to be feeling better at this stage. Her TSH levels returned to normal on 50 mgs of Eltroxin.
Submitted: 3 years ago.
Category: Medical
Expert:  Shantal-Mod replied 3 years ago.

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Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some further information:
What other evaluation (blood tests, etc.) have been done?
Do you have the exact value of the TSH?
How long has she been on the iron supplements?

Customer: replied 3 years ago.
My daughters TSH level prior to treatment with Eltroxin 50 was 8.9. Her TPO antibodies were 124. Her TSH is now 2.2. Her haemoglobin is 9 and her ferritin level is 11. She is on iron supplements for 3 weeks . Herr iron has not been rechecked yet. Her ANA level was 1:40.
Her vit B 12 and LFTs and Renal profile are normal.
Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

There are several issues to consider in this situation.

First, it would be appropriate to assure that there is optimal treatment for the thyroid disease. It is true that the primary goal with thyroid hormone replacement is to achieve a TSH that is in the normal range. However, there is some evidence to suggest that some people will do better when the TSH is decreased to low in the normal range (around 0.5-1.0). If someone is still having typical symptoms after achieving a TSH in the normal range, it is appropriate to consider whether additional treatment to achieve a TSH lower in the range would be appropriate. It would be appropriate to see an Endocrinologist to perform an assessment and decide whether to increase the dose of thyroid replacement.

It is also true that profound anaemia can cause the fatigue that you describe, but iron deficiency causing a haemoglobin of 9 will usually not be the sole cause of such symptoms. Conditions that cause a rapid decline in the haemoglobin can cause more profound symptoms at a haemoglobin of 9, but iron deficiency and other conditions that typically cause a gradual reduction in haemoglobin will typically not cause such profound symptoms at this level. It certainly can be contributing to the symptoms, but would typically not be the sole cause of the symptoms. It may take a longer period of time to fully replace the iron, but it would be difficult to say that this is the primary cause of her symptoms.

Therefore, it would be appropriate to first reassess the thyroid disease by an Endocrinologist. If there is persistent general malaise despite appropriate thyroid hormone replacement, and since the iron deficiency anaemia cannot be the sole explanation of symptoms, that would be an indication that there is another cause of her symptoms and it would be appropriate to pursue further evaluation.

If you need any clarification, please let me know.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18458
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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