Hello, I’d appreciate your input on this patient’s scenario:
- H41+ female, Hypothyroid since birth [uncertain of any presence of gland]
- Medicated from 18mths
- Oroxine medication monitored every few months. blood pathology indicating appropriate dose.
- Dose for many years: 400mg daily.
- No notable deformities, other than stunted thumbs.
- Patient treated for depression over past 12 months with cipramil 20-40mg. unsuccessful.
- Recent agitation, anxiety, and depression led to hospitalisation;
- Recently additional: feeling hot all the time; shakes internal and to some degree externally; worsening of agitation, anxiety and depression..
- Blood tests reveal:
- free T4 @ 33.6H [normal upper limit of 19];
- free T3 @ 7.5H [normal upper limit of 6.2];
- TSH @ <0.01 [normal lower limit of 0.3]
- Dose dropped to 300mg 3 days ago
The concerns are
- Could these extraordinary thyroid levels be contributing to the patient’s crises;
- Is there any permanent damage possible; and
- Does the pathology suggest another condition or complication?
Thanking you in advance. Have a happy day,
Dr. Sifu Crockett, HAPPI Foundation Ltd
I do not connect stunted thumbs and congenital hypothyroidism, but maybe another reader can help. Regarding the blood hormone levels, certainly it seems that the patient has been under excessive thyroid hormone dosage, and needs to be reduced gradually to a level that keeps the TSH preferrably around 1-1.5, and the freeT4 in the high normal range. It probably will take many months for the pituitary to return to normal as you lower the dose. Regarding the future, I guess you wait and see. If the patient was untreated for 18 months after birth, that suggests a major developmental problem unless there was in fact significant endogenous thyroid hormone production at that time.
L De Groot, MD