Q: T3/T4 Appropriate for a Child...?
Dear Dr. Phelps,
My 10-year-old son has been diagnosed with bipolar disorder. We have had
some limited success with bipolar medications but with many side effects.
I am intrigued by your t3/t4 treatment results. My son has subclinical
hypothyroidism and is currently being treated with 25 mcg synthroid. He
has been on the synthroid about a month and I see some improvement in energy
levels and sleep patterns but he has had other medication changes during this
time so itís difficult to sort out cause and effect.
My sonís psychiatrist didnít feel qualified to treat a child with thyroid
medications and it wasnít easy finding and convincing a pediatric
endocrinologist that thyroid treatment would potentially improve my sonís
cycling. Iím sure Iíll never find anyone to prescribe t3 but Iíd like to know if
you think t3/t4 treatment is appropriate for a child and if itís worth pursuing.
What do endos worry about when treating a child? Do you think the
following is significant?
1. My son had an elevated TSH level before he took any meds so the problem
is not med related. His first test showed TSH = 6.9. He then started
taking depakote and needed monthly blood tests so the pediatrician added TSH to
the tests for the months he was on depakote. Subsequent levels were: 8.6,
7.9, 3.9, 6.2. These levels
increased after lithium was added and went as high as 10.2.
2. We have significant family history of thyroid problems and autoimmune
disease. My son's father, paternal uncle and two paternal aunts have
hypothyroidism (out of 7 children.) His maternal grandfather and
great-grandfather have/had hypothyroidism. His maternal aunt had
hyperthyroidism as a teenager and his maternal uncle showed thyroid nodules on
autopsy. He has a male cousin on his father's side with autoimmune
hepatitis. There are other more distant relatives with thyroid disorder.
There are many family members on both sides with eczema.
3. The people on my side of the family who have or have had thyroid
disease are the ones most often described as "interesting", "eccentric", and
"difficult." No relatives have been diagnosed with bipolar disorder
although there is lots of anxiety and depression.
Dear Ms. M' --
I have just finished writing a letter to a Ms. J' on the subject of thyroid
treatment approaches. I am going to refer you to that
letter as I think
all of it applies, unfortunately probably most of all the warnings about
"I don't know much about this!"
on the basis of what I've learned so far and what I see in the literature
(e.g. try a search on
Med and enter just thyroid bipolar and look at all the articles you
find that target the emergingly obvious connection; just look at stuff since
2000, because before that the notion was less strongly recognized), I'm pretty
sure you're onto something very important. For example, at minimum we
know so far that people with bipolar depression symptoms are more likely to
get better in response to their treatment, whatever it is, if their TSH is
closer to 1 than it is to 4 -- even though both values are in the "normal
et al: Slower treatment response in bipolar depression
predicted by lower pretreatment thyroid function).
with your inquiry. Good luck to you.
Published September, 2002