Q: My daughter is a pre-term baby with a gestation period of 32 weeks. I was at bed rest all through my pregnancy. From the sixth month of pregnancy, the water level in my uterus went down due to which I was put on IV fluids for the rest of my pregnancy. I had high BP due to which the doctors performed an emergency caesarean and the baby was delivered. I was 24 when my daughter was born. I was 60 kg before I conceived. By the time my daughter was born, I weighed 94 kg. My daughter’s birth weight was 1.81 kg. She was 6.63 kg by the end of six months. But from the 10th month she started having vomiting and vomited almost everyday. She weighs 9.3 kg and is 2.5 years old now. She has been diagnosed to have TSH of 7 and T3, T4 are under control. Her height is also less. Could you detail me regarding her condition? Is it a serious problem and can it be cured? Will she grow to a normal height and weight. Does the treatment have any side effects?

A:Elevated TSH with normal (under control) T4 and T3 indicates that your daughter has compensated or sub-clinical hypothyroidism. It is essential to find out the cause for this by additional tests, which include ultrasound for thyroid, nuclear scan/uptake for thyroid and if possible thyroglobulin estimation. Once treatment with thyroxine is started, it will be difficult to know the exact cause for the hypothyroidism. Treatment will be justified if the tests are not available in your place of residence. In any case repeat hormone estimations are necessary to determine the course of the disease and the length of treatment. Optimal replacement with thyroxine does not produce any side-effects. Only investigations will tell you whether it is genetic in origin. It has most probably no relation your blood groups or prematurity. Hypothyroidism however is not the cause for the repeated vomiting. It probably is due to some immaturity or abnormality of the lower part of the oesophagus and stomach. Your daughter is underweight for her age and it is probably due to prematurity and low birth-weight and hypothyroidism. Correction of hypothyroidism and the cause of persistent vomiting is necessary for normal growth. And you certainly need evaluation for the rapid gain in weight!