I’m asking this question for a friend whose daughter was just diagnosed with Hashimoto’s – she doesn’t have diabetes, just the thyroid disorder. She is struggling & feeling sick & tired, but the doctor wants to wait 4 weeks between blood draws to come up with a treatment plan. So her mom called the doctor to ask for some kind of treatment in the interim & the doctor wants to start prednisone for thyroid inflammation. Has anyone ever taken this for Hashimoto’s? What was your experience?
I went through the same battle with my daughter. She was diagnosed with T1 & then felt sick & tired & it was a fight to get the hypothyroid diagnosis & get medicine started so she could feel better! What’s the deal?
I’ve never taken steroids for Hashimoto’s or known anyone who has. His theory is to stop the autoimmune response, of course, but that’s not any kind of a solution & prednisone is a risky drug, especially for children.
Absurd to wait. I was immediately put on thyroid supplementation. My fights have been to get the correct thyroid tests done because TSH is useless. Honestly, most doctors don’t care how awful we feel. They drag out treatment perhaps to get paid for more office visits.
I developed a goiter in my late 20’s, and was never treated until I reached my 40’s and they finally started testing TSH and then antibodies, when it was finally revealed that I had Hashimoto’s. I was immediately put on thyroid hormone. I have never heard of anyone being treated with prednisone, probably because it suppresses the WHOLE immune system, not just the cells which are attacking the thyroid. And it has other side effects as well.
If I was the mom, I would go for a second opinion before subjecting a child to a steroid. There ARE bad doctors in this world.
I’m dealing with Hashimoto’s disease and the inadequate transfer of T4 to T3 as evidenced by my labs for Free T4 and Free T3 while taking a synthetic T4 only medication. Relying on TSH tests are not very helpful when you are dealing with Hashimoto’s. I just began taking hydrocortisone and recently weaned myself off as I have learned there are other less drastic treatments out there for adrenal fatigue that should be attempted first. Each person is different, but living in your own body tells you whether or not you are out of gas so to speak. My endocrinologist is against letting me use desiccated thyroid (Armour) and didn’t even suggest adding a synthetic T3 only medication to add to my synthetic T4. I saw my PCP this week and he supported me in my attempts to find another physician to treat my thyroid disease and adrenal fatigue. He has prescribed desiccated thyroid and feels comfortable doing so, but admitted that my case is more complicated for him to handle alone. He actually Listened to me- which was a relief. I want to begin taking desiccated thyroid (Armour) where you will receive all of the thyroid hormones ( T4, T3, T2, T1 an Calcitonin. I hope the Preventative medical doctor I will see on Sept. 20th will get me on the right path to regaining my energy and stamina. Our physicians are there to support us and our medical treatment, but we have to use our own brains to decide what seems reasonable or not.
My advice is to get another opinion to begin thyroid treatment and wait on the use of a steroid. That’s a big step and while in some patients it might be needed for adrenal insufficiency…I believe there are other steps to be taken to address the thyroid symptoms first. Good luck to your friend’s daughter! Keep us posted.
I do agree with you Gerri for the most part. In my case I feel my endocrinologist is used to treating Addison’s and Cushing’s disease. I found her less informed about adrenal fatigue and more informed about adrenal insufficiency. That is why I believe she wanted to have me try hydrocortisone to see if that helped. While I may end up taking it, I’d rather try something else first to see if my adrenals can recover. Also, it’s far easier to dose with synthetics (T4) as they measure up well on lab tests. We all know, however, that our labs can look "normal, "while in reality we can feel anything but normal!
Understand your endo’s thinking wanting to try a steroid for your adrenal issue & I’m with you on wanting to try other options first. Instead of the first go-to drug of choice, steroids should be the last when others fail. The question here is a kid being treated with prednisone for Hashimoto’s.
yes, definitely the wrong treatment for Hashimoto’s. Like Natalie said…get a second opinion.
Thanks for the thoughts. The strange thing is, this same doctor treats my daughter & he started her on Synthroid when I pressed for some kind of treatment to help her get her energy back. My daughter’s thyroid must have been testing much lower (?)
Which variety of Hashimoto's - this one, which is often treated with prednisone?
Or this one, which usually isn't?
One idea is to ask her doctor to arrange FT4 and FT3 tests to get a better picture of just what her problem is.
If the FT4 level is low a common treatment is levothyroxine and ignoring whatever this does to the TSH level.
If the FT4 level is normal but the FT3 level is low, her doctor should consider all three of the known medicines for that situation:
If her doctor cannot handle all this, it's probably time to ask for a referral to an endocrinologist, a type of specialist more likely to be able to deal with the more difficult thyroid problems.
Since the FT3 test measured the most active form of thyroid hormone (T3), getting that level right is especially important. However, many endocrinologists seem to think that getting a normal FT4 level is sufficient, and a low FT3 level can be ignored. This may mean time to look for a different endocrinologist.
Also , anyone with an autoimmune condition may want to watch this web site to see when they reach clinical trials for that type of condition:
Note that the T1 and T2 thyroid hormones do not have known effects, so it's unclear if they're important.
Robert – I read that about.com link yesterday when I was researching this. The doctor hasn’t mentioned that disorder. Thanks for the ideas. The trials could be something to check out. I have my daughter in a clinical trial for T1 & it’s been a good experience, because we see the doctor so often & I think she may have benefitted from the trial drug also.
First off, prednisone when used in the short term isn’t dangerous. Prednisone can be used an an immunosuppressant, but I don’t think that’s the idea in this case. Prednisone is a corticosteroid and a very important tool used every day in clinics across the world to decrease inflammation as a result of illness. I’m betting 90% of us at some point have taken pred when you have a bronchitis or a URI to decrease the inflammation associated with the infection. You usually take it for 5-14 days with a step-down dosage at the end to prevent the adverse effects of suddenly coming off of corticosteroids. He may being trying to see if this is specifically a developing chronic thyroid problem or if it’s more of an acute thyroiditis (inflammation of the thyroid). Rechecking the TH (T3 and free-T4) and TSH levels in a month is a good plan. If they are very low, or if they are continuing to go down then she needs TH-replacement therapy. If they are within the normal range and stable over the long term (see below) then that’s more then likely her natural set point for TH levels. Thyroid antibody checks are essential, but with pred therapy it may result in a false negative. I would have them checked at month 6 if no adverse features are seen at the 4 week interval.
I completely agree with him on the 4 weeks thing. The majority of the time it’s come back in 3-6 months. This is because thyroid hormone levels can fluctuate widely within an individual and especially between individuals. See below figure. One man may have a relatively low natural TH level, whereas the general range for the population is much higher. With only a single time point it’s impossible to figure out what her normal levels are. My sister is going through this and she’s on 6 month rechecks because she is antibody positive, but her TH levels are completely stable.
Miller et al. EHP 2009 (http://www.ncbi.nlm.nih.gov/pubmed/19654909).
The other thing is that there are literally thousands of ways to change TH levels (Figure below this paragraph). Mainly through exposure to environmental chemicals (http://www.ncbi.nlm.nih.gov/pubmed/20363719) and even an unintential bolus of iodide can significantly alter thyroid physiology. Giving high doses of Iodide shuts off secretion off thyroid hormone for 2-3 days (think IV contrast for CT scans). Thyroid physiology is exquisitely complex and while seemily a very simply pathway, it can be altered by very minute amount of things including stress, drugs, lifestyle changes and just about anything else (http://www.ncbi.nlm.nih.gov/pubmed/19654909). Lethary, fatigue and feeling sick are not specific to the thyroid and may be a result of a number of other things which will resolve on their own or without chronic therapy.
Miller et al. EHP 2009.
Hopefully this helped. I know quite a bit about the thyroid. My comprehensive exams were a 50 page grant proposal on a thryoid disruptor and an hour long defense of my paper. So don’t assume this is all wikipedia, the majority of this information can be found by going to pubmed and searching for the name Zoeller. He is an expert in thyroid physiology and has a lot of free access journal aricles published (http://www.ncbi.nlm.nih.gov/pubmed?term=Zoeller%20thyroid). If you’re interested this is pretty much the best overall review paper of the HPT axis I have ever found (http://www.ncbi.nlm.nih.gov/pubmed/17364704).
PS I didn’t proof read this, so sorry about any errors.
PSS Hopefully she gets everything figured out. Feeling sick sucks. Not knowing why sucks even more.
Sorry, in one of the last paragraphs it should say dozens of ways to inhibit thyroid function. The thousands was a sentence about endocrine disruptors that was started but never finished.
Thanks, SuFu! So far, she is feeling better after a few days of 5mg prednisone 2x a day. Even if it is an interim step toward figuring out the thyroid levels, at least it’s giving some relief. I remember how difficult it was for Sam to feel so lethargic & we had no reason why. It’s true, that can be the hardest part. Waiting 4+ weeks is hard, and I understand they want to gauge the levels, but it’s really impossible to stand by & wait while your kid is crying on the couch because she doesn’t have the energy to go to school and play her sports.
Steroid treatment for acute thyroiditis is not uncommon. But it would be if your friend 's daughter was also a diabetic. I have had severe bouts of acute thyroiditis (loss of voice, difficulty swallowing, painful neck, etc) but steroids are not an option because it would elevate my bg. Like some people get colds, I get bouts of acute thyroiditis. I just have to ride it out. Acute thyroiditis attacks can occur even while on Synthroid (which I take daily).
Acute thyroiditis is not the same as Hashimoto’s. I looked it up – it’s called acute granulomatous thyroiditis, and as you say, it’s painful. There is a write-up on it here:
If the child in question has Hashimoto’s, I’m still not sure prednisone is indicated, and it wouldn’t hurt for the mom to get a second opinion.
I agree – i assumed she had an acute attack. I have Hashimotos and, as a result, am prone to acute thyroiditis. I guess I assumed that what was going on with the child. Not everyone with Hashimotos gets acute thyroiditis. But some, like me, endure it often.
Could be, Donna. Maybe that is why she’s getting some relief. I know she has the Hashimoto’s diagnosis, but not sure on anything else yet – I did see her play field hockey tonight, so she’s definitely feeling better. Last time I saw her, she was sitting on the sidelines crying.
So glad to hear she is feeling better!