I'm a pediatrician in Altoona PA with an interesting case.  Am looking for a
little feedback/info, so please reply if you have any.  Here's the case:
Female infant, born at 31 weeks gestation, birthweight 3lb 10oz.
 Hospitalized at level 3 nursery x 3 wk, only required respirator x 2-3 d,
home breastfeeding well.  Seen age 2 mo for first time by me, weight very
good at 7lb 11oz, normal exam, alert, active, mild jaundice.  Significant
info:  baby had abnormal thyroid tests x 2, but not so abnormal that was
classic for hypothyroidism. (Lab data listed below)  Parents live on dairy
farm.  Baby may have had some exposure to iodine in hospital; mom taking some
sort of herbal preparation which contains some iodine (but started after baby
home from hospital); the cows on the farm are washed regularly with
iodine-containing solution; mom routinely helps wash cows.  Iodine is known
to concentrate in breastmilk.
Lab data:  (baby birthdate 2/8/96)
         Initial thyroid screen:   T4 5.0    TSH  10.0      on 2/14/96
         Repeat screen:           T4 4.5    TSH  13.0      on 3//4/96
         My initial labs:            T4 8.0    TSH  10.7      on 4/11/96
                         T3 35  T7 2.8   ALT 34  AST 43  TBili 12.3  DBili
0.6
                         Hgb 9.8  Hct 28.5  Retic ct 1.9
         After talking with Pittsburgh Children's endocrine dept, had
following add'l labs done:                Free Thyroxine 1.1     TSH  11.7
  on 4/23/96
         Baby will be seen for consultation by Endocrine specialist.
Questions:  This is not typical for hypothyroidism, as they tend to have very
high TSH values.  Endo consult worried about pituitary problem, but also
mentioned that iodine exposure a possibility.  Could the mother have absorbed
iodine through her skin while washing cows enough to cause abnormalities in
TSH in baby?  Is continued iodine exposure the culprit for the TSH
abnormality?
If anyone has any ideas or info, let me know!       Linda Shaw MD