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