My recently adopted daughter from China had an elevated TSH (thyroid stimulating hormone) on her initial labs, and her pediatrician has recommended treatment with thyroid hormone. Is this common from China? What should we do? What is her prognosis?

China does not test thyroid function at birth, and would not necessarily have detected hypothyroidism in the context of institutional growth issues. But I often see mildly elevated TSH levels in new adoptees. Roughly 10% of Chinese adoptees in one study (Health of Children Adopted from China, Pediatrics, 2000) had elevated TSH.

Be careful - many labs do not report correct normal ranges for TSH in infants and toddlers. Make sure that your doctor not only repeated the TSH but also found low free T4, which is the active thyroid hormone. A mildy elevated TSH (<10) alone would not necessarily lead me to jump to thyroid replacement; truly significant hypothyroidism usually has quite high TSH levels (>40 or so). It might be a good idea to also consult with a local pediatric endocrinologist before embarking on thyoid replacement therapy.

Prognosis? I'm not convinced you have a diagnosis, without seeing more abnormal labs ... mildly elevated TSH is often transient, and may be related to malnutrition, iodine deficiency, or brisk catchup growth. So I'm not pessimistic based upon what you've said.