expert type icon EXPERT

Dr. Stuart J. Brink

Endocronologist (Pediatric)

Dr. Stuart Brink is a pediatric endocrinologist and diabetologist practicing in Waltham, Massachusetts. He was the Joslin Clinic's first staff pediatrician and then opened up a private endocrine and diabetes practice, first in Chestnut Hill MA and subsequently in Waltham MA called NEDEC: New England Diabetes and Endocrinology Center. Dr. Brink specializes in growth, puberty, diabetes, pituitary, hypothalamic, thyroid, adrenal, testicular and ovarian problems as well as vitamin D deficiency, osteopenia and osteoporosis. He takes care of kids, adolescents, young adults and adults with these hormone problems with a special interest in diabetes, insulin pumps, continuous glucose monitoring, empowerment and motivational interviewing as well as associated endocrine issues with Down Syndrome, Klinefelter, Kallman, Turner, Noonan, Prader Willi Syndrome. He helped create and participated as a co-investigator in the DCCT. He also has participated in numerous growth hormone registries and evaluated idiopathic short stature as well as growth problems associated with small for gestational age babies/children. well. Pediatric endocrinologists possess copious knowledge on hormone chemicals and how they can affect other parts of the body and their functions. He lectures and writes nationally and internationally about these hormone conditions and has done so in more than 75 countries to date.
Dr. Stuart J. Brink
  • Waltham, MA
  • University of Southern California
  • Accepting new patients

Can you live long with hyperthyroidism?

Simple answer is "Yes." But if you don't want symptoms of hyperthyroidism to disrupt your life (or your child's life), then you have to take thyroid blocking pills (anti-thyroid READ MORE
Simple answer is "Yes." But if you don't want symptoms of hyperthyroidism to disrupt your life (or your child's life), then you have to take thyroid blocking pills (anti-thyroid education) or get treated with thyroid surgery (and then need once-a-day thyroid pills so that you don't become hypothyroid) or radioactive iodine treatment instead of surgery (although both surgery and RAI treatments usually end up hypothyroid so you need a

Can pediatric hyperthyroidism be cured?

No, unfortunately hyperthyroidism cannot be cured at present. But it can be well treated most, but not all of the time, with thyroid blocking hormone production medication. It READ MORE
No, unfortunately hyperthyroidism cannot be cured at present. But it can be well treated most, but not all of the time, with thyroid blocking hormone production medication. It can also be treated by thyroid surgery or by radioiodine treatment as well but these are usually used if the blocking hormone treatment doesn't work or if there are allergies or other side effect from that treatment. Usually, after surgery or RAI treatment, hypothyroidism occurs (underactive thyroid hormone) so thereafter an easy once-a-day thyroid hormone pill is needed for life. Important to consult with a thyroid hormone expert (thyroidologist/endocrinologist) if not already doing so.

Is type 1 diabetes serious?

Very serious because it requires so much work from your daughter but also your entire family, your daughter's teachers and school nurse, any after-school activity supervisors plus READ MORE
Very serious because it requires so much work from your daughter but also your entire family, your daughter's teachers and school nurse, any after-school activity supervisors plus a dedicated multispecialty team of diabetes doctor, nurse educators for the PWD (person with diabetes) and their family, certified diabetes dietitian and perhaps social worker or psychologist because all the work to learn about controlling diabetes is difficult. A dedicated multidisciplinary team of health care workers who know about diabetes and these education and support needs can help teach and introduce how best to monitor her sugar levels (finger sticks, meters (SBGM), continuous glucose monitors (CGM) , how much and how to administer her insulin (syringes, pens, pumps) and whether or not she can treat her diabetes with multidose insulin (MDI) or use pumps (continuous glucose subcutaneous insulin infusion (CSII/insulin pumps) and now connect CGMS with CSII and have them talk and self-adjust automatically. There have been amazing advances in diaes care of the past few decades in addition to new, faster and better insulin medication available to ease the tasks and improve glucose control. So make sure you support and assist with her learning needs, make sure you are working with a full multidisciplinary diabetes team of doctor, nurse, dietician and mental health worker to suggest the best ways to learn what everyone needs to learn to optimize care. This helps minimize complications of diabetes, low sugar (hypoglycemic) reactions, DKA and also the long-term complicatoins of high sugar levels and the damage that can affect the eyes, kidneys, nervous system, kidneys and heart/circulation if glucose control isn't optimized. The team can recommend support from local JDRF and ADA programs, camping and family camping support programs, CWD (children with diabetes support website), education brochures and books too. All very important, somewhat complicated especially with newly diagnosed PWD but all very important to optimize health, education and minimize and/or avoid complications with the newest and best choices available. Best of luck. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

What does a high TSH in children mean?

TSH, thyroid stimulating hormone, comes from the pituitary gland near the bottom of the brain. It's like the thermostat control for the thyroid gland production of thyroid hormones READ MORE
TSH, thyroid stimulating hormone, comes from the pituitary gland near the bottom of the brain. It's like the thermostat control for the thyroid gland production of thyroid hormones so if the thyroid gland is underactive for any reason, TSH goes up to try to stimulate more production, if possible. So low T4 and high TSH indicates hypothyroid conditions like Hashimoto's thyroiditis and usually indicates the need for starting or a higher dose of thyroid hormone prescribed.

My son has thyroid nodules. What happens if they are malignant?

Sorry to hear about that but good that they were detected. If the biopsy shows malignancy, then depends a bit on how small or large they are and how many there are as well as their READ MORE
Sorry to hear about that but good that they were detected. If the biopsy shows malignancy, then depends a bit on how small or large they are and how many there are as well as their exact location. Usually surgical removal and then consideration for radioiodine treatment. If enough thyroid tissue is removed because of location and/or size, then likely there will need to be a once-a-day thyroxine pill provided to ensure adequate thyroid function for his health, growth and well-being. If radiation treatment is needed, usually this also destroys the nearby normal thyroid tissue and so one ends p being hypothyroid too and needing the same thyroxine daily pill. Important that you are working with an experienced pediatric thyroid specialist/endocrinologist who can confer with surgeon and any thyroid cancer specialists to make such decisions. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

Type One Diabetes?

Sounds like diabetes symptoms except for the blood glucose levels which weren't so high. I think you should call your doctor and get a pull history and physical exam as well as READ MORE
Sounds like diabetes symptoms except for the blood glucose levels which weren't so high. I think you should call your doctor and get a pull history and physical exam as well as some lab tests. Urinalysis for specific gravity as well as sugar and ketones as well as chemistry profile that includes salt levels and acid-base data. There is another type of diabetes called diabetes insipidus where the pituitary and hypothalamic part of the brain don't make a hormone called vasopressin and that hormone also controls urinary output and could be an explanation if too little vasopressin is present. Other conditions of the pituitary gland also can affect thirst and urination and so also should be considered based

Can diabetes type 2 be reversed?

Type 2 diabetes has an inherited/genetic component but also is related to insulin resistance associated with being overweight. In essence, with the extra body weight usually associated READ MORE
Type 2 diabetes has an inherited/genetic component but also is related to insulin resistance associated with being overweight. In essence, with the extra body weight usually associated with extra calories from food as well as less than optimal activity/exercise, the pancreas cannot keep up with demands to control blood sugar (glucose) levels and then diabetes develops. Older age is another factor although with extra weight more and more common in children and adolescents, especially in the United States, type 2 diabetes is showing up in youngsters too. Certain ethnic groups, for instance, endogenous people such as Native Americans, Eskimos, Australian aboriginals as well as those with African ancestry or coming from Latin American regions are also more at risk than European/Caucasians of the same age. There are numerous medications that are useful for type 2 diabetes but dealing directly with food excess and also increasing daily activity, both to help promote lowered weight are very helpful and can decrease the doses of medication needed and sometimes eliminate the need for medications completely. Recent work on low carbohydrate diets where needed calories are provided by fat and protein (also called low carb or keto diets) also seem to be helpful although longer reserach studies are still desirable. In summary, type 2 diabetes and even prediabetes or the metabolic syndrome, earlier stages of type 2 diabetes, can be treated and remarkably improved upon as well as reversed with decreases in weight, increases in activity and lowered dietary carbohydrate intake. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

Can nuclear medicine help in treating endocrine disorder?

Puzzling question about why a parent's hormone levels would change constantly related to a diagnosis in the parent's daughter. This doesn't make sense unless you mean your daughter's READ MORE
Puzzling question about why a parent's hormone levels would change constantly related to a diagnosis in the parent's daughter. This doesn't make sense unless you mean your daughter's levels are constantly changing. Thyroid disease can be with normal blood hormone levels but cause an enlargement of the thyroid gland called a goiter. Another possibility is a thyroid cyst or a thyroid cancer. Thyroid cancer is often treated with surgery to remove the cancer itself. Many times nuclear medicine is also used to treat thyroid cancer and kill the cancer cells. Another form of thyroid disease happens from inflammation called Hashimoto's thyroiditis. This can cause a goiter (thyroid enlargement) or can produce hyperthyroidism with excess thyroid hormones and their symptoms (bulging eyes, rapid heart rate, hypertension, nervousness/anxiety, loose bowel movements, sweating excessively, unexpected weight loss) and this hyperthyroid condition is called Grave's disease. Hyperthyroidism can be treated with thyroid blocking medications and sometimes also with nuclear medicine or surgery. IF Hashimoto's disease causes low instead of elevated thyroid hormone problems, this is called hypothyroidism and produces unexpected weight gain, fatigue, delayed puberty or absent periods, slow reflexes, slow pulse, low blood pressure, constipation. Hypothyroidism is usually easily treated with once-a-day thyroid hormone pills to replace what the body no longer makes. Many thyroid problems show up in several family members because there is an inherited component of the disorder that is passed along so family history can be important for awareness and early diagnosis. There also is a congenital form of hypothyroidism where the gland itself (or the hypothalamus or pituitary control sites for the thyroid gland) is abnormal or not present. This is often difficult to diagnose but in the United States and many other parts of the world, newborn screening tests with just a simple heel stick blood sample automatically check for normal thyroid levels (and other abnormalities) so early diagnosis and treatment occurs. To come back to the original question, if the daughter with thyroid diagnosis has frequently changing levels of thyroid blood hormones, this may indicate problems remembering to take medication correctly. Would be recommended to make sure that a board certified endocrinologist experienced with thyroid disorders is consulted or a second opinion obtained to review the situation. American Thyroid Association website as well as Pediatric Endocrine Society website has some useful information as well. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

Why does my son feel so hungry after taking his diabetes medication?

Difficult to know without knowing actual blood glucose levels. So, important to check just before eating and then after eating when he feels hungriest. Could be a sign of hypoglycemia READ MORE
Difficult to know without knowing actual blood glucose levels. So, important to check just before eating and then after eating when he feels hungriest. Could be a sign of hypoglycemia from too much insulin for his food intake? Would be important to document these BG readings several times and then discuss with diabetes health care team for adjustment. Sometimes could also be from too little insulin and hyperglycemia too especially if chronically underinsulinized/high A1c levels etc. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

Can hypothyroidism be fixed?

Hypothyroidism is very easy to treat since it involves taking a single, small pill containing thyroid hormone when the body no longer makes sufficient thyroid hormone itself. Most READ MORE
Hypothyroidism is very easy to treat since it involves taking a single, small pill containing thyroid hormone when the body no longer makes sufficient thyroid hormone itself. Most of the time this is caused by an inflammation problem called Hashimoto's thyroiditis but sometimes babies are born without a thyroid gland present or functioning, sometimes there is some surgical procedure that removes the thyroid gland and sometimes there are cysts or other thyroid problems causing hypothyroidism. All are treated with thyroid pills. For babies, these are usually crushed up in apple sauce or something else so the baby doesn't have to work to swallow the pills. Thyroid hormone treatment usually needs to be adjusted with growth and development; followup blood lab testing is needed to learn when and how much change of dosage is needed and this too is fairly simple to follow and adjust. Thyroid treatment is a life-long need so having a board certified pediatric thyroid specialist and eventually an adult thyroid specialist follow these problems is the best system to optimize care and followup.. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

Is it necessary to bring my child to an endocrinologist?

More important to talk to your pediatrician or GP who knows your child and your family. Looking at height and weight information and making sure they are being plotted on standard READ MORE
More important to talk to your pediatrician or GP who knows your child and your family. Looking at height and weight information and making sure they are being plotted on standard charts and there is no deviation present. Good and detailed list of usual questions about general health also important. There are also staging of puberty, brast and pugic hair patterns, menstrual history in addition to growth that suggests either normal or problems related to timing of puberty. Some questions about family patterns of early, on-time or late puberty and family heights are also important to assess. If all these are unremarkable, then no reason to question puberty means no need for an endocrinologist. If there is some question of deviation by history or exam or family history/risks, then some endocrine evaluation may be needed. If your pediatrician or GP is comfortable, they may be able to do some lab and bone age xray screening about growth and pubertal development. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

What foods to avoid with hypothyroidism?

No specific foods to avoid vis-a-vis hypothyroidism. Multiple causes for hypothyroidism: congenital hypothyroidism with various subtypes; acquired hypothyroidism usually from Hashioto's READ MORE
No specific foods to avoid vis-a-vis hypothyroidism. Multiple causes for hypothyroidism: congenital hypothyroidism with various subtypes; acquired hypothyroidism usually from Hashioto's thyroiditis, an autoimmune attack (often but not always with positive family history suggesting some genetic risk), thyroid nodules or cancer or cysts that required surgery or other treatment which removes the thyroid tissue and results in hypothyroidism. Treatment of hypothyroidism is fairly striaght-forward with thyroid pills

Can hyperthyroidism be fixed?

Hyperthyroidism can be treated but not absolutely cured. Depends a bit also on the reason for the hyperthyroidism in the first place. Most commonly from an autoimmune "attack" READ MORE
Hyperthyroidism can be treated but not absolutely cured. Depends a bit also on the reason for the hyperthyroidism in the first place. Most commonly from an autoimmune "attack" called Grave's Disease and the treatment is then usually a thyroid blocking pill. Sometimes there is a nodule or cyst causing the problem and then surgery may be required which would "cure" the hyperthyroidism itself. If too much of the gland is removed or if the cysts or nodules are especially large, then removal of the hyperthyroid source would result in hypothyroidism which needs to be treated with thyroid pills forever. Hyperthyroidism should usually be evaluated by a thyroid specialist such as an endocrinologist, pediatric endocrinologist for kids and adolescents and adult endocrinologist for adults who would order specific thyroid blood tests and consider thyroid scans, ultrasounds or other imaging for making a proper diagnosis. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

What could be the reason of urinary incontinence in my daughter?

You need to bring her to your doctor, have her history and exam taken including how long the incontinence has been going on and seek an answer. If there is excess thirst and urination READ MORE
You need to bring her to your doctor, have her history and exam taken including how long the incontinence has been going on and seek an answer. If there is excess thirst and urination not just incontinence, urinalysis and checking for diabetes would be important. Evaluation of vaginal and urinary/bladder problem also should be considered. Not likely puberty related but detailed history and exam as well as appropriate lab testing should help figure this out. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

My daughter's on estarylla. Can this affect her mood?

The answer is yes since each person can have individual response and/or side effects. You should have your daughter speak to her prescribing physician and review these symptoms READ MORE
The answer is yes since each person can have individual response and/or side effects. You should have your daughter speak to her prescribing physician and review these symptoms as well as ask if there are other alternatives (usually possible) that may be considered with different hormone doses that would work better for her. Best of luck. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

How can diabetes type 1 be controlled?

Type 1 diabetes is an autoimmune track on the pancreas, specifically the beta cells where insulin is produced. This stops automatically controlling the sugar levels when the beta READ MORE
Type 1 diabetes is an autoimmune track on the pancreas, specifically the beta cells where insulin is produced. This stops automatically controlling the sugar levels when the beta cells can no longer make sufficient insulin and this causes the diabetes symptoms to show up. At the moment, controlling the sugar levels is difficult and involves getting insulin by injection, pens or mini-pumps multiple times each day based on what's eaten, activity, stress, infections and other hormonal factors. It's gotten more and moe semi-automatic with pumps and glucose sensors that communicate with the pumps. This makes type 1 diabetes somewhat different than type 2 diabetes because weight excess and older age are not key issues with type 1 but as younger kids are gaining excess eight around the world, we are also seeing type 2 diabetes increase dramatically in youngsters too. The most important factor is having excellent educational support from a multidisciplinary diabetes team with a diabetes specialist, nurse educator, dietician and sometimes social worker or psychologist as well and to make sure that there is developmentally appropriate education for the person with diabetes (PWD) as well as the parents and others in the family. As the PWD gets older and takes on more self-care responsibility, the education and support needs to continue so that weekend programs with peers an family as well as summer camp programs are extremely helpful. Website support programs like CWD (childenwithdiabetes) also are great for moms meeting other moms, dads meeting other dads, and for kids meeting other kids their own age to support each other. Deciding how best to administer insulin, what typeof meal plan works (and why), what to do with school staff, after-school staff, family members and peers all are very important aspects of diabetes care in type 1 diabetes. Adolescent and young adult issues also are important to be acknowledged and specific support for type 1 PWD needs to address those as well. College diabetes support groups also play an important role too. Best book for education, in my opinion, is Ragnar Hanas' Type 1 Diabetes (in its latest edition revision) which can be ordered at his website and ordered through most bookstores but there are lots of excellent education options that should be a big part of ongoing diabetes care. The new pumps and sensors, the newest insulins and attention to the education and psychosocial challenges for the PWD all come together to help achieve optimized glucose control for the PWD. Best wishes for reaching your goals. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

Can juvenile diabetes be cured?

At the moment juvenile type 1 diabetes cannot be cured. However, modern treatments involve increased self blood glucose monitoring (SBGM) and automatic continuous glucose measurements READ MORE
At the moment juvenile type 1 diabetes cannot be cured. However, modern treatments involve increased self blood glucose monitoring (SBGM) and automatic continuous glucose measurements (CGMS) as well as updated insulin preparations (faster rapid acting insulins to cover immediate meal and snack excursions as well as flatter, basal insulins to better cover between meals and overnight values) and newer, smaller and the beginnings of automatic closed loops pumps that communicate with the CGMS. More details of meal and snack planning also have become available as well as more attention to exercise/activity, stress and psychosocial issues and key importance of family and peer support for the pwd: person with diabetes. The most important issue for children and parents remains working closely with a diabetes care team of specialists, optimizing food, activity, education, support and monitoring/insulin delivery to get the closest A1c values to normal without producing increased hypoglycemia and also avoiding hyperglycemia. Time in range needs to be taught and optimized while minimizing time below range and time above range. Focusing on age-appropriate education for the PWd and also the family is critically important and a training book like Hanas' Type 1 Diabetes Manual is extremely helpful as are summer and weekend camp support programs. There are also some newer medications that may be able to address the root cause of type 1 diabetes which is an autoimmune attack, now better (but not completely understood) against the pancreatic islets where insulin is produced. Early clinical trials have been able to postpone the need for insulin but not yet completely and we do not know how long these effects really last. But medical science is focusing on this with good information becoming more and more available. If you are interested in such an approach then you should review the possibilities with your diabetes specialty team.

If my daughter has an overactive thyroid, will she be overweight?

Overactive thyroid usually increases metabolism rate so there is usually unexplained weight loss not weight gain. If she takes anti-thyroid medication, the common starting treatment READ MORE
Overactive thyroid usually increases metabolism rate so there is usually unexplained weight loss not weight gain. If she takes anti-thyroid medication, the common starting treatment for hyperthyroidism and the dose is too high or for too long a time period, then the thyroid hyperactive changes to underactivity (hypothyroidism) and that can induce weight gain. Key is to have close endocrinology followup with periodic exam and lab testing to track thyroid hormone blood levels to guide treatment decisions.

What are the treatments for type 1 diabetes?

Education, education, education about insulin treatment options (multiple injections, basal-bolus insulin option, insulin pumps) monitoring of blood glucose levels with blood glucose READ MORE
Education, education, education about insulin treatment options (multiple injections, basal-bolus insulin option, insulin pumps) monitoring of blood glucose levels with blood glucose meters, continuous glucose monitoring, and integrated pumps and CGM to create hybrid closed loop insulin delivery automatically coupled with carbohydrate counting and nutritional education, exercise counseling, optimizing weight and monitoring for complications of the blood pressure, kidneys, eyes, nervous system and cardiovascular system (cholesterol checks) as well as checking for other autoimmune problems like thyroid disease, adrenal disease and celiac disease. Using motivational interviewing and educational approaches maximizes education efforts for the patient with diabetes (PWD) as well as family member and care providers (school nurses, coaches, teachers, scout leaders) etc. Periodic re-education is also needed with education materials such as Insulin Dependent Diabetes Mellitus by Ragnar Hanas, American Diabetes Association, Juvenile Diabetes Research Foundation and many others around the world. Optimizing glucose levels while minimizing hypoglycemia is also a key educational goal. Assistance and support from other parents and other PWD the same age is also very helpful and available on-line as well as in local groups as are weekend as well as summer diabetes camp programs. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com

My daughter has been advised Thyronorm 25mg. Will it be lifelong?

Not quite enough information in your question to answer properly. Need to know something about what symptoms or abnormalities on exam were present that prompted the blood work READ MORE
Not quite enough information in your question to answer properly. Need to know something about what symptoms or abnormalities on exam were present that prompted the blood work for thyroid functions, exact results of the blood work for total T4, free T4, total T3, TSH levels and also for thyroid colloid and microsomal antibody results. Most common reason for hypothyroidism is a condition that is an autoimmune attack on the thyroid glands called Hashimoto's thyroiditis - so positive antibody results make this diagnosis if present. The thyroid gland can function normally but get enlarged, called a goiter. Sometimes there are cysts and sometimes there has been damage from chemotherapy or radiation therapy or even surgery; other times there are problems with the hypothalamus or pituitary thyroid controlling centers and this too can cause hypothyroidism. And in parts of the world where salt is not supplemented with iodine, iodine deficiency can interfere with thyroid function too. Some newborns are also born with abnormal thyroid glands for a variety of reasons but currently most states in USA do newborn blood screening and thyroid testing is included so this isn't missed as much as when there was no automatic screening done after birth. Once a proper specific diagnosis is made, then answering your question becomes easier and usually once hypothyroidism is diagnosed, thyroid hormone treatment with once-a-day pills is all that is needed. Some people need a little bit of T3 added to their T4 but most just need the thyroxine/levothyroxine once-a-day. The dose you described is actually 25 ugm not mg and this is a very small dose but depends on age and weight. Usually if there is hypothyroidism this is a permanent condition and doses need to be checked 3-4x/year during infancy, childhood and teenage years to adjust individual needs. Goal is to keep the total T4, free T4, total T3 and TSH levels all within normal limits for optimizing outcomes so followup blood work needs to be done 3-4x/year indefinitely to double check that doses are okay and/or any changes identified and treatment adjusted. Hope that gives you some information. The American Thyroid Association has some good information available on line too. Stuart Brink, MD Senior Endocrinologist, New England Diabetes & Endocrinology Center (NEDEC) c/o NEDEC, 196 Pleasant Street, Newton Centre MA 02459-1815, USA phone 1-781-572-4533, e-mail: stuartbrink@gmail.com