Creator: Dr. Rajyaguru
Published: 2016-09-29T12:37:13-04:00

Patient's Query

Hello doctor,

I am a 38 year old male. I was diagnosed with hypothyroidism before 1.5 years. Currently, I am on Thyroxine 75 mcg and Aten 25. Still, I have the symptom of passing out feeling. Please advise.

Answer

Dr. Rajyaguru

Neuro Surgery Neurology Spine Surgery

Hi,

Welcome to icliniq.com.

I would like to have some more information.

When was your last FT4 and TSH levels checked?

What do you feel exactly? Is there any generalized weakness or giddiness?

Do you have an inability to tolerate cold? Please let me know the answers to discuss further.

Revert back with the answers to the above questions to a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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Patient's Query

Thank you doctor,

Last month my TSH was 5.36 and this month 4.45. My TPO and TgAb antibody are positive. My T3 and T4 are in normal range. I am feeling extreme fatigue, dreamlike vision, high pulse and nervousness, inability to tolerate cold and a feeling of being passed out without dizziness. Is this due to any neurological disorder?

Answer

Dr. Rajyaguru

Neuro Surgery Neurology Spine Surgery

Hi,

Welcome back to icliniq.com.

I have gone through your details.

TPO and TgAb positivity is the catch in your case (TPO - thyroperoxidase and TgAb - thyroglobulin antibody). It is suggestive of autoimmune thyroiditis.

In this condition, initially you will have hypothyroidism and then when the thyroid gland cells are destructed, the thyroid hormone is released in the circulation and you have features like hyperthyroidism, anxiety, nervousness, etc. Again, in the third stage you will have hypothyroidism.

So, the dose of your Thyroxine should be adjusted accordingly.

Aten 25 (Atenolol) is required in hyper state, not in hypo. Your symptoms are more of hyper now and Thyroxine is not required in the hyper state.

I suggest you take only 25 mcg of Thyroxine for a week and see the difference. Consult your doctor, discuss with him or her and take the medicine with consent.

FT4 - free T4 values should be done to decide further on your Thyroxine dose. It gives an idea about the actual amount T4 available in your body for functions.

Total T4 values give both protein bounded and unbounded T4 and out of which bounded T4 is of no use to the body.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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Patient's Query

Thank you doctor,

If I take Thyroxine 25 mcg I feel good. But, my TSH will increase. Six months back, it was 24. My endocrinologist advised not to reduce the dose as it affects my heart function in the future. Can I test for FT4 and stop Aten? Please advise.

Answer

Dr. Rajyaguru

Neuro Surgery Neurology Spine Surgery

Hi,

Welcome back to icliniq.com.

No, you should not stop Aten 25 as it protects your heart. In fact, if your anxiety levels and pulse rates are constantly high, then you need to increase the dose.

As I explained you, the hormone levels are not constant in this disease. The hormone levels will change over a period of time and so, the doses have to be changed accordingly.