Dr. Nagaraj
Diabetology
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Patient's Query
Hi doctor,
I am 35 years old male. In my recent blood work, the T4 level is low, indicating hypothyroidism. I also feel a little bit of muscle pain some days. I have a medium hair loss, slight weight loss of around 2 kg every year for the last five years. I feel a little bit itchy and crawling sensation in my feet. I recently started taking Levothyroxine 25 mcg per day as per the doctor recommendation. Please let me know if I need to diagnose further or taking Levothyroxine should be fine. My T4 free was 0.62 ng/dL and TSH - 62 mlU/L three months back, T4 free was 0.75 ng/dL and TSH - 42 mlU/L, four months back, T4 free was 1.37 ng/dL and TSH was 5.1 mlU/L, a year back, and TSH was 6.3 mlU/L, a couple of years back.
Hi,
Welcome to icliniq.com.
I understand your concern. I believe your TSH (thyroid-stimulating hormone) was 6.2 mlU/L two months back. In any case, TSH is on the higher side more than T4 (thyroxine); it is elevated TSH coupled with low T4 that indicates hypothyroidism (rather a severe one). The symptoms you have like, hair loss, muscle pains, dry skin (causing itchiness), crawling sensation are typical of hypothyroidism. Usually, weight gain is seen in hypothyroidism, but you are mentioning it as weight loss which is a paradox. Do you have any other medical conditions like diabetes? Any other autoimmune conditions either in you or in your family? As of now, continue with Levothyroxine (Levoxyl). The dose can be increased slowly till thyroid profiles gets normal. Even after normal reports, it should be continued for another two to three months.
Patient's Query
Thank you doctor,
TSH level is 62 mlU/L in my report. Most likely, it is correct since the earlier report showed around 40 mlU/L. I am not aware of any autoimmune disorders in my family. I have few questions to ask. Can you please tell me the test names for diagnosing autoimmune diseases? Will Levothyroxine supplement improve natural T4 level in the long run? If the natural T4 level keeps reducing every year, how do we treat that? Up to 30 years of my age, my body used to be hot most of the time even if I drink a lot of water and I become thin even if I eat well. Now I feel cold most of the time. Would it be possible that I might have hyperthyroidism at that time and now turned to hypothyroidism? If I test for Hashimoto’s thyroiditis and it is positive, what are treatment options?
Hi,
Welcome back to icliniq.com.
I understand your concern. Let me help you with explanations. Quite possible that TSH can be 60 mlU/L. However, it is unusual to see such higher values, especially in males, so I wanted to confirm. There are many autoimmune conditions. Based on your symptoms (weight loss), I think that hypothyroidism (possibly Hashimoto's) with other autoimmune conditions like celiac disease often coexist. However, it requires a battery of investigations to confirm the relation with other autoimmune conditions. The only available medication for hypothyroidism is Levothyroxine (Levoxyl) which helps T4 return to normal levels. When T4 starts to come back to the normal level, TSH level automatically comes down. How far it is going to help you depends on the underlying cause of hypothyroidism. It happens if the Levothyroxine drug is insufficient. You have to have an adequate dose to keep a check on t4 levels. Looking at your TSH, I would even think of 100 micrograms of Levothyroxine daily. Please discuss the same with your doctor. I think 25 microgram is too low a dose to start with a TSH of 60 mlU/L. It could be celiac disease, as mentioned earlier. Typically you eat well but do not gain weight due to malabsorption. Another possibility is if you ever had a viral infection of the thyroid gland (De Quervain's thyroiditis) it can lead to initial hypothyroidism, followed by transient hyperthyroidism and later prolonged hypothyroidism. Usually, this is seen following viral upper respiratory infections, and the thyroid gland becomes painful. The last phase of hypothyroidism in this condition usually lasts for six to twelve months and rarely persists for a lifetime. If you test positive for Hashimoto's, the only treatment is replacing the T4 hormone with Levothyroxine, which requires continued life long with periodic monitoring of response (Thyroid profile). I hope this explanation helps you.
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Diabetology
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