Dr. Shaikh Sadaf
Endocrinology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 35 year old male. I had a hyperthyroid since the last five years and was taking Carbimazole 5 mg thrice a day for the last two and a half years. Then, last month, I got my complete physical test done, and I got to know that my hyperthyroid had shifted to hypothyroid. So, the doctor put me on 25 mg of Eltroxin (Thyroxine sodium). Now, I just got another test done, and I am probably back to hyper as per the reports, and the doctor has stopped my medicine for a month. Please advise. What is wrong with my thyroid?
Hello,
Welcome to icliniq.com.
I just read your query about your thyroid dysfunction and saw your reports in detail (attachment removed to protect patient identity).
It appears that you were diagnosed with hyperthyroidism initially and were treated accordingly. The problem occurred when you had a slightly high TSH (thyroid stimulating hormone) and the doctor put you on Eltroxin 25 mcg. It is not recommended according to the recent guidelines to start treatment for hypothyroidism at the level which was noted in your case. It would have been better to have a wait and watch approach and then start it. The thyroid dysfunction, particularly hyperthyroidism, has to one day ultimately turn to Euthyroidism (normal) or hypothyroidism (under functioning) due to the treatment. So, that is not something unusual. The current plan is to wait for another four weeks and repeat your thyroid function test again.
Hope you find my advice of some benefit. Good luck.
Patient's Query
Hello doctor,
I just received my report for T3, T4, and TSH test, which is done after a month without any medicine, and it shows T3 is 318, T4 is 16.2, and TSH is 0.05, which points toward hyperthyroidism again. My doctor has prescribed 10 mg Neo-Mercazole two times for 15 days and, after that, 5 mg three times a day.
Also, I still have many symptoms of hypothyroidism like very dry skin, constipation, and constant fatigue, along with symptoms of hyperthyroidism like shortness of breath, fast heart rate, difficulty sleeping and staying asleep, and hand tremors. Please suggest if this is the correct dosage and the right course of treatment?
Thank you.
Hello,
Welcome back to icliniq.com.
I read your recent reports and they do suggest hyperthyroidism. The treatment plan advised by your doctor is correct. The symptoms will gradually get better with treatment. Hope you find my my advice beneficial. Good luck.
Patient's Query
Hello doctor,
Thank you for the reply.
I got another query. Is it normal to switch from hyperthyroidism to hypothyroidism and then back to hyperthyroidism within such a short span of time (three to four months)? I am afraid that if I start taking Neo-Mercazole as suggested by my doctor, then next month, I will probably get hypothyroidism again. I am very confused due to the fast-changing thyroid. Is it advisable to get RAI done as suggested by my doctor? I am married and planning to have kids probably next year. I have heard that after RAI, it gets harder to have kids. Please suggest.
Thank you so much.
Hello,
Welcome back to icliniq.com.
Yes, it is normal for hyperthyroidism to switch to hypothyroidism with treatment. It is better in your interest that you just keep repeating your thyroid function test every four weeks initially, and then once your thyroid stabilizes, you can do it once in three to six months. Although there is no evidence that radioactive iodine treatment can cause conception problems, it is better to follow medical treatment and wait until you have completed your family. Then you can have radioactive iodine ablation done.
Good luck.
Patient's Query
Hello doctor,
Thank you for the reply.
Please find the attached report for T3, T4, and TSH tests done before four years, showing high T3, T4, and very low TSH. I was prescribed 20 mg Neo-Mercazole for the initial ten days and, after that, 15 mg each day, but as evident from the report, my hyperthyroidism has worsened a bit. Thus my doctor has now increased the dosage to 20 mg of Carbimazole (Neo-Mercazole) per day.
Please advise if this is the correct dosage as per my current report?
Hello,
Welcome back to icliniq.com.
I just read your recent reports and I feel that your doctor has prescribed the correct dosage. Your results are not that low. Hope you find my advice beneficial.Good luck.
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Endocrinology
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