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Q. I have thyroid problem with high TSH value. Please help.

Answered by
Dr. Zulfiqar Ahmed
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Sep 30, 2020 and last reviewed on: Oct 06, 2020

Hello doctor,

I have a thyroid issue. My TSH value is 7.24 (range 0.35-5.5) tested last week. Even the same test conducted before seven months shows the value of 7.06. The remaining TT3 and TT4 are in the normal range. Kindly advise.

Dr. Zulfiqar Ahmed

Diabetology Endocrinology
#

Hi,

Welcome to icliniq.com.

I have seen your blood tests (attachment removed to protect patient identity).

You are overweight. Your HbA1c (glycated hemoglobin) is in the pre-diabetic range, but your fasting and postprandial sugar levels are normal. Your HDL (high-density lipoprotein) is quite low, whereas LDL (low-density lipoprotein) and TG (triglycerides) are a little bit above the desired range. Your vitamin B12 level is also low. Are you a vegetarian? It might be low because of that. Your TSH is high and T3, T4 are normal and is called as subclinical hypothyroidism

You did not mention about any of your symptoms or problems. Usually, we start medication for hypothyroidism once TSH (thyroid-stimulating hormone) is 10, or over 10, if the patient has symptoms, high lipids, or high TPO antibodies.

My advice is right now to do TPO (thyroid peroxidase) antibodies. If this is positive, then you may need to start on Levothyroxine, especially if you have symptoms. If it is normal, then just repeat your TSH after six months.

Regarding your overweight and lipids derangement, you need to follow lifestyle modifications. Consume a low carbohydrate diet and no added sugar. No sugary juices, bread, rice, pasta, and potatoes. If you cannot stop, at least take as little as possible. Consume more vegetable salads. Take fruits only as a sweet dish. Do not take mango, grapes, and banana. Strawberries and other berries are fine.

Intermittent fasting will also help you to control your weight. You can fast for 16 hours like taking your dinner at 7 PM and do not eat anything after that. Then you can take your breakfast at 11 AM the next day. During fasting just drink water and green tea without sugar. You can extend fasting to 24 hours then 36 hours as your body adopts. You can fast two times a week or as you feel comfortable. It will control your weight.

Drink more water. Sleep well and do exercise at least 30-40 minutes daily. The more you practice these things, the better will be your control overweight. Check your vitamin D levels and repeat HbA1c after three months along with FBS and RBS (fasting and random blood sugars).


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Thank you doctor,

I am not getting the meaning of lipids and TPO. Please suggest for my thyroid issue. Do I have to do fasting for controlling the thyroid? After a good diet and exercise, will it come to control? I am a non-vegetarian. As you mentioned, if my TPO antibodies are positive, then should I start Levothyroxine? What exactly I have to do now?

Dr. Zulfiqar Ahmed

Diabetology Endocrinology
#

Hi,

Welcome back to icliniq.com.

I am sorry. You miss understood. About the thyroid issue, you need to do TPO antibodies. If it is positive, you may need to use Levothyroxine. If negative, just repeat your thyroid function tests after six months.

If your TSH goes up to 10 or your T4 is down, you have to take Levothyroxine. Right now, your TSH is less than 10, so no need for medication.

Lipids are cholesterol like HDL and LDL. HDL is good cholesterol, and LDL is bad cholesterol. I insisted on fasting to decrease your weight and bad cholesterol.

Right now, you need to do TPO antibodies test.


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