Dr. Thiyagarajan. T
Diabetology
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Patient's Query
Hi doctor,
My daughter is 12-year-old of weight, 72.7 lbs, and her height is 4.7 feet. She is suffering from thyroid for the last two years. She has daily taken Thyronorm 25 mcg, but as per the latest report, her TSH level increased (5.99). Her TSH was 4.82 six months back. Please suggest medicine.
Hi,
Welcome to icliniq.com.
What was her initial TSH (thyroid-stimulating hormone)? Does she take medicine without missing any dose on an empty stomach? No drinks or food or any other medications for at least one hour after Thyronorm (Thyroxine)? Does she have any symptoms now? For now, I suggest increasing the dose to 37.5 mcg. Take 25 mcg and 12.5 mcg. Repeat TSH with FT4 (free T4) in three months.
Please get back if you have further doubts.
Patient's Query
Hi doctor,
Thank you.
She gets regular tests done, TSH level as from three years ago is 7.58 three months later it is 2.46, two years ago it was 3.33, and three months later it was 4.49, last year it was 6.27 and eight months later it was 4.11, this year starting it was 4.82 and this month it is 5.99. She takes medicine regularly on an empty stomach, but her TSH level increases. No, any other problem. Please give a revised dose and further blood tests that have to be done.
Hi,
Welcome back to icliniq.com.
She never had TSH more than 10, which is good. Thyroid function can fluctuate, and thyroid hormone needs will change as the kid grows. So her dose will also change as years go by, as she reaches puberty, etc. At this age, the recommendation is to check TSH and FT4 every three to four months. I stand by the same dose, 37.5 mcg (25+12.5) daily. Repeat TSH with FT4 in three months.
I hope this was helpful.
Patient's Query
Hi doctor,
Thank you.
My wife is 38-year-old, of weight 88 lbs. Presently her TSH is 4.70 (T3-97.68, T4-9.81), and she takes daily 88 mcg Thyronorm. Her previous reports are as under:
1) Three years ago, TSH-14.834 (T3-96.49, T4-7.40), and three months later TSH-6.563(T3-98.68, T-4-8.50).
2) Two years ago, TSH-1.640 (T3-118.57, T4-10.30).
3) Last year, TSH-7.831(T3-104.39, T4-8.90) and eight months later TSH-1.23 (T3-112.20, T4-10.47).
She has some problems like hair fall and sometimes headaches. Kindly give your opinion.
Hi,
Welcome back to icliniq.com.
Your wife is only 38-year-old, and her TSH goal can be less than 3. But she weighs only 88 lbs, and she is taking 88 mcg, which seems to be a slightly higher dose for her weight. (This is in contrast to children who will need a higher dose compared to their weight, for example, a newborn baby may weigh only 3 kg, but the dose may be 25 mcg. So please do not be confused). Now, maybe she is not absorbing the medicine completely. Please emphasize proper taking of the medicine - empty stomach, not missing doses. If she forgets to take the dose in the morning, then she can take it anytime in the day so as not to miss the dose completely. For now, let her stay on the same dose of 88 mcg and recheck TSH and FT4 in three months. Another point is always to check FT4 and not T4 (total T4).
I hope this was helpful.
Patient's Query
Hi doctor,
Thank you.
I will continue 88 mcg and after three months will do the test again, but sir some time headache and hair fall is there. What to do? Kindly give your advice.
Hi,
Welcome back to icliniq.com.
Can take simple analgesics like Crocin (Paracetamol) or Dolo (Paracetamol) for headache. For hair fall, I suggest taking tablet Hosit-Fe (Folic acid, Mecobalamine, and Vitamin B6) daily, one tablet at night after food for two months. She can also try tablet BTN 5 mg (Biotin) but has to stop the tablet at least one week before the next blood test. If you do a blood test while taking a BTN tablet, the results will come out wrong. Please remember that.
I hope this was helpful.
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Diabetology
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