Concluded Case

Iatrogenic Hyperthyroidism

A 60 year old male patient presented to OPD with complaints of abdominal bloating from last few weeks, increased frequency of urination day and night He has undergone cataract surgery for right eye in July 2020 No H/O DM, HTN, Constipation, Prostatomegaly He also underwent a brain surgery 4 years back for disturbances in vision, after which he was put on L thyroxine 150mcg (Records not available) His current report of TFT is attached 1) Can we descalate the dose to 125mcg? And repeat TFT after 6 weeks 2) Can he be prescribed Urimax D at bedtime and asked for a USG KUB with PVRU/Prostate Size meanwhile? 3) Will Rifaximin help in bloating issues?

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Concluded answer

1.As TSH is too low and patient is now hyperthyroid. Gradually reduce the dose to 75 mcg for 5 days and then 25 mcg for 5 days and stop L - Thyroxine completely for 1 week. Again get TFT done - and if required re - assess the dose 2.Urimax - D can be prescribed with out hesitation 3.Rifaximin along with a pre - probiotic , PPI and prokinetic will improve bloating

All Answers

1.As TSH is too low and patient is now hyperthyroid. Gradually reduce the dose to 75 mcg for 5 days and then 25 mcg for 5 days and stop L - Thyroxine completely for 1 week. Again get TFT done - and if required re - assess the dose 2.Urimax - D can be prescribed with out hesitation 3.Rifaximin along with a pre - probiotic , PPI and prokinetic will improve bloating

Valuable opinion
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Yes descalate 125mg as he is heading in hyperthyrodism? And repeat TFT 2 yes urimax-D can be prescribed Also go for usg kub If needed than PVRU 3 yes Rifaximin will help for bloating but add ppis as well

Thanx dr Kute Ankush
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1) TSH is very low with Thyroxin 150 mcg It's Dose can be reduced to 100 mcg 2) Urimax D is good choice 3) Pantoprazole, Itopride and Domperidone combination will be good for bloating of abdomen

Valuable opinion
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* REDUCE..DOSE OF THYROXINE..WITH.. CLINICAL CORELATION.. * PPI + DOMPERIDOME .. * URIMAX-D.. * PROBIOTICS.. * NEED'S.. TFT.. USG..STUDY.. PVRU ..

Tnx &wc Dr Ajeet Singh
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Yes you can decrease the dose till 75 step by step You can give urimax d at bed time Instead of rifaximin give him vibact ds or econorm

Thank you doctor
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1. Can de-escalate to 100mcg , as TSH is too low. 2. Urimax D cna be prescribed. 3. For bloating , add PPI and prokinetics. Esomeprazole and levisulpiride works good.

Valuable opinion
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Hyperthyroidism

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