Overt Hypothyroidism + HTN + Hyperuricemia + Insufficient VIT D3 Level

A 48 year old obese female presented with complaints of mild edema in legs and weight gain for the past 2 to 3 months. She is a known case of Hypothyroidism(25mcg) with HTN( Amlokind AT) on medications Upon examination, his BP was 190/110, Pulse 110/min Gave her ampoule of lasix and 5mg amlodipine stat I had started her on Tazloc H OD Dytor 5mg OD Vit D3 60k L thyroxine 25mcg continue until fresh TSH reports On follow up visit, her ECG is attached, TSH is 13.85 BP is 130/80mmHg Uric Acid 7.6 Vit D3 is in insufficient category B/L chest clear Hb - 11.8 So now the concerns are - 1) Ideal dose to titrate L thyroxine ? Considering her weight 85 kgs, dosage should be 125mcg ? 2) She has hyperuricemia, so added furic 40 and change tazloc H to Tazloc AM? 3) Kindly comment on ECG

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Dose of L Thyroxin is not related to body weight but it is based on TSH Inj. Lasix preferably not to be used in the setting of high blood pressure on OPD basis, high blood pressure need to be lowered slowly over 2 - 3 days. No need to panic and reduce blood pressure rapidly. Rapid reduction of blood pressure known to precipitate Acute myocardial infarction, cerebral ischemia etc High blood pressure need to be reduced slowly over 2 - 3 days except in circumstances, there are specific indication for rapid lowering of blood pressure such as intracranial bleed Uric acid is borderline elevated, with repeating it before starting on medication T wave inversion in lead III, worth serial monitoring of ECG
Thank you doctor
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Even amlodipine atenelol pedal oedema known pta hypertensive uricosis sinus tachycardia hypothyroidism xray chest serum protein venous Doppler lower extremity increase dose of thyroxine after tsh bring down for 4 point 5 add febustat40 mg bd change of talma h & lasix stat salt low 1 tsf one person day salt allowed serum creatinine
What is the level of tsh.we have to decide the dose of thyroxine with the levels of tsh.pl.add indepamide 1.5 mg 8am.which will control bp as well as oedema feet.pl hold amlodipine as it may increase oedema feet.pl add some uricosuric agent. Fuboxostat 40 mg daily. Pl get her diabetic & lipid profile ecg & 2d echo
Sir, TSH is 13.85
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NEED'S TO.. INCREASE DOSE OF THYROXINE.. DOUBLE OF PRESENT DOSE.. REPEAT.. TFT.. AFTER TWO MONTHS REST..WITH..CARDIOLOGIST OPINION..
Tnx Dr Vipin Bihari Jain
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Stop giving Amlodipine Start Tab Telmisartine H bd Increase the dose of L thyroxine Serial ecg Add Atorvastatin and ecosprine.
Thank you doctor
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Ecg shows st depression 11 111 avf.v5 v6. Pl make thyroxine dose 65.5 micrograms. Pl.repeat tsh after 6 wks
In ecg there is ST depression in inf leads go for trop i Continue same dose of eltroxin and switch tazlocAM
Dose of levothyrox is 1.6 ug/kg/day
So sir, as per this dosage it would come out to be 125mcg, but this patient has changes in ECG
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There are three major issues paedal oedema is due to Amlodipine and in hypothyroidism . So Stop Amlodipine and u have replaced it's ok. For hypothyroidism Thyrox 75 MCG od bbf. Uric acid is borderline so start fubutaz40 one daily for 15 days. And adv low proteins, fatty, fried foods, no nonveg. Change lifestyle, daily exercise . Repeat tsh after 4 week. Add vit D suppliment.thats it ECG St dep and T wave inversion in Inferior leads with st depression inlead v5,6. So adv bsr f pp HBA1c Lipid profile electrolyts kft ECHO
In my opinion ECG IS NORMAL except tachycardia 2 since tsh is 13.85 uiu and she is taking 25ug so stepup to 75ug od 3uric acid is 7.6 i will stepup the febuxoate 4continue vitd3 -60k weekly 5 oedema feet yes withdrawal of amylodipine and stepup diuretics
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