Concluded Case

Overt Hypothyroidism

A 35 year old male presented to OPD to consult about his reports, weight - 74kgs at present History 2 months back his TSH was 63 and he was started on 75mcg by a GP and his weight then was 74 kgs too 16.12.2020 report of TSH is 12.34 His lipid profile has improved from last reports and Vitamin D has improved from 10 to 22 now Management My concerns are - 1) Dosage of L- Thyroxine initiation? Shouldn't he be started on 125mcg E/S, calculated as 1.7mcg/kg BW/day, 2 months back when his TSH was 63 2) He was also prescribed Rosuvastatin and Fenofibrate too 2 months back. What do u think was it necessary to be given? Dyslipidemia was only due to Hypothyroidism 3) Ideal supplementation of Vit D in such cases? 60k unit for 12 weeks, then 60k unit once monthly Please share your valuable opinion on this

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A case Hypothyroidism ,hypothyroidism itself cause Dyslipidemia Dose of initiation of Eltroxin depends on TSH level not on weight basis,so 75 mcg is right Noneed to start statin and fenofibrate As TSH level is 12..34 so dose of Eltroxin should reduce to50 mcg Vit D 60k weekly for 2 month then monthly for 4 month Repeat Thyroid profile after 3 month ,dose of Eltroxin adjusted accordingly

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Hypothyroidism is treated basically on TFT levels generally and not on weight basis hence he was right in initiating with 75 mcg though you are right in doses of wt wise Cholestrol are found in cases of hypothyroidism hence nothing wrong in rosuvastatin as lowering of tsh usually do not correct the cholesterol levels hence i agree here as well Your last concern is vit d3 well you can follow the schedule suggested or can choose the brands containing vitd3 4000units on daily basis

Thanx dr Kute Ankush
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Judgement of the dose of Thyroxin supplement for hypothyroidism is usually based on value of TSH, body weight, presence of malabsorption syndrome etc Therefore, such a dose may change from person to person However, it need to be titrated later on to achieve euthyroid status

Valuable opinion
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Hypothyroidism causes Hyperlipidemia which usually comes down to normal after proper per kg body weight dose . We should wait and should not be treated with lipid lowering drugs until proved otherwise. Hypothyroidism itself produces osteoporosis . So Vitamin D treatment should be initiated.

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* NEED'S TO..REDUCE DOSE OF.. THYROXINE..WITH..CLINICAL.. CORELATION.. * VITAMIN D..AS PER REQUIREMENT.. * REGULAR EXERCISE.. * FOLLOW UP WITH TFT..

Tnx Dr Shivraj Agarwal sir
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I think TSH is well controlled... Reduce Levothyrixind to 50 mcg. Vit -D 2000 IU daily. Strict about calorie intake. If needed go for Anti TPO 3

A case Hypothyroidism ,hypothyroidism itself cause Dyslipidemia Dose of initiation of Eltroxin depends on TSH level not on weight basis,so 75 mcg is right Noneed to start statin and fenofibrate As TSH level is 12..34 so dose of Eltroxin should reduce to50 mcg Vit D 60k weekly for 2 month then monthly for 4 month Repeat Thyroid profile after 3 month ,dose of Eltroxin adjusted accordingly

Valuable opinion
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1.shigru swarasam with kanchanaraguggulu 2tab, BID. 2.liquid.varanad kashayam 20ml+40ml lukewarm water with tab.trikatu 2tab, bid. 3.regular exercise pranayam 30min/day. 4.Aswagandha churnam +Triphala churnam + punarnava churnam 5gm with honey bedtime.

@Ajeet Singh , dose of Thyroxine increase to 125mcg, Diet control with exercise Supplement of Cholecalciferol 60k weekly for 6 weeks then monthly, Lipid profile is normal, then no need to continue for statin and fibrates Diet control, exercise and avoid junk foods

Make it thyroxine dose 100 Vit d3 and calcium suppliment

I am agree with@Dr. Shivraj Agarwal Sir.

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