Overt Hypothyroidism(Anti TPO+ve) with T2DM

A 35 year old female presented to OPD for routine follow-up for Hypothyroidism and T2DM Chief Complaints No fresh complaints as of now, she only complaints of pain left knee and gastric discomfort, which I attribute to metformin 2gm/day that she was on Investigations RBS - 193 BP - 148/90 PR - 90 Weight - 70kgs Her last TSH was 23.6 in September 2020 and she was on 150mcg L-thyroxine Her recent report of TSH is 18.21 on 16.12.2020 Management Previous medications - glimipiride 2mg bd+ Metformin 1gm bd + Linagliptin 2.5mg BD She is started now on - Tab. Gliclazide 60mg XR + Metformin 500mg BD Tab Dapagliflozin 10mg OD Increased the dose of L-Thyroxine from 150 to 175mcg E/S Tab. Telmisartan 40mg OD Tab. Tramadol + PCM SOS for pain I was also willing to advise her a gluten free diet, but she is already taking only 2 chapatis in BD dose, Secondly, I thought of advising her to get herself tested for TTG IgA but I didnt do Please give me your opinion on gluten free diet advises that you give and whether u get someone of this picture tested for TTG IgA??

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There is no need to increase the dose of L-thyroxine rather it needs to lower to 50ugm as fresh tsh are quite acceptable than old reports Yes no signs of celiac disease hence gluten free diet is not needed She looks to be obese and overweight and since she is diabetic her c/o joint pain should be evaluated in that view Reduce the BMI

Thanx dr Dinesh Gupta
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HYPOTHYROIDISM..WITH.. DM-II .. CONTINUE WITH THE TREATMENT .. AS IT IS .. NO..NEED OF..GLUTEN FREE DIET.. AND.. tTG IgA ..

Tnx Dr Vipin Bihari Jain sir
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HYPOTHYROIDISM Start treatment as adjuvnt therapy with eltroxin. Treat the disease as kaphaj soth or pandu medicine like kanchnar guggulu, punarnava mandur, punaravadi kwath, arogyavardhini, shigrupatra kwath,varunadi kwath, trikatu churna

There is no clinical picture of coeliac disease/gluten hypersensitivity Therefore, no need to plan Gluten free diet or no need to test tTG IgA level

Continue with same treatment Consult dietitian

Thanks Dr. Kute Ankush, Dr.Dinesh Gupta
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I think, consult with an ENDOCRINOLOGIST for better treatment and management.

Hypothyroidism. Eltroxin Anti-diabetic Endocrinologist opinion..

NICELY DISCUSSED BY. THE. RESPECTED DOCTORS THANKS

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