Raised TSH with normal YE T4

She is already taking 100microgm past 6 month. But still Her reports show raised TSH with normal T3T4. 6 month back when she start treatment her TSH was 43 with normal T3T4 SO no change in TSH value despite 6 month treatment Her main comp is wt loss. My Q is 1. Why TSH is still high despite regular treatment. 2.is she case of subclinical . 3 . Why wt loss in hypothyroidism




Thanks Dr @Paras Goyal for mentioning. This patient was having TSH of 43 at the time of diagnosis & started with 100mcg of Levothyroxine. Now the TSH level has decreased to 33.59. But to clarify your doubts, you should've mentioned about the process of medication e.g. whether she is taking it early in the morning in empty stomach or not, whether she is taking any food or PPI within 1hr of taking the medication or not, whether she has taken her medication on the day of testing or not. Follow up monitoring should be done by testing FT3, FT4 n TSH as the free hormone changes are noticed earlier than the total hormones. Any other information are welcome from Dr @Sepuri Krishna Mohan , @Dr. Dineshchandra Sharma , Dr @Vilas Deshpande

Thank you doctor

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I agree with Dr.Sandipji.. For comparing the result and progress it should be clear in mind that you are accessing the controll level with medicine to review the doses. Weather it's BS or TSH..Every time *SAMPLE MUST BE GIVEN AFTER TAKING YOUR REGULAR SCHEDULED DOSE AND WITH OUT FOOD & PPI.. EXCEPTION IS FBS/Fasting S. Insulin. Very important clarification Dr Sandipji texted.

Thanks @Dr. Dineshchandra Sharma Sir

Its a case of overt hypothyroidism Get her lipid profile and Serum 25(OH)D done too You can also advise to put a little restriction on gluten and start her with Vitamin 60k weekly along with L Thyroxine Up titrate the dose to 125mcg Empty Stomach She might have lost that weight which she had put on due to hypothyroidism, due to L thyroxine supplementation

Dear Sandip sir, you have nicely pointed out the reasons of raised TSH, I agree with you.

1) LEVOTHYROXINE DOSE SHOULD BE INCREASING UPTO 112Mcg or 125 Mcg ..... Dose Needed High to decrease level of TSH... 2)Wt gain is clinical sign of Hypothyroidism .. but weight loss in some cases due to low bmr 3)Due to High TSH & Low T3 , T4 level , Decrease basic metabolism rate in Hypothyroidism pt . Thyroid Hormone normal level need for maintenance of BMR .

Case of ethyroid ../ hypothyroidism.. Increase the dose of Eltroxin . Fasting sugar and PP USG thyroid gland

@Dr. Sandip Debashis Mishra @Dr. Sandip Debashis Mishra

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