SCH with high anti-TPO - treat or watch?

I saw a 17 year old girl 165 cm tall weighing 55 kg (BMI 20.2) - reasonably fit and energetic - doing well academically. She was diagnosed to have a subclinical hypothyroid state in 2017 (see reports) and was observed. Interim, she was diagnosed to have PCOD with minor menstrual irregularities. She has atopy with high IgE and sensitivity to dust and cold. A follow up TSH and FT4 done recently (see reports) showed slight worsening of values and anti-TPO came out to be rather high. She has a lowish Hb 12.3 of normocytic normochromic type. Does this girl need to be treated with replacement LT4? If no, how frequently should her TFT's be monitored? If yes, what dose of LT4 would you start with?

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This is a case of subclinical Hypothyroidism probably Autoimmune thyroiditis or Hashimotos thyroiditis or Graves disease with PCOS. Absolutely she requires treatment with low dose of Thyroxine . As serum TSH is elevated ,and Anti Tpo antibodies titres are raised, start with low dose of thyroxine 25 mcg on empty stomach and regularly monitor serum TSH levels after 6 to 8 weeks and adjust the dose of thyroxine. When Anti Tpo antibodies are raised eventhough T3,T4 and TSH are with in normal limits,low dose of thyroxine should be started. A course of 8 tablets of vitamin D weekly once should be given. Start with low dose of Metformin or Pioglitazone to treat PCOD. Advice her regular exercise and to take Plenty of fruits.

Thank you doctor

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Hashimoto's thyroiditis in hypothyroid state Needs low dosage of levothyroxine , 12. 5 / 25 mcg daily. These people are brittle thyroid patients and may swing from hypo to hyper state with thyroxine . Needs once in 3 months monitoring of TSH Need to rule out Vitamin D3 deficiency

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She is to be treated as she has PCOD, overweight, SCT

Overweight? Please note her BMI - it's 20.2!

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