Subclinical Hypothyroidism progressed to Overt Hypothyroidism

A 36 years old female Anganwadi worker presented to OPD Chief Complaints She presented on 30.01.2021 with complaints of weight gain and menstrual irregularities and brought her TFT of 25.01.2021, in which TSH was 9.69 Considering her as a case of subclinical Hypothyroidism she was put on L Thyroxine 50 mcg ES on 30.01.2021 and asked to follow up with anti TPO report She by mistake repeated her TFT along with anti TPO on 3.02.2021 and her TSH further raised to 16.95 and Anti TPO was positive She is now a case of overt Hypothyroidism In summary - 30.01.2021 - TSH 9.69( lab report of 25.01.2021) put on 50mcg L Thyroxine 04.02.2021 - TSH 16.95 ,anti TPO +ve(Lab report of 3.02.2021, continued same 50mcg dose of L thyroxine, added Vit D 60k weekly Asked her to review with TSH report after 4 weeks Management My concerns are - 1) Whether I habe done in continuing same dose of L Thyroxine? 2) I even added her on VitD 60k weekly supplementation without Vit D report? Is it right? Kindly give your valuable opinion on this case


Dear dr Ajeet Pal Singh My submission is as per guidelines of thyroid care society of india Subclinical hypothyroidism should be given time to explore the clinical status till than better to follow diet restrictions and exercise and weight management In this case it is established c/o of hypothyroidism as tsh was 9.69 so no harm in starting L-thyroxine but doses would have been gradual Fresh rise in tsh is actual levels and nothing in concerned of L-thyroxine as we can't expect results in couple of days So my advice is continue L-thyroxine 50ug for 3months before jumping on higher doses Addition of vit d is nothing to worry

Thanx dr Pushkar ji Bhomia

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Tnx Dr Pushkar Bhomia sir

Increase the dose of L thyroxine Supplement with D is not wrong

Wait for 15 days with same dose Then repeat TFT You can give vit d3 with out report in patient of hypothyrodism

Continue with same dose of L thyroxine for 3 months. Then assess TSH and adjust the dose

Continue the same dose till 6 weeks and repeat the TFT. dose should be adjusted according to the next report. There is no harm to start vit d supplement.

I am agree with@Dr. Shivraj Agarwal Sir.

Thanx dr

Change dose of L thyroxine. Vitamin D .

Can wait for at least 3 months before changing to higher dose

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