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36 years, suffering from PCOD,hypothyroidism, conceived after 12 years. On pills. Advise correct dosage to control thyroid and diet plans

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General & Family Physician
Practicing since : 1980
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Hi Doctor,
I (XXXXXXX,age 36 years,,weight-59kg,height1.5748 meter) am pregnant after12 years of marriage and suffering from HYPOTHYROIDISM,PCOD, and INFERTILITY.


DETAIL MEDICAL HISTORY ARE AS FOLLOWED.
Medical History of XXXXXXX, Age – 36 Years.
Married in XXXXXXX 2001, continuous trying to conceive.
Under treatment from 2004
1.     In 2006 diagnosed Hypothyroidism, PCOD, Hypertension & Infertility
2.     In 2007 March suffered with Endometrial infection (Tuberculosis), Treated with full coarse of anti tuberculosis drug, re-biopsy done no infection repeated.
3.     In 2008 January HSG done as per advice of Dr. Sohani Varma - Apollo Hospital Delhi. Diagnosed as Left fallopian tube with hydrosalpynx and right side tube with cornual block.
4.     In 2008 XXXXXXX IUI performed – UN success.
5.     From 2010 to 2011 continuous treatment under Dr. Sohani Varma – Apollo Hospital Delhi.
6.     In 2011 April as per the advised of Gynecologist – Dr. Sohani Varma, HYSTEROSCOPY + LAPAROSCOPY WITH CHROMOTUBATION & RIGHT SIDE OVARIAN DRILLING Done on 15 April 2011. By Dr. XXXXXXX Badhwar, Delhi.
OPERATIVE FINDINGS: Hysteroscopy – Cavity – Normal. Endometrium – Normal. Right cornu – Normal. Left cornu seemed covered by flimsy adhesions- broken with hydrostatic pressure.
Laparoscopy: Uterus – Normal. Bilateral Tubes apparently healthy. Bilateral Ovaries polycystic. POD Clear. Chromotubation done . Right Tube showed partial Hydrosalpinx with free glow of XXXXXXX When the XXXXXXX was pushed, there was a spontaneous perforation of the uterus in the posterior wall near the Fundus & another pinpoint hole seen next to that (? due to previous intervention). The perforation was sutured and hemostasis assured. Right sided ovarian drilling done.
From 2004 to 8 August 2011 treated with following medicine
•     Bigomet SR -500mg (Metformin Hydrochloride Extended release tablet) 1 tab. X 2 time daily.
•     Rabium 20mg ( Rabeprazole ) 1 tab. X 2 time daily.
•     Thyronorm (50 to 100 mcg.) 1tab. daily (as per dose advised by Endocrinologist)
•     Zaart – H 50mg ( Losartan potassium ) 1 tab. daily.(up to 7th August 2011)
•     Vitamin C 500mg 1 tab. daily
•     Folvite 5mg (Folic acid) 1 tab. daily (From January 2008 till continue )
•     Aldactone and Pioglar also used up to 2010.

7.     In 2011 8 August Pregnancy conformed in Zulekha Hospital Sharjah (Dr. Geetu Motwani)- US – Pelvis ( Trans Vaginal) - 6 weeks 3 days of gestation with cardiac activity heart rate is 123 bpm, Pathological test on 9th August 2011 Glucose (fasting) – 112.3 mg/dl, TSH - 6.96ulU/ml. Medicine prescribed as Duphastone 10mg 1 tab. x 2 times daily, Aldomet 250mg 1tab. X 2 times daily, Aspimed 75 mg 1tab. daily with all other previous medicine Bigomet,Thyronorm 100mcg, Vitamin C and Folvite.
8.     On second visit to Dr.Geetu Motwani on 23th August 2011, US – Pelvis ( Trans Vaginal) impression was cardiac activity is absent and suggestive of intrauterine fetal demise, Correlate clinically. Advised DNC.
9.     DNC done in Apollo Hospital Delhi under guidance of Dr. Sohani Varma on 30 August 2011.
10.     In November 2011 Suffered with Typhoid Fever and Febrile UTI – Ecoli infection and treated in Zulekha hosp. Sharjah under Dr. XXXXXXX XXXXXXX XXXXXXX and Dr. Amer with antibiotics and other medicine.
11.     LMP – 5th Feb. 2012, Pregnancy confirmed through Pregnancy kit and HCG test on 11th of March 2012 in Zulekha hosp. Sharjah (Dr. Betty John). TSH value on 11 March 2012 is 3.459uIU/mL ,TT3-77.90 ng/dL, TT4-9.51uIU/mL


Medication continue with following medicine as on 24th March. 2012
•Bigomet SR -500mg (Metformin Hydrochloride Extended release tablet) 1 tab. X 2 time daily.From 2004.
#.Thyronorm 125 mcg(THYROXINE SODIUM TABLETS I.P) . 1tab. daily in fasting.from 2004 in variance dosage.
•Duphastone 10mg 1 tab. X 2 times daily (From 11th March 2012)
•Aspimed 75 mg 1 tab. daily (from 11th March 2012)
•Vitamin C 500mg 1 tab. daily
•Folvite 5mg (Folic acid) 1 tab. daily
•Calcium 800mg 1tab.daily.

Now dr. advised to do TVS on 26th march 2012.

CURRENT REPORT OF THYROID PROFILE II IS ATTACHED.
NOTE: This is 2nd pregnancy after 11 years,1st pregnancy in 8th August 2011-but misscarriage in 23th aug 2011.dr.advised dnc.
PL'S ADVISE THE CORRECT DOSE TO CONTROL HYPOTHYROIDISM AND ALSO ADVISE DETAIL REGARDING DIET.
RGDS.
XXXXXXX
Posted Tue, 22 May 2012 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Rahul Tawde 18 hours later
The international recommendation during pregnancy is TSH has to be less than 2.5 in 1st trimester and less than 3 in 2nd and 3rd. T3 and T4 levels have to be in the upper half of normal. So although your TFT is near normal for a non pregnant state your patient requires increase in
Thyronorm dosage because she is pregnant.

Consider increasing thyronorm dosage to 150mcg/d and repeat T3, T4 and TSH 6 weeks later. Medicine has to be taken in empty stomach early morning and there has to be a gap of at least 45 min between medicine and coffee, tea, breakfast etc. In addition there has to be a 4 hour gap between thyronorm and calcium tablets as well.

Nothing specific as for diet is concerned from thyroid point of view. She needs to cut down on cauliflower, cabbage, radish and soya bean -that's all. PCOD patients are at increased risk of diabetes during pregnancy- so avoid too much sweets, free sugars and junk food. Consume lot of XXXXXXX leafy vegetables.
Above answer was peer-reviewed by
 
Follow-up: 36 years, suffering from PCOD,hypothyroidism, conceived after 12 years. On pills. Advise correct dosage to control thyroid and diet plans 28 days later
DEAR DOCTOR,
PL'S FIND ATTACHED CURRENT REPORTON 21ST. APRIL 2012 FOR TSH(0.093 uIU/ML),FT3(2.34 PG/ML),FT4(1.46 NG/DL), CURRENT DOSE OF THYRONORM FROM 25TH MARCH 2012 TILL TODAY IS 150MCG/DAY AS PER UR ADVISE.
NOW PLEASE ADVISE FURTHER REGARDING CORRECTION OF DOSE.

RGDS.
XXXXXXX
 
 
Answered by Dr. Rahul Tawde 18 minutes later
You need to reduce your thyronorm dosage to 137 mcg/day. I think you did total T4 and total T3 last time and this time you have done Free T4 and Free T3. So comparison is difficult between them. Any way the TSh is suppressed which means you need to reduce the dosage. From now on check FreeT3, Free t4 and TSH to maintain uniformity.
Above answer was peer-reviewed by
 
Follow-up: 36 years, suffering from PCOD,hypothyroidism, conceived after 12 years. On pills. Advise correct dosage to control thyroid and diet plans 53 minutes later
Dear Doctor,
Is there is any problem if TSH is below required level, if u will advise i will repeat the test for T3,T4,And TSH, actually here local gynecolgyst advise for FT3, FT4 AND TSH.
PL'S ADVISE. XXXXXXX
 
 
Answered by Dr. Rahul Tawde 12 hours later
No problem at all. It only indicates that Thyroxine dosage is more than required. So i have reduced the dose. Thyroxine dosage needs frequent adjustment during pregnancy and so we check thyroid function tests frequently during pregnancy. There is no need for T3,T4,And TSH again.
Above answer was peer-reviewed by
 
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