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In pre-diabetic and sub-clinical thyroid stage, have observed rise in HbA1c. Should I start thyronorm?

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I am aged 54 years and am now in a prediabetic stage. Gradually my HbA1c has been rising from 5.6 to 5.8, then 6.0 , 6.2, 6.3 and now it is 6.8.This has taken nearly 5 years to increase. My adiponectin level is low, and my weight has been consistent between 72 to 74 kgs for past 8 years. My TSH has been between 7.5 to 9.4 for past 5 years. I am on Betaloc 25mg 1-0-1 , Fenolip 145 for high uric acid and Triglycerides for past 5 years. My HDL has been at 29mgs/dl for past 25-30 years. My diet, work style is all very well controlled. Now it looks like Insulin resistance has developed. Should I start with 50mcg Thyronorm, which may improve upon my prediabetes and thyroid (sub clinical) status as well. Is metformin required at this stage ? because my FBS is 110mgs/dl and PPBS 1.5hrs is 154mgs/dl. Only HbA1c is increasing!!! Let me know. Thank you.
Posted Thu, 6 Jun 2013 in Diabetes
Answered by Dr. Om Lakhani 58 minutes later

Thank you for your question.

Your TSH is high. I would advice you to get done Free T4 and Anti TPO antibody. If your free T4 is low or Anti TPO is high, there is an indication for starting Thyronorm. What is your LDL ? High LDL also is an indication for starting Thyronorm.

You high TSH could explain the higher HBA1c without weight gain and treatment with Thyronorm would help in this regard.

Your sugars including fasting and PP2BS and HbA1c are in Prediabetic range. One report of HbA1c is 6.8 % which is frankly Diabetic ! However I would not read much into one report. We would start with thyronorm first. Once your thyroid levels are under check we may take a call on Metformin later on.

Hope this is helpful

With Regards
Dr. Om Lakhani.

Above answer was peer-reviewed by
Follow-up: In pre-diabetic and sub-clinical thyroid stage, have observed rise in HbA1c. Should I start thyronorm? 15 minutes later
I have forgot to mention , my FT4 is normal 1.4ng/dl (0.8- 2.1 NR), and Thyroid antibodies are normal. LDL is also normal 72mgs/dl.Inspite of this should I start on Thyronorm, so that metabolic syndrome/insulin resistance gets corrected.
Answered by Dr. Om Lakhani 4 hours later

You have what is known as "Subclinical hypothyrodism" The indications of starting treatment in subclinical hypothyrodism are :

1. Anti TPO positive
2. High LDL
3. TSH >10

You donot full fill any of these criteria so I we will not consider using Thyronorm as of now.

We can start Metformin 500 mg Sustained Release prep once a day. This will reduce the insulin resistance. Metformin is now indicated for use in Prediabetes and can infact prevent development of Diabetes in future. Also it will bring down Insulin Resistance. You can have you HbA1c and Thyroid function test repeated after 6 months

With Regards
Dr. Om Lakhani

Above answer was peer-reviewed by
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