Suggest treatment for elevated TSH levels and vitamin D deficiency

Posted on Wed, 25 May 2016

Question: On 15th Feb 2016, I went for a proactive full body check up at apollo clinic and surprisingly TSH level came out as 12.49 µIU/mL. Upon suggestion from a local physician, I did not start any medication and got the TSH, T3, T4 and Vit D tests done on 13th Mar and this time the levels are as follows: TSH=10.17, T3=109, T4=8.1, 25 OH Vit D=19.4. Both T3 and T4 appear to be normal as per reference range however TSH is still on higher side while Vit D shows deficiency. I have attached both test reports for your reference.

Could you please advise what should I be doing next?

Answered by Dr. Ajish TP (20 hours later)

Brief Answer:
Hypothyroidism - start on medications

Detailed Answer:
Hi,

Welcome to HCM. I have gone through your question and understand your concerns.

You are having hypothyroidism. That means your thyroid is not producing enough thyroid hormones. Since you are having only mild hypothyroidism, the T3 and T4 are normal. We usually start on medications once TSH go above 10. So you need to be on thyroid medications (Levothyroxine 25 mcg once daily in empty stomach) even though your TSH is only slightly above 10.

Additional tests you may do are anti thyroid antibodies (Anti TPO and anti TG antibody - blood tests ) and an ultrasound of neck to see the cause and extend of thyroid damage.

Hope I have answered your question. If you have ant further questions I will be happy to help you.

Regards,
Dr Ajish TP
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ajish TP (3 hours later)

Thank you Ajish, I will start with 25mcg and go for additional tests your recommended. Your explanation is very clear and to the point, much helpful for a layman.
Hi Dr Ajish, do you think vitamin D deficiency can lead to hypothyroidism? Given 25-OH Vit D=19.4 for me, could you please recommend dosage for Vit D3 supplement?

Answered by Dr. Ajish TP (35 hours later)

Brief Answer:
See details

Detailed Answer:
Hi,

Welcome back. Sorry for the delay in answering.

1. Vitamin D deficiency is not a cause of hypothyroidism.

2. The dose of vitamin D is 60,000 iu weekly once x 8 weeks as replacement and once in 2 months there after as maintenance dose.

It is available as sachets, tablets or syrup of 60,000 IU single dose preparations. Popular brands are D Rise, Torflash, Arachitol nano, Vit D3 60K etc

Regards. Dr Ajish TP

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar