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Suggest treatment for elevated TSH levels

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Practicing since : 2001
Answered : 1663 Questions
Hello doctor. my name is XXXX. I was diagnosed as having hypothyroidism by doctor. I was given eltroxin 50 mcg to be taken. for four years I took it. but in the middle I took it late in the noon or evening time in empty stomach. recently my TSH was 10.36 then after one month I checked TSH was 8.42 still high. but for the past one and half month i am taking early morning in empty stomach. still it is high. free T4 was 1.69. please tell me if I have to change the medicine or take a stronger dose. but for one day I took eltroxin 100 mcg for high TSH I began to feel worse.

Answered by Dr. Shehzad Topiwala 21 minutes later
Brief Answer:

Detailed Answer:
Sorry to learn about your bothersome symptoms.

You will need fine-tuning of your eltroxin dose. This process of adjusting the dose to individualize it to your body's requirement can take 2-6 months at times.
Generally, when I am faced with reports like yours, I advise a gradual increment from 50 to 75 mcg and recheck TSH and Free T4 in 6 weeks.

When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:

CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)

None of these tests require any fasting and can be done at any time of the day Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person.
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Follow-up: Suggest treatment for elevated TSH levels 13 hours later
doctor, the orthopedoogist prescribed nervijen p one year back for peripheral neuropathy. he told only with diabetes person gets. but I don't have diabetes even now. I came to know due to hypothyroid peripheral neuropathy is there, so my TSH is high. can I stop the nervijen p capsule
Answered by Dr. Shehzad Topiwala 9 hours later
Brief Answer:
Follow up

Detailed Answer:
The purpose of this forum is not to make direct treatment and prescription recommendations. It is also discouraged by the proprietor of this service.

So generally speaking, when symptoms suggestive of peripheral neuropathy occur one should get examined by a Neurologist who will run appropriate test to diagnose the cause. Hypothyroidism and diabetes are two of the dozens of the potential reasons for peripheral neuropathy.
No medication should be started or stopped without consulting a doctor in-person.
Above answer was peer-reviewed by
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