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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for hypothyroidism

Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1418 Questions

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Posted on Wed, 26 Nov 2014 in Thyroid Problem and Hormonal Problems
Question: Hello Doctor,

I am XXXXXXX I am diagnosed with Hypothyroid before 1.5 years, and was suggested 12.5 mcg Thyronorm (but physician made one mistake in prescription - he asked me to take tablet after breakfast and I was following same). I was little irregular in taking dosage also.

Before six months, I am finding problem of - water getting accumulated in stomach. We have consulted family physician and then Gastroenterologist. He did all the tests including liver biopsy, CT scan etc., but all the reports were normal. In my sonography, many times found ASCITES, so CT scan also done but it was normal. (Attaching available reports)

Before one month (13.10.2014), my Gastro asked to do Liver Laparoscopy to diagnose more, but at that time my Thyroid (TSH) was 16.2 and Anaesthetist refuse to carry on laparoscopy. Then we have consulted Endocrinologist on 15.10.2014. He suggested to take 100 mcg Thrynorm daily. I have again gone through test and now the result was increased (TSH-17.0) So he had increased dose upto 200 mcg daily from yesterday and asked me to consult after 03 weeks. My Thyroid test results history is as below.

Date T3 T4 TSH

29.05.2013 NA 0.72 10.33

17.08.2013 NA NA 15.47

18.03.2014 0.84 08 16.95

12.07.2014 NA NA 12.99

03.10.2014 NA 0.67 16.2

30.10.2014 NA 0.36 17.0

My Endocrinologist also given Thyrowell - After breakfast and Calcium tablet after dinner as medication. My weight is reduced from 94 to 69 kg, feeling very tiredness and also feeling balancing problem while walking, even can't stand for half minute. Seek your advise regarding medication and treatment.

Regards,
XXXXXXX
doctor
Answered by Dr. Binu Parameswaran Pillai 32 minutes later
Brief Answer:
Please test only after 6 weeks

Detailed Answer:
Good day,
Noted your concern and sorry to hear your symptoms. Noted that you had been prescribed 100 mcg on 15/10/2014 and again increased to 200 mcg yesterday. Please remember that, once you change or increase the dose of Thyronorm, you need to wait for atleast 6 weeks before you test again. I feel, you can reduce the dose to 150 mcg and recheck the Free T4 and TSH after 6 weeks. Please remember to take Thyronorm in empty stomach.

Kind regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 45 minutes later
Hi Doctor,

Gone through your answer. I still have some questions.
1.) Water is again getting accumulated in my stomach. (May be Ascites - Don't know exact medical term).
2.) Feeling very weak and can't stand even for half a minute. Walking is also problem. Have to take support to walk.
3.) Is there any possibility of Tuberculosis for Ascites. One of my doctors had advised me for Mantoux test and result is as below.
________________________________________________________________
Test
Mantoux Test

MT Test - Positive

Observation

Induration: 17 mm X 15mm present after 48 hrs
Erythema : Present
Result : Positive ( 4 mm-Positive)
________________________________________________________________

Other reports of Ascites are normal related to Tuberculosis are negative.

Is there any possibility of Tuberculosis for Ascites OR it may be possible due to such High TSH value.

Pls. advise.

Regards,
doctor
Answered by Dr. Binu Parameswaran Pillai 1 hour later
Brief Answer:
Ascitis and Thyroid

Detailed Answer:
Hi,
Mantoux is positive. You may require treatment. But this has to be discussed with the physician locally. So many things have to be considered.

Yes, Hypothyroidism can cause ascites. But looking at the amount of ascites and TSH value, I don't think there is any link. Usually TSH will be too high ( >100) and T4 very low in such situations.

We need to think about alternate causes for ascites apart from thyroid problems.

Please discuss with a gastroenterologist regarding Ascitis. Meanwhile continue with 150 mcg Thyronorm

Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 2 days later
Hi Doctor,

Attaching my all the reports till date. My gastroenterologist suggested for Laparoscopy diagnosis for liver.

As of now, I am facing issue of balancing while walking. I am feeling very much difficulty in walking, even I can't walk without support or stand for half a minute.
Is this due to Hypothyroid?

Should I visit any multi speciality hospital like Bombay Hospital or Hinduja Hospital, where I can get all the specialist. Pls. suggest any such hospital to consult.

Regards,
doctor
Answered by Dr. Binu Parameswaran Pillai 2 hours later
Brief Answer:
Need multi speciialty approach

Detailed Answer:
Dear
It is defenitly better to meet a gastroeneterologist and Physician in a multi specialty hospital. Your all symptoms can be explained by this mild case of hypothyroidism. You surely need a multi specialty approach.

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