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Suggest treatment for hypothyroidism

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Posted on Mon, 7 Dec 2015
Question: My brother is 40 yrs old. He had dengue fever 2.5 months back. It was very sever in which his head veins also looked to be swelled. but that became fine in 2 weeks. Thereafter he started loosing weight and when we got some new tests done, we came to know that there was a Potassium and Sodium imbalance in body. Now after 4 weeks, he is now diagnosed with sever sugar level (400 with fasting and 587 without fasting) and thyroid.

Please suggest on immediate next steps.Also there are ketones detected in report
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Answered by Dr. Ajish TP (1 hour later)
Brief Answer:
Sugars very high, needs insulin. Hypothyroidism - needs thyroxine

Detailed Answer:
Hi,

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

The problems with his reports

1. Diabetes - Uncontrolled, sugars high, HbA1C very high

Action needed: He needed to get hospitalised immediately and get started on insulin and intravenous fluids. The treatment of diabetes at this point will be only insulin as his weight loss, very high sugars and ketones in urine suggest insulin deficiency. Once sugars are controlled his weight and general condition will improve and can be tried with oral medicines for diabetes. Ketones are not very high. It will dissapear once insulin is started and fluid intake is increased.

2. Hypothyroidism - His thyroid function is showing high TSH. That means his thyroid is under active and not producing enough thyroid hormones

Action: He needs to be on thyroid medicines. Usually we start thyroxine at a dose of 100 mcg per day (thyronorm or eltroxin).

3. Vitamin D is deficient - vitamin D replacement (60,000 iu once in a week x 8 weeks) is needed. Not a serious problem at present.

4.Other blood parameters are probably abnormal due to dehydration in uncontrolled diabetes. Please repeat it once his blood sugars are controlled.

Since he is having lot of hormonal problems like diabetes, hypothyroidism and vitamin D deficiency, it is better to consult an endocrinologist.

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. Vaishalee Punj
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Dr. Ajish TP

Endocrinologist

Practicing since :2002

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Suggest treatment for hypothyroidism

Brief Answer: Sugars very high, needs insulin. Hypothyroidism - needs thyroxine Detailed Answer: Hi, Welcome to HCM. I have gone through your question and understand your concerns. The problems with his reports 1. Diabetes - Uncontrolled, sugars high, HbA1C very high Action needed: He needed to get hospitalised immediately and get started on insulin and intravenous fluids. The treatment of diabetes at this point will be only insulin as his weight loss, very high sugars and ketones in urine suggest insulin deficiency. Once sugars are controlled his weight and general condition will improve and can be tried with oral medicines for diabetes. Ketones are not very high. It will dissapear once insulin is started and fluid intake is increased. 2. Hypothyroidism - His thyroid function is showing high TSH. That means his thyroid is under active and not producing enough thyroid hormones Action: He needs to be on thyroid medicines. Usually we start thyroxine at a dose of 100 mcg per day (thyronorm or eltroxin). 3. Vitamin D is deficient - vitamin D replacement (60,000 iu once in a week x 8 weeks) is needed. Not a serious problem at present. 4.Other blood parameters are probably abnormal due to dehydration in uncontrolled diabetes. Please repeat it once his blood sugars are controlled. Since he is having lot of hormonal problems like diabetes, hypothyroidism and vitamin D deficiency, it is better to consult an endocrinologist. 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