Thyroid Test Shows TSH 10.1. Should I Take Thyronorm Continuously. Why Prescribed Higher Dosage?

Posted on Mon, 18 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 18 Nov 2013 Answered on

Mon, 9 Dec 2013 Last reviewed on

Question : Dear Doctor, I am 71 year old male. I have in the year 2011 casually undergone blood test for Thyroid. While the T3 and T4 are normal, TSH shown 10.1. I have not even one symptom of thyroid disorder so far. My physician prescribed 25mg as a starting dose for Hypothyroidsm.The following table shows my blood tests and the prescribed dosages by my phisician to me. Please go through and give me your personal and XXXXXXX opinion.Also please advise me whether I have to continously take the Thyronorm to the rest of my life or can i stop it forthwith, as i have no symptoms at all. Date reading Dosage 17/8/11 10.1 25 mcg 8/9/11 8.4 50 mcg 1/12/11 9.8 50 mcg 29/2/12 6.1 75 mcg 14/6/12 6.0 75 mcg 26/8/12 1.3 75 mcg 26/11/12 3.7 75 mcg 13/2/13 2.01 100 mcg 21/7/13 1.9 100 mcg 16/10/13 0.4 75 mcg All these doses are taken as advised by my phisician Though the readings from Aug 26th are well below normal level i.e 0.35-5.5 mclU/ml why should i have been asked to take higher dosage? Is it due to taking into aspect my other health conditions like BP (1980)/Diabetes (2010)( both are always normal), or these conditions do not have any bearing on my hypothyroidsm.Kindly advise in detail.

Answered by Dr. Chakravarthy Mazumdar (-5 hours later)

Brief Answer: Need complete thyroid profile Detailed Answer: Hi, Whether to start a person on thyroxine supplements or not is a question of ambiguity after 70 years of age with multiple medical conditions. I would like to know your complete thyroid profile not TSH alone. Serum TSH, Free T3 and Free T4 is also important. Most of thyroxine is protein bound and post 60 years the protein is gradually lost so free T4 has a significance and vary enormous to influence the body's metabolism. Physicians try to acheive a target TSH level below 3.5 and may be till 2.0. Not this, the medicines that you take for High BP and sugar would influence the thyroxine supplements. They have complex interactions fluctuating the levels of thyroid. So there is no definite answer for your query posted except to go under intense monitoring again under the guidance of true and certified Endocrinologist. I suggest you to undergo intense thyroid monitoring not with TSH alone but with complete thyroid profile under the guidance of an Endocrinologist. You may consult Dr. S. XXXXXXX near XXXXXXX Mandir / Dr. XXXXXXX who are well known in your area. Thank you.

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Chakravarthy Mazumdar (20 hours later)

Dr.Mazumdar, I thank you very much for your expert advise. I give below the levels of T3 and T4 for your persual and necessary advise. Date T 3 Reading T 4 Reading 5/8/11 1.6 6.5 1/12/11 1.7 5.8 29/2/12 1.6 7.7 Since they are in the normal ranges, i was not asked by thedoctor to undergo these two tests. Kindly advise

Answered by Dr. Chakravarthy Mazumdar (3 hours later)

Brief Answer: Free or Total Detailed Answer: Are these total T4 or Free T4 results that were mentioned above. IF they are free T4 then these are not optimal values. The optimal values are around 1.5 for Free T4. and around 320 for Free T3. I would mainly rely on TSH, Free T3 and Free T4 values. On very few occasions the optimal TSH was achieved in the above list ( Optimal TSH is around 1.5 to 2). So I still suggest that the monitoring was not a standard line of care and advice to meet an Endocrinologist for further management. Hope the serum cholesterol and HDL levels are normal.

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Chakravarthy Mazumdar (11 hours later)

Dear Doctor, The desired values given for T3 and T4 are shown against these two are as follows.I do not know they are free or not. Desired levels T3 -- 0.8 to 1.6 ng/ml T4 -- 4.8 to 12 ug/dl LIPID profile as on 16/10/2013 Serum Cholestrol 132 mg/dl 125-200 Serum Tryglycerides 147 mg/dl Risk if more than 150 "" HDL 41 mg/dl Risk if less than 35 "" LDL 65 mg/dl Risk if more than 130 "" VLDL 36 mg/dl 10-35 Blood sugar leels HB A1c 6.4% Meanblood glucose 150 mg/dl 70-110 Fasting serum glucose 119 mg/dl Urine sugar Nil SErum Urea 23 mg/dl 17-43 Serum Creatinine 0.7 mg/dl 0.8-1.4 Doctor in the light of this , please give me your opinion

Answered by Dr. Chakravarthy Mazumdar (10 hours later)

Brief Answer: Do not stop Thyronorm without physician consent. Detailed Answer: All the other values look good except for the blood glucose. The blood glucose is not under control. The HbA1c is also raised that means it is not under control. Please do not stop Thyronorm by yourself. You should do it under the guidance of your physician. If your physician does not want to stop it, you can seek another Endocrinologist review before stopping it. It should be gradually stopped if the target T4 levels was achieved. Caution here the doctor should get thyroid profile test each time there is a dose change. Hope this is clear.

Above answer was peer-reviewed by : Dr. Aparna Kohli