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What Do The Following Test Reports Indicate?

Posted on Mon, 6 Jul 2015

Question: Hello Doctor,
Five months ago, I had some BP & Cholesterol problems. On further investigation, it was concluded that anxiety, BP & Cholesterol problems are due to Thyroid problems. On further investigations, it was concluded that all these are because of HYPO-Thyroid.

January 2015 reports:
THYROID PANEL II, SERUM
FREE TRIIODOTHYRONINE (FT3), SERUM
FREE TRIIODOTHYRONINE (FT3) 3.15 (2.0 - 4.4 pg/mL)
METHOD : ELECTROCHEMILUMINESCENCE
Comments
CORRELATE CLINICALLY

FREE THYROXINE (FT4), SERUM
FREE THYROXINE (FT4) 0.71 Low           (0.93 - 1.70 ng/dL)
METHOD : ELECTROCHEMILUMINESCENCE

TSH 3RD GENERATION ULTRA( TSH3 - UL)
TSH 3RD GENERATION 49.570 High      (0.27 - 4.20 μIU/mL)
METHOD : ELECTROCHEMILUMINESCENCE

I am taking regular medicines and under control since last 3 months. I have got TSH tests done evry month.

Also, I got TPO tests done and results are below:
ANTI-THYROID PEROXIDASE ANTIBODIES >1300.00 (< or = 60 (Negative)> 60 (Positive) U/mL)
METHOD : CHEMILUMINESCENCE

Question:
1)     What is the root cause of this hypothyroid?
2)     Is there any natural ways to cure it?
3)     I am having low sperm motility and my wife is not able to conceive. Is hypothyroid related to it?
4)     Kindly suggest whether line of treatment & medicines are correct or not.
5) I have noticied since last 3 months that I feel like tonsil/slight pain whin pressed near my tonsils/low on the front of the neck. What can be the reason?
Any further treatment/tests required?

Thanks.

Answered by Dr. Ajish TP (13 hours later)

Brief Answer:
See detailed answer

Detailed Answer:
Hi Mr XXXX,

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

The answers to your questions:

1. Your type of hypothyroidism is called Hashimoto's hypothyroidism. This is a auto immune disease - some antibodies are formed in body ( unknown reasons - may be genetic) that destroyed your thyroid gland and decreased its function.

2. There is no natural cure. The thyroid damage is usually permanent in 95% of patients. There are no natural or medical agents for cure. The treatment is replacement of thyroid hormones.

3. Hypothyroidism is not a cause for male infertility. You can do a sex hormone tests (LH,FSH, morning testosterone, prolactin) to see if there are any other causes.

4. The medications are correct. Thyroxine is thyroid hormone replacement and atorlip is for cholesterol.

5. It could be tonsillitis. Please have your tonsils examined by an ENT surgeon.

6. Additional test needed for thyroid is an ultrasound thyroid which will show the structure of thyroid gland and presence of nodules, if any.

Hope I have answered your questions. If you have any further queries I will be happy to help you

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist

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

Follow up: Dr. Ajish TP (11 hours later)

Thanks Doctor for the detailed reply.

Thyroid doctor ( endocrinologist) suggested me Cap Zevit one daily for two months. I took this for two months.

1) Shall I continue further taking Cap Zevit and till when?
2) Today, I got my TSH test done (after 2.5 months) and results are as follows:

TSH 3RD GENERATION ULTRA( TSH3 - UL)
TSH 3RD GENERATION 14.960 High ( 0.27 - 4.20 μIU/mL)
METHOD : ELECTROCHEMILUMINESCENCE

Currently, I am taking 75 mcg of Throxine. 1 tab daily in the morning.
Kindly suggest.

3) Also, I came to know that MOST of the hypothyroid patients are having deficiency of Vitamin D & B12. I am non-vegetarian. Kindly suggest whether I shall get the Vitamin D & B12 tests.
QUOTE -
" 3. Hypothyroidism is not a cause for male infertility. You can do a sex hormone tests (LH,FSH, morning testosterone, prolactin) to see if there are any other causes."

I have got my LH,FSH, testosterone tests done a year ago and they were ok. Shall I get these tests again?

Also, I have read many articles & my endocrinologist also told that Hypothyroid brings down your sperm quality & motility. How correct it is? Please give references.

Answered by Dr. Ajish TP (8 hours later)

Brief Answer:
See detailed answer

Detailed Answer:
Hi,

Welcome back.

1. Zevit is a multi vitamin. You can continue the medication as a health supplement.

2. Your TSH is high. Are you regular with medications- morning empty stomach? If so you need to increase the dose after consulting your Endocrinologist. We usually increase the dose to 100 mcg.

3. Vitamin D and B12 deficiency are seen with hypothyroidism. So you can do the blood tests.

4. If you have a previous normal LH,FSH and testosterone - no need to repeat it if your sexual functions ( erection and sexual interest) are normal. If not, repeat the tests.

5. Both hypothyroidism and hyperthyroidism are associated with problems with sperm productions. These reports are not consistent and the mechanism are not clear. It is not closely related to infertility and abortions as in females. Still when thyroid function is abnormal, we will try to normalise it.

reference : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/ Elzbieta Krajewska-Kulak and XXXXXXX Sengupta - Thyroid Function in Male Infertility

If you have any further queries I will be happy to help you

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist

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

Follow up: Dr. Ajish TP (2 days later)

Thanks once again.

1)
Quote- "Your TSH is high. Are you regular with medications- morning empty stomach? If so you need to increase the dose after consulting your Endocrinologist. We usually increase the dose to 100 mcg."

I consulted my doctor and he has advised me to increase the dosage to 100 mcg daily. My weight is 79 kg and height around 5.10 feets.

Is that the correct dosage?

2) Is weight also a factor to determine the thyroxine dosage?

3) Quote- "Zevit is a multi vitamin. You can continue the medication as a health supplement."

I took Zevit for around 2.5 months between XXXXXXX to Mar 2015. Kindly suggest that if I start how long shall I take it since overdose of vitamins is also bad.

4) Quote - "Your TSH is high. Are you regular with medications- morning empty stomach? If so you need to increase the dose after consulting your Endocrinologist. We usually increase the dose to 100 mcg."

Yes, I try to take it regularly. Sometimes, I forget to take it in the morning. (twice or thrice in a month). Shall i take it later in the day? If yes, when? Empty stomach during the day?

5) Minimum how long shall I wait for breakfast after taking throxine tablets?

Thanks.

Answered by Dr. Ajish TP (8 hours later)

Brief Answer:
See detailed answers

Detailed Answer:
Hi,

Welcome back. I understand your concerns. The answers :

1. Your Endocrinologist has appropriately increased the dose to 100 mcg. You can recheck TSH after 6 weeks to see if the dose is correct.

2. Weight is a factor for starting Thyroid medications. We start thyroxine initially based on weight. Then further adjustment is based on TSH values.

3. Zevit contain water soluble vitamins. So even if you take excess it will be excreted through urine. So no issues with over dose if you are taking it once daily. This is a diet supplement and no problems in having it regularly. If your diet is well balanced, you need not have any supplements.

4. If you miss a tablet, you can take 2 tablets next day. ( this is because thyroxine has half life of 3-4 days). If you prefer to take it same day, you can take it 4 hours after a meal and 1 hour before next meal.

5. You can take breakfast after 1 hour of thyroxine.

Hope I have answered your questions. If you have any further queries I will be happy to help you

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist

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

Follow up: Dr. Ajish TP (15 hours later)

Thanks for the details which my doctor never told.

1) I will start taking Zevit for 2 months and will then stop. As I said, I took it for approx 2 months starting XXXXXXX 2015.

2) Will try to take a gap of 60 minutes before my breakfast after taking throxine. Since, I have to rush to office, I usually get approx 30 mins only.

Regards.

Answered by Dr. Ajish TP (6 minutes later)

Brief Answer:
wishing you good health

Detailed Answer:
Hi,

Great to know that the information provided were useful to you.

Wishing you good health. I will be happy to help you with any further queries in future.

Regards
Dr Ajish TP

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Shanthi.E