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HYPOTHYROID SYMPTOMS (?) AND THEIR TREATMENT- 3 September 2014
QUESTION-I will appreciate for help in another patient who is a neurosurgeon, had RAI for graves disease in 2009. He has been on levothyroxine since then but for last 6-8 months, he has been having episodes of dizziness and vertigo. He tend to have these symptoms when his TFT levels are in euthyroid range but feels extremely WELL when his TSH is high. His TFT are shown below. I checked his TSH with HAMA and it did not change. As you can see, in May 2014, when his TFT were normal, we had to admit him to hospital for his symptoms. His alpha subunit to TSH ratio is less than 1 when his TSH is 5.5 FT4 is 1.1 ad FT3 is 2.0 and alpha subunit is 0.5. MRI of pituitary has been done and is normal.
Is it pituitary resistance to TH that he AQUIRED in 2013?
Iftikhar A. Malik, M.D. , TCP Endocrinology
|Component||FREE T3||T4 THYROXINE, FREE||TSH|
|Latest Ref Rng||2.8-5.3 pg/mL||0.7-1.9 ng/dL||0.50-5.00 uIU/mL|
RESPONSE-Whether the episodes of dizziness and vertigo related directly to the thyroid hormone levels in the past is unclear. but they could at this time. Most likely your patient needs a slight increase in T4 dose. Most patients on thyroxine need to have a T4 at the top end of the normal range in order to be properly replaced, with normal T3, TSH of 1-2, and feeling best (as on 5/18). The TSH recorded on 5/18 is strange, but possibly his dose of thyroxine was somehow higher just before that test, since his fT4 was at the unusual level of 1.8 at that time. L De Groot, MD
ADEQUATE IODINE SUPPLEMENTATION IN INDIA?? 22 July 2012
QUESTION-Currently, in India we are consuming iodized salts everyday still there is very high prevalence of thyroid cases. My question is that in clinical practice do doctors need to completely avoid any nutritional supplement containing iodine (100-150mcg), considering that we all are consuming iodine salts and additional iodine containing preparation though in nutritional amount will be harmful to patient. Kindly throw some light on this issue. Makwana Altaf A; M.Pharmacy (Pharmacology)
RESPONSE-As you have correctly pointed out the Universal Salt Iodisation Program (USI) in India has had its “ups and downs” and there have been many reports in the literature of it not being as effective as one had hoped for.
Indeed, in a very recent publication in Clinical Endocrinology by Marwaha et al ( Vol 76,905-910) it is clear that iodine deficiency remains prominent in India. In the study population of schoolchildren in Delhi 16.4% had goitre and 7.3% were hypothyroid.
If you cannot access the article please let me know and I will send it to you.
Dr Pandav from AAIMS informs me that current iodised salt coverage in India is only 71%, therefore one would expect to see persistence of endemic goitre and other manifestations of IDD.
The current WHO/ICCIDD/UNICEF recommendation is that where USI coverage is not effective then pregnant women should be taking an iodine supplement of 150 ug per day. There is no recommendation for men or children to take a supplement. It is recommended that iodine intake should not exceed 500 ug per day. The normal iodine RDI for adults and children is 150 ug and for pregnant and breastfeeding women it should be 250 ug per day.
Sincerely, Prof C J Eastman AM