Drug continuation query
Dear physicians, This is regarding my mothers thyroid nd dianetes issue. Mother's prescribing physician suggested to take 12.5 mcg of thyroxine as she was detected with elevated TSH value: 8.87 (0.35-5.0 uIU/ml). She was suggested to contineu for 6 weeks and then again perform test to check the status and dose adjustment as per the results. After 6 weeks the value came down to 5.17 (.3-5.5 uIU/ml ), however i feel the TSH is still in borderline. I just want to know wat is the international range of TSH and diabetes (both fasting and pp) because different diagnostic senter have different ranges whivh really makes confusion. Also kimdly let me know whether my mother can contineu on 12.5 mcg or the dose needs to be increased considering borderline TSH level cirrently she is on 12.5 mcg only. Your any help will be really helpful. Please find the attached diabetes and T3, T4, TSH results for your persual. With regards, Padmalochan Rout
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Dr. Abhishek Pandey
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A. For Diabetes, as per international guidelines, Fasting Blood Sugar greater than or equal to 126, Post Prandial Sugar greater than or equal to 200 B. For Hypothyroidism, as per international guidelines first test is TSH only. If TSH is elevated then we go for free T4 ( not T4 ), which is low in primary Hypothyroidism. But if TSH is high and free T4 is high, then it's subclinical Hypothyroidism. If TSH is normal, but patients has symptoms of Hypothyroidism then we repeat TSH and free T4 to get diagnosis of Central Hypothyroidism. International experts define an elevated serum TSH as a TSH concentration above the upper limit of the normal TSH reference range, which is typically 4 to 5 mU/L in most laboratories. Presently there is considerable controversy over the appropriate upper limit of normal for serum TSH. Some experts have suggested that the true upper limit is only 2.5 or 3 mU/L in healthy individuals without thyroid disease, while others argue that the serum TSH distribution shifts towards higher values with age, independent of the presence of antithyroid antibodies . In this case, the upper limit of normal could be as high as 6 to 8 mU/L in healthy octogenarians.
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