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Can you clear my doubts on hypothyroidism?

Q: I am a 30 years old female. I was detected with hypothyroidism 3 years back during my first month of pregnancy. It was slightly above the acceptable limit (6.6). I was prescribed Thyronorm 100 mg once daily and I took it regularly throughout my pregnancy. The TSH was in the normal range. I stopped taking Thyronorm for a couple of months after my delivery and got the TSH done. It increased to 9.2 so I started taking Thyronorm again. When I take Thyronorm regularly my TSH remains in the normal range. Does taking Thyronorm daily for long periods (say 20 years or so) have any negative effects in old age. One of my friends says that it may weaken the bones or may lead to paralysis or some heart/brain related problems. Can I plan a second pregnancy or should I get any specific tests done? Do I have to consult an endocrinologist before planning? My TSH level is normal now as I am taking Thyronorm daily. Does having hypothyroidism affect the baby in any way? Is it hereditary? How frequently should I get the TSH test done? Can I have tea/coffee immediately after taking the medicine or should there be some gap after taking the medicine? Do hypothyroid people become fat? How can we detect whether a person has hypo/hyperthyroidism when it is in its initial stages?

A:Long term use of Thyroxine (Eltroxin) if over treated has impact on bone in the form of loss of calcium from bone leading to osteoporosis. But it does not cause any paralysis or brain problems. Other problem is heart enlargement (hypertrophy) and abnormalities in heart rate etc. But remember these occur only if long standing over treatment which can be easily recognised by TSH levels which becomes low. In your case I think you need less dose. You can reduce the dose to 75 micrograms and repeat TSH after six weeks, if normal reduce it to 50 and then again repeat TSH after six weeks if normal continue 50 but if high then increase back to 75 and continue same. This will avoid any impact on your bones. Yes, you can plan pregnancy. Just be sure that your TSH levels are normal before pregnancy. Treatment is monitored by TSH levels which should be in normal range. Once normal range is achieved TSH is done once a year only. But during pregnancy TSH has to monitored every 8-10 weeks. Do not take anything even tea and coffee for 30 minutes after taking the tablet. There is some weight gain in hypothyroidism which goes away as your TSH becomes normal. Most of the patients who are on treatment are overweight, the obesity is due to lifestyle and not due to hypothyroidism. Symptoms of hypothyroidism are lethargy, physical and mental slowness, mild weight gain, constipation, body aches and pains, period irregularities in females. Symptoms of hyperthyroidism are weight loss, increased appetite, nervousness, tremors, loose stools heat intolerance etc. But in a large number of patient these diseases are diagnosed on routine tests.

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