Q: I am a hypothyroid patient for the past 15 years. I am on eltroxine 100 mcg. My latest report is as follows - T3 1.02, T4 8.62, TSH 1.42. Do I need to regulate my dose? I feel tired in the morning and don't sleep too well too, please advise. How much calcium do I need to take? Is alphaD3 better than shelcal 500?

A:The issue involved in this query is treatment of hypothyroidism and its effect on bones. Adequacy of thyroid hormone replacement is assessed by periodic TSH levels. Goal of treatment is to keep TSH levels in normal range in patients with primary hypothyroidism. Once TSH is normal, it is enough to measure TSH once in a year only. As in your case TSH is normal, so continue the same dose. Symptoms like tiredness and lack of sleep are not due to thyroid disease if hormone values are normal. Go for lifestyle modifications like exercise acand positive attitude etc. for these symptoms. If given in excess, eltroxine causes bone loss and osteoporosis. Over treatment is indicated by low levels of TSH during follow up. Routinely there is no need for calcium and vitamin D therapy in patients who are being treated for hypothyroidism but I would suggest the women who are at high risk for osteoporosis like thin built, poor calcium intake in diet, postmenopausal, etc, its advisable to use calcium one gm/day along with cacirol one sachet per week. In your case I suggest to continue same dose of eltroxine along with shelcal 500mg/day and calcirol one sachet per week.