Q: I have hypothyroidism for the last 14 years. I take 2 tablets of Eltroxin 100 mcg daily in the morning, 2 hours after breakfast. I have not got TSH level tested for the last 3 years. I also take a tablet of Tenoclor-50 every morning empty stomach for high BP control. My blood pressure is usually 145/95 even after this medicine. Is the dose ok or should I get TSH tested again?

A:One should get TSH test done periodically, say once a year, to ensure that thyroid function with medicine (Eltroxin) is normal. With regard to treatment of blood pressure, globally accepted guidelines have now been updated. Betablockers such as atenolol (an ingredient of Tenoclor-50) are no longer accepted as first option. They can lead to development of diabetes when used over prolonged periods. Also their efficacy is less than other medicines not to mention the fact that atenolol decreases pulse, which may already be low in hypothyroidism. For sexually active male patients below the age of 55 years, the first option is to use enalapril (sold under the trade name of BQL, Enam etc.) and titrate the dose from 5 mg once daily to a maximum of 10 mg twice daily, depending on response. If the response to enalapril is not adequate, a low-dose, long-acting diuretic such as indapamide (sold under the trade name of Indicontin Continus - one tablet in the morning) can be added.