Q: My wife is 33 years old. She is 5 weeks pregnant (conceived through IVF). Her TSH level on 14/7/07 was 7.34, and her Thyroxin levels are normal. She started bleeding two days back. We urgently called doctors in India and they told to start Gestone injections and Thyronorm tablets. She has been daily taking Eltroxin-100 since the last four months. I want to know if Eltroxin and Thyronorm are the same. Did she bleed due to elevated TSH? Can she continue taking Thyroxin, but with increased doses, say 125 mg or 150 mg? She is on daily progestone support of 400 mg. Since we don't have access to Gestone injections here, which is the best possible alternative for that she should take? She is now on complete bed rest. How can her bleeding be stopped? We immediately did an ultrasound, and found out that everything is normal. The sac growth is how it should be in five weeks. Please suggest what precautions need to be taken.

A:Yes, Eltroxin and Thyronorm are the same medicines, and 125 mg a day of Eltroxin would be good enough for your wife. Bleeding is not due to elevated TSH, but a de novo problem. For this, progesterone support, which your wife is already taking, is a very good dose. There is no need to add gestone, if she is inserting progesterone suppositories adequately. The bleeding will stop on its own.