Help needed for TSH & CBC Test Results

[saikatde]

My mother (age: 55+ yrs) is a patient of Hypothyroidism. She had Goiter earlier, for which she had undergone surgery in Jan, 2000, due to which one full & another half of her thyroid glands were removed. She currently takes Eltroxin 50mcg daily. Recently she had a TSH test, which shows a value of 4.38, where normal lab range is 0.27 - 4.2. Her previous TSH test had been done in Oct, 2007 where TSH was 3.01 in a lab reference range up to 6. Since her current TSH level is a little higher than normal, our doctor advised her to take 75mcg of Eltroxin instead of 50mcg.

Couple of months back she had a fever with cough. As advised by doctor, we have done her CBC tests, results of which are mentioned below -
Haemoglobin : 12.1 (Range 12.5 - 16.00)
Packed cell volume : 37.3 (R 37-47)
RBC Count : 4.17 (R 4.2 - 5.4)
Mean corpuscular volume : 89 (R 78-100)
Mean corpuscular haemoglobin : 29 (R 27-31)
Mean corpuscular haemoglobin concentration : 32.4 (R 32-36)
Total leukocyte count : 8900 (r 4000 - 10500)
Neutrophils : 74% (R 40 - 75)
Lymphocytes : 18 (R 20 - 45)
Eosinophils : 03% (R 01 - 06)
Monocytes : 05% (R 02 - 08)
Basophils : 00% (R 00 - 01)
Platelet count : 1.5 lakh/cu.mm (R 1.5 - 4.5)
ESR : 88 mm/hr (R 0 - 30)

Recently we have again done her few tests, results of which are mentioned below -
Current haemoglobin : 11.4 (R 12 - 16)
Current ESR : 29 mm (R < 30 mm 1st hr)

Couple of months back, she developed a high BP (160/110), for which medication (Olsar 40mg tablet) has been started. After one month BP shows 135/80 & after two more months, it shows 120/70. Also, she has osteoporosis due to vitamin-D deficiency (around 14 ng/ml), for which she is taking medicines (vitamin-D, potassium & phosphorous tablets) as per advice of an orthopedic doctor. So, overall, are we on the right track in terms of the treatment & is there anything to worry about ?

[Kenneth N. Woliner, MD]

I did respond- please see the May 27th post -your questions are too complex and must seek out a doctor for further answers. Thank you.

[saikatde]

Can you please respond to my previous questions ? Thanks.

[saikatde]

Thanks Kenneth. Just couple of more questions -

1) Do you think the current ESR "29 mm (R < 30 mm 1st hr)" is ok for my mother ?

2) Do you suggest any dietary or lifestyle change for her (considering the details in my first post) ?

[Kenneth N. Woliner, MD]

At this point, your questions are complex enough to have a good evaluation with an official doctor-patient relationship. Florida's Board of Medicine allows for Telemedicine (with the exception of controlled substances). iPhone pics sent via e-mail or Skype connections work, so if you can't find a doctor near you, and you can't travel to Boca Raton, that may be your next step to resolve your troublesome symptoms.

[saikatde]

Hello Doctor,

Recently we have again done her few tests, results of which are mentioned below -
Current haemoglobin : 11.4 (R 12 - 16)
Current ESR : 29 mm (R < 30 mm 1st hr)

Considering all these details, can you please help me with the below mentioned questions -

1) Regarding TSH, she started taking the new dosage as suggested by our doctor (i.e. 75 mcg).
a) When should she again go for Thyroid tests ? Is there any other test (except TSH) needed ?
b) Is there any dosage adjustment needed ?

2) Regarding her high BP (160/110), she started taking Olsar 40mg daily. After one month BP shows 135/80 & after two more months, it shows 120/70.
a) How frequently her BP should be checked ?
b) Is there any dosage adjustment needed ?

3) Overall is there anything to worry about ?

4) Any other specific suggestion (e.g. precaution, diet, life style etc.) for her ?

[Kenneth N. Woliner, MD]

With minimal symptoms nor signs of worsening heart disease or osteoporosis, most patients and docks are not overly concerned. Any infection/inflammation can raise the sed rate (ESR), but it should be re-tested when not sick, to see if it came down. Same is true for vitamin D, if it doesn't come up (50-100 is optimal), dose adjustments are needed.

As for thyroid, if patients have symptoms that are troublesome, I get more aggressive with the Eltroxin or other thyroid meds (Cytomel, natural desiccated thyroid, etc). Otherwise, I don't force patient's to come in every other week for blood draws and medication adjustments.