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 ?

[saikatde]

Can you please respond to my previous questions ? Thanks.

[saikatde]

Thanks doctor for your detailed views. She has not yet gone thru any Calcium tests, but a recent Xray of her left knee joint had suspected osteoporosis.

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 ?

[Mark Lupo, M.D.]

Agree with slight dose increase for borderline high TSH in patient with hypothyroidism, but thyroid does not explain other labs particularly the high ESR which may have been infection as seems to have resolved.  Would test Caclium levels to make sure not high in face of low D -- such a pattern would suggest parathyroid disease.  Calcium levels should be low-ish with low D and would improve with correcting low D.