Dr. Ajeet Singh (General Practice) needs a second opinion on this medical case.
A 35 year old female presented to OPD for routine follow-up for Hypothyroidism and T2DM *Chief Complaints* No fresh complaints as of now, she only complaints of pain left knee and gastric discomfort, which I attribute to metformin 2gm/day that she was on *Investigations* RBS - 193 BP - 148/90 PR - 90 Weight - 70kgs Her last TSH was 23.6 in September 2020 and she was on 150mcg L-thyroxine Her recent report of TSH is 18.21 on 16.12.2020 *Management* Previous medications - glimipiride 2mg bd+ Metformin 1gm bd + Linagliptin 2.5mg BD She is started now on - Tab. Gliclazide 60mg XR + Metformin 500mg BD Tab Dapagliflozin 10mg OD Increased the dose of L-Thyroxine from 150 to 175mcg E/S Tab. Telmisartan 40mg OD Tab. Tramadol + PCM SOS for pain I was also willing to advise her a gluten free diet, but she is already taking only 2 chapatis in BD dose, Secondly, I thought of advising her to get herself tested for TTG IgA but I didnt do Please give me your opinion on gluten free diet advises that you give and whether u get someone of this picture tested for TTG IgA??
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