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Does your TSH fluctuate throughout the day?
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Does your TSH fluctuate throughout the day?

I have Graves Disease (and other autoimmune diseases) and my thryoid was removed 25 yrs ago.  I've always felt that my now hypothyroidism was acceptably treated.  Recently I was on Prednisone and other antihistamine type drugs for 8 months.  Now that I'm off Prednisone my Endo tested my Adrenal function and it is normal, however my problem is I have gained weight and it won't come off!  I am on a strict (weight watchers) diet of 1150 cal per day and I've increased my exercise to 5 to 6 days a week both aerobic and weight training, yet the scale doesn't budge and if I eat any more or exercise less I actually gain more weight!!!

I have been trying to regualte my Synthroid/Cytomel dosage for many months now.  I was on Sythroid 88mcg and Cytomel 5mcg.  Meanwhile my TSH score has been going up and up consistantly with every test I take (~ every 6 weeks lately).  Test #1 - TSH .35 (I felt great), Test #2 - TSH .68 (I still felt fine), Test #3 - TSH 1.28 (that's when I started to gain weight, need 11 to 15 hrs of sleep a night, lost 50% of my hair and it's still falling out!, brain fog, etc.) and then Test #4 - TSH 2.38 and I feel miserable.

Clearly I feel best when my TSH score if uner 1.  My Endo claims that your TSH fluctuates throughout the day and since I'm still in the normal range, she doesn't want to increase my thyroid hormone.  She did increase it ever so slightly from Synthroid 88mcg to Synthroid 100mcg, but I have not seen any difference so far (though it's only been 2 weeks since that itty bitty increase.

So -- in your opinion, does your TSH score really fluctuate that much throughout any given day?

Joyce
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The TSH will fluctuate a little during the day -- your levels though appear to represent a consistent increase - suggesting a need for a dose adjustment.  May be worth exploring adding additional cytomel (eg 5mcg 2x/day) -- this will require a decrease in synthroid.
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Does anyone know the answer to this "TSH fluctuation" question?
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From what I have read, yes it does, however it does not occur during the time we are tested so we are not aware of it.  I believe I read  between 9 PM and 2 AM and the difference of TSH concentrations is 1 to 4 mU/L.
Sleep prevents the further rise in TSH and reflects in the presence of increases in TSH to 5-10 mU/ml during sleep deprivation.  Remaining awake on a constant routine, TSH levels remained elevated throughout the nighttime hours. I'd think it would be the other way around because with my sleep issues I feel more hyper. Hope this answers your question.


GL,
Just my personal opinion
as a thyroid Patient.
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Thanks. Your response helps. So, if my TSH scores consistantly keep going up, it is because I'm getting more and more hypo and it is not simply a natural fluctuation of my TSH.  I happen to be going to my Endo tomorrow and I am going to insist on an increase in either my Synthroid or Cytomel. I'll go back in six weeks to see where I stand then, but I don't want to stay like this for 4 more weeks before increasing.  I need an increase now.

I have to say, I've had Graves for nearly 30 years now and I've never been kept in this condition before!  My Endo is way too conservative and if she is not going to treat my symptoms and she wants to treat me as a lab score, then I may have to go back to the drawing board and find a new Dr.  This is so depressing.

Joyce
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TSH that keeps going up is not fluctuation, but rather going more hypo. Fluctuation would be TSH level going up and down and down and up - back and forth like that.
I wouldn't jump the gun too fast.  That is to say, adjust your dose before giving the new dose it at least 6 weeks for its effects.  You might not think a dose from 88 to a 100 is enough, but it very well can be speaking from experience.  I was on a 100 which brought my TSH level out of Labs hyper range.  Went to 88 and became out of Labs hypo range, so there can be a difference between the two doses. It takes the full 6 to 12 weeks before feeling the effects and you need to give it its full time. The best is to go low and slow to prevent the ping pong roller coaster effects like I've been going through, for it takes twice as long to get where you want to go - your goal level.  Good luck with the new endo.


GL,
Just my personal opinion
as a Graves' Patient.



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Along with getting these great responses from the expert forum - along this Dr Lupo posting - you may want to include your question on the thyroid community board. Many there can be very informative also.
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