Why are 2 sets of thyroid labs taken 3 months apart so vastly different?

[duchess101]

I was diagnosed with Hashimoto's about a year ago.  I started off with a TSH of 10.71, high antibodies and was extremely sick with everything imaginable. Initially taking 50mcg of synthroid, it was gradually increased to 88mcg by February. Feeling a little better but still plagued with many symptoms, especially extreme fatigue,I went back to my doc and had my labs done again. This time I was "hyper" and  out of range with my TSH .02 FT4 2.43 FT3 5.64. My doctor told me that some people have to be "high" to feel normal. Well, I guess I could accept that if I DID feel normal, but believe me, I felt anything but normal!  I explained to her that over the last nine months that I had reached a plateau: I had got to a point where I was feeling just well enough to barely function normally.  My health had simply stopped improving over the past couple of months.  She dismissed this and recommeded that I stay on the 88mcg of synthroid and come back in 3 months. Frustrated and sick and tired of feeling crappy, I took it upon myself, even with my "hyper" results, (I had absolutely no hyper symptoms) to increase my synthroid to 112mcg. If what she was saying was the true, just maybe I had to be "higher" still to find further relief.  That brings us to the present. Last week's labs were TSH 4.09 FT4 1.28 FT3 2.61.  How could these results be so radically different when I've increased my meds???  Even though FT4 and FT3 are in normal range, they're leaning toward the low side and the TSH is not nearly where it should be.  And the worst part of this is that I still feel the same way! Help!

[Mark Lupo, M.D.]

Does not make sense that increasing the dose increased the TSH unless 1) lab error 2) interfering meds/food/supplement 3) change in brand 4) inconsistent dosing AND/OR 5) progressive thyroid failure.  There may be more reasons that are rare.

In any case if you had been consistent with syn 112 for 2 months prior to TSH 4.09 and you are not on interfering meds -- estrogens, zoloft, iron etc then inc to 125mcg -- I disagree about keeping the TSH @ 0.02 being okay.  The goal is around 1.0.  WIll likely need labs every 8 weeks until stable pattern

[mrs. bug]

It sounds to me like you need a smarter doctor.  One that will put more effort into  helping you feel better rather than dismiss you for another 3 months.  There are lots of other things that could be affecting how you feel and your body's tolerance to synthetic T4 medication.  Before the stupid TSH test was used, doctors knew how to treat Hashimotos patients to eliminate their symptoms.  Now it seems that most of them just give you Synthroid and send you away for months at at a time.  This is just not acceptable!
TSH is Thyroid Stimulating Hormone.  It is just an "order" from your pituitary gland to your thyroid to release hormone into your system.  The greater the need that goes unanswered ,  the higher your TSH level becomes.With Hashimotos, your thyroid can still produce some hormone off and on until the antibodies destroy it completely.  When you added the synthroid to your system, your TSH went down because you had as much T4 as you needed. Your own thyroid then stopped putting out hormone because the pituitary gland wasn't calling for it. Then the level of T4 went down in your system and your synthroid dose stayed the same.  Your body then needed more T4 so the pituitary sent anther message(TSH) to your thyroid to put out more.  Your own thyroid couldn't so the TSH went higher calling for more.  That is why your labs look that way.  
This is why you need a doctor who will help you manage your disease.  Getting all of the hormones in balance initially take a lot of attention.  and  There are lots of other drugs besides Synthroid that might work better for you.

[GravesLady]

Some people have both hashi and graves' antibodies and swing back and forth between the two with levels and symptoms, creating a push-pull situation, playing havoc on you system.  This is not a very common situation, but it is believed by some that graves and hashi are different phases of the same disease.
The hyper side is delt with first, then the hypo side.
Hyperthyroidism symptoms don't cancel out your hypothyroidism symptoms, they are added to them.

Ask for a full antibody profile to detect the presence of both Hashimoto's thyroiditis and Graves' disease.