TSH level elevates after increasing Synthroid

[New AggieMom]

I am a 49 year-old female that was diagnosed with hypothroidism about 6 years ago & went through early menopause. I feel normal when my TSH level is kept at 1.0 bu my TSH has bounced around along with my weight. My TSH levels have reacted appropriately when my Endo Dr. has adjusted my synthroid. In April,'05 I lost 15% of by body weight-still overweight though- my TSH dropped too much.
Lab Work on 04/2005 after taking synthroid dosage 224mcg-2x112
TSH was .032
T3 286
T4 1.6
ANA1:80
PTH 81
CAl 10.7
Bun 27
Treatment: reduce synthyroid to 200mcg

Lab work on 10/2005 after taking 200mcg (gained weight back)
TSH 5.07
T3 275
T4 1.2
ANA1:80
PTH 68
CAL 10.6
Treatment: Increase synthroid to 212mcg (1-100 & 1-112)

Lab work on 4/2006 after taking 212 mcg
TSH 6.07
T3 277
T4 1.4
ANA neg.
PTH 90
CAL 10.4
BUN 26
Treatment: Increased to 250mcg (2x125)

Retested on 07/2006
TSH 12.61
T3 250
T4 1.4
PTH 71
Cal 10.7
Treament: Retested, no dosage change

My meds have always been taken alone with water 1 hour before food.  Should hear this week on the re-test. Could there be other organ/gland/antibodies problems going on that is causing this upward trend in my TSH? While charting these #'s, I noticed my BUN are slightly above normal, any ideas there?

I also have hyperparathroidism that we are watching. I had 2 parathroids removed in 2002 but my calcium never came down as was expected--it stays around 10.5 to 10.7. Path report revealed that surgeon removed 'good' parathroids-my luck!

Any information or direction would be appreciated. Thanks

[Mark Lupo, M.D.]

No other meds?  Always getting brand Synthroid?  No increase soy in diet?  No recent anti-acid treatments? Those are just a few possibilites.  HRT?

Consider Sprue antibodies (to diagnose malabsorption due to celiac sprue).  Not likely, but possible.

Otherwise simply increase until TSH back to 1.0.

PTH/Ca is clearly still a problem -- have they localized the culprit of the "two" remaining glands?  At your age, watching is not preferred -- repeat surgery is likely inevitable but you must "localize" an excellent surgeon.  Search the web for parathyroid and you might come across a few....

BUN is slightly elevated, not clear why -- often dehydration does this

[New AggieMom]

Thanks for your speedy reply.  In response to your questions, no other meds have been taken, no soy in diet, no anti-acids and no HRT and yes to always getting the synthroid brand.  

In regards to the PTH, finding a parathroid surgeon specialist in Houston has been a challange. A Dr. Norman in Tampa, FL has a parathroid.com website and a friend actually went to Tampa for her surgery. My sestamibi scans were negative but my blood count showed I have a problem. I emailed all my path and surgerical reports to Dr. Norman and his reply was that he wouldn't want to take the chance in another surgery especially since living a 'normal' life without parathroid is challenging. I am scared to think of what could happen if I don't or if I do have another surgery.

[lhowell]

AggieMom, I am in the Houston area also.  I'm just curious if the doctor who removed your parathyroid glands is in the Houston area?  If so, would you mind sending me an email with his/her name so I can steer clear if I should ever need that surgeon?  Also, I have come to the conclusion that it's nearly IMPOSSIBLE to find a good endocrinologist in Houston!  I've already been to 2 of the top rated ones in Houston and neither were helpful at all (and actually contradicted eachother).  Currently my GP is treating me and is doing a good job thus far.  If you know of one in the area, would you mind passing the name along?  I appreciate it.  

Sadly, we all don't reside in the Sarasota area. :(

My email is ***@****

Thanks!

[Free Bird82]

I have been diagnosed with hypothyroid since December 2005.  Only started on meds in April.  TSH was 12.5 then & they put me, a 147lb. woman on 12.5 mcg Synthroid.  I took it faithfully for a few weeks, then increased my own self to 25mcg.  When I went back to the doctor 2 weeks ago, my TSH rose to 15.58 & Free T4 is 0.48!!  They now have me on 50mcg. tabs, but I feel that I should have more aggressive therapy.  At least be on 75-100mcg., or get checked in four weeks instead of six.  Also, is it possible for the Synthroid to not work ever?  Will I eventually go down with my TSH?  Dr. also is monitoring my cycsts/nodules (multi) - under 1cm all of them, non-palpable & he says he is "not worried" about them.  This is an Endocrinologist.  Could my TSH be elevated due to a cancer, or is is only because the stupid dosage is and was way too low?  

Thank you so much

[Mark Lupo, M.D.]

I am surprised Jim Norman did not suggest repeat surgery -- many of the cases he does are second/third operations.  Perhaps he did not think the risk of surgical hypoparathyroid (yes, tough to treat but treatable) was worth it at this stage of relatively mild persistent hypercalcemia -- but the odds are it will only get worse and that surgery will be indicated at some point.

[Denise23]

A related discussion, Appropriate TSH levels after complete thyroidectomy was started.