Don't quite understand

[ms320]

I was diagnosed as Hypo over ten years ago.  My dose of Synthoid was gradually increased and I was on 224 mcg for at least 8 years.  This past Jan. I went to see a fertility specialist who routinely tested my thyroid functions.  The results were  Free T4 3.97, T4 19.00 and TSH 0.02.  My fertility MD sent me to another MD to get the thyroid under control.  She has been steadily reducing my synthoid, I am now on 50 mcg.  My problem is this - my TSH is still suppressed - even moreso. Most recently 0.01.  I have also noticed since decreasing my dosage from 75 to 50 I am feeling more sluggish, and I have gained almost 10 pounds despite running 4 miles per day and wt training
Anyway, I don't usually pay too much attention to my thyroid as long as I am asymptomatic and feeling well, but I cannot proceed with IVF until my TSH problem is resolved.
Any clue as to what is going on in this body of mine?

[Meravie]

I dont understand my blood test.  I had a test done on m y thryoid.  Results are
FT4 13.8
TSH1.34
FT 4.28

I have gained 22 pounds over 7 months.  I eat less than 1500 calories a day ( I have a lap band in my stomach for three years).  Is this blood test an indicator of a condition as the numbers are normal however in a low range.  What other tests should I preform, I have asked for a test for the cortisol.  Please help....

[Mark Lupo, M.D.]

Sometimes it takes many months for the TSH to come up if there has been hyperthyroidism for a while.  Would be interested in T4 and T3 levels at this point.  If low, consider a pituitary problem.  If not, then consider stopping the synthroid altogether and seeing what the TSH does and also look at thyroid ultrasound and possible I-123 scan (scan only if TSH still low after stopping synthroid).  There may be some over-activity from the thyroid gland itself.  

My guess is that things (hyperthyroid numbers) are generally improving with decreasing the dose, but the relative decrease in thyroid hormone is contributing to your symptoms (ie, your body is trying to adjust).  

Would also be intrested in thyroid antibodies as well as TSH-receptor antibody to see if the immune system is attacking the thyroid.  Likely your initial diagnosis was Hashimoto's as the cause of hypo.