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Fluctuating tsh
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Fluctuating tsh

I had a subtotal throidectomy i1971 iam 51 years old. Always had a tsh around .50 and free t4 aroun1.4. Never had a dose change until 2 years ago, and have never been the same. In November  my tsh was 1.69 free t4 1.3.....2 months later tsh 6.20 free t4 1.2...dose change 6 weeks ago, still feeling very sluggish, tsh now 1.05..free t4 1.4. My question is how can a tsh swing this much in such a short amount of time, and is 6 weeks to soon to feel a little more energetic if with good lab values for me personally. thank you


This discussion is related to Fluctuating TSH Levels.
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649848_tn?1357751184
It's normal for TSH to fluctuate.  TSH is a pituitary hormone that signals the thyroid to produce hormones.  

Subtotal means you still have some of your thyroid left, so perhaps the remaining portion has been helping the medication all this time, but has finally given up and stopped producing hormones. Why did you have part of your thyroid removed?

Have you had a Free T3 test, along with the FT4?  FT3 is the hormone that correlates best with symptoms.  

It normally takes approximately 4-6 weeks for a dosage change to reach full potential in your body, so no, it's not too soon to feel more energetic.
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Avatar_m_tn
Neither TSH or Free T4 actually causes biological activity at the cell level in your body.  Only Free T3 does that.  TSH is a pituitary hormone that is affected by so many variables, including time of day when blood is drawn for the test, that it is totally inadequate, even as a diagnostic for thyroid.  At best it is an indicator, to be considered along with more important indicators such as symptoms, and also levels of Free T3 and Free T4.   Free T3 is the most important because it largely regulates metabolism and many other body functions.   Scientific studies have also shown that Free t3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.

So you really need to know the level of Free T3, along with Free T4 and TSH.  If the doctor resists testing for Free T3 then you should insist on it and don't take no for an answer.  Even though the doctor might tell you that if your Free T3 is adequate, then Free T3 will be okay also.  That is frequently not the case because hypo patients taking thyroid meds often find that their bodies do not adequately convert the T4 to T3.  In view of its importance, why not just test and be sure?

The next issue may be that your Free T3 is within the range, so the doctor will tell you that it is "normal", and not a problem.  This is also incorrect because the ranges have never been corrected like done for TSH 8 years ago, so the ranges are far too broad.  Many members, myself included, report that symptom relief for them required that Free T3 was adjusted into the upper third of the current range, and Free T4 adjusted to around the middle of its range.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can gain some insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

If you are able to get the Free T3 testing done, it would also be a good idea to test for vitamin D, B12, ferritin, and a full iron test panel.  When results are available, if you will get a copy and post results and their reference ranges, members will be glad to help interpret and advise further.

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Avatar_f_tn
Thank you so much for the reply. I was 10 when my surgery was done. It was in 1971, I have no idea why they left some. I have been to 4 endo's here in florida. None of them believe in the free t3, all say body does that on its own. I have had the 2 worst years....once they started messing around with my thryroid dose, I have never been the same.
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Avatar_f_tn
Thank you..endo's here reluctant on the free t3 test, not sure why. Have had vit d and b12 all good. will get with pcp ask her to test free t3 and iron panel.
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Avatar_m_tn
Just tell the doctor that frequently hypo patients taking significant doses of T4 med find that their body does not adequately convert the T4 to T3.  In view of the fact that Free T3 has been shown to correlate best with hypo symptoms, and Free T4 and TSH did not correlate, why not test and be sure of Free T3 level?  It's that important.
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