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Why is my TSH up then down and up and down..
Good Afternoon,

I was diagnosed hypothyroid about 2 years ago by my PCP, at the time my TSH was 8.7.. For years I had told many of the my PCPs I had that I felt lethargic, just down right terrible. I had migraines, seeing "floaters"..  I knew something wasnt right.  When I finally found a Dr to test my thyroid, sure enough it was 8.7 so he put me on 50mcg and off I went..  I started feeling SUPER.. I was able to function!! About 2 months later I was in the same boat, no insurance and not able to have my TSH checked, I stopped the meds.. I thought maybe I became hyperthyroid.  Anyway.. to make this long story short...  about 3 Drs later and a trip to my OBGYN, I finally was put back on my synthroid @ 25mcg by my OBGYN that explained to me that once your Hypothyroid, it just doesnt go away.. my labs showed my TSH was 5.8 which is just above normal range, however.. it was unacceptable for him.. he said that 2.5 is optimal, especially if I was feeling Hypo..  (I was taking a diet pill, I believe that this caused my TSH to probably be lower and effect my test) ..  Ive been on 25mcg for about 5 months now and I was feeling GREAT....and my TSH was 2.2!  Well now im feeling hypo so going back to the Dr he did some more blood work and it was still within normal range @ 3.5 but he said it wasnt optimal and he said he would try upping it to 50 MCG now..

NOW MY QUESTION :)

Why is it that my TSH levels teeter totter like this?  Should I find an endo Dr now?  As of right now I am seeing my PCP ..  bless his heart, besides my OBGYN he seems to be the only Dr  to want to help me!  but I feel that maybe an endo Dr would be better suited for the job..  

sincerly,
frustrated and exhausted
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7 Answers
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Avatar universal
The first thing to be aware of is that TSH is a pituitary hormone that is affected by many variables and it does not correlate very well at all with hypo symptoms.  At best TSH is only an indicator, to be considered along with more important indicators, which are symptoms and the levels of the actual, biologically active thyroid hormones, which are free T3 and free T4 (FT3 and FT4).  FT3 is actually four times as potent as FT4 and FT3 largely regulates metabolism and many other body functions.  FT3 levels also correlate best with hypo symptoms.  

Trying to regulate a thyroid paient's medication is like trying to fly an airplane while blind.  In my opinion the very best way to treat a thyroid patient is to test and adjust FT3 and FT4 levels with meds, as required to alleviate symptoms.  It is really all about symptoms, not TSH level.  You should also be aware that the reference ranges for FT3 and FT4 are so broad, that many patients with test results in the lower half of these ranges, and who are told by their doctors that they are "normal", still continue to have hypo symptoms until their med is increased enough to move their FT3 and Ft4 levels into the upper part of their ranges.

If your doctor is willing to treat you clinically, by which I mean by testing and adjusting your FT3 and FT4 with meds as required to alleviate symptoms, then that's what you need.  If the doctor only wants to test and adjust based on TSH, then you will need to find a good thyroid doctor.  Also be aware that not all Endos are good thyroid doctors.  Many specialize in diabetes, not thyroid.  Also, some are so rigid in their treatment protocol that they also won't treat a patient clinically, but only by the lab numbers and reference ranges.  So if you find yourself needing a good thyroid doctor, you might post a request here, looking for a recommendation from one of our happy members.  

You might also get some good info from this article.

http://www.hormonerestoration.com/Thyroid.html
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Sorry, I noticed an omission in second paragraph.  I meant to say that trying to regulate a thyroid patient's medication based on TSH alone, is like trying to fly an airplane while blind.  
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It sounds like your OB/GYN is the best caring Doctor you have right now. I know your PCP is a good Doctor, but you really need to see an Endocrinologist now. They will work with you and are patient when you have tons of questions to ask. My Endocrinologist is wonderful! My sister-in-law also sees her for her thyroid issues.
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Thank you for the advice, my Dr touched briefly on my T3/T4, all I remember him saying is that my T3 or T4 was optimal at 1.3 or something to that affect...  However I still have hypo symptoms.. Im really wondering what else could be going on..  If there is something else  that is effecting my thyroid ..  My symptoms are usually the EXTREME fatigue, migraines with ocular migrains "floaters"  and terrible night sweats..   I will have to call and verify my T3/T4 levels tomorrow...  all I know is i'd like some relief..  unfourtently I have a feeling that this is a very long road with lots of bumps.. likely something I'll deal with forever..and it may never be "perfected"  *sigh*...

Thank you for the advice, Ill keep you posted!

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Hello, I think my OBGYN was pretty awesome.. I see him next week. but he told me that he couldn't maintance my thyroid, Id have to find a Dr that would..  I think because insurance, my primary Dr wont write the referral to and endo..  and like Gimel said.. its hard to find a good endo Dr even..  I think for now Im going to trust my PCP because he seems to want to help..  I dont want to end up with another Dr I have to convince that I am still having hypo symptoms...  You wouldnt happen to live in MI would you?  :) So I could go to your Dr :)

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231441 tn?1333896366
Hi,

Your thyroid can slowly become less effective over time.

If you have just had the increase up to 50 mcg, then you need to wait about 6 weeks and test again.  Probably this dose will be fine for you, considering you were on it before and you felt great.

Test TSH (many people feel best when this is between 1 and 2).
Test FT3, FT4.  many people feel best when this is mid up upper of the reference range.

For some people testing TSH is enough, particularly once you know that FT3/FT4 are at best level for you, and that you are not having symptoms.

Do your best not to just stop your meds, even if you can't get testing done. As your obe said, once hypo most likely you will need meds long term.
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What part of Michigan?
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