increasing TSH

[lagahn]

I had Hashimoto's Thyroiditis since 2000. In 2008, it reversed into Graves Disease, doctors told me because of the thyroid antibodies I have. I've also haven't had a thyroid antibody test since I was diagnosed in 2000. Shouldn't I get another one?
So I chose radiation to destroy my thyroid and I'm back on Synthroid 100mc. I am 27 years old and for the past year my TSH has steadily been increasing from .5 last year to 1.8 this year. I am feeling so exhausted, hair falling out, etc, the same symptoms as if I weren't getting enough Synthroid. Is it time for an adjustment in my medicine? Also, I've been under a lot of stress lately. Does stress affect the absorption of the Synthroid or how does that work?
I also heard that Celieac Disease is common in patients with thyroid disease. How common is that?
Thank you.

[goolarra]

Your FT4 looks good currently...it's a little over midrange and midrange or slightly above is the rule of thumb for FT4.  It dipped a bit in February, but it's recovered again.

However, your FT3 started out low and remains so.  It's at 30% of range right now, and the recommendation here is upper half to upper third.

After RAI, it can take a long time before your hormones stabilize, and I think that's what you've been seeing over the past year.  The thyroid doesn't die immediately (it's a process), and the amount of time it takes for it to die completely is very individual.  You may only recently have reach the point where you can expect things to be stable.

I think you're having symptoms because of your low FT3 and need to add some T3 meds (Cytomel) to go along with your Synthroid.  Your FT4 can be perfect, but if your FT3 is too low, you will still have hypo symptoms.  Has your doctor considered that at all?

Since you are still having symptoms, I agree with you completely that a year is way too long to wait for bloodwork.  You need a meds adjustment, and when meds are being adjusted, labs should be done every 4-6 weeks until symptoms are relieved and meds have been stable.  Then, you can move to three months, four months, six months, etc.  My meds have been stable for over a year, but I still have bloodwork and see my endo at six month intervals.  Don't wait around for a year, feeling miserable.  Either demand more of your current doctor or find one who will help you to be truly WELL!

FT3, FT4 and TSH should be enough to make meds adjustment decisions on unless your symptoms are not relieved once FT3 and FT4 are at optimal levels.  Then, it would be time for further testing to see what else might be going on.  For the moment, however, I'd work on getting that FT3 up in the range...I think you'll be amazed at the difference that makes in your symptoms.  

[lagahn]

Sorry..here are my test results over the past year and the reference ranges:
5/2009
TSH is .54   range is .4 to 4.5
FT4 is 1.4    range is .8 to 1.8
FT3 is 294   range is 230 to 420

10/2009 There was another lab in here sometime, I believe my TSH was .8 or 1.2

2/2010
TSH is 1.53  range is .4 to 4.5
FT4 is 1.1    range is .8 to 1.8
FT3 is 288   range is 230 to 420

5/2010
TSH is 1.86  range is .4 to 4.5
FT4 is 1.4  range is .8 to 1.8
FT3 is 287  range is 230 to 420

My doctor always compares one lab to the previous lab, which looks like there is some flucuation but over the year when with no thyroid, I should be stable. I take my meds at the same time every morning with no food, don't eat a lot of soy, don't take BC pills, etc. I'm feeling like I felt when my TSH was way out of wack. The same symptoms are coming back. I figured stress affects your thryoid, but how should we compensate having stress to managing or stablizing your TSH? I like to be tested every 3 months. My doctor said to come back in a year. But I never feel comfortable going longer than 3 months, b/c my body/TSH always seems to change for some reason or another. Having the Radioactive Iodine to destroy my thryoid, how "regular" should I be going for blood work? and are only TSH, FT4, FT3 enough?

[goolarra]

Once you have antibodies, you have them for life unless your thyroid is removed.  Also, if you have RAI, the antibodies have nothing to attack, so they are no longer a concern.  Sometimes after TT, RAI, or thyroid "death" from Hashi's, antibodies will go into remission.  So, no, once diagnosed, it isn't necessary to have further antibody testing.

It sounds like you need a meds adjustment.  Are you being tested regularly for FT3, FT4 and TSH?  If so, please post results and reference ranges.  These are lab specific and have to come from your own lab report.

Stress is a majot factor in thyroid disorders.

Celiac, Hashi's and Grave's are all autoimmune diseases, and once you have one, you are more likely than the general population to get a second (or third).  The only way to be sure is to be tested for Celiac...antibody testing (not 100% accurate) or endoscopy with small intestine biopsy.