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Amount of time off thyroid hormone to determine function/Justified thyroid issue?

Dr. Lupo,

I had a silent (subacute) thyroiditis dx. 08/2010.  It's been some time since then and I have been off and on thyroid hormone three times.  Each time I get off thyroid hormone, my TSH is not too bad, typically in the 2-3 range.  Example below of my labs off Synthroid:

TSH 2.79 (Range: 0.40 - 4.50 mIU/L)
Free T4 1.0 (Range: 0.8 - 1.8 ng/dL) (20 percent of range)
Free T3 2.8 (Range: 2.3 - 4.2 pg/mL) (26.3 percent of range)
Thyroid Antibodies (ATA, TPO) NONE
RT3 ratio: 14

However, I still feel a fatigue that cannot be figured out, so I get back on Synthroid.  This past summer, I got off the Synthroid again and my TSH was an alarming 4.70 and I honestly felt worse than I have ever felt.  I waited 8 weeks after my last Synthroid pill to get tested, and the results were:

TSH 4.70 (Range: 0.40 - 4.50)
Free T4 1.1 (Range: 0.8 - 1.8)
Free T3 3.5 (Range: 2.3 - 4.2)
Reverse T3 15 (11-32)

My endo has put me on Synthroid since August 2012.  Am I feeling a lot of energy?  Not really.  So, I am thinking about going back off the Synthroid.  I have had a couple other opinions from other endo's, and they vary, so I am hoping you could let me know your opinion on:

(QUESTION #1) Whether or not I should be medicated on Synthroid?

(QUESTION #2) How long is a sufficient amount of time to determine whether full, natural thyroid function has been restored?  Is eight weeks a sufficient amount of time, or would waiting 12 weeks be better?

Also, I have never tested positive for thyroid (AG, TPO) or ANA antibodies and I have no family history of any autoimmune or thyroid disease.

Thank you!
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97953 tn?1440868992
Looks like you had essentially normal levels after recovery and no benefit from treatment of the "borderline high" TSH levels.  Would usually monitor without treatment but this needs to be discussed with your doctor.
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