Flucations in TSH

[Cin121]

My PCP and my allergist disagree about further testing of my TSH.

I am a 50 year old female with a very strong family history of autoimmune disease.  I have been diagnosed with significant allergies.  Both parents and two sisters also have allergies, mother and three sisters have Hashimoto's.  My mother's sisters and brother have Graves, Hashimoto's, Addison’s, and Lupus.  My father's brother and sister had MS and Rheumatoid Arthritis.  

In July of 2006, because I had some symptoms of hypothyroid, my allergist requested the following tests:
TSH  3.29   (0.27-4.20 range)
FT4  1.24  (0.70-2.10)
Free T3  2.6  (2.5-4.3)
THY PEROS ABS  29  (0-60)
THYROGLOB AB  <20  (0.0-25.0)

Since everything was normal, we did nothing more about thyroid at that time.  

Then, in February of 2007, as part of a routine office visit, my PCP did blood work which showed:
TSH  7.9

Because it was not over 10, she repeated the TSH test in May of 2007, which came back at 3.6.  At that point, I was told that obviously my thyroid was now normal and no further testing needed to be done.

My allergist (who is in another city) requested follow-up testing to follow what was going on with my TSH.  Over the year, I had the following lab results:
August 2007:  TSH  3.2
November 2007:  TSH 4.0
February 2008:  TSH 1.43

My allergist wants to recheck the thyroid in six months time, which my PCP disagrees with since all of my results are in the normal range with the exception of February 2007.

Should I follow the recommendation of my allergist?  I would appreciate any insight you may offer about this.

[Mark Lupo, M.D.]

The TSH values have been  borderline high - about 10% of hashimoto's patients have negative antibodies.  An ultrasound to look at the appearance of the thyroid - done by a thyroid specialist - may be helpful.  There is no data/research to support for or against a trial of thyroid hormone in these settings.  If there are no symptoms, then I usually observe w/o meds in these cases.  Testing 2x/year is reasonable.

[Momtoteenboys]

I have had a very similar situation to the above poster's.  I have been symptomatic for a while, and in fall 2007, the right lobe of the thyroid was noted to be enlarged.  I did have thyroid antibodies checekd (negative) and an US of the thyroid which just noted the difference in size of the lobes, but nothing really showed any significant problems.  My general medical doctor put me on a low dose of levothyroxin (25 mcg) and I will say I feel 100 x better.  I am no longer falling asleep throughout the day, no longer feeling like my brain is "fuzzy", etc.  WOuld a doctor be willing to let you have a trial with a low dose of medication?