tsh levels different for same amount of thyroxine

[manyana]

hello dr
i am a 43yr old female who has been hypothyroid since 1999 - taking 125mcg thyroxine which has always been stable - i do not know if it is hashimotos or not
in november 2005 i was on 125mcg and my blood test came back as tsh 10.5 so the doc increased to 150mcg - i then started having palpitations and ectopic beats
my next blood test showed i was hyperthyroid with tsh at -1.75 so the doc reduced thyroxine back to 125mcg
still had the ectopics/palps/loose stools/night sweats and nervy buzzing feeling
next blood test in june 06 showed tsh 0.9 and they reduced it again due to being slightly hyperthyroid and my symptoms

my question is how can i be on 125mcg and have a tsh reading of 10.5 and then on the same dose have one come back with tsh 0.9 ?

at the moment i am on 100mcg since june 06 and have started to get my palpitations/ectopics/sweats/loose stools back again

i also have a sensation of a slight lump in throat and lots of phlegm
docs say its not my thyroid - i think something is definately going on with my thyroid
i have been told that with hashimotos the thyroid slowly dies and as parts die they release their thyroid hormone into the body - causing sudden raised levels which make you hyperthyroid - could this be what is happening to me?

what are your thoughts on this as i cannot get my doctor to send me to an endocrinologist - do you think i need one?
many thanks for your time
lynne

[MS Hashi]

Have you had your adrenals tested at all? Your symptoms could point to adrenal fatigue. The TSH could fall on the same amount of thyroxine if the thyroxine is circulating in your blood and not being adequately taken into the cells. I have been in the same situation where I have taken less thyroxine at a later blood test but had even a lower TSH! I am not a doctor but have researched this subject carefully in my own endeavours to become well. My own personal view is that TSH is a poor guide on its own to thyroxine replacement and my own experience supports this.
Best wishes to you.

[Mark Lupo, M.D.]

You most likely need to see an endocrinologist.  Also, consider the possibility that the symptoms are not thyroid related.  Make sure you are not getting generic and that you stick with one brand of thyroid treatment.  Also, there are 112mcg and 137mcg doses that might be of benefit to you.  You likely need a thyroid ultrasound.  The phlegm is not likely thyroid and more likely sinus congestion or acid reflux from stomach.