Fluctuating TSH in beginning treatment for Hashimotos?

[paisleykd]

I was recently diagnosed with Hashimotos hypothyroid in the beginning of the year (6-months postpartum). My lab results were: TSG  44.47, Free T4 0.92 and Free T3 2.8

After 6 weeks of 50mcg Levothyroxine, my TSH was 4.61.  We increased the dose to 75mcg Levo and 6 weeks later my labs are: TSH 5.88, Free T4 1.43 and Free T3 3.0

However, I'm feeling a lot better. My anxiety has improved, no more heart palpitations.
My question is why would my TSH increase after 6 weeks on a higher dose of Levo?  This doesn't make sense in my brain!  Is that normal for hashimotos?  I assume the next step would be a further increase of the Levo (maybe to 100mcg).  I feel like I'm trying to outrun a train wreck (my body destroying my thyroid).

Thanks in advance!

[Barb135]

What are the reference ranges for the Free T4 and Free T3?  Ranges vary from lab to lab and have to come from your own reports for the best comparisons.

There are a number of reasons why TSH could fluctuate, since it's affected by many things, other than thyroid hormone levels.  One thing could be the time of day you had the blood tests done.  TSH tends to be highest in the morning.  

Another thing could be whether or not you took your medication prior to having the blood draw done.

The course of your Hashimoto's could have changed. As Hashimoto's destroys the thyroid, levels are changing all the time; that's why medication dosages have to be changed as time goes on.

There are other things that could cause that change, as well.

It's not Hashimoto's that affects TSH; it's thyroid status i.e. thyroid hormone levels (hypo or hyperthyroidism), along with other outside influences.

The levels of Free T4 and Free T3 are much more important than TSH.  Free T4 should, typically, be about mid range and Free T3 should be in the upper half to upper third of its range.  We'll be able to determine those levels once we know the ranges.

What, if any, remaining symptoms do you have?

[gimel]

First thing to realize is that TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator to be considered during initial diagnosis efforts, along with more important indicators such as symptoms and levels of the biologically active thyroid hormones, Free T4 and Free T3.  After starting on thyroid medication, TSH is basically unimportant.  As noted in Recommendation 3 on page 10 of the following link,  "Dosages should be adjusted according to symptoms first and FT4 and FT3 second. It is totally ineffective to dose a hypothyroid patient to just bring the TSH level within the reference range determined using group test data 36, 37, 47 Further dose adjustment should be guided individually by relief of symptoms and tolerance of the medication dosage."

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

In the link you can also note in Rec. 10 on page 13, " In addition, serum thyroid hormone levels are a sum of both natural thyroid hormone and thyroid medication. As
medication dosages are increased the production of both TSH and natural thyroid hormone is diminished. As a result, equilibrium serum levels are not increased with
small starting doses of thyroid medication. Only when TSH is no longer stimulating natural thyroid hormone production, or is suppressed, will serum thyroid levels reflect further increases in thyroid medication. 37

A good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels.  If your doctor is unwilling to treat clinically as described, then you will need to find a good thyroid doctor that will do so.  

Also, hypothyroid patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, all of which are very important.  If not yet tested for those I suggest doing so and then supplement as needed to optimize.  D should be at least 50, B12 in the upper end of its range, and ferritin should be 100.  You will also find this info in the link given above.  
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[paisleykd]

That was supposed to be TSH 44.47 in the first lab work.  :)  Not TSG