Should I increase my dose of Thyroxine to alleviate my symptoms?

[Meriam881]

Hi all,

After a year and half of suffering, I am finally daignosed with hashimoto in April this year with a very high anti bodies:

Anti Thyroglobulin Abs: My Result: 187.8 IU/ml

BIOLOGICAL REFERENCE INTERVALS:
0 - 60

Anti Thyroid Peroxidase Abs : My result >1300.0 IU/ml

BIOLOGICAL REFERENCE INTERVALS:
0 - 60

My thyriod results were as follows:

TSH 7.33 (Ref. 0.4- 5.0)

Free T4 .87 (Ref. 0.8- 1.9)

Free T3 2.1 (Ref. 2.0-4.4)

My doc put me on Thyroxine 50.The only medication I can get because in my country there was no T3 supplement, just levo. I follow gluten,and diary free diet which help improve my symptoms.I also take B12 and D3  supplements.

Inspite of that, I still suffer from irrgular heart beats,burning leg,excessive sweating, and feeling hot all the time.I experience two periods in one month also. yesterday, I have another thyriod tests after two months of taking levo 50 and the results as follows:

TSH: 2.69  Ref ( .55- 4.78)
Free T3 2.3 Ref ( 2- 4.4)
Free T4 1.1 Ref ( .8-1.8)

I did not take my dose 24 hours before the test.The problem here is that my doc did not want to increase my dose and said that all my results are normal but I feel that my dose should be increased in order to improve my daily hypo symptoms. I appreciate your advice.Thank you.

[flyingfool]

All I know is I had PVC’s (pre ventricular contractions). And once I started taking T4 thyroid medication, they have almost completely gone away. As long as I do not over do caffeine!

My wife has fast heart rate. She is now on a high dose of both T4 and T3. And her heart rate did not increase with it. Nor does the rate decrease with dose cut. Only with dose cut she feels horrible and hypo! The cardiologist went crazy. But they didn’t know what they’re talking about! As they were100% positive it was the T3 dose. WRONG! At least in my wife's case!

All I can say is that palpitations and even rapid heart rate were both cured or not effected by increased thyroid.

So hypo in both cases would have by “traditional” symptoms said we were over medicated and hyper.  Yet in BOTH cases we were or remained hypo! Snd frlt better with increased dose.

This was just OUR personal experience and everyone is different!

[gimel]

just thought I'd mention that there are a number of members' messages on this site, where they reported palpitations with hypothyroidism.  Also, I ran across a member's message where he said, "When hypo, before hashimoto diagnosis, and after but low in ranges, I could not take heat very well and sweated much more than usual".

[Meriam881]

Yes,you are right.I could not tolerate either heat nor cold.but these days,may be because it is hot summer I feel very hot and could not tolerate it.I found that Hashi is worse than hypo.yes, it is caused me being hypo but the flare up while destroying the thyriod is much much worse.

[gimel]

I would definitely get tested for cortisol and ferritin.

[Meriam881]

Thank you gimel.Definitely I will.In the mean time I will increase my dose by 12.5 and see how I feel.

[Meriam881]

Thank you Sarahjogs and gimel for your valuable response.In fact what I mean with not taking my dose 24 hours before the test is that I did not take my morning dose until I have the test so my last dose was 24 hours before the test not 48 hours.I know that my symptoms seems hyper more than hypo and I did not know the reason.I have a flare up since April and I read during flare up the immune system attack the thyriod and the damaged thyriod cells realease their horomones into the blood which made the patient a temporary hyper.but my tests  does not indicate I am hyper at all.also, These are the first tests my doc asked and he actually asked for TSH alone but I have done the three to know what is my situation.Even if I stay on 50 dose, I experience the heart beats,and the other hyper symptoms so I am very confused.

[Sarahjogs]

I'm sorry for my misunderstanding.  This makes much more sense ,  I was just confused with the wording, but that is exactly what I do as well.

[Meriam881]

Never mind and thank you for your interest and great info.I finally get my doc consent to increase my dose to be 62.5 instead of 50.This is my second day of the new dose and my irregular heart beats improved.I really do not know if such improvement is due to the increased dose or my changing in diet as I eliminate the nightshades vegetables from my diet which increase inflammation in hashimoto patients.

[gimel]

And we should also mention that there are a couple of variables that when deficient can cause reactions as thyroid medication is increased.     Two of those are reported to be cortisol and ferritin.  So Merriam should make sure to also get those tested.  She mentioned she is already taking D3 and B12 supplements.

[gimel]

I totally agree with you on not self-medicating unless there is no other option and it is an extreme situation.   I thought that Hashi's has a period of hyper followed by consistently being hypo.   I haven't been aware of Hashi's causing fluctuations day to day.  I would like to read about this if you have any links.  Thanks.

[Sarahjogs]

Hi gimel,

I will see if I can find some articles that refer to switching day by day.  I've seen people post about this on message boards, but that's not cold hard data so I will do a deeper dive and get back to you on that.  

A shallow dive brought up a couple of articles that show the hypo-hyper fluctuations over several years in case studies, so it is not necessarily one hyper swing and then hypo after that.  The problem with Hashi's is if TSH causes the thyroid to grow, more thyroid hormone is produced and you swing hyper, and then the immune system attacks the thyroid, less thyroid hormone is produced, and you swing hypo, causing more TSH to be produced and that can go on and on in cycles for a long period, apparently years for some people.

https://pmj.bmj.com/content/75/882/243

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140938/

These articles show fluctuations over a several year period, but I will try to find some that show fluctuations over a shorter period when I have time to look.

Again, I still agree that those labs definitely showed hypothyroidism and that maybe even if she is experiencing hyper fluctuations, she may need more T4 anyway.

[Sarahjogs]

I'm not finding anything but anecdotal evidence (people reporting on message boards such as this one) that they have Hashimoto's and fluctuate from hypo to hyper and back again from day to day... I don't know if any studies have looked at the role Hashimoto's plays in these fluctuations in a short term (within a few days) though, so I'm not surprised it is difficult to find more than just what people post.  I'm also not finding "large population" studies that look at the long term fluctuations, but I've found several case studies like the ones I listed previously that show hypo to hyper and back again swings over a long period of time (several years) in people with Hashimoto's.   I think for most people with Hashi's, there is a hyper phase (or no hyper phase, in my case) followed by increasing hypothyroidism as the thyroid is destroyed, but some people seem to go through hypo to hyper and back again fluctuations over a long period of time.

There are many websites that describe why the fluctuations are occurring: as TSH increases, this stimulates the thyroid to grow and make more hormone, and can cause a hyper swing.  As the immune system attacks the thyroid, the person once again becomes hypo as thyroid tissue is destroyed and less hormone is produced.  This in turn drives up TSH, and causes the thyroid to grow and produce more hormone, causing another hyper swing, and can continue for quite some time (some people report oscillating between hypo and hyper for decades).

I also found one article that examines heart rhythm problems in people with subclinical hypothyroidism, and this may be what is going on in Meriam's case (apparently fluctuations in thyroid hormone can cause heart problems).

Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism

Serkan Ozturk, Aytekin Alcelik, Mehmet Ozyasar, Oguz Dikbas, Selim Ayhan, Fatih Ozlu, Alim Erdem, Mehmet Tosun, Davut Baltaci, Mehmet Yazici
Cardiol J 2012;19(4):374-380.

Abstract
Background: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction.

Methods: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters.

Results: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control.

Conclusions: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients.

https://journals.viamedica.pl/cardiology_journal/article/view/22982

[missyj98]

I have this problem as well.  I was diagnosed with Hashi's in 2015.  I had been on Armour 90 until March 2020 and for some reason, without my knowledge, my medicine got switched to NP Thyroid.  It was recalled in May of 2020 for super potency.  My symptoms started in April 2020 with Leaky Gut issues and severe allergy symptoms, especially watery eyes.  Then it went from that to hypo symptoms, TERRIBLE brain fog,  hair loss, fatigue, depression, but I also had anxiety,  by the end of May I was experiencing hyper symptoms, jittery, heart palps, hot flushes, like sunburn and itchy skin, combined with Hypo symptoms, brain fog and fatigue being the worse.   I was finally able to get into a doctor on June 8, 2020 and my Labs showed my TSH was High, My TOP's were in the 600 range, my T4 was Low and My T3 was high 5.09.  I was put back on armour 90, and I started feeling better, then a couple of months in, I got the Hyper symptoms again, Blood tests, TSH high 10.6, T4 low, FRT3 High.  After numerous blood tests, and tweeking my meds, it came to a tipping point in December 2020 where my Hyper symptoms were so bad, I was ready to go to the hospital.   They took me off my meds completely and basically did a reset.  My D3 all my crucial minerals were in range, estriodal, testosterone, progesterone, all in range.    but my TSH was high, 17.9,  t3 was low t4 was low 0.6.  Funny, I felt fine at that point.   So we did this reset, Now January 13, 2020 I'm back on Armour 90.  My TSH is 17, my T4 is 0.78 my T3 is 1.41.  Weird thing, is I didn't feel bad.  I had hypo symptoms, hair loss mostly.  I lost the outer portion of my eyebrows and some head hair.  But I didn't feel fatigued, no weight gain, no cold intolerance.  Allergy symptoms completely gone.  They put me back on Armour 90. Now here I am February 3, 2021 and I'm experiencing hyper symptoms again, even though my labs as of 1/272021 say my TSH is at 1.97, Free T3 is 4.1, which is on the higher end of the spectrum, but still within normal range, Low T4 0.8    I seem to function better when my T3's are on the low side of the range and my TSH is on the higher side of the Range.  They are still tweeking this and it's getting really annoying to say the least.  This has also caused my A1C to be high at 5.9, but has since dropped to 5.7, and my cholesterol was and still is high.   I eat a clean diet, chicken and high protein meats, balanced with natural sugar/ carb sources  and I only use coconut oil to cook with.  I have natural vitamin E oil I use and natural Progesterone oil that I use along with taking 500 mg of selenium a day and my other necessary vitamins.  

[gimel]

Although Meriam's symptoms sometimes are identified as hyperthyroid, perhaps surprisingly they are frequently related to hypothyroidism as well.  There is a site linked below where the author has accumulated a list of over 300 symptoms gathered from thyroid experts around the world, plus additional symptoms from her research.  If you look through the list you will find Meriam's symptoms.

https://hypothyroidmom.com/300-hypothyroidism-symptoms-yes-really/

So in view of the above and her two sets of thyroid tests with low FT4 and FT3 it seems much more likely that her issues are from low thyroid.  

  

[Sarahjogs]

gimel,

I checked out that hypothyroidmom website, and while some of the sources like thyroid UK seem pretty legitimate, they don't include the symptoms Merriam881 has listed.  The Long and Pathetic List of Symptoms referenced does include many or Merriam881's symptoms, but  "The majority of hypothyroid symptoms listed are totally based on actual thyroid patient descriptions of their symptoms while on a T4 medication"  which is not the same as hypothyroidism, and seems to include many hyper symptoms.  (I had stomach flu while on T4 based medication, and according to this classification, flushing my digestive tract non-stop for 24 hours and having a fever could all be hypo symptoms).

I can't access the three books listed without buying them on Amazon, but so far I am skeptical about the list being accurate in its entirety (many of the symptoms are hypo symptoms, but all hyper symptoms are also listed which is a.) confusing  and b.) not helpful in merriam881's case, since we are unable to distinguish between them.  )

Thyroid UK has a helpful list of symptoms, I checked 35 out of the about 100 symptoms listed that I had experienced when I was hypo:
http://www.thyroiduk.org.uk/tuk/about_the_thyroid/hypothyroidism_signs_symptoms.html

Merriam's symptoms do all appear on thyroid UK hyperthyroidism symptoms, including increased sweating, sensation of warmth, heart palpitations, and longer or shorter menstrual cycle.  http://www.thyroiduk.org.uk/tuk/about_the_thyroid/hyperthyroidism_signs_symptoms.html

This is probably going to be one thing we disagree on, but that list of over 300 symptoms doesn't take in to account that some of those symptoms are people with Hashi's with fluctuating hormone levels, and some are T4 people over medicated, and not entirely hypo symptoms in that case.  Basically, it is a list of "thyroid" symptoms but I'm uncomfortable calling them hypothyroid symptoms at this point.

Merriam881 states that "I did not take my dose 24 hours before the test.  The problem here is that my doc did not want to increase my dose and said that all my results are normal but I feel that my dose should be increased in order to improve my daily hypo symptoms. ".  

I do not know what effect skipping a thyroid dosage and going 48 hours between your last dose and the blood test would have on the blood test results, but I'm not convinced it would have zero effect.  (I know half life of T4 is pretty long and it takes awhile to build up in your system, but purposefully skipping doses to skew results makes me not trust this blood test all that much).

Is there another blood test that was taken when the dosage wasn't skipped, in between the two reported ones?  I'm just curious because the first set, she definitely is hypo, and the second where the dosage is skipped indicates low in the range for freeT4 and freeT3, but again, it is 48 hours after the last dosage, and she references that "all my results are normal" when her doctor wouldn't raise her dosage.   I'm assuming her doctor tested her after putting her on the medication, and presumably she took the test 24 hours after taking her thyroid medication, but we don't see any of those results, and she indicated that on this test where she skipped the dosage that "most docs here see that the only test that should I have is TSH which made me do the tests in a private lab on my account."  Did her doctor just do a TSH test at some point or am I missing something here?  (And I agree, TSH is not the best indicator of thyroid hormone function and especially in Hashimoto's where you have fluctuating hormones, it is not at all an adequate way to determine thyroid hormone levels)

My thoughts:  the symptoms listed are all most often associated with hyperthyroidism, and if she has irregular heart beats (arrhythmia) caused by being hyper, increasing the dosage could be dangerous.  If she had a mix of hypo and hyper symptoms, I'd probably feel otherwise, but everything I have seen points toward hyperthyroidism.  I have no idea what the actual hormone levels are because of skipped doses.  I strongly caution against increasing the dosage given the symptoms, and stand by my original comment.

[gimel]

You said,  " "The majority of hypothyroid symptoms listed are totally based on actual thyroid patient descriptions of their symptoms while on a T4 medication"  which is not the same as hypothyroidism, and seems to include many hyper symptoms. "  First thing is that the author said she collected the symptoms from top thyroid experts and added to the list some symptoms she found in her research.  Second, even if all were patient's descriptions, the occurrence of those symptoms while on T4 med would still be hypo related since the  vast majority of  those people on T4 med continue to have hypo symptoms because their doctors titrate their T4 dosage  based on TSH.  Also,  hypo patients taking T4 med do not convert T4 to T3 well and usually end up with FT3 that is lower in range than   FT4, just like Merriam, and with lingering hypo symptoms.  .  Third, if you reviewed enough of the past input from Forum members you would find many hypo patients with symptoms like palpitations/irregular heartbeat, excess sweating, heat intolerance, and menstrual issues.  So those are not exclusive with hyperthyroidism.  There is no question that there are some symptoms that occur with both hypo and hyper conditions.  

We really don't have to speculate about the effect of Merriam not taking her thyroid med for some time before the blood draw.  I read it that she did not take her morning dose of med, which would have been for 24 hours before the blood draw, which is the correct procedure, even according to the AACE/ATA Guidelines for Hypothyroidism. .  You interpreted it as being 48 hours, and suspected that her levels were really higher than indicated by the test results.  Regardless, she also reported that she suffered with those same symptoms right along, even when she had FT4 and FT3 levels that were at rock bottom of the range.    If we are to assume that her symptoms were really due to being hyper, we would have to assume somehow her levels were cycling from hypo to hyper and back  and the blood draw  just happened to occur during a time when her FT4/FT3 levels were typically hypo, yet she only had hyper symptoms..  And this would have had to occur not once but twice.     Too much coincidence for me.   To me it is too difficult to make all the results fit the scenario of hyper symptoms.  

[Sarahjogs]

Hmm... I read "I did not take my dose 24 hours before the test." as she skipped both the dose 24 hours before the test as well as the morning dose before the test, but I could be wrong.  I am just going off of what is written.  If I did not take my dose 24 hours before the test (which is what is written), that means that I have not taken my dose for 48 hours or more before the test, since I also do not take it the morning of the test.  Maybe I am mis-reading this, but it literally says "I did not take my dose 24 hours before the test".  If it said "I did not take my dose for 24 hours before the test" then that has a completely different meaning, and maybe that was what she meant.

Honestly, I agree with you and I don't think skipping a dose 24 hours is going to have that big effect, but from the wording of the statement, it sounds like she was trying to convince the doctor she is hypo and that is why she skipped the dose 24 hours before the test.  Again, she is in the very bottom range and I would expect that even if she hadn't skipped a dose she would still be hypo, but that can't be known for sure and increasing her dosage on her own without her doctor's consent or knowledge based off of a blood test where she skipped a dose seems like a bad idea to me.  She still has her thyroid, which with Hashimoto's means she can have periods of hyper symptoms as well as hypo symptoms and still show up as hypo on a blood test.  Some people flip back and forth between hypo and hyper on a daily basis, so it is not at all a given that this is not what is occurring.  Maybe the hyper symptoms are more obvious or harder to deal with than the hypo symptoms.   (I would assume that once someone starts taking thyroid medication and TSH is suppressed, this flipping back and forth would be suppressed as well because lower TSH means less thyroid growth stimulation, but her TSH is still above 2.5 so thyroid growth it probably still stimulated a bit).

I do realize people experience hypothyroidism in different ways, but I have concerns about the sources of some of those symptoms based on the references given, as I said, and the list includes all symptoms that are associated with hyperthyroidism as well, which makes it very difficult to distinguish between hypo and hyper based on symptoms alone using the list.   Those sources I wrote about are her "top thyroid experts", unless she has other sources that weren't listed.  I remain skeptical about this list, based off of looking at the source materials I could access.  I think we just have a different opinion on this, which is fine.

Anyway, I don't want to disagree with you, and I will leave it at if she did take a dose 24 hours before the test and those are her results, then she was definitely hypo on the day of the test based on the numbers alone (Is she experiencing Hashimoto's fluctuations and sometimes hypo, sometimes hyper? That remains unclear to me.)

If she is experiencing hyper fluctuations, does increasing the dosage of T4 help with this?  My first instinct is to think that it would drive her more hyper, but maybe more T4 would help slow down the growth of the thyroid and decrease the fluctuations by suppressing TSH.  (I'm not suggesting she should increase her dosage on her own without her doctor's knowledge, but I would assume this would ultimately help get the fluctuations under control, if that is what is occurring.)  I understand how frustrating thyroid symptoms can be, especially if your doctor isn't listening to you, I just want to make sure if she is increasing her dosage it is done in a safe and controlled manner.

[gimel]

Your doctor decided to treat you because your tests showed that your TSH was above range, due to the effect of high levels of antibodies associated with an autoimmune disorder called Hashimoto's Thyroiditis.  Now that you are on a relatively small dose of T4 med that has reduced your TSH back within range, the doctor says you are fine.  Not so.  

To understand what you need let me first explain that hypothyroidism is not just "inadequate thyroid hormone", correctly sensed by the pituitary gland which then secretes TSH.   Instead it is correctly defined as " insufficient T3 effect in tissue throughout the body, due to inadequate supply of, or response, to thyroid hormone".  Suboptimal T3 effect in any or all tissues of the body causes hypothyroid symptoms.  

Doctors misunderstand that the objective of treatment should be to alleviate your hypothyroid symptoms, not just to get TSH test results back within the so-called "normal" range.    Many of us have found that we required  FT4 around mid-range, and FT3 in the upper half of its range, and adjusted from there as needed to relieve symptoms.  There was a recent, important study that quantified for the first time the effect of FT3 on the incidence of hypothyroids symptoms.  The authors concluded that, "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range. "  

Your FT4 is only at 30% of its range, and your FT3 is only at 12.5% of its range.    So you need gradual  increases in your med dosage as required to relieve your hypo symptoms.    Since you said you have no access to T3 med, that means your T4 med dosage will likely have to be high enough to get your FT4 near the top of its range, in order to try and get FT3 high enough to relieve symptoms.   That would surely result in a suppressed TSH and alarm your doctor.   In order to help with conversion of T4 to T3, and raise your FT3 level,  you should also test for ferritin and supplement as needed to get to a min. of 100.   Selenium is also a help to conversion, so some of our members have recommended eating one Brazil nut daily.   They are high in selenium.

Just as a forewarning, most doctors would respond to a suppressed TSH in the treated state as being thyrotoxicosis: due to over treatment, and decide to reduce your med dosage.   That is also incorrect.   Our bodies usually get a continuous low flow of thyroid hormone from the gland.  When you take thyroid hormone adequate to relieve symptoms all in one dose it spikes your FT4 level and to a lesser degree your FT3 level and suppresses TSH for most of the day.   A suppressed TSH does not mean you have become hyper unless there are hyper symptoms due to excessive levels of FT4 and FT3.    

I expect that you are going to have to provide your doctor with enough info to persuade him to treat clinically, for symptoms, rather than just lab test results.  If you will click on my name and then scroll down to my Journal, there is a one page Overview and a link to  a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.   In the Overview and the paper you will find a lot of supporting scientific evidence  for everything I have listed above.  

[Meriam881]

Thank you very much for your great info.I totally agree with you.When I become hypo due to hashi,I totally think that the most important tests are T3 and T4 which are the real thyriod horomones, I never believe in TSH alone but most docs here see that the only test that should I have is TSH which made me do the tests in a private lab on my account.I will increase my dose by 25 and see how I feel. I tried many times to tell my doc that I have symptoms despite the normal results but in vain.I will read the paper carefully. I am sure that it has valuable info.Thanks.I appreciate your help.

[Sarahjogs]

Hi Meriam881,

I would recommend being very careful increasing your dose on your own (if that is not what the doctor has prescribed).  Many of the symptoms you have listed are actually hyperthyroidism symptoms: irregular heart beats, burning leg, excessive sweating, and feeling hot all the time.  

Hashimoto's is a tricky disease because as the immune system attacks the thyroid, you can have times where you are experiencing hypo symptoms as your immune system destroys thyroid tissue and you produce less thyroid hormone, followed by periods where you experience hyper symptoms as the TSH stimulates the thyroid to grow and produce more hormone. This can cause you to have normal thyroid labs because the hormone levels fluctuate.  (Usually, taking thyroid hormone medication will suppress TSH so you don't end up with the hyper swings, but it clearly sounds like you are experiencing hyper symptoms).

If you are experiencing hyper symptoms like irregular heart beats (atrial fibrillation) and tachycardia (a high heart rate), increasing thyroid hormone can be dangerous - too much thyroid hormone can cause serious heart problems, long term effects of hyperthyroidism are serious heart problems as well as bone problems.

That being said, your numbers especially freeT4 and freeT3 seem low in their ranges (like gimel said), so I am a bit surprised that the symptoms you listed are indicative of hyper and not hypothyroidism.  With hypo you would expect to be cold all the time, feeling sluggish, brain fog, fatigue, etc.

You said you did not take your test 24 hours before the test --- I wait until after my blood test to take my morning dose because I know the thyroid hormone can skew my results if I take it shortly before (up to a few hours before), but skipping an entire dose the day before the test may alter your results and indicate that you are more hypo than you actually are.  I don't know how much an effect one missed dose the day before the test will have on results though, but perhaps it is having some effect.

I would recommend looking at hypo vs. hyper symptoms before altering your dosage and think about whether you are experiencing hypo symptoms, because if you are experiencing hyper symptoms, increasing the dosage could make your hyper symptoms even worse and could be dangerous.  

If you ultimately decide to increase your dosage on your own without a doctor's recommendation (I would not recommend doing this at this time based on your symptoms) --  I suggest using extreme caution when increasing your dosage.  My doctor increased my dose by 12.5 mcg  at a time and I would stay at that new dosage for about 5 weeks, have more tests, and then increase some more if I was still hypo, and that was when I was experiencing a lot of hypo symptoms following my thyroidectomy.  Thyroid hormone dosing is tricky and not something that I feel comfortable playing around with on my own.  (I had a thyroidectomy last year and quite a few thyroid hormone tests after to get to the right dosage).  

I hope you feel better soon - I know how frustrating it can be to deal with thyroid related symptoms and not have the doctors listen to your symptoms and just base their diagnosis off of TSH.

[telus2]

Meriam:

I totally agree with Sarahjogs. You (and your doctor) need to be aware that occasionally people with Hashimoto’s disease can have symptoms of hyperthyroidism in the early stages, and go back and forth between hypo and hyper.

The following paper discusses such a case and they resolved it with radioactive iodine thyroid ablation.
Oscillating hypothyroidism and hyperthyroidism – a case-based review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246140/