Rising TSH but free Ts not moving?

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Good morning! (10am here in Canada)

I’m hoping I can get some insight regarding my lab work.

My TSH is consistently rising. I take 2.5 mgs methamazole daily. I feel fine, no major symptoms at the moment. 

My recent lab work came back and it’s as follows:

TSH 2.18 (0.32-4.00)

T4 13 (9-19)

T3 3.5 (3.1-6.2)

My TSH was undetectable for a long time until I started taking ALC (500mgs) but I’ve basically stopped taking ALC consistently as I seem to be producing TSH on my own, which is good I guess but I don’t understand why my Free Ts remain the same? I’ve had the same Free Ts for over a year even when my TSH was suppressed. Basically, the only number that changes is my TSH, regardless of my dosage of anti thyroid meds.

I’ve tried to lower my dosage last month by taking 2.5mgs every other day and my TSH immediately dipped (again, my T Frees never budged) so I’m back on 2.5mgs daily and TSH shot back up very quickly. 

Can someone provide some insight about this? When should I attempt to lower my dose again? I’m afraid my TSH will continue to rise. I have my appt with endo today but tbh she is not very good at reading lab results and tends to skip through explaining anything as long as they’re in the “normal” range.

P.s. not sure if this is relevant but I’ve had all my antibodies tests completed and as far as I know I have only Graves/hyperthyroid. Everything else came back negative. 

Thank you in advance. 

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  • Posted

    Cecelo, your pattern is exactly like mine was.  I prefer a TSH around 1.5, and I made frequent adjustments to get it there and keep it there.  I was not concerned about where my Frees were as they normalized immediately when I took my starting dose of 10 mg of Methimazole.  As my TSH rose, my doc lowered my Methimazole dosage and I currently take 2.5 mg on Sat, Sun, Tues and Thurs.  At one point I was only taking it 3 times a week.  I stopped the ALC because it did its job in getting my TSH where I wanted it.  And I have had to sometimes take it when my TSH fell too low.  So now I take this low dosage of Meds and I take 500 mg of Regular L-Carnitine on the off days I am not taking Methimazole.  I don't know what my values are and need to be tested soon.  My last one was TSH 1.3.  While I was raising my TSH with Acetyl-L-Carnitine, my Frees dropped right to the bottom of the range and stayed there until I stopped the ALC and they rose again quite like where yours are.  Your Free T4 is pretty much mid-range but it does not seem to be converting to Free T3 as your Free T3 is low in range.   I never worried much about this in my case as I was more concerned with raising my TSH.  You can do some research on T4 to T3 conversion if you are concerned about this however.  At this point, if you are like me and like a TSH at around 1.5, you would have to play around with your Methimazole dosage as you have done but instead of every other day, just don't take it for 2 separate days a week (perhaps like on Mondays and Fridays).  Also, I would get your antibodies tested again.  You don't want to stop meds until your antibodies are not detectable.  Aside from your values, how are you feeling in general?

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    • Posted

      Hi Linda, 

      Thanks for responding. From what I remember, my hyper/Graves journey has been very similar to yours from the start. I’m going to try and play around my dosage at your suggestion. 

      When I asked my endo today about my stable free Ts, she said my body seems to function well at those levels that’s why they haven’t fluctuated much, my body sort of “self adjusts” but I’m definitely going to look into T3 conversion as I’ve also noticed my T3 is a bit on the low side. Luckily, I feel fine for the most part. I get headaches every now and then and seem to struggle with weight loss though. How are you feeling now?  

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    • Posted

      From a thyroid point of view, I feel fine.  My values do shift a lot too because I have been under a lot of stress at work, however, they have never gone out of the normal range since I used the supplements to get my TSH up.  For the most part, since I stopped the Acetyl, my Frees rose again to mid range for both.  At one time before I got Graves, I was on a very low dose of Cytomel (T3) (5 mg)  to boost the action of an antidepressant I was on without having to take a high dose of the antidepressant and thereby avoiding side effects.  I did this for a number of years, I think from 1993 to 2007 when I was diagnosed with Graves.  What precipitated my Graves was abusive behavior from a co-worker which I tolerated for 6 months before I told my boss I would not continue to work with her.  And of course when I got symptoms of hyper and was worked up and diagnosed with Graves, I immediately stopped the Cytomel.  I asked the docs who put me on it if patients on this treatment usually developed Graves and they said no.  I did feel it helped me depression-wise and energy-wise while I was on it.  I did not lose weight on it but did lose recently when I was off work for 2 weeks before I moved.  So stress has a lot to do with feeling good or bad as well.  My weight loss difficulties has to do with insulin resistance (I am pre-diabetic) so diet and types of food I eat affect my weight loss tremendously.  This was true for my brother as well.  He is a type 2 diabetic but he lost 80 lb when he paid attention to the foods he ate and what foods caused his sugar to spike.  He then avoided those foods, did some walking and lost 80 lb and kept it off.
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    • Posted

      Glad to hear you are feeling fine Linda. It seems like we have to Adjust our dosage every now and then, as my endo suggested also. I try to not allow stress to get to me because i Find when I am stressed I start to get heart palpitations. My graves/hyperthyroidism was originally triggered by my fathers death while going through postpartum with a 6 month old baby. Happy to know you eliminated your source of stress, over time Im learning how much it really affects our levels. 

      Thanks for your advice and take care! 

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