# Trying to figure out why TSH went up



## jade (Aug 6, 2013)

I've been doing fine on generic levothyroxine since my TT last summer and my labs have been consisently good, but when I had labs done recently, my TSH went up quite a bit and my Free T4 is down a little in only two months. I've also been more tired in the last month or so, feeling and looking run down and gained 5 pounds even though I'm not a big eater.

I have a family member who's had major surgery after an accident and has been in the hospital and a rehab place and I've had to drive a lot to visit them and care for their house, I've started a business and all sorts of other stressful things going on, so I thought being tired was just all that, but the high TSH and somewhat lower Free T4 explains things.

Everything else has been the same. I've been on the same dose of levothyroxine, not eating anything different or exercising more. I'm always careful to take my vitamins more than 4 hours after my thyroid pill.

My endo didn't give me an answer about why she thinks this happened, only raised my dose from 7.5 pills per week to 8.5 and is re-checking labs in a few weeks. So can anyone help me figure out why my TSH went up this much in only 2 months? Could I have gotten a bad batch of levothyroxine? I filled my prescription (90day) in mid-August. I get my pills from the same hospital pharmacy all the time. Could all the stress I've been dealing with this summer just cause me to need a higher dose? Should I think of switching to brand name Synthroid or just request a new bottle of levothyroxine? I'm frustrated with feeling like crap all the time lately. Any thoughts?

7/9/15 - TSH was 2.63 (0.400 - 5.500 uU/mL range)
7/9/15 - Free T4 was 1.4 (0.7 - 1.8 ng/dL range)

Most recent:
9/9/15 - TSH was 8.94 (0.400 - 5.500 uU/mL range) High
9/9/15 - Free T4 was 1.2 (0.7 - 1.8 ng/dL range)


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## Lovlkn (Dec 20, 2009)

If it were me - I would ask for a new prescription and also increase dosage as instructed your physician.

Have you ever had a FT-3 run?



> 7/9/15 - TSH was 2.63 (0.400 - 5.500 uU/mL range)
> 7/9/15 - Free T4 was 1.4 (0.7 - 1.8 ng/dL range)


In this lab your FT-4 is almost 3/4 of range which is good - your TSH should be lower, which leads me to the possibility that you are not converting optimally


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## jade (Aug 6, 2013)

Lovlkn said:


> If it were me - I would ask for a new prescription and also increase dosage as instructed your physician.
> 
> Have you ever had a FT-3 run?
> 
> In this lab your FT-4 is almost 3/4 of range which is good - your TSH should be lower, which leads me to the possibility that you are not converting optimally


My last FT-3 was in January: 3.0 (range 1.8 - 4.6 pg/mL)
Prior to my TT, my FT-3 numbers tended to be between 3.2 and 3.8 (same lab range)

Other January 2015 Labs:
TSH was 0.562 (range: 0.400 - 5.500 uU/mL)
Free T4 was 1.7 (range: 0.7 - 1.8 ng/dL)

Since then, the TSH has been creeping up, then the big jump between July and Sept.


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## Lovlkn (Dec 20, 2009)

Are you positive they refilled your prescription with the exact generic brand you were using?

There are several "generic" brands - sometimes a pharmacy will refill with what they have on hand and not necessarily your exact brand. I've caught my pharmacy trying to do this so I know it happens.


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## jade (Aug 6, 2013)

Lovlkn said:


> Are you positive they refilled your prescription with the exact generic brand you were using?
> 
> There are several "generic" brands - sometimes a pharmacy will refill with what they have on hand and not necessarily your exact brand. I've caught my pharmacy trying to do this so I know it happens.


The pills have always been the same size and color, but I can't be sure. I'll call the pharmacy on Monday when they're open. The only other thing I can think of is the fact I've been keeping them in an upstairs bedroom that doesn't have A/C and gets very hot and sunny from mid-day to sundown. I read thyroid pills shouldn't be kept over 77-degrees. The summer has been very hot here and that bedroom becomes an oven in late day.


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## Lovlkn (Dec 20, 2009)

How long do you typically go between lab's?

How long is your doctor waiting to test after your increase? Insist they run both the FT-4 and FT-3 at your next lab - remember, TSH can lag up to 6 weeks for an accurate reading.


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## jade (Aug 6, 2013)

Lovlkn said:


> How long do you typically go between lab's?
> 
> How long is your doctor waiting to test after your increase? Insist they run both the FT-4 and FT-3 at your next lab - remember, TSH can lag up to 6 weeks for an accurate reading.


In January, they said they'd do a TSH and T4 about twice a year unless something changes. I had to specifically request the F-T3 from my PCP or it probably wouldn't have been done.

I started the increase 9/12 and I'm going for the re-test around 10/12 or so. She said 4 to 6 weeks. Is closer to 6 better? I'll definitely request the Free T3, but for whatever reason, the doctors I currently go to always try to tell me the Free T3 isn't necessary since I'm taking levothyroxine. The two doctors who always did my F-T3 without me having to ask aren't there anymore.

Thanks much for the suggestions on what to do. Things seemed to be going well so far post-TT and I've had no problems at all until these last couple months.


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## Lovlkn (Dec 20, 2009)

> I started the increase 9/12 and I'm going for the re-test around 10/12 or so. She said 4 to 6 weeks. Is closer to 6 better?


Give it the full 6 weeks.

As far as the FT-3, keep requesting it be run everytime, despite what your doctor thinks, it does matter to help dial in med's.

Most doctors also live and die by TSH which we all know, lags up to 6 weeks ans is more an indicator of thyroid hormone need, rather than actual hormone in your system.


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## jade (Aug 6, 2013)

I spoke to the pharmacist where I've been getting my levothyroxine and he said they dont switch generics. He only uses Mylan. I know nothing about generics and if this is a good or bad one. Anyway, he didnt hear anything about a recall but he's contacting them and my drug plan to get a new bottle for me today. He didn't know if storing it in a bedroom gets hot could be the problem or not. I'm trying to read about Mylan but this stuff is just upsetting. My weight has gone up a couple more pounds and I'm someone who eat very light and almost never eats candy or junk. Also brain fog and fatigue. My arms felt tired shampooing my hair the other day which for someone my age is insane. I hope to figure out what's going on or if I should consider switching to a brand name drug.


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## jenny v (May 6, 2012)

Honestly, I would switch to a brand name drug. I've heard the generics can vary in the actual amount of medicine in them more than brand name ones do. My endo always used to put on my prescription "brand only" because she was convinced it was more consistent.


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## jade (Aug 6, 2013)

jenny v said:


> Honestly, I would switch to a brand name drug. I've heard the generics can vary in the actual amount of medicine in them more than brand name ones do. My endo always used to put on my prescription "brand only" because she was convinced it was more consistent.


Thanks, that's what I've been thinking. The pharmacist told me has hasn't got other complaints about the levothyroxine there. I drove all the way there and he only gave me 3 pills from a new lot # because my doctor didn't get back to him in time to order a new script. I will have to talk to my dr. about getting a brand name and let her deal with my difficult prescription plan, but I would feel better about being on a brand name, especially if I need to have it filled at different pharmacies while traveling. I've been driving to this hospital pharmacy that's a half hour away just to stay on a consistent brand because I've been doing just fine until lately, but I don't know why my TSH would just shoot up so fast if I'm not doing anything different than before.


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## jade (Aug 6, 2013)

I still haven't figured out what caused the rapid TSH rise, but my thyroid numbers have improved to a TSH of 1.73 (0.400 - 5.500 uU/mL) and a Free T4 of 1.6 (0.7 - 1.8 ng/dL) I requested the Free T3 at least twice, but my Dr. won't run it. After about 5 or 6 weeks on my increased dose of levothyroxine, the brain fog, heavy arms/leg, fatigue improved. I barely notice those things now, but my weight went up about 8 lbs since August and won't go down. I'm normally thin and not a big eater so many of my clothes aren't fitting.

My endocrinologist said I could either switch to Armour or add one 5mcg tablet of Cytomel to the levothyroxine I've been taking to see if that helps with energy level, weight, etc. I chose the Cytomel to give it a try before I consider going to Armour, but I've never taken it before.

Is anyone here on the levo/Cytomel combo? I'm wondering if this sounds like the right thing to try or switching to Armour is better? Dr. said the Armour adjustment might be more difficult and since I've been through a lot with these hypothyroid symptoms lately, it might not be the best time to switch.


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