# TSH not responding to Synthroid increases



## Jaimee (Aug 18, 2010)

Hi! It's been about a million years since I've been on here, but I am having a predicament and was hoping maybe somebody would have some insight. First of all, I had a total thyroidectomy back in Nov 2010, followed by RAI in January 2011. I have had some degree of difficulty keeping a steady TSH all along but at some point did manage to hold steady at a suppressed level for probably close to a year, on Synthroid and Cytomel combined. Well, in the past year I have lost 50 pounds. I fully expected to need to decrease my Synthroid because I was starting to feel a bit "hyper." Come to find out my TSH had gone up (from <0.4) to 2+. Increased from 125 to 137, re-tested and was told it still wasn't where it needed to be. Increased from 137 to 150. I've been on 150 for about 2 weeks now. For about 4 weeks I have been having some difficulty breathing, just feeling like I can't get a deep breath. It was annoying, but I would slow my pace, take a few deep breaths and get over it. This past week I ended up in the ER for seriously difficult breathing. Did a chest x-ray, normal, and EKG, normal, but TSH was 9+. My endocrinologist wanted to just raise the Synthroid again, but I am a little concerned about what might be causing my body to not respond to the medication. I go to my family doctor tomorrow. What types of things should we be looking at?


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## Andros (Aug 26, 2009)

It might be wise to get RAIU (radioactive uptake) to see if there is any regrowth of thyroid tissue and also get Thyroglobulin and Thyroglobulin Ab lab tests.

Please let us know what your family doctor thinks.


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## Jaimee (Aug 18, 2010)

Sorry, I forgot to mention that I had a clear neck U/S and TG/TGab panel about 2 months ago.


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## joplin1975 (Jul 21, 2011)

Are they only looking at TSH? What about free t4 & free t3?


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## Jaimee (Aug 18, 2010)

I believe they only did TSH. It was at the ER and I had mentioned I had had 2 recent med increases, thinking I may possibly have gone hyper. When I called to follow up with my endocrinologist, he wasn't going to test anything else or try to figure out what was causing this to happen but rather, just raise my Synthroid again. Needless to say I will be in the market for a new endocrinologist in the very near future.


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## Lovlkn (Dec 20, 2009)

> I fully expected to need to decrease my Synthroid because I was starting to feel a bit "hyper." Come to find out my TSH had gone up (from <0.4) to 2+. Increased from 125 to 137, re-tested and was told it still wasn't where it needed to be. Increased from 137 to 150. I've been on 150 for about 2 weeks now. For about 4 weeks I have been having some difficulty breathing, just feeling like I can't get a deep breath. It was annoying, but I would slow my pace, take a few deep breaths and get over it. This past week I ended up in the ER for seriously difficult breathing. Did a chest x-ray, normal, and EKG, normal, but TSH was 9+. My endocrinologist wanted to just raise the Synthroid again, but I am a little concerned about what might be causing my body to not respond to the medication. I go to my family doctor tomorrow. What types of things should we be looking at?


Jaimee,

AN increase in Cytomel might be what you are needing.

Please have a Free T-4 and Free T-3 done prior to any dose adjustments. You also need to get into the habit of insisting they run those 2 Free tests at every lab. While they are attempting to suppress TSH - that will be impossible without proper level Free T-4 and Free T-3

You said your TSH fell when you added Cytomel awhile back. I bet your conversion isn't good - thus the elevated TSH and inability to suppress with Synthroid only.


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## Jaimee (Aug 18, 2010)

Thank you! I will definitely ask for free t3 and free t4. My TSH had been successfully suppressed on Synthroid; however, we added Cytomel about a year or so out from TT because I just felt like a zombie all the time.


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