What Causes Fluctuating TSH Levels Despite Being On Thyronorm?

Posted on Tue, 28 Jul 2015

Question: Hi Doc...this is about my dad who had been diagnosed with Hypothyrodism for the past 15 years. He has been on a regular Thyronorm dose (depending on TSH level). Of late, he is facing many others problems like palpitation, dizziness, weakness and losing balance. His blood result taken recently:
a) 17/06/2015: T4 - 9.8 ug/dl & TSH - <0.05 uIU/mL
b) 05/08/2015: T4 - 58.4 nmol/L & TSH - 10.10 uIU/mL
My Question is why is there such a great fluctuation of TSH within 15days even though he was taking the prescribed dosage of Thyronorm? Also, can you please suggest the ideal dosage he should be taking at this moment. Thanks in advance.
XXXXXX

Answered by Dr. Saumya Mittal (26 minutes later)

Brief Answer:
I need more information

Detailed Answer:
Hi XXXXX
Thanks for the query.
I think I can help you.
First , the 2 test dates are almost 45 days apart. in that time variation can happen do ending on the dose given and regularity of medicine taken.
As for the dose needed, I need to know the current dose.
Also , is she on any other medicine?
Please let me know the details.
Awaiting your message.
Dr Mittal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Saumya Mittal (20 minutes later)

Hi Doc...the second test date is supposed to be 5/07/2015 (wrongly typed as 5/08) which is just 15 days from the first test 17/06/2015. Also, during this period, he had stopped Thyronorm and instead took Methimez -5mg.

Currently he is on the following medications (left ventricular diastolic dysfunction):
a) Deplatt A - 75mg
b) Flavedon

he is taking 150mcg of Thyronorm. Is this the ideal dose? Please Help!!!

Thanks,
XXXXXX

Answered by Dr. Saumya Mittal (7 hours later)

Brief Answer:
Needs dose reduction

Detailed Answer:
hi
thanks for the response.
I should tell you that the tsh goes low because of thyronorm. when you stop it tsh goes high.
I personally would not start methimez. that is the cause of the fluctuations. it's work is exactly opposite that of thyronorm.
I suggest trying 100 mg thyronorm, assuming he was on 150 mg before tsh got low. If on that dose Tsh is low after 3 months, reduce the dose by 25 mg further till TSH gets in normal range.
I have tried to make it as simple as possible. I hope that the information contained in this message will be able to help you find the best solution for your problem. Best of luck. Dr Mittal

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar