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The TSH is elevated, which indicates that there is still not a sufficient amount of thyroid hormone. When replacing thyroid hormone, our first goal is to achieve a TSH that in within the normal range. There is some evidence that suggests that certain people do better with a TSH that is low in the normal range, but the first goal is to achieve a TSH within the normal range. The free T4 and free T3 are within the respective normal ranges, although both in in the lower portion of the normal range. The free T3 is relatively lower than the free T4.
There are several options for adjustment of thyroid replacement doses at this point, but I would probably do two things. I would increase the Synthroid to be taking the same amount each day of 224 mcg, which is only a minimal change, but would make it simpler to be taking the same dose each day. And I would increase the Cytomel to 50 mcg per day, which would be the primary increase in thyroid replacement.
Your doctor may choose to adjust the medicines differently, and that would not necessarily be wrong, as long as the dose is increased with the goal of achieving a normal TSH.
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