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Dr Uzair
Dr Uzair, Doctor
Category: Endocrinology
Satisfied Customers: 7620
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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If a TSH AND FT4 are both elevated in a patient on synthroid

Customer Question

If a TSH AND FT4 are both elevated in a patient on synthroid do you increase or decrease the dose?
Submitted: 2 years ago.
Category: Endocrinology
Expert:  Dr Uzair replied 2 years ago.
Hi and thanks for the query.
You neither increase or decrease the dosage based on test results alone, the first thing to consider is, are there any symptoms, if yes, are the symptoms of thyroid overactivity or under activity, secondly, a free T3 test should also be done to see if the levels are in normal range or decreased. If the T3 levels are normal, then you need to look for causes related to the hypothalamus-pituitary axis like an adenoma, that might be provoking production of TSH by releasing excessive amounts of TSH releasing hormone (TRH). If that is the case, then that is treated first. If the T3 levels are decreased then that means the T4 being given in the form of synthyroid is not being actively converted to the T3, so a combination of T3 and T4 supplement is given instead of synthyroid e.g., Armour thyroid.
For now, I would suggest that you do not increase or decrease the dosage yourself and make an appointment with your Endocrinologist who will repeat the thyroid function tests to rule out erroneous report and also get a free T3 done this time. Further testing may be necessary as well.
Let me know if you have any queries about this.
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Best wishes.