Do I Have Been Diagnosed With Hyperthyroidism ?

Posted on Thu, 10 Sep 2020

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 10 Sep 2020 Answered on

Wed, 2 Jul 2025 Last reviewed on

Question : Brief Answer:
Please write your concern

Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your attached reports.
There are reports of different dates, suggesting probably that you have been diagnosed with hyperthyroidism in july and started treatment, actually the results suggest for hypothyroidis ( probably due to high dose).
Please explain your situation for an accurate response and your actual concern.
Will be a pleasure to help you.
Best wishes,
Dr.Mirjeta

Follow up: Dr. Mirjeta Guni (5 hours later)

You see, I did, but it disappeared and customer service is unresponsive to correct the error or to tell me what happened with the post. Anyhow, I'm a 39 year old, 5'3" (160 cm) tall, 136 lb (60 kgs), Caucasian woman with some history of hypothyroidism. I had 18.1 TSH level at age 28-30 with normal T3, T4, free T4 and antibody so instead of taking hormones I just increased my iodine intake, which fixed my TSH w/n 2 years and then it stayed within normal range for 7-9 years. I'm also not aware of Hashimoto disease on either side of my family tree or any auto-immune disease for that matter. Last August I still had my TSH within normal range, 3.4. This April, however, my TSH went up to 5.66 (see report), so my fertility doctor (as I'm trying to conceive) prescribed 75 mcg Levothyroxine. I was taking it for about 3 months when the new result showed that my TSH was 0.01, free T4 2.0 (see report attached), and I was experiencing hyperthyroidism symptoms (hair loss, dierreah, insomnia, etc). So we reduced my doseage to 25 mcg and now, after 5 weeks, my TSH is 11-something and free T4 is lower than normal range (see report). Before taking hormone supplements, even with very high TSH levels, my T3, T4, free T4 always stayed within normal range. My doctor will probably increase my dosage again to somewhere between 25 mcg and 75 mcg, but I'm afraid that changing the hormones so frequently would create a havoc in my system and mess up my natural hormone production for good. Reducing 75% hormone replacement (1.6 mcg/kg) suddenly to 25%, of course my body now does not produce enough hormone on its own right now as it got used to getting all the hormones from outside sources. So my question is what is your opinion? Should I give a bit more time for my body to adjust to a lower dose and keep taking the 25 mcg? Or is it clear that 25 mcg is not enough? Because I feel if I had been taking 25 mcg when my TSH was 5.66, I should probably be fine by now.....75.mcg was ovwrdosing. Should I go to an endocrinologist and return to my fertility doctor only after my thyroid level is stable and fixed or is it normal that results are so off at the beginning and the fertility doctor knows what he's doing? I am concerned, b/c like I said even when my TSH was really high, all of other indicators were in normal range, but now even the free T4 is off, so first time ever, I reallydo not have enough hormone in my system.... But maybe it is all normal and I'm overreacting.... What dosage should I take?

Answered by Dr. Mirjeta Guni (19 hours later)

Brief Answer:
About levothyroxine dose;

Detailed Answer:
Hi again,
Now the situation is clear.
The appropriate dose for you is 50 mcg.
Once you start levothyroxine your body needs 6 weeks to adjust TSH, so if you checked TSH 6 weeks after taking 25 mcg, it means that the dose is not enough.
Before seeing a fertility doctor, TSH should be 0.4-2.5 mUi/ ml, so you need to correct it before.
Six weeks after taking regularly 50 mcg you need to check TSH, if it is within the above mentioned range, you will continue with the same dose for other 3 months.
Hope the information will help.
Best wishes,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Mirjeta Guni (6 hours later)

Thank you so much for your detailed reply. So just to clarify, I checked the TSH 5 weeks after starting to take 25 mcg. Do you think it was checked too soon? Also, if it takes 6 weeks for TSH to react, than is it not that my TSH level is just catching up with the fact (reacting to the fact) that hormone is not coming from outside sources (75mcg) and I should check it again in 6 weeks to see how it is reacting now to the reduced 25 mcg? Or does it reacts to both at the same time? What confuses me is what is 6 weeks and what is 3 months? If it takes 6 weeks for my TSH to react and give "new hormone production order", then right now it is just instructing my body to produce more hormone, right? Which is quite normal, afterall 5 weeks ago I had excess free T4 and enough hormones withot any 0 stimulations (TSH 0.01)... So should we not just wait to see if my TSH normalized after 3 months, once my body had a chance to follow the new TSH "production instructions "? Or TSH should be w/n normal range throughout the entire process? Or what is 6 weeks and what is 3 months? Because right now I understand that it 6 weeks for TSH to give new stimulating "instructions" to my body and then my body complies with the "order" in 3 months. If that is the case, should we not wait a bit without changing anything and recheck TSH to see if it is going down in another 6 weeks with keeping the same 25 mcg dose and then keep checking it to see if in 3 months everything is back to normal? Because if we keep changing the dose every 6 weeks, how do we figure out what is the right dose? Or if 6 weeks is enough to figure out the dose then what is the 3 months mark? Sorry, but it is quite confusing for me right now and I really do want to understand. Thank you.

Answered by Dr. Mirjeta Guni (7 hours later)

Brief Answer:
About levothyroxine dose:

Detailed Answer:
Hi again,
I am trying to explain the situation again.
The thyroid gland does not produce enough hormone and you need to take it orally in order to keep hormonal balance within the normal ranges. The TSH control is done to be sure that you are taking the right dose (not more and not less than neccessary). 75 mcg was too much for you, 25 is not enough, so you will try 50 mcg. If it is the right dose for you, it will be reflected in normalisation of TSH after 4-6 weeks. So if after 4-6 weeks ( ideal 6 weeks) it is back to mormal, it means that this is the dose you need and it will not be neccessary to check it after 6 weeks anymore but after 3 minths. So, once you have found the right dose for you, TSH should be checked rarely.
You know that the hormone is for life, and the tendency will be to need higher doses with the passing of the years as more thyroid tissue will be destroyed by the antibodies.
Hope i have been clear.
Best wishes,
Dr.Mirjeta

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Above answer was peer-reviewed by : Dr. Nagamani Ng