Raised TSH despite TSH suppression

[sebinho]

I had papillary thyroid cancer with local metastasis 4 years ago. I had a total thyroidectomy and iodo-therapy. I take I high dose of T4 and normally my TSH  level is around 0.5 or less. My thyroglobulin and anti thyroglobulin antibody levels remain low, however in a recent blood test, the TSH level rose to over 6. My T4 levels remain close to the upper limit where they should be for TSH suppression (at the moment free T4 is at 1.68ng/dL). Is there any reason why the TSH level jumped in such a way?

It will be over a month before I can see my endocrinologist again, which is why I'm here.

I also have dizziness and my hands tend to shake when I am eating and manipulating objects, etc.

The only medication that has changed recently is that I started taking sulfasalazine for apparent psoriatic spondyloarthritis, for which I'm currently in the processes of being diagnosed (I have a very painful left elbow, difficulty in raising my right arm above my head and pain in the right arm -- a recent problem, sacroiliitis and some lower back pain).  I also had an MRI of my pelvis with contrast done 10 days before the blood test -could this raise the TSH? There is a unspecific 1.2cm sclerotic lesion on my pelvis - the MRI results have not yet been released by the hospital. I have an apparent adenoma on my adrenal gland for which I've done a adrenal-specific MRI exam. At one stage my DHEA-S levels were high but have fallen back to the upper limit of normal levels. Years ago they were far lower. A recent 24h urine test shows that I have excreted calcium above the the normal reference but bone density is normal. LH,, FSH and Total testosterone are normal. Still waiting on renin and fractional metanephrines results) I am a 57 year old male. Thanks

[sebinho]

I asked my rheumatologist to do the TSH test again (I won't be seeing the endocrinologist for a month). She asked also for Free T4 and what must be total T3 (it just says T3). The lab's reference range for TSH is 0.55 t 4.78 mcUI/mL. My TSH when down from 6.08 on Friday to 4.29 today. The Free T4 reference range is 0.74 to 1.72 ng/dL. Since Friday my free T4 went up from 1.68 to 1.70. The lab's T3 reference range is 60 to 181 ng/dL. My reading is 71. Three years ago it was measured at 77ng/dL.

Probably unrelated but I also did a 24h urine collection for fractional metaphrines. Metaphrine was 90µg/24h (ref. less than 320 µg/24h) but normetaphrine was 524µg/24h (ref. less than 390 µg/24h). I have an adrenal nodule, as mentioned above, however I take one tablet Bupropion 150 each day and I understand that this can increase normetaphrine.