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TSH is high(9.15), but everything else within normal range

I recently went off levothyroxine for a few months, I wanted a 'clean-slate' for my labs. (Diagnosed Hypo Fall of 2007). My labs just came back within normal range (both antibodies, T3 Total, Free T4, reverse T3), except for my TSH, at 9.15. My general practitioner wants me to start back on 100mcg and get rechecked in 6 weeks. He wants me to be firm on taking it first thing in the morning, and not taking any other medications/vitamins for at least 2 hours (Biotin, birth control, singulair, spironolactone). My questions is, why would everything be 'normal' except my TSH?
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649848 tn?1534633700
COMMUNITY LEADER
You didn't indicate a reason for stopping your Levothyroxine, other than having a clean slate for your blood work.  What made you think that was necessary?

Apparently, you doctor didn't test Free T3, which is the most important of the tests?  What were the actual results of the other tests that were done, with their reference ranges?   If we know those values we will be better able to advise.  

Other than that, your doctor is correct about the medication, except that it's possible you don't need as much as 100 mcg.  Perhaps you could start at a lower dose and go up if needed.  It's correct that you should take thyroid medication first thing in the morning with water, then not eat drink anything for 30-60 minutes.  Vitamins/minerals should be separated by 2-4 (depending on the vitamin/mineral).  I take my spironolactone approximately and hour after my thyroid med.   Your singulair could interfere with metabolism of the thyroid med.

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Avatar universal
As Barb suggested, you should always be tested for Free T3, and also Free T4.  When taking thyroid med, TSH should never by used to diagnose your status and your med dosage.  If you will click on my name and then scroll down to my Journal you will find a link to a paper : Managing the Total Thyroid Process:.  In the paper there is a graph of TSH and FT4 which shows that TSH cannot be used to reliably estimate a patient's Free T4 level (or Free T3).  TSH also does not correlate with hypo symptoms .   Treatment of hypothyroidism should be based on symptoms and FT4 and FT3 levels.  

Many people taking T4 med find that their body dos not convert the T4 to T3 adequately.  Symptomatic change has been shown to be strongly associated with serum thyroid hormone levels but not TSH levels​​,   You may find that you need to add a source of T3 to your med in order to get your FT3 high enough in range to relieve hypo symptoms. In addition you should make sure to test and supplement as needed to get Vitamin D at least 50 ng/ml, B12 in the upper part of its range, and ferritin to at least 100.  All are very important to achieving the optimal result.  

If your doctor has a problem with any of this you can use the paper to try and persuade him to give you adequate treatment.  
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649848 tn?1534633700
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