bluegreyeyes, I think I should start by explaining that hypothyroidism is not just "inadequate thyroid hormone levels" sensed by the hypothalamus/pituitary and resulting in elevated TSH levels. There are numerous body processes and associated variables that affect what is known as Tissue T3 Effect, which creates a person's thyroid status as hypothyroid, euthyroid, or hyperthyroid. For this reason there is no biochemical test that can accurately determine a person's thyroid status. A person's thyroid status is best evaluated with an integrative approach including a full medical history, evaluation for symptoms that occur more frequently with hypothyroidism, and extended testing that includes Free T4, Free T3 and TSH. Since Reverse T3 and cortisol can affect Tissue T3 effect those need to be tested at least at the start, to assure okay. In addition, hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin so they also need to be tested and supplemented as needed to optimize. And as you mentioned, with the high TSH, but negative TPO ab, you do need to test for TG ab.
Your TSH is on the high side, and your FT4 was only at about 29% of its range. Those tests alone are not enough to diagnose hypothyroidism. TSH is affected by so many things that at best it is only an indicator to be considered along with more important indicators such as symptoms. TSH is an indicator of thyroid hormone levels, but there is only a weak correlation there.
Without any symptoms I don't really see the need to start on thyroid med until you get additional testing done. But I would go ahead and try to get that done now. With that in hand you can know better what needs to be done. If further tests confirm the need, the med dose of 25 mcg is not going to do anything for you. Since serum thyroid levels are the sum of both natural thyroid and thyroid med, patients starting on thyroid med most often find there is little or no effect on FT4 and FT3 levels. This is because the med causes TSH to drop, resulting in less output of natural thyroid hormone. Only when the med dose is high enough to essentially suppress TSH, will further dose increases start to increase FT4 and FT3 levels. If you start on that small dose now, the doctor is not going to want to re-test for 5-6 weeks and then consider another small dose increase. Small starting doses and small increases every 5-6 weeks will not get you to where you want to be for Sept. So if you can get those tests done and then post results here we will be happy to try and advise further and suggest a more appropriate starting dose.
A good thyroid doctor will treat a hypothyroid patient clinically by evaluating for symptoms and then testing and adjusting FT4 and FT3 as needed to relieve symptoms, without being influenced by resultant TSH levels. In those situations symptom relief should be all important, not just test results. Since you have no symptoms, but do have the high TSH and relatively low in the range FT4, your TG ab test may indicate Hashi's. If that is the case, then the doctor will need to medicate, not based on symptoms, but as needed to get your FT4 and FT3 into the upper half of their ranges, regardless of resultant TSH.
Do you think you can get the additional tests done soon?
78.640 was my tsh level. I'm extremely exhausted, cold feet, hot flashes, etc. How long before I feel the synthroid (100mcg) kick in?? Thx 49 yo Diag. W/hashimotos.
78.640 was my tsh level. I'm extremely exhausted, cold feet, hot flashes, etc. How long before I feel the synthroid (100mcg) kick in?? Thx 49 yo Diag. W/hashimotos.
My husband and I are planning to try to get pregnant in September so my Dr would like to get these levels under control asap.
My husband and I are planning to try to get pregnant in September so my Dr would like to get these levels under control asap.