TSH SPIKE

[dmimperial]

I had my thyroid out almost 5 yrs. ago (no cancer). I gained weight but recently have been on weight watchers and lost 20 lbs. Have been taking 88mcg but it was lowered to 75mcg when I started to lose weight because TSH dropped. Repeated bloodwork and it went up a little but not enough so they again lowered it to 50mcg. Another 6 mos. has gone by. I went and had it repeated again and now the TSH has spiked to 34.73 but my T4 Free is normal. Does this mean I could have a pitituitary issue now?

[gimel]

The spike in your TSH is due to reducing your dosage so much.  That amount is far too little for someone with no thyroid gland.  TSH should never be used to determine thyroid replacement dosage.  The only time TSH is useful as a diagnostic is when it is at extreme levels.   This is because TSH has only a weak correlation with thyroid hormone levels and has a negligible correlation with hypothyroid symptoms.

Your dosage should be adjusted as needed to relieve hypo symptoms, without going so far as to cause hyper symptoms.  This typically requires that your Free T4 and Free T3 levels are around mid-range, or higher.  Also you need Vitamin D at least 50 ng/ml, B12 in the upper part of its range, and ferritin at least 100.

If not tested for Free T4, Free T3, Vitamin D, B12 and ferritin then you should make that happen as soon as possible.   I also recommend reading our paper in the following link, so you can confirm what I have said.  Your biggest problem will be to get a doctor to treat clinically, as described.  You might be able to get your doctor to read the paper also and consider clinical treatment.  

https://thyroiduk.org/wp-content/uploads/2022/10/Patients-Guide-Final-V5.pdf