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I was diagnosed with sub clinical hypothyroidism about a year ago and was started on 100mcg synthroid which made my tsh level lower than normal. The dose was then decreased to 50mcg and was doing well but then the PA said the tsh level was creeping up faster than he'd like so he increased the dose to 75mcg despite the fact my tsh was still within normal range, like smack in the middle normal, not even high end. Then my tsh bottomed out. He then decreased the dose back to 50mcg and nothing happened. So he finally referred me to an internist who told me to just discontinue the medication entirely. This happened about a month ago. My issue now is that my tsh is slowly recovering but my T4 has continued to increase over this month despite discontinuing synthroid. The PA cannot tell me if this is normal reaction or not and he also is unable to refer me to another internist since the previous one has left the hospital.(military medicine...) I am currently goin though IVF treatment and while the fertility doctor is saying we should be fine to proceed, he is still concerned with my now laboratory-hyperthyroidism. I'm not clinical for the most part, I do have heart palpitations and headaches here and there but not too bad. So my question is, should I go ahead with this ivf treatment? Can I expect my T4 level to come back down? I know tsh takes a little bit longer, but how fast does t4 return to normal?

Category: Endocrinologist

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Category: Diabetologist
 22 Doctors Online

Thank you for your query at
From your description, it is clear that you had subclinical hypothyroidism for which the dose that was started was higher than required. Therafter, as you have reduced the dose, the TSH seems to be recovering. The T4 may be more than normal because of IVF treatment, if hCG injections or Estradiol hormone are being given. you can check your Free T4 to confirm that, which is likely to be normal. you can then wait for the TSH to recover. You can proceed with IVF treatment even if T4 is slightly high. Its unlikely to be harmful in any way.

Patient replied :

Thank you for the rapid and informative response, Dr. Muthukrishnan. So with the TSH currently still being low but recovering (previously was so low, the actual level wasn't even registering), it shouldn't be a concern for IVF treatment? And if I do get pregnant, will that cause any issues with my thyroid function, ie. Do I need to push for closer monitoring of my thyroid level when I do become pregnant? Or just as become symptomatic, I can request for further testing?

Yes, you need to monitor your thyroid function closely. Once you conceive, check it and then every three months. Till you conceive, check after 6 weeks.

Dr. J Muthukrishnan
Category: Diabetologist
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
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