Suggest Treatment For Persistent High TSH Levels Despite Medications
Need to investigate the cause of high TSH
Noted your question . we need to get your TSH with in normal range. In most individuals I like to keep TSH around 2.5. Despite being on 300mcg of Thyroxine, your TSH is still high. We need to find out the reason why TSH is still high.
Some of the possible reasons are, a) malabsorption of medicine from your stomach. b) medicines getting damaged by exposure to heat or sunlight. c) Bacterial infection in stomach like H. Pylori infection. d) not giving adequate gap between food and thyroid medications. e) Skipping medication often.
There is no cutoff level of dangerously high TSH level. May I know what is your Free T4 level?
Could you please let me know your height and weight? Dose calculation is usually done based on weight.
b) No exposure issues or storage issues with temp variations
c) Was tested for H Pylori about 6 mo ago and it was negative
d) Take meds in a.m. about an hour to 1 1/2 hrs before eating and I don't drink coffee
e) I NEVER skip meds. It is part of my morning routine and I understand the need for consistency.
Thank you for the reply.
Normal Thyroxine requirement is around 1.6 mcg per kilogram. As you are taking more than double the required dose and if TSH is still high, mal-absorption of the medicine should be suspected.
Do you have any intolerance to wheat /gluten ? There is an approved Thyroxine malabsorption test done at many places by endocrinologists and it may be good to discuss with your endocrinologist. Interested to know about your free T4 results, if available.
Gluten insensitivity ( celiac disease) can coexist with hypothyroidism
If digestive issues/gluten is an issue, that probably is responsible for the mal absorption of thyroid hormones. It is good to prove gluten insensitivity by doing tests ( Total IGA , ttg IGA and Anti Gliadin antibody). If it is positive, you may try a gluten free diet which will dramatically improve the absorptive capacity and your TSH levels might improve well and the dose of thyroxine may need to be reduced as well.( i have many patients with gluten insensitivity and hypothyroidism). Gluten insensitivity and hypothyroidism can co exist in many patients .
And yes, free T4 levels will surely help the clinician in adddition to TSH levels.