Ongoing strange readings

My Mum's TSH has been up and down like a yo-yo for the past year. She had radio iodine treatment which resulted in total ablation in 2010 and has since had blood results which have been up and down. The GPs have been managing it by altering her meds during this time. About 4 months ago she was on 125 7 days her readings were TSH 8.7 / T4 19 so we insisted to be referred back to an endo. At the initial consultation he suggested altering the stomach protector drug in case it was interfering with absorbtion of T4, he said he would see how this went and would test for antibodies if it did not help. The next tests showed the TSH had shot up even further (TSH 14.73 / t4 21.) but he didn't do antibody tests he just recommended she take T4 150 7 days a week. Her symptoms have got worse and she has become shaky and very agitated. She has recently discovered she has several compression fractures in her vertabrae which it would appear have been caused by an over enthusiastic chiropractor (another story) she is due to have an operation next week to place cement in to help, but is concerned shes not strong enough to go through the procedure. I feel the endo has not done enough. They sit behind their desks and barely move - he did check her pulse and felt her neck and said she was clinically euthyroid!

Due to her worsening symptoms and my feelings that her muscle weakness, general malaise and possible her bone density (fractures dont happen easily for no reason) were something to do with the thyroid I insisted that further tests be done and the GP agreed - the results are in but still waiting on antibody test to come back - they are TSH 2.4 and T4 22.5 - a turnaround! The GP says shes now hyper so suggests whilst we wait to see endo to reduce T4 to 125 4 days and 3 days at 150. Has anyone got any thoughts as to why this TSH has been so up and down and why it is not easily controlled.

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Jcoops, Your mother's TSH is going up and down because her GPs are altering her dose in accordance with her blood tests and it's wrong. 150mcg has brought her TSH down to 2.4 which is still too high for most people who usually need it just above or just below 1.0 to feel well. If your mother stopped taking a proton pump inhibitor her absorption of Levothyroxine will have improved and will have helped reduce her TSH.

Her GP is totally wrong to say she is now hyperthyroid. If she was hyperthyroid her TSH would be suppressed <0.03 and her FT4 considerably elevated above range. You don't provide the lab ref range for FT4 but 22.5 is acceptable in a range of 10-22 and not even at the top of a range 12-24. Your GP should get the endo's approval before reducing your mother's thyroid meds and continuing this yo-yoing.

PPI's reduce the stomach's ability to break down meat and fish into B12 so I would advise you request a B12 test to check for B12 deficiency and also request ferritin, vitamin D and folate to be tested as these will contribute to fatigue, musculoskeletal aches and pains and low mood if low/deficient.