Hi Halinka, sorry for the delay.
Latest BNF Guidelines: - "ADULT over 18 years, initially 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (e.g. coffee, tea), or other medication, adjusted in steps of 25–50 micrograms every 3–4 weeks according to response (usual maintenance dose 100–200 micrograms once daily); in cardiac disease, severe hypothyroidism, and patients over 50 years, initially 25 micrograms once daily, adjusted in steps of 25 micrograms every 4 weeks according to response (usual maintenance dose 50–200 micrograms once daily);
See full page here: - evidence.nhs.uk/formulary/b...
The "Up-Down Effect" is originally quoted and observed by Dr. Kenneth Blanchard who has an excellent book on the functioinal approach to treating Hypothyroidism. Dr. Myhill quotes his observations, including this up-down effect. I have personally had this symptom with under prescribing by my hopeless hand-wringing GP's, and it took Dr. Myhill to make them realise they were wrong!.
Also Dr. M has her own evaluation / prescribing guidelines : - drmyhill.co.uk/drmyhill/ima...
Dr. A. Toft is also referred to by Dr. M, and he again prefers a similar approach to give sufficient medication to move the T4 & T3 to the upper parts of their ranges (sometimes above range for T4). All these "Knowlegeable Doctors" agree that the TSH can be very misleading and dosing according to TSH is NOT satisfactory!
Please understand I'm no expert, I'm only going off personal experience here. My own opinion is that your results above most definitely warrant a decent trial / increase of Thyroid medication. Others on here are much more knowledgeable than I am on prescribing, and would be better able to advise on that.
Apologies for the long reply.
Good luck - I hope you find a good Doctor who will help you get better!