If a patient on synthroid has an increased TSH level and normal T4 after 3 months, what action should be taken?

When a patient on Synthroid (levothyroxine) presents with an increased TSH level while T4 remains normal after three months, this scenario indicates that the current dosage of the thyroid replacement therapy is not sufficient to suppress TSH production. Under normal circumstances, TSH (Thyroid Stimulating Hormone) levels should decrease in response to adequate levels of circulating T4. An elevated TSH level suggests that the thyroid hormone supplementation is inadequate, and therefore, the next logical step is to increase the medication dosage.

Increasing the dosage of levothyroxine would help in achieving a more optimal thyroid hormone balance, leading to lower TSH levels and normal T4 levels. It is important to monitor the patient's response to the dosage adjustment over the subsequent months, as thyroid hormone replacement therapy often requires fine-tuning to achieve optimal thyroid function.

In this situation, continuing the current dosage could perpetuate the existing imbalance, while decreasing medication would likely worsen the patient's thyroid status. Switching to a different medication is unnecessary as levothyroxine is typically very effective; the issue is likely dosage-related rather than a need for a different formulation.