Your very high TSH level of 281 with low T3 and T4 indicates significant underactive thyroid function, so your Thyronorm (thyroxine sodium) dose will likely need to be increased substantially from 25 mcg.

🩺 What This Means for You

• Such a high TSH suggests your current dose is insufficient to normalize thyroid hormone levels.
• Typically, doctors increase the dose gradually, often doubling or more, but exact dosing depends on your weight, symptoms, and other health factors.
• Close monitoring with repeat thyroid function tests every 6-8 weeks after dose adjustment is essential to avoid over- or under-treatment.

💊 Dose Adjustment Guidance

• Your doctor may consider increasing your Thyronorm dose to around 50-100 mcg daily initially, but this must be personalized.
• Take Thyronorm 1 hour before or 2 hours after meals for best absorption.
• Avoid taking calcium, iron, or antacids within 4 hours of your dose.

🩺 Next Steps

• Consult your endocrinologist or thyroid specialist promptly to review your test results and adjust your dose safely.
• Do not change your dose on your own, as too rapid or excessive increase can cause side effects.
• Regular follow-up blood tests will guide further dose changes.

If you want, I can explain how thyroid hormone replacement dosing is typically managed in more detail.