Can you have both primary and secondary hypothyroidism?

In order for my free T4 to be in the higher end of the range (18+), my TSH needs to be suppressed (0.05). Interesting also to note that when my free T4 recently fell to 13.6 (very low for me, felt very unwell), my TSH climbed to a heady 0.3. I'm fairly certain that if my free T4 fellow below 10 then my TSH would probably still be under 1. Would this indicate central / secondary hypothyroidism? Is it possible to have both primary and secondary hypothyroidism together?

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  • I cannot think of any reason at all that the having primary hypothyroidism would stop you having secondary (or tertiary) hypothyroidism. Or vice versa. Indeed, I am convinced that at least mild secondary or tertiary hypothyroidism is a potential explanation for some people not getting diagnosed. That is, their TSH might rise but never above local reference range, or never above 10, due to the secondary/tertiary issues.

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