Below range T4 - normal TSH - Pituitary?

Many years ago I suffered extremely with anxiety and panic attacks. I ended up resigning from a career, took on a minimum hours job, ruined my life basically. It wasnt until 19 years later that I lost part of my vision for about 20 minutes, had various tests and it was found that I was hypothyroid. I started taking thyroxine but still I wasn't much better and seemed to swell up.

After a couple of years of agony and pain, I saw Dr Peatfield. He asked me to take all my blood tests and the GP surgery gave me 19 years worth which I was astonished by. What these blood tests showed that while, for a long time, my TSH was within range (ish), my T4 was very low, even noted as low by the hospital. Yet nothing was done about it.

Dr P advised me that I wasn't converting the T4 and I started taking T3. I knew the various thoughts against it but I was so bad, I was prepared to die early if I had something of a decent life in the meantime. However I still find it extremely hard to lose weight and I am now on a silly diet of only 600 calories per day.

However, I read only yesterday that if the T4 reading is low (mine was below the bottom of the range) and TSH ok, that it is something I should have been referred immediately to an endocrinologist over and that my pituary should have been checked.

Basically, does anyone know anything about this? Could all those of years of agony been unnecessary and is it something I should discuss with my doctor about the pituary. I believe this is an extremely rare condition and possibly why it was overlooked. I am also concerned because my daughter has started suffering badly with anxiety and depression, I suggested she had her blood tested and it came back "normal" again. What I don;t know is what her T4 reading was and is it possible she could have the same. I dont want her to suffer the way I did. Since being treated correctly, it was as if my anxiety flew out of the window.


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7 Replies

  • Numberone1, the 600 kcal diet: don't. This is a starvation diet. Your body will scavenge protein out of your muscles. You will lose muscle mass and it is muscles that help to burn calories when you use them. Also, muscles support your joints and if they are wasting away, you will end up with more joint pain.

    Walking 1 mile briskly will burn up about 100 kcal. If you walk 5 miles per day, that'll be 500 kcal more calories burned. Better to incorporate some walking into your daily life than to starve the muscles. Just start at some distance that you can manage and increase it as time goes on. Swimming is an even better exercise for burning calories but not everyone has easy access to a decent swimming pool. Lots of walking will also strengthen the heart. A person doesn't have to go running around to get better heart function. Consistent walking will accomplish this.

    The 5:2 diet isn't too bad. If followed for long enough, it will result in substantial weight loss. If physical activity is also included, muscles don't disappear. Women seem to do better on this diet than men. The men I know who have done this and continue to do it all look emaciated. But generally, men need more calories than women.

    The problem between the pituitary and the thyroid may actually be a problem with the hypothalamus. So there's that possibility as well. There are tests to determine if the pituitary or the thyroid or the hypothalamus is the source of the problem. Just these tests are extremely unpleasant experiences. (been there, done that, won't agree to doing it again.)

  • Thank you for the advice. I currently and have for many years carried out extensive exercise including walking and swimming. I cannot run as I have arthritis in my hips from a traffic accident. 600 calories is very hard but actually is showing some results.

    My main point of the question was about the 19 years of non treatment and I really want more information about that which I can put to my doctor ie why was this not picked up at the time. Also, is it possible my daughter could have the same.

    Thank you again.

  • Numberone, low-normal TSH and below range or bottom of range FT4 indicates secondary hypothyroidism which is due to pituitary dysfunction and isn't particulary rare. Tertiary hypothyroidism due to hypothyalmic dysfunction not signalling the pituitary gland is rare. Secondary and Tertiary hypothyroidism are managed in endocrinology as pituitary/hypothalmic dysfunction can cause deficient sex and growth hormones.

    If your daughter's GP won't test FT4 you can order private thyroid tests from Blue Horizon and Genova via Blue Horizon have reduced their Comprehensive 10 package from £99 to £80 until Friday. Not sure if that is inclusive of TUK10 discount.


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Thank you Clutter. What I am saying is, why was this never picked up when my results continually showed this and how might I have been affected in the long term as opposed to what might have been happening at the time. Should I have been referred somewhere do you think or was it okay to leave me appearing at the doctors with tiredness, depression etc and not acting on the blood test result. Because I knew no better and thought I was just struggling with depression I had no idea I should have been referred somewhere because of the T4 result.

    So far as my daughter is concerned she thinks she's okay and is struggling with anti depressants because the doctor says her thyroid results are normal. I can't interefere because she;s 22 and I know about Blue Horizon because I have my blood tests done there all the time.

    I guess Im just wondering if I should push her situation after going for so many years with mine.

  • Numberone, if your doctors were only looking for abnormal TSH (primary hypothyroidism) they may not have considered secondary hypothyroidism or pituitary dysfunction which many doctors wrongly think are rare. A pituitary function blood test may have confirmed or ruled out pituitary dysfunction.

    I would encourage your daughter to have a full thyroid panel. As you know, normal TSH is not always an indicator of good thyroid levels.


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Why would doctors not have considered it when the hospital actually put LOW on the below bottom of range T4 test results? Surely its something they should know or query with those hospital comments.

  • Numberone, I'd like to think GPs confer with colleagues, biochemists or endocrinologists when in doubt about thyroid levels, or when labs flag abnormal levels, but it clearly doesn't always happen.

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