Advice regarding atypical hypothyroidism with surpressed tsh and low t4 and t3

Hello everyone! I'm a 27 year old male who have been struggling with symptoms of hypothyroidism since June. However, my endo have told me that thyroid medication is not an option yet because he thinks that my current hypothyroid state is probably just a transient case of hypothyroidism.

My thyroid problem was discovered by chance in March. At that time I had some blood tests done that showed suppressed TSH, normal free T4 and elevated free T3, and I was then referred to further examination for hyperthyroidism. Since then I have had regularly blood tests done and there has been a continuous decline in free T4 and free T3, while TSH has been unchanged and thus suppressed throughout the whole period. Thus, my thyroid test results have been as follows:


TSH: 0.01

FT4: 19.5

FT3: 8.9


TSH: 0.01

FT4: 12.5

FT3: 5.3


TSH: 0.01

FT4: 11.1

FT3: 3

End of July

TSH: 0.01

FT4: 6.8

FT3: 2.1

* Lab normal reference ranges: (TSH: 0,3-4); (FT4:10-26); (FT3: 3,3-6,1)

* In addition, normal antibody levels detected: TPO = <28 (lab normal ref-range: <60); Thyrotropin receptor antibodies = <0,3 (lab normal ref-range: <1,2)

As shown by my last blood test, my current t4 and t3 values ​​are too low, which currently gives me many disabling typical symptoms of hypothyroidism. However, my endo has concluded that thyroid medication is still not an option. His medical hypothesis is that I probably have had some prior inflammation in my thyroid gland which resulted in a temporary high metabolism (I never felt any hyper-related symptoms) and that my thyroid after a transitional period with hypothyroidism probably will soon stabilize again, when my TSH starts to increase, which, however it has not yet, in spite of my current low values ​​t3 and t4. Therefore he have decided that I should wait another 3 weeks from now and then get new blood test to see if the TSH have started to increase. I'm not sure what he will suggest for further examination in case my TSH is still suppressed in 3 weeks.

Since I don't know much about all this thyroid stuff and have only been to a brief consultation with an endocrinologist, I would very much like to ask for advice and some answers to the following questions:

- How low is my current t4 and t3 values ​​compared to typical cases of hypothyroidism?

- Is it normal for TSH to remain suppressed when t4 and t3 values ​​are as low as they are in my case?

- And if yes, how long does it usually take before TSH starts to increase?

- Is secondary hypothyroidism with pituitary dysfunction a possible assumption in my case?

Thanks in advance for your time - and sorry if I'm not strictly following the rules of the language in which i'm writing but English isn't my native language.

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7 Replies

  • Hi Klaus, Have you had any of your other pituitary hormones (e.g. sex hormones) tested to see if there are any problems with those? Often if you have pituitary problems other hormones will be affected (but not always - mine aren't).

    The fact your TSH isn't changing at all with varying FT4/3 results does suggest a pituitary problem to me...

    To rule out secondary hypothyroidism (or even hypothyroidism in general) ask your endo for a TRH test.

  • Welcome to the forum, Klaus4000.

    Thyroid peroxidase antibodies (TPOab) are negative for autoimmune thyroiditis (Hashimoto's). It's not uncommon to have negative TPOab but positive thyroglobulin antibodies (TgAb) which could mean you have Hashimoto's. Hashimoto's often causes transient hyperthyroidism as thyroid cells are killed off and dump hormone.

    Your T4 and T3 levels are both considerably below range and as TSH has failed to rise in response your endocrinologist should consider secondary hypothyroidism which is caused by pituitary dysfunction.

    It's not common to have autoimmune thyroid disease (Hashimoto's) and secondary hypothyroidism. One or the other is more usual.

    I hope your endocrinologist will prescribe thyroid replacement if your T4 and T3 remain low. You must be feeling extremely unwell.


    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.

  • Klaus,

    Welcome to our forum, sorry to hear you are not feeling well and your english is PERFECT ! ....

    T4 & T3 levels are low and you (might) feel perfectly HORRID ...Your antibodies test shows you are negative for Graves and TPOAb (Hashimotos), ... but Hashi can also be determined by the presence of TGAb's. Ask your GP to test as your results could indicate the onset, although usually TSH is higher (as the pituitary struggles to keep up with demand).

    In secondary hypothyroidism the pituitary makes inadequate TSH, and the thyroid gland will not produce enough T4 hormone (& so T3), and hypothyroidism will ensue. Your endo may wish to test pituitary function by injecting TRH (hypothalamic hormone).

    Hypothalamic hypothyroidism occurs when there is inadequate secretion of TRH by the hypothalamus, (to keep the pituitary gland secreting enough TSH, to produce enough T4 and T3 by the thyroid gland). This is unusual BUT only in that "they" don't test for it so it records as " unusual".

    Post any results complete with ranges (numbers in brackets) for members to comment. DO NOT be bamboozled into a diagnosis you don't agree with, although treatment is the same... thyroid hormone replacement (Levothyroxine in UK ) ,.

  • T3 is the active thyroid hormone which controls the metabolism and therefore the symptoms. When your Free T3 was above the top of the normal range in March it is unusual that you should not have hyperthyroid symptoms.

    One possible cause of this and your unusual thyroid test results is a genetic condition commonly known as Thyroid Hormone Resistance. It causes hypothyroid symptoms and requires very high T3 levels in the body to overcome the resistance.

    If there are other family members with fibromyalgia, CFS, ME, Coeliac Disease, MS, Heart Disease, thyroid or depression this would further support this.

  • Thank you all for your replies and advises!!!

    If my TSH remains suppressed in my next blood test I will talk with my endo about the possibility of secondary hypothyroidism and make sure to get the necessary tests for that.

    Also, I would like to know: in medicated patients with secondary hypothyroidism is the low TSH just accepted and ignored, so that it remains permanently suppressed when these patients are put on thyroid hormone replacement and there t4/t3-levels are normalized?

    @strawberrysorbet; No, I haven't had my other pituitary hormones tested yet, but I will make sure that they are tested in my next blood test.

  • Klaus,

    In secondary hypothyroidism, the TSH should be ignored but when endos pass patients back to GP's who may be ignorant of this fact, they may be dosed by the TSH results.

    Therefore, it is important you learn all you can and the be prepared to investigate further.

    Posting on the end of your post only notifies yourself. If you wish to reply to someone, click on the green reply button & the person will be notified.

  • Yes the TSH should be ignored when you're being treated with secondary hypothyroidism. They should go by FT4 and FT3 but as radd has said GPs often don't realise this. My endo has told me I need to tell my GP and explain it to them! Ridiculous but obviously he's seen this before. He's warned me I mustn't let them try to reduce a dose or do anything based on TSH. I've had GPs ask me what secondary hypothyroidism is!

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