Hypothyroidism and/or general pituitary dysfunction and bulimia (pathophys experts help!)

[josh1989]

Hey guys, have you seen the development of hypothyroidism either in the midst of or after bulimia? I am a 27 year old male and have struggled with it for over 11 years now. A few years, all hypo symptoms began. Generally, my TSH has been normal around 1.5 with low FT3 and low/normal FT4, no antibodies, low RT3. I actually thought the insane stress of the bulimia could have induced the autoimmunity but the lack of antibodies seems to tell another story.

My testosterone is also currently very low. Last year, a hormonal panel showed low/normal LH, FSH, and testosterone. I also have issues with waking up during the night to urinate (several times with a full bladder) so I'm thinking ADH could be low as well.

Further, my WBC's have been low and decreasing the past couple of years. My ferritin has been as low as 7 but most recently was at an all time high of 49. Vitamin D is okay, serum B12 has fluctuated from low normal to double the top of the reference range, and folate seems to be okay.

Just starting on some thyroid tx now. Currently taking 1/2 grain NDT twice daily and 5 mcg cytomel daily. Nothing yet but it's early on in the tx. Tried levo 3 years ago with no success and also tried Thyrogold with no effect. Hoping this is helpful. More than anything, I'm curious about the root of it all. Any ideas?!

[josh1989]

I can post numbers and ranges later. My question is not really why bulimia occurs (I know it was years of heavily restrictive eating and over-exercise around 10-13 years old). My concerns are more related to the long term effects of bulimia on the endocrine/HPA system. Thank you for your response!!! I hope some others will weigh in.

[greygoose in reply to josh1989]

It's more like the effects of low-calorie diets on conversion of T4 to T3. It can become permanently impaired. Most anorexics end up with hypo.

[josh1989 in reply to greygoose]

Yes I've seen this. But all of my pituitary hormones seem to be low. I'm guessing that once I find the right thyroid med regimen, I'll need to stay on for life because of the impaired conversion?

[greygoose in reply to josh1989]

Well, secondary hypo and bad conversion, are two separate issues. But, yes, you will need to stay on it for life.

[Silver_Fairy]

I know this is AN but similar as the body doesn't get the proper nutrition. Scroll down to 'HYPOTHALAMIC-PITUITARY-THYROID AXIS'

ncbi.nlm.nih.gov/pmc/articl...

[josh1989]

So especially given the above study and others that show potentially permanent peripheral conversion of T4 to T3, I wonder if it would be better for me to be on T3 alone as opposed to 1 grain of NDT and 10 mcg cytomel? What do you guys think?