Secondary hypo?

[Margiebess]

Hi. I'm on a t4/t3 combo with additional 5mcg t3. My tsh is .016 but free t3 and t4 remain slightly below normal range. Does this mean I need to up my medication? A naturopath told me I need pituitary supplements. Any advice?

[greygoose]

Can you give us your results, with the ranges? It's always better to see the actual numbers.

What was your TSH when you were diagnosed? At the moment it is low because you are taking T3, that's normal.

What on earth is a pituitary supplement?

[Margiebess in reply to greygoose]

Thanks for your reply. Was dx 12 years ago with tsh of 3.8 and many symptoms. My typical tsh had been below 1.0 in years prior. My tsh is currently.016, free t3 1.8 (2.0 -4.4)free t4 .70 (.82-1.77), no hashis.

Pituitary supplement is called Gb manufactured by systemic formulas. Consists of various herbs and rna/dna tissue factors. Also brain and pituitary tissue factors.

[greygoose in reply to Margiebess]

Well, with a TSH of 3.8, it's rather doubtful you have central hypo. It's rather amazing, though, that you have such low Frees when you are on thyroid hormone replacement. How much T4 and T3 are you taking? Do you take it on an empty stomach and wait an hour to eat or drink anything but water? Are you taking any other medication or supplements with it?

I very much doubt that supplement will help you, but it won't do you any harm, I don't think.

[Margiebess in reply to greygoose]

Thanks so much. Taking two grains ndt plus 5mcg t3. Yes on your other inquiries. Guess its some kind of resistance going on. Administrator suggested increasing ndt to see if that helps.

[greygoose in reply to Margiebess]

Have your Frees ever been at a decent level? Or have they always been below range?

[Margiebess in reply to greygoose]

FT3 always slightly below, ft4 used to be normal (after starting ndt)

[greygoose in reply to Margiebess]

What do you mean by normal?

[Margiebess in reply to greygoose]

Within normal lab levels. But never on the high normal side.

[greygoose in reply to Margiebess]

When a doctor says 'normal', he just means 'in range'. But, the ranges are much to wide, all the readings can't be 'normal'. If the range goes from 12 to 22, people with a result of 12, are not going to feel the same as someone with a result of 22. So, how can they both be called 'normal'?

It's such a vague word as to be meaningless. It's much better to give the actual numbers that people can understand.

So, what you're saying is, the T4 was in range, but low? But, I presume you don't have the numbers to hand.

[Margiebess in reply to Margiebess]

Within normal lab levels

[greygoose in reply to Margiebess]

Sorry, there's no such thing.

[Joesmum in reply to greygoose]

Greygoose,

Central hypothyroidism can be diagnosed with a TSH within the normal range or just above. FT's will usually be below range.

There is a reason this is possible but I can't remember the science???

I was diagnosed with a TSH of 6 and FT's below range.

As soon as I was put on the smallest amount of levo my TSH dropped below range.

I have hypopituiatary.

[greygoose in reply to Joesmum]

OK How did they diagnose your hypopituitary?

[Joesmum in reply to greygoose]

Hi Greygoose.

Have a look at this link as it mentions elevated TSH in central hypothyroidism.

cursoenarm.net/UPTODATE/con...

My TSH had already suppressed by the time they got my FT's in range.

I had all my pituitary hormones tested.

Stim test.

Pituitary scan.

I now take T4, T3, hydrocortisone, estrogen.

[Clutter]

Margiebess,

If you had high TSH with normal or low FT4 at diagnosis you have primary hypothyroidism.

If TSH was low-normal with low FT4 at diagnosis you have central hypothyroidism (secondary or tertiary hypothyroidism).

If your naturopath is diagnosing secondary hypothyroidism based on low TSH and low FT4 and FT3 while you are taking T4+T3 combination s/he doesn't know what s/he is talking about.

If FT4 and FT3 are below range you are under medicated and need to increase dose.

[Margiebess in reply to Clutter]

Thanks for clearing that up! Definitely central. Would you think increasing t3 only would work or should all be increased?

[Clutter in reply to Margiebess]

Margiebess,

I would increase the T4+T3 combination tablet dose.

[Margiebess in reply to Clutter]

Many thanks.

[Margiebess in reply to Margiebess]

Many thanks

[Margiebess]

My naturopath said it was because my tsh was so low .016 while t3and t4 remain slightly below level. However I'm on ndt so not accurate according to administrator.