Thyroid UK
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Empty Sella - pituitary compressed - is this a problem?

Hi everyone, after MRI of the head i was told that pituitary gland is compressed but a neurologist said it should not be a problem. But i am very ill and decided to test some hormones, could you please tell me if they are OK:

TSH 0.866 (0.27 - 4.2)

fT4 11.04 (9.30 - 17)

fT3 2 ( 2 - 4.4)

ACTH 18.2 (7.2 - 63)

DHEA-S 133 ( 89 - 427)

Many Thanks

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vb2005,

Your results suggest that you are not producing an appropriate amount of TSH. The result of that being your FT4 and FT3 levels are low. If your pituitary were to respond properly, you'd expect higher TSH, resulting in higher FT4 and FT3.

I'll not comment on ACTH and DHEA-S as I do not know much about their levels.

One of the observations of hypothyroidism is that in some people the pituitary enlarges (pituitary hyperplasia). Obviously, if your pituitary is compressed it is unlikely to be able to enlarge. However, you'd need someone with good understanding to identify whether the reported compression is a result of it trying to grow. That could happen if you ALSO have primary hypothyroidism - that is, your thyroid is not producing enough thyroid hormone.

Here is a link to a paper reporting a series of cases:

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

At a quick glance, none appears to be the same as yours, but they might provide some general background/interest.

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It means that your pituitary can't work properly so you have secondary hypothyroidism (meaning that TSH should not be tested, just free T4 and free T3 to see how you are doing). it probably also means that you won't produce other hormones (including cortisol and sex hormones) and may need replacement meds for those too. I'd look for a hypopit forum - I don't know if there is one on HU.

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No there isn't!!! You can produce other hormones - I have secondary adrenal insufficiency from Cushing's disease but just need to replace cortisol & thyroxine, he others are fine.

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I can't do TSH or sex hormones or cortisol.

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How did you find out that pituitary is causing low tsh? I mean when endocrinologist see low tsh they say - thats fine your body just dont need more t4. Some thyroid gurus like raypeat.com even say that you should have tsh almost 0

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Below range free T4, bottom of range TSH, hypo symptoms, not on meds.

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Hi, do you take something to replace your cortisol, maybe adrenal cortex extract or hydrocortisone. I tried 30-40 mcg t3 but see abolutely no effect positive or negative, i guess t3 will not work without cortisol.

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I take adrenal cortex.

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It seems different people have different hormones affected, my testosteron is at the maximum of the reference range for males, aldosteron and antidiuretic hormone seems fine

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Did you have your cortisol levels checked as well? If your ACTH level is high it may be that you're not producing cortisol from your adrenals. It would be worth checking what your cortisol level is - it needs to be done between 8-9am in the morning. Have a look on the Pituitary foundation website pituitary.org.uk If there is a problem with your pituitary it will affect your thyroid levels so that it's your T3 T4 that needs to be checked rather than your TSH.

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Thank you!

PaulineS here is what i found regarding ACTH on stopthethyroidadness website:

5) What labs will detect hypopituitarism?

-low TSH (below 1.8 for men, below 0.8 for women)

-low ACTH (below 30 for am. Is possible to be secondary with ACTH as high as low 40’s)

Unfortunately i visited endocrinologist and she said - all hormones are in the reference range so she see no problem.

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