Thyroid UK

Do my thyroid results suggest secondary or tertiary hypothyroidism?

Hi all, I posted last week specifically about a low ferritin result that I had and Saya85 suggested I post all of my thyroid results to see if anyone had any thoughts or advice.This was Saya85's comment:

'However I am quite interested in your thyroid results. I know when you’re taking t3 also that t4 results aren’t all that important... but given both your t3 and t4 are very low in range, and your tsh is so very low, with primary hypothyroidism you would expect the opposite. (Very high t4 levels and low tsh if you were overmedicated- hence reducing Levothyroxine). If your t3 is low you would expect your thyroid to be secreting a lot of tsh in order to stimulate thyroxine production.

It appears more like secondary or tertiary hypothyroidism (problem with pituitary or hypothalamus rather than thyroid) based on those results but maybe your original rest results would give a clearer picture. Do you have those from when you were first diagnosed?

I would post a new thread with your thyroid results first to see if other members can give you better advice.'

My results are as follows, diagnosis was in Jan 2015 following hemi thyroidectomy in Nov 2014

Jan 2015 TSH 6.91 T4 13.6 Anti TPO 10

Feb 2015 TSH 6 T4

14.3

Apr 2015 TSH 3.63 (didn't test T4 given TSH now in range)

Oct 2015 TSH 0.01 T4 15.9

Oct 2016 TSH 0.01 T4 1.10 at this time I was referred to endo, had been self medicating T3

Jan 2017 TSH 4.17 T4 12.20 (back on levo 100mcg, no T3)

Feb 2017 TSH 1.63 T4 17.40 T3 2.9 (on increase of levo to 150 mcg)

April 2017 TSH 1.65 T4 15.10 T3 7.10 (self medicating T3 again but after this prescribed 10mcg T3 and reduced to 125mcg T4)

July 2017 T3 3.1 (can't find results but remembered T3 was just in range)

Jan 2018 TSH 0.65 T4 12.4 T3 3.6 (T4 increased to 150mcg and after a year of seeing her, locum consultant suggsted she couldn't help any further and suggested I see someone else)

Feb 2018 TSH 0.05 T4 13.6 T3 4

Ranges are TSH 0.3-4.2, T4 12-22 T3 3.1-6.8

Saw new endo last week who reduced levo to 125mcg and increased T3 to 40mcg. Wants re-test in 8 weeks when if bloods ok he has suggested further T3 increase to 60mch with 100mcg levo. He requested other bloods which show ferritin is low at 19. I have spoken to GP today and I am having a full blood count test tomorrow and he has done a prescription for iron. He said my ferritin was 123 in 2015

Any thoughts please on whether I am slowly going in the right direction now that I am seeing a new endo who is willing to alter meds to change my T3/T4 rather than just look at my supressed TSH or on Saya85's comment regarding secondary or tertiary hypothyroidism?

Thank you

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I think the Endocrinologist is knowledgeable and I would stick with him. Especially when he is willing to try, at least, T3 and combination T3/T4.

It is rare to get a professional who can think 'out of the box'.

p.s. when you state results it is helpful to also give the ranges. We don't need you to amend the post as you were querying about the Endo/treatment.

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Thank you, I am feeling more positive about him than I have about the locum I have been under for the last year.

I posted the ranges as one line under the results, I knew you would need them but wasn't sure the best place to put them, didn't want to put them after each result given there has been no change in them since my diagnosis. Perhaps chose the wrong place, given you didn't see them so apologies for that.

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That's fine. It's me that didn't notice the ranges.

I wish you well and know how we look forward to deal with someone who will at least try to get us feel much better.

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Once you are on thyroid hormone replacement, it's difficult to tell if it's Central hypo, because the TSH will be low due to taking the hormone. But, given that your hypo results from the removal of half your gland, it's unlikely to be Central (secondary/tertiary) hypo. Also, with a TSH of 6.91 it would very much appear to be primary hypo.

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If the hemithyroidectomy was for Graves ,,,,you will never be well if they insist on keeping so called normal levels ...TSH will need to be zero

T4 and t3 will need to be above the top of the ranges for quite a while

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Ah no, not for graves. Removal of a lump as tests had been inconclusive

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you may find that only NDT will restore health ...it seems to be the case after thyroidectomies

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It’s an old myth that TSH is not elevated in central hypothyroidism, recent research suggests TSH can be low, normal, or even slightly elevated. Even then, because of disturbance in the signal between the brain (hypothalamus and/or pituitary) and the thyroid, the TSH does not rise as much as it should.

Check out this important extensive piece by Nature, most cited peer-reviewed scientific journal in the world, published last year.

qbpatologica.files.wordpres...

My highest TSH was at 5.30 in range 0.30-5.50. Half a year later it was 4.20. You need to investigate this with your doctor, I can only speak for myself. But for me and many others, we often are misdiagnosed with primary hypothyroidism, resulting in under-treatment as the T4/T3 levels never reach where they should.

The complexity of if a patient has one or the other, whatever form of hypothyroidism, can be cut across if only doctors would look at the T4/T3 levels along with symptoms, rather than fetishizing the TSH. But the government is very strict about its protocols on which tests to run simply to save the medical system money, leaving many with thyroid problems undiagnosed or under-treated.

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However it seems reasonable to suspect that rT3 might be low in those with central hypothyroidism - and not just neonates as in this abstract:

J Perinatol. 1997 Jan-Feb;17(1):15-7.

Decreased reverse T3 levels in neonates with central hypothyroidism.

Faase EM1, Meacham LR, Novack CM, Brakin MI, Mosier HD, Culler FL.

Author information

1 Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.

Abstract

Concern arises when a sick infant is found to have a low serum T4, normal thyroid hormone binding, and a nonelevated thyroid-stimulating hormone. Hypothyroxinemia in this situation can result from either euthyroid sick syndrome or central hypothyroidism. To help distinguish between these diagnostic possibilities, we have measured reverse T3 and other thyroid function chemistries in six neonates who have central hypothyroidism in association with hypopituitarism. We found that these infants all had reverse T3 levels that were much lower than reported normal levels for premature and term neonates. This finding suggests that low reverse T3 levels can help to distinguish infants with central hypothyroidism from sick and well infants who tend to have relatively elevated reverse T3 levels.

PMID: 9069058

ncbi.nlm.nih.gov/pubmed/906...

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