Thyroid vs pituitary issue?

[swebes]

Hi all,

Apologize for the length. I was diagnosed with Hashi's in 2014. No raised antibodies, but TBG was elevated. Has been well-controlled ever since, following a period of about six months to get the dosage dialed in. I take a custom compounded med containing 85.5 mcg T4 and 9 mcg T3.

Recently been diagnosed with dysautonomia (discussed in a previous post: healthunlocked.com/thyroidu....

During this process to find an underlying cause for the dysautonomia, pituitary hormones have been tested and some are elevated. PCP says these are only slightly out of range and therefore insignificant.

Prolactin 22 (2-20 ng/mL for post-menopausal) - I've had a complete hysterectomy so assume I fall into the post-menopausal category

DHEA 1221 (102-1185 ng/dL)

Cortisol 32.5 (6.0-23.0 ug/dL)

**Other pituitary hormones like progesterone, testosterone, estrogen, LH, & FSH were in normal range.

Thyroid labs have also been fluctuating recently as well. Here's a sampling and I've had no thyroid med changes during time:

**July 21, 2018**

TSH 3.95 (0.30 - 3.80 uIU/mL)

FT4 1.13 (0.80 - 1.80 ng/dL)

FT3 3.03 (2.30 - 3.80 pg/mL)

**July 3, 2018 / ER visit**

TSH 6.76

FT4 1.22

No FT3 measured

**June 23, 2018**

TSH 2.51

FT4 1.22

FT3 3.24

**April 29, 2018**

TSH 2.42

FT4 1.25

FT3 3.20

Does this sound like primary hypothyroidism or secondary hypothyroidism? I've been referred to an endocrinologist next month but want to be prepared to argue my case if needed.

[greygoose]

Progesterone, testosterone, and estrogen are not pituitary hormones.

As your TSH went up to over six, I doubt you have Secondary hypo. Secondary hypo is when the TSH is low but so are the FT4 and FT3. The levels are probably jumping around because you have Hashi's. Were all the tests done at the same time of day?

I'm not an expert, but it doesn't look like a pituitary problem to me.

[swebes in reply to greygoose]

Thanks gg. The ER visit was drawn around midnight.

The July 21 and June visits were planned and drawn fasting around 7:30am prior to taking dose for the day.

The April visit was drawn around 5pm.

I normally try to have them drawn fasting first thing in the morning.

[greygoose in reply to swebes]

So, you can't compare them except for the July and June results. And they were very different. But it's the July result of 6.76 that suggests it's not Secondary hypo. It must be the Hashi's that is causing them to jump about.

[swebes in reply to greygoose]

Yeah, it just seems odd to me that the TSH jumps so drastically when I end up in the ER (for tachycardia related to dysautonomia supposedly).

No one has been able to explain why and of course the ER never runs a complete thyroid panel to give us a better idea of overall thyroid function. I've had at least 3 ER visits with TSH over 4.0, with two of them occurring around 6am fasting and before daily meds.

[greygoose in reply to swebes]

I really can't answer that. Could be something to do with the lab itself.

[swebes]

Assistant from doctor's office just called regarding the July 21 results. Said TSH "went up a bit, but FT3 and FT4 are in the normal range."

Yes, normal but not optimal right you guys? A dosage increase wouldn't be a bad idea correct? I feel like I'm banging my head against the wall here.