My doctor always believed I have a secondary hypothyroid as my TSH is suppressed to 0.1 or below with normal T4/T3. However, I skipped thyroid medication for a week and my T4 dropped to borderline and TSH increased above range:
FT4 10.7 (10-28)
TSH 4.85 (0.46-4.68)
My T4 medication is not elevating my symptoms and neither did T3 or desiccated thyroid meds. I get very tired and my tiredness is associated with cortisol rhythm (get worse during the morning hours) and lessen at night.
Whenever I sleep my heart rate gets low and wake up from adrenaline rushes, I found that with one day heart monitor. My cortisol is normal during the day but slightly low at night.
I'm so confused what is wrong! IS it pituitary not making enough TSH, is it sluggish thyroid or abnormality in adrenals and too much adrenaline inhabiting my pituitary and thyroid functions?
Any suggestions are welcome!
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Ali1101
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This may sound flippant, but the treatment will be the same whatever the cause. Your doctor doesn't appear to understand that taking thyroid hormone replacement will reduce your TSH. And, sometimes, in order to get enough hormone into you the TSH becomes suppressed. Doesn't automatically mean that the pituitary has stopped working.
Do you remember what your levels were when you were diagnosed? Difficult to tell if it's a pituitary problem once you start supplementing. Although, of course, it is possible for the pituitary to become less active with time. But, if he suspects a pituitary problem, he should be testing the other pituitary hormones.
As for your symptoms, maybe you've just never taken enough of anything to get rid of them. If your doctor is dosing by the TSH, that is probably the case.
Actually TSH was suppressed before I take any medications or any supplements. My T4/T3 were well within normal range, I cannot recall exactly now but they looked normal. The reason I was prescribed T4 is my symptoms and my low TSH. And low iodine uptake test. Yes my thyroid and/or pituitary not optimal but not sure if the root cause is the adrenals.
I even doubled my T4 from 100 mcg to 200 mcg, my T4/T3 both went up to high range and close to exceed it and guess what, I didn't feel any difference.
Hi Ali, I read a few of past posts and I think I replied once. It looks like you are in the same boat. This is all speculation but I think you are right about your night time low (thyroid hormone is lowest in the night) and forcing your adrenals to fill in. Your pituitary seems to be working if when you stopped hormones it ramped up your TSH. I wonder if progesterone would help. You are not taking estrogen, are you?
This is what Ray Peat says about progesterone.
Dr. Ray Peat: Often it's because they were given thyroxine, instead of the active thyroid hormone, but hypertriglyceridemia can be caused by a variety of things that interact with hypothyroidism. Estrogen treatment is a common cause of high triglycerides, and deficiencies of magnesium, copper, and protein can contribute to that abnormality. Toxins, including some drugs and herbs, can irritate or stimulate the liver to produce too much triglyceride. T3, triiodothyronine, is the active thyroid hormone, and it is produced (mainly in the liver) from thyroxine, and the female liver is less efficient than the male liver in producing it, as is the female thyroid gland. The thyroid gland, which normally produces some T3, will decrease its production in the presence of increased thyroxine. Therefore, thyroxine often acts as a "thyroid anti-hormone," especially in women. When thyroxine was tested in healthy young male medical students, it seemed to function "just like the thyroid hormone," but in people who are seriously hypothyroid, it can suppress their oxidative metabolism even more. It's a very common, but very serious, mistake to call thyroxine "the thyroid hormone."
High cholesterol is more closely connected to hypothyroidism than hypertriglyceridemia is. Increased T3 will immediately increase the conversion of cholesterol to progesterone and bile acids. When people have abnormally low cholesterol, I think it's important to increase their cholesterol before taking thyroid, since their steroid-forming tissues won't be able to respond properly to thyroid without adequate cholesterol.
Mary Shomon: You feel that progesterone can have anti-stress effects, without harming the adrenal glands. Is progesterone therapy something you feel is useful to many or most hypothyroid patients? How can a patient know if she needs progesterone? Do you recommend blood tests? And if so, at what point in a woman's cycle?
Dr. Ray Peat: Estrogen blocks the release of hormone from the thyroid gland, and progesterone facilitates the release. Estrogen excess or progesterone deficiency tends to cause enlargement of the thyroid gland, in association with a hypothyroid state. Estrogen can activate the adrenals to produce cortisol, leading to various harmful effects, including brain aging and bone loss. Progesterone stimulates the adrenals and the ovaries to produce more progesterone, but since progesterone protects against the catabolic effects of cortisol, its effects are the opposite of estrogen's. Progesterone has antiinflammatory and protective effects, similar to cortisol, but it doesn't have the harmful effects. In hypothyroidism, there is a tendency to have too much estrogen and cortisol, and too little progesterone.
The blood tests can be useful to demonstrate to physicians what the problem is, but I don't think they are necessary. There is evidence that having 50 or 100 times as much progesterone as estrogen is desirable, but I don't advocate "progesterone replacement therapy" in the way it's often understood. Progesterone can instantly activate the thyroid and the ovaries, so it shouldn't be necessary to keep using it month after month. If progesterone is used consistently, it can postpone menopause for many years.
Cholesterol is converted to pregnenolone and progesterone by the ovaries, the adrenals, and the brain, if there is enough thyroid hormone and vitamin A, and if there are no interfering factors, such as too much carotene or unsaturated fatty acids. Progesterone deficiency is an indicator that something is wrong, and using a supplement of progesterone without investigating the nature of the problem isn't a good approach. The normal time to use a progesterone supplement is during the "latter half" of the cycle, the two weeks from ovulation until menstruation. If it is being used to treat epilepsy, cancer, emphysema, migraine or arthritis, or something else so serious that menstrual regularity isn't a concern, then it can be used at any time. If progesterone is used consistently, it can postpone menopause for many years.
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Discrimination against central/secondary hypothyroidism 
HYPOTHYROIDISM SECONDARY 
Possible secondary hypothyroidism 
Secondary hypothyroidism 
Possible secondary hypothyroidism (Levels are standard not metric).
