Need help plz

[Rania_20]

One year ago i was diagnosed Hashimoto’s and Dr treatment with 50 mg euthyrox thyroid hormone replacement medication. Recently I'm not feeling well where I felt suffocation throat and lost weight so decided to change Dr and he told me make MRI brain on the sella turcicathe" pituitary gland "and recommended make Acth am, Acth pm, Serum cortisol am, Serum cortisol pm, prolactin, TSH, FT3, FT4 and the results are

prolactin 30.63 where normal range is 2.8 to 29.2

Tsh 9.911where normal range is 0.55 to 4.78

Serum cortisol 9 am <0.5 where normal range is 4.3 to 22.4

Serum cortisol 9 pm <0.53 where normal range is 3.1 to 16.7

Acth 9 am is <5.00 where normal range is less than 65

Tomorrow I will be checked MRI brain on the sella turcica pituitary.

I'm very panic and I am confused so would you plz any one explain my case. I can't understand where is my problem is it in pituitary gland or

Thyroid??????

[SlowDragon Administrator]

50mcg Levothyroxine is only a starter dose of Levothyroxine

Your TSH is far too high. Your doctor should prescribe 25mcg dose increase in Levothyroxine and bloods retested in 6-8 weeks

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water . This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

Ask doctor to test vitamins and thyroid antibodies

[Rania_20 in reply to SlowDragon]

Would u please to tell me where's the problem

pituitary gland orThyroid??????

[SlowDragon Administrator in reply to Rania_20]

Almost certainly thyroid....your TSH is far too high

If it was pituitary, your TSH would be more likely low

[shaws Administrator]

Hashimoto's is short for Autoimmune Thyroid Disease and I'll give a link.

Hashi's is the commonest form of hypothyroidism as it is the antibodies in hashimoto's that attack the thyroid gland, they also wax and wane until we're hypothyroid. Going gluten-free can help reduce antibodies and it is those that attack the thyroid gland.

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

[Lora7again]

I was bedridden when my TSH was 8.00 you need more Levothyroxine - you must be feeling dreadful.

[Teresamarie]

Hi Rania_20

I can under your panicky feeling all too well. As I’m not a doctor nor a healthcare professional all I have to offer you is advice from my own experience with a pituitary adenoma that was surgically removed and since then been diagnosed with adrenal insufficiency and hypothyroidism.

Please be good to yourself....right now you cannot know the answers until the MRI is done to find out if you may have an adenoma on the pituitary. To me, you have been tested for adrenal insufficiency, which in layman’s terms is low cortisol. Cortisol is the energy hormone that changes our food into energy so with low cortisol you probably feel wiped out and I mean so tired you feel like someone stuck you to the floor with super glue! 😊.

Please, please do what your body tells you to do. An idea for you in the meantime is to try orange juice with some salt in it to help with the fatigue and your body’s need for salt.

Let us know how you are doing! Prayers to you... Teresamarie

[LillyTheCat]

Hi Rani, I'm not a doctor or medically trained, but from my knowledge your low Cortisol results could suggest adrenal insufficiency. An older GP at my practice who used to work as a Private Thyroid specialist & for Thyroid UK & was very active on this forum told me not to take Thyroxine if I had low cortisol as this can lead to an adrenal crisis (she suggested private salivary cortisol test). As someone else suggested here, the prolactin test is one of the tests for Pituitary function & it looks like your doctor is testing for a benign pituitary tumour, called a prolactinoma. This is treatable, so no need to worry. This can result in adrenal issues (too high or low cortisol) & thyroid issues as the Pituitary is the master gland governing function of the Adrenals & Thyroid. No need to panic, but I would ask for a fast referral to a Consultant / Endocrinologist specialised in Adrenal / Pituitary / Thyroid issues (not any old Endocrinologist, most of them just know about diabetes!)if your doctor is not already one - if you're in the UK, best to ask the Pituitary Foundation for someone in your area. In the meantime, I'd talk to your doctor about all this, he / she sounds like they know what they're doing & if that's a UK GP, way more 'on the case' than most. You sound like you are in good hands. These things take time to figure out. Good luck. xxx