Is this hypo due to pituitary?

[Yeswithasmile]

Hello 👋🏼

I have a friend who has been poorly for a very long time. Fibromyalgia diagnosis. Finally persuaded to get bloods done privately.

I am interested to know any thoughts on the low t4 and tsh.

Any advice would be much appreciated.

Edit: crp hs 5.4 <5

Vitamins not dire.

[SlowDragon Administrator]

What are their actual vitamin results

What were Antibodies results?

Email Thyroid UK for list of recommend thyroid specialist endocrinologists..

.NHS and Private

[e-mail]

[Yeswithasmile in reply to SlowDragon]

Ferritin 73ug/l Vit d 71nmol

Vit b12 131 pmol

Folate 10.5ug

So not great just not as bad as mine.

I don’t have antibodies. She isn’t confident with technology and tbf I was lucky to get the information I did get from her screen shots.

[SlowDragon Administrator in reply to Yeswithasmile]

What approx age are they

What’s their diet like....vegetarian or vegan?

Are they active...or immobile

Main symptoms ?

Fibromyalgia is frequently inadequately or undiagnosed hypothyroid

Negative antibodies?

[Yeswithasmile in reply to SlowDragon]

55.Not vegetarian. Good diet.

She does walk.

Spent many years unable to work. Depressed.

Walked with a stick in case of falling. Exhausted. Slept 6pm until 9am. Improved once children left home maybe due to less work? but still not energetic.

Walks her dog but wipes her out.

Does what she can. Less depressed. Still has terrible aches and pains. So much so she ignored appendicitis last year as she’s says she has pain everywhere and is always told nothings wrong.

I think antibodies were negative but will double check tomorrow.

[SlowDragon Administrator in reply to Yeswithasmile]

Needs to see a thyroid specialist endocrinologist.

Roughly where in the U.K. is she?

First step is to get BOTH TPO and TG thyroid antibodies tested

If both. Negative...look at getting ultrasound scan of thyroid

And seeing specialist

[Yeswithasmile in reply to SlowDragon]

I will. Thank you.

It seemed to me that with the low t4 result and tsh not even at 2 that something else may be a miss as thought her pituitary should be trying to raise her t4.

Thought it is possible the doctors never saw this low t4 as obviously they don’t test it generally.

She is going to attempt a referral and hopefully She will get one and some answers as she wouldn’t be able to find the money for scan/private endo.

Thank you x.

[SlowDragon Administrator in reply to Yeswithasmile]

Depression and thyroid closely linked

health.harvard.edu/diseases...

[Shakeyjakeblues]

Yes, the low FT4 with a low or normal TSH indicate secondary hypothyroidism caused by pituitary dysfunction. I would get the bloods retested at the doctor's to see that it's correct. They may need to point out the NICE CKS guidelines to the doctor because a lot don't understand Pituitary dysfunction and think it's primary hypothyroidism. The treatment is the same but monitoring is different. They will also need more blood tests to check Pituitary hormones and a MRI.

[Yeswithasmile in reply to Shakeyjakeblues]

Thank you Shakeyjakeblues. That’s really helpful of you. I will let her know your comments. That’s great x.

[Shakeyjakeblues in reply to Yeswithasmile]

If the doctor agrees that it might be secondary hypothyroidism they should urgently refer them to an Endocrinologist. Treatment should not start until cortisol/adrenal function has been checked. cks.nice.org.uk/topics/hypo...

I hope they get some answers/treatment!

[Yeswithasmile in reply to Shakeyjakeblues]

That’s brilliant (the info not the problem obviously!) I have already sent her your Nice link and have tried to guide her on what to say. It’s awful to wish her ‘ill’ but it would be so amazing to get some answers after all this time.

Thanks so much Shakeyjakeblues x.