Possible pituitary problem?

[les121]

my latest bloods...

TSH 0.05 (0.3-5.5)

T4 11.7 (12.0-22.0)

Been refered to an Endo

currently on 100mcg levo and 25mcg tiromel

all taken with 24hr gap

no vitamins or other supplements

does this indicate a pituitary problem at all?

[SlowDragon Administrator]

Probably not

Taking almost any dose of T3 will suppress TSH

Just testing TSH and Ft4 is completely inadequate

Low Ft4 suggests you might need dose increase in levothyroxine……but you need to know Ft3 result before you increase

So …..You need TSH, Ft4 and Ft3 tested together

Plus ideally vitamin D, folate, ferritin and B12 too if not tested recently

ALWAYS test thyroid levels early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

Day before test split T3 as 3 smaller doses spread through the day and last dose T3 approx 8-12 hours before test

Exactly what vitamin supplements are you currently taking

You know you have Hashimoto’s

Not currently on gluten free diet or dairy free diet?

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

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[les121 in reply to SlowDragon]

T3 was 4.4 (3.1-6.8)

[SlowDragon Administrator]

previous post including ferritin result

healthunlocked.com/thyroidu...

Have you had full iron panel test for anaemia yet via GP

Or vitamin D, folate and B12 levels tested yet

Ideally coeliac blood test too BEFORE trailing strictly gluten free diet

[SeasideSusie Remembering]

les121

When taking T3 it's essential to test FT3 as well as FT4 and TSH, otherwise you wont know if you are taking the right amount of hormone.

currently on 100mcg levo and 25mcg tiromel

all taken with 24hr gap

It has been explained to you in a previous post that when testing the time gap for T3 is 8-12 hours, leaving longer gives a false low FT3 result when tested. The 24 hour time gap is for Levo only.

does this indicate a pituitary problem at all?

In my opinion no. If you had a pituitary problem this would have been obvious before you were originally diagnosed, it would have shown with a normal, low or very minimally elevated TSH along with a below range FT4 level. The fact that your FT4 is now so low is because you are taking T3, this lowers FT4 level. I think what is indicated with these results is that you are undermedicated, whether with Levo or both Levo and T3 cannot be said until you test TSH, FT4 and FT3 all at the same time from the same blood draw with a time gap of 24 hours for Levo and 8-12 hours for T3. Also, you apparently have Hashimoto's as you've said before that your antibodies were positive.

[les121 in reply to SeasideSusie]

i understand this is the guidelines you give however my GP says there is no rule that says you must not take medication before a blood test?

[SeasideSusie Remembering in reply to les121]

my GP says there is no rule that says you must not take medication before a blood test?

Because your GP, like most, doesn't understand how it all works. Some endos and GPs do understand it and tell their patients to take their meds after the test.

We give this information to members so that they get the most accurate measure of the amount of normal circulating hormone and avoid any false high or false low thyroid hormone levels.

If you didn't take exogenous thyroid hormone then your body would produce what it needs when it needs it. Taking synthetic thyroid hormone means that you are getting an unnatural big hit once a day, your level will spike to an unnatural high 2-4 hours after taking it before it gradually starts to taper off and if you test whilst the level is high then it doesn't give a true picture. In some people this means that if they are undermedicated and symptomatic they would be denied an increase in their dose because their level is "high"and may even result in a reduction in dose.

Because so few doctors understand this we suggest that members don't discuss it with them or the phlebotomist.

Your FT3 result is low but this is a false low because you left 24 hours since last dose of T3.

[les121 in reply to SeasideSusie]

T3 was 4.4 (3.1-6.8)

[SlowDragon Administrator]

Good explanation and graph here as to why it’s recommended to split dose T3 day before test (even if you don’t do so every day)

thyroidpatients.ca/2020/07/...

Peak and trough after single dose T3

[PixieElv]

I have secondary hypothyroidism ie a pituitary gland issue, and had similar TSH & T4 results. However, my Endo made me stop all thyroid meds for 2 weeks then tested. That is apparently the only way to find out if it’s really your pituitary or something else

[Hedgeree in reply to PixieElv]

Hi PixieElv,

Do you know which of the tests that you had done indicated your problem was at a pituitary level?

[PixieElv in reply to Hedgeree]

it was a blood test. Testing my TSH and T4 & T3. T4 and T3 were below the range and TSH was around 1, so well within range.

Now I was only taking Levo and stopped for 2 weeks. I note that taking T3 lowers your TSH and I’m not sure stopping that for 2 weeks will return your TSH to normal. I’ve seen people saying it takes months. Your Endo should know and your T4 should definitely respond as it takes about 2 weeks to get out of your system.

Getting a secondary hypothyroidism diagnosis is like good dust. The NHS doesn’t bother. You’re such a marginal case. I had to pay £00 to a private Endo to finally get a diagnosis and treatment. So persevere. Having your life back is worth it!

[Hedgeree in reply to PixieElv]

You must have felt terrible; glad you were able to eventually get the appropriate diagnosis.