following on from the last episode of my Heath saga…I’m undiagnosed. Endocrinologist on the back of these results sent me for a pituitary scan to find the cause of secondary hypothyroidism, expecting to find a pituitary adenoma/issue
TSH 0.97 (range 0.35-4.94)
FT4 11.4 (range 9-19)
9am, Fasting
The MRI says the pituitary is fine but made this comment;
“Several T2 white matter hyperintensities in the deep white matter in this young patient. Appearances have a wide differential including post-inflammatory, vasculitis, vasculopathy, migraine accelerated white matter disease. Is there any neurological history? Please consider neurology opinion if clinically indicated.”
Does anyone know what this means? What might be going on?
Or what could be causing my “secondary” thyroid issues if my pituitary is fine?
I’ve asked a neurologist to look at it but I’m worried what this might mean..
The Endocrenologist said she would treat thyroid if I get below t4 11, I’m 11.4 so not much further to fall! I’ve got another blood test next week…
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Laundry
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Thanks slow dragon, I have been following the advice from here so blood tests were 9am, vitamins are low but in range (see last post, i will resume its after my next blood test) and i've had both antibody tests twice and all negative.
The endocrinologist was concerned about secondary hypothyroidism because of low T4 and TSH (both in range but right at the bottom), she thought my pituitary might be not functioning but as the MRI is clear i'm wondering what else might be causing this and what the "several deep white matter hyper intensities" might be. I'm a bit worried about it
'White matter microstructural integrity impairments were found in multi-segments of the multiple fiber bundles in hypothyroidism, which might be a potential mechanism of the underlying neurocognitive decline and cerebral impairment. The CCF_A might serve as a neuro biomarker for early warning of cerebral impairment in hypothyroidism.'
T3 is known as a neurotransmitter and has more receptors in the brain that anywhere else oin the body. It helps regulate the action of serotonin, noradrenaline, GABA, etc. and insufficient amounts can result in neurotransmitter abnormalities and neurological changes.
Also if you have Hashi (you can have Hashi & central hypo), read ‘Why Isn’t My Brain Working” by Datis Kharrazian. He claims many Hashi people also experience autoimmune reactivity occurring in other tissues in the body including an area of the brain called the cerebellum. Thyroid antibodies can bind to cerebellum tissue, triggering a kind of autoimmunity in the brain but which isn’t full on Hashimoto Encephalopathy. Food proteins can cross the blood-brain-barrier, similar to our gut intestinal barrier triggering the unwanted inflammatory responses, only in this case it is aimed at microglia (brain immune cells).
There is a test that identifies positive antibodies to neurological tissue but it is expensive and I’m not even sure if available in the UK. I too have had several MRI’s and CT scans for neurological issues and found all cognitive skills to have improved ten fold once T3 levels were corrected and autoimmunity controlled.
I know everyone is different, but how far up the scale did you have to have your t3 levels to see the difference in your scan & in daily life?
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Laundry I have had the same issues found on a scan of my brain for another matter (trigeminal neuralgia).
The neurologist said it was normal with aging, which makes me think you're a lot younger (I am in my fifties). I did think it was a Huh? at the time, since I was dealing with brain fog and other cognitive issues. And reading radd's post does make me wonder about t3 levels. Mine were not all that high on combination therapy, which at the time included a good dose of Cytomel.
Hope you get it all figured out soon. All the best.
I had a light switch on the day after I started T3 (added to Levo), but good temperature control took another 5 years with other symptoms recovering along the way. I'm of the opinion after a life time of undiagnosed Hashi/hypo that recovery takes many years and passes through various different stages, offering a cumulative effect.
Yes, every persons dose is individual because of the complex interplay between deiodinase enzymes, transporter proteins and receptors, requiring best levels of iron and nutrients, good adrenal health and well controlled autoimmunity (when present).
I now function best on lower thyroid hormone levels, although used to need slightly more meds and slightly higher levels in range. Whether it is usual to decrease thyroid hormone levels with better health, I do not know but I always remain cautious as experienced some psychosis in the early days of treatment.
Last two sets of TFTs have shown similar results of FT4 at 51.37% through range and FT3 just 35.14% which has surprised me but I feel well and am keeping warm in this freezing weather which must be a good sign.
I never advocate for the highest dose of T3 but the lowest dose that brings wellbeing. If meds aren't working as they should it is worth considering the essential cofactors rather than just taking FT3 levels higher as this can prove counter productive if the natural sweet spot is exceeded.
"Last two sets of TFTs have shown similar results of FT4 at 51.37% through range and FT3 just 35.14% which has surprised me but I feel well and am keeping warm in this freezing weather which must be a good sign."
Such interesting & helpful information radd. And great that you are feeling well.
Thank you for your reply. This is really interesting and gives me hope that it’s a correctable thyroid issue. Googling this brings up all manor of horrors!
I have tested negative twice for the thyroid antibodies but recently RA factors were very slightly raised so I might be beginning to get autoimmune issues
Have you had both TPOAb and TGAb tested? Both sets anare capable of impairing good thyroid function. Thyroid anntibodies also fluctuate so tests are not always conclusive.
Hashi & RA share some same inflammatory immune markers. Many have a diagnosis of both conditions.
yes i've had both twice but always negative, i will keep checking though.
i'm currently undiagnosed but my TSH and T4 are both at the very bottom of the range, i've been working on vitamins recommended here are levels are ok now. Endo scanned pituitary for adenoma and suspected secondary hypo which would make sense but showed my pituitary was fine... why could i have low tsh/t4 if its not pituitary? any ideas?
Secondary hypothyroidism happens due to failure of the pituitary to secrete TSH. Therefore, you have a form of pituitary failure which a thyroid specialist would like to be due to a tumour so they have a definitive diagnosis, where as yours appears due to some sort of signalling issues.
This always confuses them as there is much complex interplay between the thyroid, hypothalamus and pituitary and unless intensive investigations were to be carried out, you most likely won’t know the exact cause. However, the cause is irrelevant to an extent because the treatment for the deficient thyroid hormone remains the same and that is to medicate replacement meds.
Your situation isn't uncommon but because you aren't following the usual pattern of hypothyroidism (eg low thyroid hormone + high TSH) GP'often seem baffled when it is obvious to us that the thyroid hormone levels must take precedence.
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