Pituitary? Advice please!

[LoveAndPeas]

Hello everyone!

I've just joined this group and been reading some of the really helpful advice on here.

My daughter, myself and my friend all have thyroid issues. So I'll be asking a few questions... but first...

I'm looking for help for my friend who is really suffering from poor health (fatigue, anxiety, heart palpitations, pain in throat, dizziness, neuralgia, getting very thin) and the doctors are unable to give any answers.

All her blood test results are normal except that she has low TSH, T4 and T3.

TSH 0.1 IU/L (0.4 - 4.5)

T4 51 nmol/L (50 - 160)

T3 0.9 nmol/L. (0.9 - 2.5)

TPO is normal.

As far as I understand it, TSH and T4/T3 have an inverse relationship. (TSH goes up when T4 is low and the other way round).

So why would they ALL be low? Her GP isn't concerned about this.

These test results are from before taking any T4/T3. She has been taking 80 mg Metavive daily for a few weeks (and will show on these results).

She has now seen a private doctor and just been started on 30 mg Thyroid Erfa. (Equivalent to 18mcg T4 and 4mcg T3).

Is this something anyone else on here has heard about?

Many thanks for any input, it is really appreciated!

[greygoose]

Hi LoveAndPeas, welcome to the forum.

Are the T4 and T3 Free or Total? If they're Total, they don't give any useful information. It's the Frees you need.

What time of day was the blood draw for these tests?

[LoveAndPeas in reply to greygoose]

Thank you! She only got free T3 tested. It is 4.7 pmol/L

Tests were done in the morning. But she wasn't fasting.

[greygoose in reply to LoveAndPeas]

So, what's the range for the FT3? Looks low-ish.

Fasting or non-fasting will only affect the TSH - if it affects anything at all. Depends what you have for breakfast - tea and coffee will definitely lower the TSH.

What time was the blood draw? The exact time matters. TSH levels drop throughout the morning.

[LoveAndPeas in reply to greygoose]

The range is (3.8 – 6.0 pmol/L), so 4.7 is not actually super low ?

She doesn't remember the blood draw time but thinks around 10am. It was after her morning coffee.

[greygoose in reply to LoveAndPeas]

OK, so her TSH is lower than it would have been before 9 am and without coffee.

The range is (3.8 – 6.0 pmol/L), so 4.7 is not actually super low ?

Well, it's only 40.91% through the range. 'Normal' (euthyroid) is around 50%. I wouldn't want my FT3 that low. It's more than likely the cause of her symptoms.

[SlowDragon Administrator]

Also she needs vitamin D, folate, ferritin and B12 tested

plus Thyroglobulin antibodies tested too

Would need to test privately

Possibly looking at central hypothyroidism - also called secondary hypothyroidism

see yellow box on flow chart

gps.northcentrallondonccg.n...

Central hypothyroidism

academic.oup.com/jcem/artic...

ec.bioscientifica.com/view/...

[LoveAndPeas]

Thank you, I'll let her know to get testing.

Those links are very useful. Lots of possible causes of central hypothyroidism.

Have you or anyone on here come across these kind of results before? With the vitamin deficiencies or after an illness?

[SlowDragon Administrator in reply to LoveAndPeas]

Have you or anyone on here come across these kind of results before? With the vitamin deficiencies or after an illness?

Yes to both

Quite a number of members arrive with similar results

How old is she approximately

Thyroid can be down turned due to other diseases/illnesses or medications

Lots of possible avenues to explore

[LoveAndPeas]

Oh that's good to know. She's 55 years old, just been through menopause. Had 6 amalgam dental fillings removed (about a year ago) and says she hasn't been the same since.

[Incoguto]

She should really get tested for central hypo, if the issue is with pituitary, it needs to be investigated. It could be she might be deficient in more hormones than just thyroid.

[PixieElv]

Hello there

Menopause and hypothyroidism often get confused by doctors. I was pumped full of oestrogen for years when I needed thyroid medication 🙄. So I’d advise you friend to get her female hormones checked as well.

Those results do look like secondary hypothyroidism, but taking any T3 (as in Metavive and Efra) will lower your TSH and she may not be taking enough medication for it to increase her T3 and T4, so she might be caught in between lowering TSH and not raising her enough T3 and T4. Hormones are tricksy…

your friend needs an Endocrinologist (the ones on the list by Thyroid are a start?) to check her out. GPs are hopeless.

Good luck!

[LoveAndPeas]

Thanks Incoguto and PixieElv, those are both really helpful things to consider.

She has an appointment next week for the GP to 'see if he's missed anything'. So she will try to push for pituitary testing and an endocrinologist referral. She says she has to pretend to be a 'good patient' or they will write her off completely.

She does have 'completely flat' oestrogen and progesterone levels and was told by a naturopath to take DHEA, but she's reluctant.

Interesting about maybe being stuck in the grey zone between lowered TSH but not enough T4/T3

[Incoguto in reply to LoveAndPeas]

Low estrogen and prog can also be caused by hypothyroidism. Or it could be pituitary. I would not take any DHEA yet in case that would disrupt further testing. I'd say it could be just that she's hypo and needs her thyroid numbers higher, estrogen and progesterone should then follow. If it a pituitary problem, then pit may not be sending signal to ovaries to make enough lh and fsh therefore female hormones could be affected

[LoveAndPeas in reply to Incoguto]

Thanks, thats really helpful. I didn't know hypo could lead to other hormones being low. I wonder if it also affects neurotransmitters? Enzymes? Is it that everything in the body slows down and is generally produced less of? So depression, poor digestion, infertility etc.

[Incoguto in reply to LoveAndPeas]

Everything slows down, low stomach acid, low neurotransmitters, slower cholesterol clearance etc

[Poniesrfun]

is she still taking the Metavive? Won’t that interfere with a correct diagnosis and Erfa dosing as it’s not stated how much T3 and T4 it contains?

Patti in AZ

[LoveAndPeas]

Yes, I think you're right. She should probably just be on the Erfa for a while until things are more clear. Thanks