overactive pituitary...

[dbm113]

For many years my husband has had horrible headaches and neck pain w no rhyme or reasoning...
dry skin and hair... and more and more fatigued... not himself lately, irritable... just not feeling well in general... some days better than others...
My husband was seen for a routine physical... and thyroid came back with off levels... further testing showed TSH 82 and T4 and T3 were low. More tests showed FSH 14.0 LH 12.4 and testosterone 336.. Also TPOAb was 50. His PCP suggested he see an endocrinologist... with overactive pituitary...
Went to endo and more tests... Testosterone dropped to 175, Free Testosterone 3.9  
TSH went up further to 108.3 ACTH and vitamin D normal... TBG and GH normal...
creatinine high 1.32 and eGFR low 59 (caucasian) TPOAb came down some, but still high at 36
The endo wants him to take syntheroid and come back in 6-8 weeks...
I understand the TSH is high... but what about all the other... and his PRIMARY CARE DOCTOR wanted him seen for an overactive pituitary... which could be an ademona...? and his kidney levels concern me too...
HELP?!

[Daniel M Prevedello, MD]

Dear dbm113,

I agree. Elevated TSH with low T4 and T3 is a primary problem of the thyroid until proven otherwise.
It is correct. T4 replacement should be started and then rechecked later on. The TSH should go down.

[rumpled]

He must not feel well. This forum is not moderated right now so I will tell you that you need to find a neuro-endo - at a pituitary center. Was your endo at a pituitary center? You need to get a pituitary MRI (done properly - dynamic) and tests that show more - like estrogen, dhea sulfate (other sources of testosterone) so the doc needs to check the complete hormonal loops and different forms of testosterone.

GH is not the proper test - IGF-1 is preferred as that is what the body uses!