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LOW TSH
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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LOW TSH

HI,
I've been having severely heavy periods (soak thru a Super tampon AND nightime pad in the night) every since I got my cycles post breastfeeding.  My doc says some people just get heavy periods and that my fatigue and foggy brain is because I have young kids. Sounds like there is more to it than that. what do you think?


TSH: in Jan was .26   2 weeks ago .24  and now .16 (.35 - 4.94)
Free T4: 2 weeks ago .74 and now .96 (.71 - 1.85)
Free T3: 3.3 (2.3 - 4.2)
T3 Uptake: 31% (23-37)
Prolactin: 4.3 (2.8 - 29.2) these were drawn the 1st day of my cycle (range is follicular phase?)
FSH: 6.8 (2.5 - 10.2) these we drawn the 1st day of my cycle (range is follicular phase?)
LH: 2.4 (1.9 - 12.5) these we drawn the 1st day of my cycle (range is follicular phase?)
Bilirubin 1.1 (.3 - 1.2)

From what I've read it seems that my T4 should be in the upper 1/3 if my TSH is so low...meaning hypothyroid. So does this point to Central Hypopituitary? or could it be andrenal?

These are my symptoms:

-cold easily
- dull aching kidney pain (flank pain?)
- aching joints especially hips and hands
- weight fluctuation
- intermitant hairloss

GYNO:
-very heavy painful menstruation since stopping breast feeding 1.3 years ago.  however now they seem to be stopping midway and then restarting again a day or two later (last 3 cycles). accompanied with diarrhea

PSYCHOLOGICAL:
- irritability and mood swings
- significant memory loss and poor consentration (decrease in executive functioning)

FATIGUE
- have to take a nap mid afternoon

SKIN
- severely oily skin which has now developed Sebasceous Hyperplasia all over my face neck and other places
- hyperpigmentation spots developing on face (not melasma but have that too from pregnancy)
- tiny white spots all over legs and arms

HISTORY:
I have a Hx of gestational diabetes even though I'm very fit
A concussion to the back of my head 7 years ago that caused temporary tunnel vision and amnesia
Had C-Section's 2006 and 2008
I'm 37 and female.
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97953_tn?1193367871
The TSH is slightly low with normal T4 and completely normal T3 -- with normal prolactin and the presence of menstruation, all this means it's not likely central hypothyroid (ie, the pituitary appears fine).

The slightly low TSH is nonspecific (but points towards mild/subclinical hyperthyroidism) and needs to be watched but would not likely cause heavy menses.  Would complete the thyroid evaluation with ultrasound and possibly anti-thyroid antibodies.  
2 Comments
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So just for clarification...
You would still lean toward sub-hyper even though my fT4 is in the bottom 1/4% of normal with a low TSH? It seems my symptoms are more hypo than hyper. In fact I don't think I have a single symptom of hyper. I had a Mild brain injury to the back of my head a few years ago and have read that might cause hypopituitary.
I also forgot to mention that I never produced enough breast milk. Could that point to something?
Perhaps I'm way off, but I've read that low TSH and low-normal fT4 points to central hypo. Am
I barking up the wrong tree here. I'd hate to push for pituitary+hypothalamus tests if it doesn't make sense. Thanks Doc!    
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