help please 2nd request

[fatgirl213]

I am going to repost my questions. For several years now I have been diagnosed with Chronic fatigue syndrome. However my primacy care doctor did some labs a couple of weeks ago and this is what she found. See below. However my primary care doctor looks at the lab and it says "normal".But I think she should look at me clinically. I really feel like I have hypopituitary symptoms. Is this what has been making me so sick for the last several years. I am pretty much housebound and very sick right now. I really need you to look at this for me.

My Free T4 levels are borderline low at 0.9 normal is 0.7-1.8
TSH is also borderline low at 0.71 normal is 0.50-6.00
Total T3 is 124
Thyroid Peroxidase Antibodies are 15, normal is <35

Symptoms:
Severe Fatigue
Just don't feel well - general malaise/Flu like symptoms
Shortness of breath with minimal exertion
Cold feet and hands sometimes purple in color
Can't loose weight
Weight Gain on 1400 calorie diet. Using Weight Watchers and I follow my plan 100%, easy to do with no appetite.
Dry Skin
I can not handle any stress
No Appetite
Gastroparesis
Constipation
Insomnia - only sleeping 3-4 hours per night and I can not initiate sleep until 3am
Joint Pain
Abdominal pain
Flank pain
Bruise easily
Hair thinning
Thin Nails
Puffy Face

I have two small hypoechoic nodules in my thyroid gland both less than 1 cm in size
My skull has an appearance of salt and pepper however my parathyroid hormone is normal.

I really need some expert advice. Does anyone have a clue what could be going on. I wonder if my pituitary may not be working correct.
I was a RN for 18 years and I know what doctors think about patients with CFS. I was given one anti depressant after another.

Thanks Dr.  
Fatgirl

[IndigoRiley]

I was also going to say maybe have the adrenals tested..i am going through the same thing pretty much and it is very frustrating and it seems i am not being taken seriously. I have an overactive thyroid(Hyper), according to my RAI Uptake, and TSH levels(even tho they are "normal"), but i have all HYPO symptoms. I believe maybe my adrenals are not working properly which is actually causing my thyroid to produce too much TSH to overcompensate for my weak adrenals. I am still waiting to bring this to my drs attention bc i dont have an appt until 2wks from now, but i am counting the days! Good luck to u!

[IndigoRiley]

Wow u sound almost exactly like me! Thankyou for posting this!

[fatgirl213]

Hi Anniegoose,
I just saw the endocrinologist today and she drew several tests however I did not ask about the adrenals. I am following up with her next week so I will pose the question at that time but thanks so much for bringing this to my attention.

[fatgirl213]

Dear Dr. Lupo,

I just saw the Endocrinologist for the first time today. She is concerned about the Low TSH and Low Free T4. She ordered blood tests today to recheck these since they were last drawn in Oct 2012.

I have never had a history of a thyroid problem nor have I ever taken any thyroid medication in the past. The only thyroid issue I have had is I have a enlarged hyper vascular thyroid with three hypoechoic nodules all measuring less than one centimeter.

My TSH and Free T4 have gradually decreased over the last 3 years. In late 2009 they were on the higher side of normal. She felt the TSH and Free T4 are "smoldering".

Because of the increase in my other labs and now the drop in the TSH and Free T4 she is concerned about "Central Hypothyroidism".  My doctor stated, "although this is very rare",  she is still going to investigate it and continue to follow it.

I have Myalgic Encephalomyelitis which affects my autonomic system specifically the Hypothalmus.

My endocrinologist also mentioned that she rarely see's a low TSH and Low Free T4 in a patient who is NOT on thyroid medications.  She also said clinically my symptoms correlate with the low TSH and low Free T4.

So for now I am going to be following up with her next week.  She is one of those doctors who communicats with her patients on all labs. She feels its too easy to miss something by saying "no news is good news or If you don't hear from me you will then know all labs are normal". I really like this quality in her.

Let me know if you have any other comments.
Thanks again Dr. Lupo.

[Anniegoose]

have you had the test to check your adrenal glands?

[Mark Lupo, M.D.]

Your thyroid labs are completely normal - would look into other causes with an internist.  The small thyroid nodules would not cause these symptoms and can be monitored with ultrasound.