Extreamly Low TSH and Low free T4

[@Sunrise]

First and foremost, thank you for having this resource!

I went to my family doc recently to do my yearly physical and we did a CBC. My THS came back radically low so he ordered more labs to check Free T4 & T3 total.

Results:
TSH: <0.02 [0.46-4.68]
FREE T4 0.52 [0.64-1.92]
T3, Total 85 [60-182]

I don't take any meds, OTC's or herbs (well a daily vitamin).

I do have some symptoms of hypo, I have a hard time not falling asleep during the day and once my morning workout is over, I'm beat!

The nurse on the phone said I was hypo, come in to get a scrip and orders to do an ultrasound. I filled the script, took a pill and went home. After looking at the meds subscribed and doing some online research, I think there was an error. Propylthiouracl 500mg/tab. That's an anti-thyroid med. I have not taken another pill since the first day. I confirmed with the doc that he gave me the right med and he said I'm hyper. He's going to talk with an endo and see what the results the u/s (those results will be back later today or Monday). After all my research, and feel like I do have secondary-hypo and have to ask, do I have secondary hypo (a pituitary gland problem which has me very scared) and what other tests should I request? I don't feel the family doc did enough research before starting treatment. I'm in shock and scared without an outlet for more face to face info right now. HELP!?!?

Thank you,


Dawn

[Mark Lupo, M.D.]

Your research may be right -- would not use PTU at this point based on the T4 and T3 labs you mention -- this is suggestive of secondary hypothyroidism.  Repeat thyroid labs  -- if still same pattern, need an endocrine evaluation for pituitary disorders.  This would include complete pituitary hormone assessment and an MRI of the brain/pituitary.

[Lake Lover]

Get a second opinion. With your FT's that low they should be looking at them and not your TSH.

I'm thinking adrenal gland issues?

Find an endo to give you additional testing before taking any meds.

[Dixie1]

Get free T3 tested and get adrenal hormones tested. Need thyroid antibody tests (TPO, antithyroglubulin) as well as ANAs tested. With autoimmune hypo (Hashimoto's), your TSH can frequently move. You may also have had a false TSH reading.

That doc definitely should have done much more testing, and that medication would have really messed you up with the low thyroid hormone results. When you get the test results back from endo, call that doc and let him know. That guy is going to really hurt someone!

[@Sunrise]

Update:  The doc’s office finally called at 4:45 yesterday.   The nurse said that my ultrasound results are normal and to continue on the meds.    I asked for a referral to an endo in the area.  I tried calling myself to make an appt (I have open insurance so I can go anywhere, in network, without a referral) and they all said that I have to have a referral. Very cold people I talked to on the phone.  None of them made a good impression on me at all.  I’m going to call back today to have the TSH/Free T4/Free T3 run again along with the pituitary hormone assessment.  I might as well get it done all at one time.  I’ll update when I hear more.  

Thank you for the responses.  At least someone listens to my concerns and give me logical, sound advice.  


Best Wishes,


Dawn

[Dixie1]

I wouldn't even go back to that doc, those people don't know what they are doing and you will probably end up having to fight with them. Btw, I went to endos with no luck on good treatment, and now see a wonderful nurse practitioner. Some holistic docs are really good. Interview anyone you are considering for a visit. Ask what tests they do. If they diagnose and treat solely on TSH and total T4...bad news. Make sure they test thyroid antibodies and the frees, as well as the adrenals. All thyroid meds state not to prescribe them with untreated adrenal insufficiency, and most docs don't know this and don't test. Get cortisol, DHEA, and aldosterone tested, as well as the sex hormones. Get full pituitary tests.

I got full pituitary, thyroid and adrenal tests done, as well as MRI. Luckily, MRI was negative. Found adrenal insufficiency and hypo/Hashis. Being properly treated for both now, and feeling better with time.

When you get all the tests done, let us know the results. Also, go to StoptheThyroidMadness.com, it changed my life.

[lumley801]

It sounds like the doctor is dosing totally off of TSH.  A low TSH would indicate hyper and maybe that's why he prescribed anti-thyroid meds...but you also have low thyroid hormones.  I'm not a doctor, but that sounds like a pituitary thing to me...
A second opinion is definitely in order.

[@Sunrise]

I will keep everyone informed on what happens next with my condition.   I feel like I need to go back to the doc and teach him so he won't do this to someone else who may not be able to research the topic themselves.     If I am meet with extreme resistance, then I will give it up and find someone else who will listen and understand.   Living in rural North Carolina, it can be difficult to find someone who is really good at something like this.   *sigh*    

When you (dixie1) were in the diagnosis process, did they do a thyroid ultrasound on you? If so, what was your outcome?

Thank you!


Dawn

[BD9554]

A related discussion, Low TSH was started.

[LoriD1966]

A related discussion, Low tsh and Low free T4 was started.

[LoriD1966]

A related discussion, low tsh low free t4 was started.