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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Free T4 level low, all other thyroid levels normal - should I be treated?
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
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.
Free T4 level low, all other thyroid levels normal - should I be treated?
by skyhawksatori, Jun 15, 2007 12:00AM
Hello,
Pertinent history: age 46 male, hx hypogonadism, Rx Androgel, however not producing positive results. Libido weak, erectile dysfunction not improved, despite good testosterone and free testosterone levels. I also have noticed a marked change in the appearance of my penis over past year: definitely smaller in both flaccid and erect states, and more dry, with thinning skin. Other symptoms: fatigue, depression at times, extremeties that easily lose circulation, very cold and very dry hands in winter, salt cravings, joint pain, significant weight gain in abdominal region despite diet and exercise.
Currently work in South Korea, treated by Korean MDs. Recent results: T3 normal, TSH 1.26 normal (range 0.4 - 4.1), T4 normal 6.2, Free T4 low 0.59 (range 0.70 - 1.80). Also: Prolactin (normal), GH (normal), FSH (low), LH (low), Cortisol (afternoon draw) low 4.0 (range 5-25), and ACTH (afternoon draw) -- high 61 (range 0-60). Re-test ACTH and Cortisol morning draw and fasting: Cortisol: 6.5 normal, and ACTH 133 high. Due to Cortisol and ACTH results, I will undergo an insulin tolerance test.
1. Do I have hypothyroidism? 2. Should I receive the insulin tolerance test? 3. Should I ask for the thyroid antibody test? 4. Should I be treated with a small dose of l-thyroxine? 5. Will my hypogonadism improve while on hypothyroid treatment, as some studies have concluded? Thank you very much.
Pertinent history: age 46 male, hx hypogonadism, Rx Androgel, however not producing positive results. Libido weak, erectile dysfunction not improved, despite good testosterone and free testosterone levels. I also have noticed a marked change in the appearance of my penis over past year: definitely smaller in both flaccid and erect states, and more dry, with thinning skin. Other symptoms: fatigue, depression at times, extremeties that easily lose circulation, very cold and very dry hands in winter, salt cravings, joint pain, significant weight gain in abdominal region despite diet and exercise.
Currently work in South Korea, treated by Korean MDs. Recent results: T3 normal, TSH 1.26 normal (range 0.4 - 4.1), T4 normal 6.2, Free T4 low 0.59 (range 0.70 - 1.80). Also: Prolactin (normal), GH (normal), FSH (low), LH (low), Cortisol (afternoon draw) low 4.0 (range 5-25), and ACTH (afternoon draw) -- high 61 (range 0-60). Re-test ACTH and Cortisol morning draw and fasting: Cortisol: 6.5 normal, and ACTH 133 high. Due to Cortisol and ACTH results, I will undergo an insulin tolerance test.
1. Do I have hypothyroidism? 2. Should I receive the insulin tolerance test? 3. Should I ask for the thyroid antibody test? 4. Should I be treated with a small dose of l-thyroxine? 5. Will my hypogonadism improve while on hypothyroid treatment, as some studies have concluded? Thank you very much.
Doctor's Answer
by Mark Lupo, M.D., Jun 17, 2007 12:00AM
, Jun 17, 2007 12:00AM
Agree with testing for addison's -- with ACTH test usually, but ITT will do this as well.
Would be interested in T3 levels - and perhaps thyroid binding globulin -- to see if there is really a thyroid function problem -- but likely thyroid is ok.
thyroid antibodies makes sense.
the biggest concern is the ACTH of 133 with a cortisol of 6.5.
Would be interested in T3 levels - and perhaps thyroid binding globulin -- to see if there is really a thyroid function problem -- but likely thyroid is ok.
thyroid antibodies makes sense.
the biggest concern is the ACTH of 133 with a cortisol of 6.5.
