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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
LOw Free T4/Low TSH
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.
LOw Free T4/Low TSH
by MarijoR, Mar 08, 2007 12:00AM
I've just recently been diagnosed with hypothyroidism, but I am not sure I'm on the right treatment course.
Labs: T4-Direct 0.5 (1st) 0.6(2nd) .8-1.9 Norm
TSH 0.453 (1st) 0.746 (2nd) .4-4.2 Norm
T3 SerPl Qn N/A(1st) 145 (2nd) 82-179 Norm
From everything I have read, my low TSH and Free T4 indicate pituitary (or hypothalamus) dysfunction. My Rheumatologist had the first set of labs drawn when I complained of unrelenting fatigue. She forwarded the results to my GP who had the labs redrawn (6 days later) along with a T3 (why T3 and not FreeT3?)
After the 2nd set of labs, he started me on Levoxyl 75 mcg, as he said "a low dose, but just a shot in the dark to try and get your levels back up". I do not return to him for 4-6 weeks to recheck labs.
I have been on the Levoxyl 4 days and am starting to feel less "foggy", but am still concerned about the potential for underlying Pituitary problems. Also, my thyroid US read "multinodular goiter". It indicated mixed solid and cystic components. My brother had thyroid CA and I wonder if I should have a biopsy.
Do you think I should wait the 4-6 weeks and see how I do? Will the Levoxyl mask problems with my pituitary once labs are redrawn? I really like my GP, but am not sure I am on the best course. Thank you!!
Labs: T4-Direct 0.5 (1st) 0.6(2nd) .8-1.9 Norm
TSH 0.453 (1st) 0.746 (2nd) .4-4.2 Norm
T3 SerPl Qn N/A(1st) 145 (2nd) 82-179 Norm
From everything I have read, my low TSH and Free T4 indicate pituitary (or hypothalamus) dysfunction. My Rheumatologist had the first set of labs drawn when I complained of unrelenting fatigue. She forwarded the results to my GP who had the labs redrawn (6 days later) along with a T3 (why T3 and not FreeT3?)
After the 2nd set of labs, he started me on Levoxyl 75 mcg, as he said "a low dose, but just a shot in the dark to try and get your levels back up". I do not return to him for 4-6 weeks to recheck labs.
I have been on the Levoxyl 4 days and am starting to feel less "foggy", but am still concerned about the potential for underlying Pituitary problems. Also, my thyroid US read "multinodular goiter". It indicated mixed solid and cystic components. My brother had thyroid CA and I wonder if I should have a biopsy.
Do you think I should wait the 4-6 weeks and see how I do? Will the Levoxyl mask problems with my pituitary once labs are redrawn? I really like my GP, but am not sure I am on the best course. Thank you!!
Doctor's Answer
by Mark Lupo, M.D., Mar 08, 2007 12:00AM
, Mar 08, 2007 12:00AM
I'm not sure you have a pituitary problem. Would retest the Free T4 by equilibrium dialysis. The TSH and the T3 are normal -- also retest as free T3. Yes, you should have a biopsy of any dominant/suspicious nodule.
Now that you are on levoxyl it will be tough to see -- would stop and retest in 3 weeks as mentioned above. It you really have central hypothyroidism, then other pituitary labs (ACTH, cortisol, IGF-1, PRL) should be tested and an MRI performed to see the structure of the pituitary.
Now that you are on levoxyl it will be tough to see -- would stop and retest in 3 weeks as mentioned above. It you really have central hypothyroidism, then other pituitary labs (ACTH, cortisol, IGF-1, PRL) should be tested and an MRI performed to see the structure of the pituitary.
