Suspected Pituatary Hypothyroidism ?

[myworlduk]

Hi Dr Lupo

Just over a year ago I was referred to an Endocrinologist showing signs of clinical hypothyroidism, at the time my TSH was 0.60 (ref 0.40 - 5.0) and my T4 was 12 (ref 10 - 25), my GP wanted a second opinion on the matter as did not want to prescribe Levothyroxine until all other tests (Addisons etc) was done.

My Endocrinoligst came up with similar TFT results and all other bloodwork was clear, so suggested a trial of 50mcg of Levothyroxine.

6 months later at follow up my TFTs showed TSH was 0.17 (ref 0.40 - 5.0) and T4 18 (ref 10 - 25), this resulted in a diagnosis of subclinical hypothyroidism and I was told to continue on 50mcg.

About a month later my GP ran further TFTs as I was complaining of feeling fatigued and my TSH had increased slightly so he put the dose of Levothyroxine up to 75mcg as it was thought that some antacids I take daily could be causing some absorbtion issues.

A futher test 3 months later by my Endocrinologist resulted in TSH of 0.07 (ref 0.40 - 5.0) and T4 of 17 (ref 10 - 25), he demanded an immediate reduction to 25mcg levothyroxine, as despite showing no symptoms of hyperthyroidism, he was concerned I had become so.

2 months later I've had another TFT and my TSH is 0.12 (ref 0.40 - 5.0) and T4 17 (ref 10 - 25), my GP now is now very confused and I'm not due to see my Endocrinologist until June.

Discussion has taken place as to why my TSH is not rising as sharply as it decreases and there has been mention of potential Pituatary issues.

My question is whether or not this is possible and if it is what should I be asking to get done, test and drug wise ?

Many thanks for your advice in advance.

Yours
Neil

[Mark Lupo, M.D.]

This does not sound to be pituitary - but would ask your endocrinologist about this.
It seems you may have had some "thyroid symptoms' but no clear evidence of thyroid dysfunction or need for medication as these symtpoms are very nonspecific.

[myworlduk]

Hi Dr Lupo

After some discussions with my Endocrinologist he has provided me with the following test results:

Testosterone 328.5 ng/dl (reference 350-1010)
IGF-1 96 ug/l (reference 114-492)
Cortisol 5.1 umol/mol (reference 5-25)
Sodium 138 mmol/l (reference 135-145)
Pottasium 4.8 mmol// (reference 3.4-4.9)
Creatinine 107 umol/l (reference 40/130)

From what I understand through talking to my PCP he agrees that some hormone and mineral levels are below and above the respective ideal levels.

I am going to see another specialist to discuss these results as we are now discussing potential Hypopituitarism,

Wonder if you could be so kind as to give me your thoughts.

Thanks