Low TSH, low free t3, low ATCh, average t4, HELP

[openblessings]

My sister is in Africa, reported weakness/fatigue and nausea. Pls help deduce the problem and possible treatment Thanks

Lab results as follows:
ATCH (cortisol results 30 mins after synacthen injection): < 0.2 pmol/L
Free T4 10.3 pmol/L
Free t3: 2.3pmol/L
TSh 0.43 mI UL

[Barb135]

Yes, I'm sure it is all very new to you.

Please make sure they check her pituitary gland.  If that's what's causing the issue with both the ACTH and TSH, it needs to be "fixed" as well.

[openblessings]

this is all new. so  they are starting her on corticosteroids i believe. thats the only hormone she has received so far.

[Barb135]

Her Free T3 is too low.  Is she already on any thyroid hormones? If so, which one(s) and what dosage? It would be a good idea for her to retest, FT3, FT4 and TSH.

I don't know a lot about the ACTH; however, I do know that it's also a pituitary hormone, that stimulates the adrenal glands.  I found the following at mayoclinic.com:

"Adrenal insufficiency can also occur if your pituitary gland is diseased. The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. Inadequate production of ACTH can lead to insufficient production of hormones normally produced by your adrenal glands, even though your adrenal glands aren't damaged. Doctors call this condition secondary adrenal insufficiency."  

I would suggest that with the low TSH and ACTH, both pituitary hormones, that your sister might want to have further testing done to check her pituitary gland.  

[openblessings]

Thanks for the reply:
I hope these help.
The lab results are based on the normal reference: units same as lab results.

ATCH: 1.6-13.9
Free T4 7.2-16.4
Free T3: 3.8-6.0
TSH 0.37-3.5

[rumpled]

If her ACTH is that low after injection, then she has Addison's disease, and she needs replacement corticosteroids. She needs to take them properly - she may also need salt tablets, florinef and other medications.

You did not put any of the ranges on the other labs, so it is difficult to tell where she it, and every lab differs, It may be that she is hypothyroid, it may be that she is ok (being at the low end of TSH is ok but too low shows a pituitary issue as TSH is a pituitary test). The other tests, one likes to be at the higher ends of the ranges. The free tests are best so kudos to the doctor.