New to this - trying to understand

[MarijoR]

Hello!  This is my first posting although I have been reading the posts for a few days.  It sounds as if there are lots of knowledgeable people out there!

I have been treated for Chronic Fatigue and Fibromyalgia for a few years.  However, I went back to my MD after unrelenting fatigue.  Here are my labs:

             TSH 0.453 (Norm .4-4.2)
             Free T4 Direct 0.5 (Norm .8 -1.9)

I have always had a low TSH, but my Free T4 has never been measured. From what I have read, the cause of this can be Secondary Hypothyroidism (i.e. Pituitary failure). Perhaps this has always been my problem with fatigue!

My MD did order additional testing.  My Antibodies were normal (although high normal), I had an US of my thyroid and it showed "multinodular goiter" with mixed solid and cystic components.  There is a history of thyroid cancer in my family.

Can anyone help me understand these results and let me know what I should expect next in the way of treatment and or testing?

Thanks!  

[mikidee28]

A related discussion, Are my Thyroid Tests NOrmal was started.

[dine]

i am having the same problem 40 lbs weight gain since august of 06'  my tsh levelis low and my t4 level is low but my t3 is normal/high

[MarijoR]

Thank you for your quick response.  My MD did retest my TSH and T4 -Free Direct.  He also did a T3 SerPl Qn.

Here are the results:

             T4 Free-Direct   0.6 (was 0.5) norm .8-1.9
             TSH 0.746 (was 0.453) norm .4 - 4.2
             T3 SerPl Qn  145 (norm 82-179)no previous  

How is the T3 SerPl Qn different from the T3 Free?  Or is it?

I am concerned because I am not only exhausted, but very short of breath.  I can't even speak more than a sentence or two without stopping to rest. My heart rate increases with minimal activity; I am also quite dizzy and feel unbalanced.  I am hoping to talk with my MD again on Monday, but thank you for your comments.  It's just good to get some feedback!

Do you know of any other reason the TSH and Free T4-Direct would both be low?

Thank you again!

[Mark Lupo, M.D.]

Retest Free T4, Free T3 and TSH.  If all still (relatively) low then the pituitary should be imaged (MRI) and other pituitary homones (IGF-1, ACTH, Prolactin and cortisol) tested.  Secondary hypothyroidism is rare however.

Would consider biopsy of the nodule(s) given the family history of CA.