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Pituitaty Issue ?

Hi

I have been on 75mcg Levothyroxine for 10 months and now also taking 20mcg Liothyronine, currently TSH is 0.17 (reference .50 to 5.0) and FT4 17 (reference 10-25).

I am a 33 year old male, 135 Kg in weight and increasing despite a <1000 calorie diet.

Many symptoms are returning and I'm researching further potential issues and have asked my specialist for results of labs done prior to starting thyroid meds, these are:

TSH 1.28 (reference 0.5 - 5.0)
FT4 10 (reference 10 - 25)
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, my specialist refused to diagnose Pituitary issues and is now saying it's likely to be CFS or Fybromyalgia.

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

Thanks
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Avatar universal
COMMUNITY LEADER
A few of your levels are off - but alas, the IGF-1 is known to pulse so it cannot even be used to diagnose (a stimulation test has to be used) so that would have to be tested over time to show a pattern.

The TSH which is a pituitary test is normal - and if it was central aka pituitary hypothyroidism - it would be much lower usually.

Your cortisol is low - but I don't know what time the test is taken and that makes a difference. ACTH should be taken as well.

It takes a lot of testing to figure out hormonal issues - and you did not give any symptoms. For example, a low cortisol in the morning is misleading when you could be high all night and that would suppress the growth hormone, the testosterone and the thyroid. High cortisol also causes a lot of pain and many of us have been diagnosed with fibro... high cortisol makes you gain weight. All that - I would think Cushing's, cyclical Cushing's etc. - and doctors can think that is rare etc.
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Avatar universal
Thanks for the info Rumpled

Below are answers to your questions:

TSH should be much higher for the low FT4 reported.

Cortisol was urine taken at 7.30am, ACTH test was not ordered due to lab not knowing when sample was stored, ultimately didn't know it was below range.

Symptoms are:

Weight gain (centralised obesity), intollerance to cold and hot, low libido, poor memory, exteme fatigue, dry skin, high cholesterol, headaches behind eyes and rear of head, anxiety, depression, agressive tendenacy when stressed.
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Avatar universal
COMMUNITY LEADER
The symptoms show hypercortisolism - Cushing's which suppress thyroid, testosterone and other hormones - but if you only test cortisol in the morning it may not show much. Your loss of diurnal rhythm is there but the doc has to be smart to pick up on it.

You are going to need 24 hour urine tests and saliva tests too to pick up when you have high cortisol. ACTH is a fussy test - it is hard to get an accurate test. Your lab is also using an old TSH range as it was changed to .3 to 3.0 years ago...
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Avatar universal
Thanks for your response I will speak to my PCP and see where to go from here.

One other thing that springs to mind is a couple of years ago a locum PCP was treating me for dizziness and noticed the "stretch" marks on my stomach and briefly mentioned checking cortisol, but it was never followed up.

Reading online this is one of the visible symptoms due to damage to the skin.

I just pray it's going to get sorted soon.

Thanks again.
Helpful - 0
Avatar universal
COMMUNITY LEADER
Yes, the purple striae are a symptom so it should be followed up on. There is no one test for Cushing's so you have to get a good doctor that knows what they are doing.

St Barts is the best in the UK - at least the buds I know in London go there and have the best luck there. You guys have a time over there since you can't get copies of your tests and that helps greatly to know if the doc is telling you really what is going on...
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