So, I have recently found out that my hypocretin deficiency (which is the cause of mynarcolepsy with severe cataplexy) also plays a critical role in the neuroendocring system. Namely, it reduces several pituitary hormones by 50% or greater due to a defect in the hypothalamus where the hypocretin neuropeptide is produced. The hormones that are reduced are: LH, ACTH and TSH. It also greatly reduces leptin levels. (journal of clinical endocrinology and metabolism).
Interestingly, I also have Hashimoto's thyroiditis which has brought about a hypothyroid state.
Despite having obvious clinical symptoms of hyopthyroidism and a low range of FT4, the endocrinologists I have been seeing are refusing to increase my thyroid medication because my TSH is in the low end of the reference range. (0.46, range: 0.4-4.0)
When there is also a defect of either the pituitary or hypothalamus that causes a reduction of TSH secretion, isn't the best method of treatment for hypothyroidism through monitoring and elevating FT4 into the upper half of the reference range? Would it be safe to say that the TSH test would not be a reliable indicator of my thyroid state in this instance?
Would this be considered both central hypothyroidism and Hashi's?