Sudden Complete Loss of Libido - Testosterone and Thyroid Questions

[drkatzjr]

Dr. Lupo:

Over the last ten years, my TSH has remained (invariably) very suppressed.

Also over the last ten years, my T4 has always been normal (with one test showing it flagged as low)
but most all showing it in the borderline low, but normal range.

Moreover, over the same time frame (10 years)  my T3 is invariably within the normal range
(but always 'high normal) yet never flagged as high.

Recent Complete Blood work showed a suppressed Total and Free Testosterone level  (it was flagged)
as well as a --profoundly-- low DHEA-Sulfate Plasma level   78      (195-600)

I am male in my early 30's and in the process of getting an opinion of this.

In 2005 I had an Iodine Up-Take scan, which demonstrated a LOW uptake  (5.3%)
but without hot or cold nodules.  

Also a brain MRI R/O pituitary problems, and other hormones such as LH/FSH are normal

Symptoms:  Fatigue, extreme intolerance to ---cold--, which is very odd..... I am cold ALL THE TIME,
and my temperature always runs around 97.2, on-and-off paresthesia  and dyskinesia in lower front legs spinal issue??) and complete sudden total loss of libido.

Right now I am experiencing what I would describe as a "pinched nerve" sensation on the top
of my foot, close to the ankle, that tingles.

My only chronic (opposing) health issue   (ie 2 docs stating two different opinions)

1. Subclinical Hyperthyroidism    2. lymphocytic thyroiditis

Lower Leg dyskinesia  Issue: No specific dx ever given.

I am really needing feedback, as these symptoms are very anxiety provoking for me.

I sincerely thank you for both your time, and any information you could provide.

[drkatzjr]

Thanks for your comments.  About 2 years ago I posted a similar question W/O the hormone aspect, and your response was:


Mark  Lupo, M.D.

If it had not been a five year history of low TSH, I would have agreed w/ the endocrinologist on silent/painless thyroiditis which resolves on it's own.  The radiologist should not have interpreted the uptake as Hypothyroid -- this is a common mistake.  Hypo and Hyper are diagnosed on blood tests. If hyper, then the uptake can tell us why.  Low uptake - thyroiditis, normal/high - graves or hot nodules.

It is possible you had contamination with iodine (vitamins, diet, etc) - making the uptake look low.

So without evidence of pituitary disease (labs, MRI), with a history of low TSH for 5 years - this is either a toxic nodule or Graves disease.  If the ultrasound shows no nodule, it's Graves

[Mark Lupo, M.D.]

Would see an endocrinologist to sort out the low testosterone and DHEA-s (assuming you are not taking any steroids...)  The low TSH is most commonly hyperthyroidism, but it does not sound like pituitary function problems have been completely excluded (though it is not a tumor based on pituitary MRI).