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  • Hypothyroid, not Hashi's, Pituitary maybe?

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    Old 10-16-2013, 03:23 PM   #1
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    Hypothyroid, not Hashi's, Pituitary maybe?

    Hello health board community!

    This is my first post but I've been doing a bit of research here lately related to my good old thyroid. Wow- you all certainly know a lot about thyroid disorders! As for me- I've been hypothyroid since 1998 (and treated accordingly). I've been on a T4/ T3 combo since 2003 to address some muscle aches I was having with just T4. I haven't really had any issues until about a year ago. I'm a 33 year old female.

    Over the past year I've developed some perplexing symptoms: exercise intolerance, weight gain, fatigue, occasional heart palpitations and sweating episodes, slight hand tremor, cold feet/ hands, achy joints, particulary knees and ankles. I also get semi-regular severe headaches (1-2 per month) that originate in the back of my neck. I should also mention that I've had a hard time getting pregnant (been trying for about 18 months). My basal body temperature has been consistently low (around 97.5).

    In May, a 4 cm nodule was discovered on my left thyroid nodule. 2 FNAs later, it does not appear to be cancerous (yay!). My endo doesn't support removing it, as he doesn't think it is causing these symptoms, which I generally agree with.

    Here are my recent labs:

    September 2013:

    T4 (free): 1.01 (range 0.93 - 1.70)
    T3 (free): 2.5 (range 2.0 - 4.4)
    TSH: 2.380 (range 0.270 - 4.200)
    ANTI THYROGLOBN <20 (range 0 - 40)
    THYROGLOBULIN 78.7 (range 0 - 55)

    May 2013: (please note, these were done in a different lab and I was not given ranges, but I expect they're similar to above ranges)

    T4 (free): .9
    T3 (free): 3.5
    TSH: .403

    Relevant treatment info: After the May labs, the first doc took me off of T3 for a month and raised my T4 dose from .75 to .88. This seemed to exacerbate my joint pain and some of the other symptoms. I switched to a new endo, who put me back on T3 in early July (I went back to .75 mcg T4 and .05 mcg T3). This might explain the difference in T3; however, I'm not sure it explains the difference in TSH.

    Based on the September labs, my endo upped my T4 dosage, so I'm now on .88 mg T4/ .05 mcg T3. I have been feeling quite a bit better on a slightly higher dose of T4, and I'll do another lab in November and we'll see if free T4 is raising.

    In the meantime, I'd love any feedback or thoughts on these numbers, particularly from anyone who maybe learned of an underlying pituitary problem which caused their hypothyroidism. I'm particularly interested in the fluxuating TSH but the T4 staying low.

    Thank you in advance for any input!

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    Old 10-17-2013, 04:22 AM   #2
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    Re: Hypothyroid, not Hashi's, Pituitary maybe?

    The numbers look like typical hypothyroid from hashis to me (I'm no expert) and your symptoms seem common to hypothyroid/hashis as well (you can't go by antibodies only). TSH can fluctuate even in throughout the day, that's why you have the other tests too. The free t3 and free t4 should be in the upper third of the range I believe that's where many feel better. If you want to get pregnant those numbers aren't ideal, consider seeing a fertility expert or a reproductive endocrinologist.

    In terms of that 4cm nodule (4cm?) if that grows or changes you should get it out sooner rather than later, because it will be challenging to get something that large out without causing other difficulties, it seems to be growing out of control. It tends to cause constriction type symptoms if tenderness, neck pain, etc.

    Last edited by Reece; 10-17-2013 at 05:07 AM.

    Old 10-17-2013, 03:37 PM   #3
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    Re: Hypothyroid, not Hashi's, Pituitary maybe?

    Thanks for writing, Reece. My dose was just upped to get me in the upper third of the range, so we'll see how that goes.

    Regarding the nodule, we'll keep an eye on it, and if it does grow or change, I'll be campaigning for its removal.

    Your thoughts are much appreciated!

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    free t4, hypothyroid, infertility, nodule, pituitary

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