Hi Dr. T, I have been concerned about my very very low normal Free T4, low Total T3 (past doctor wont run Free T3) and very very low normal to below normal TSH. My past doctor would not increase my thyroid meds synthroid(tried amour and allergic) so I went to another Endocrinologist who has raised it. I also have Veliac, hyporthroid, pernicious anemia, multiple food allergies, sorjends etc. He thinks I have a pituitary tumor or autoimmune etc. I have a long 25 yr history of Lyme, CFs, Fibro, and viral infections. and have been on cortef in the past. I had a MRI of the Brain in 2004 and cat scan in 2008 which were both normal. I have been stressed out working way to hard trying to start a photography business for a few years being hypo and ???? and I am on disabilty from the Lyme. All family members are in denial about my illness. Any suggestions? Thanks so much.
Speak with the endocrinologist and let them know that as it appears the TSH is not reliable here relative to your T4 and clinical picture, ask them if they would basically ignore the TSH and treat clinically, simply adjusting the thyroid to the dose that feels best while keeping the free T4 blood level within the normal range. If there is no clinical response that feels adequate, ask them to also check a fasting morning cortisol and ACTH level. If both of these are low normal, it suggests the possibility that you may need adrenal support as well with perhaps 5 to 10 mg of Cortef if your endocrinologist feels this is reasonable. In addition, ask them to consider adding in Cytomel 5 – 20 mcg along with the Synthroid to see if this will give a better clinical response. I hope this is helpful to you and your endocrinologist.
If there is no pituitary adenoma, the endocrinologist these to be aware that multiple studies in people with chronic fatigue syndrome and fibromyalgia has shown hypothalamic pituitary axis dysfunction with our double-blind placebo-controlled study showing significant clinical improvement with thyroid and ultra low-dose adrenal support in the context of an integrated treatment protocol.