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Low TSH, low T3 and T4. Thyroid problem or pituitary problem?

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Practicing since : 2001
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what kind of thyroid problem ?
Hello Doctor,

My 19 years old daughter recently had a blood test on 3/13/2012. The results showed the

TSH = 0.762 ( 038-3.79)
T3 (free) = 1.45 (1.8-4.2) Low
T4 (total) = 3.9 (4.5 - 12.5) Low

Both Antibodies are normal < 20.

I have Hashimoto's hypothyrodism. my husband had hyperthyrodism and now is completely normal after many years of medication. We are just wondering why my daughter has low TSH and Low T3 & T4 at the same time.
Is this a thyroid problem or Pituirary problem.

Also her Red blood cell count is 3.72 (3.87-5.15) and high MCV 101.9 (72.7-97.7), high MCH 34.1 (23.5-32.8).
Does these numbers mean she has some kind of Anemia. Is it related to the above thyroid problem ?

Please advise. THANKS very much.
Posted Tue, 22 May 2012 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 25 minutes later

Thanks for the query.

Thyroid disorders tend to run in families. So given the fact that both you and your husband have a thyroid condition, your daughter may be prone to developing it too. However, since you say the thyroid antibodies are both negative, the chance is less but sometimes underactive or overactive thyroid problems can occur without detectable antibodies in the blood tests.

Now you have raised a good point about the diagnostic considerations ie thyroid versus pituitary. In order to fully interpret the thyroid laboratory tests that you have shared here, we need more tests. I would recommend repeating the TSH, Total T4 and do Total T3 with T3 resin uptake along with prolactin. There is no need to fast for these tests and they do not have to necessarily be done in the morning.

Anemia can occur in 'hypothyroidism' but if the thyroid turns out to be normal then evaluation of the hemoglobin status requires an independent work-up.

Endocrinologists are the best type of specialized doctors to competently manage these complex test results.

Hope this answers your query. Please do write back to me if you have additional queries.

Wishing your daughter a healthy life ahead.

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