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Information needed on hypothyroidism - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Thyroid Problem and Hormonal Problems
Answered by

General & Family Physician
Practicing since : 2009
Answered : 679 Questions
User :   I have been hypothyroid for 17 years. During the last year, my TSH has dropped far below normal and stayed there (approx 0.15), even when the synthroid dose was reduced. My doctor wants to reduce it even farther; however my free T3 is now below normal also and T4 is in the bottom half of the normal range. I am also feeling cold intolerance, gaining weight, sluggish, all of the symptoms I remember from when I was diagnosed with primary hypothyroidism 17 years ago (TSH 96 at that time). I've had an MRI and pituitary was fine. What could be causing the TSH to stay low? Does TSH alone mean synthroid dose should be reduced?
Doctor :   hello
Doctor :   i am Dr xxx here
User :   Hi.
Doctor :   give me a min please
User :   sure
Doctor :   i will read your query
User :   i retyped it above, though they said it had been saved.
Doctor :   yes
Doctor :   it is let me just go thru it please
User :   sure
Doctor :   OK may i know your age please ?
User :   MRI said "no gross abnormality on sella" it was 1.5 MRI machine. could i need another, more focused MRI?
User :   sure 46
Doctor :   well let me explain you how the TSH level are considered
User :   i hope all this is confidential
User :   yes?
Doctor :   yes i am assure you that 100 %
Doctor :   everything is 100% confidential
User :   Wait, i already know that TSH is a feedback loop, inversely porportional to amount of thyroid hormone
User :   i've done a lot of research myself.
User :   i just can't find answers to the two Qs above. Is TSH alone enough to lower synthyroid dose?
Doctor :   sure i will tell you
User :   and what else could be keeping TSH low? (What else, assuming it's NOT because I have too much T3 or T4, because I'm low on those?)
Doctor :   the body will work with what we call as a negative feedback mechanism
User :   Right.
Doctor :   Low TSH can indicate that there's an abundance of thyroid hormone being produced by the thyroid gland, so the pituitary gland sees no need to release TSH
User :   But T3 is below normal. and T4 is low normal. That's the issue.
Doctor :   and yes TSH is considered as the gold standard for dose maintenance
User :   Why would TSH be low AND thryoid hormones be low? In the blood tests. Pituitary problem? Or has that been ruled out by MRI? I just need answers to this.
Doctor :   as the hormone is in two parts the free and the bound part , the active part is the free hormone
User :   The free and total are below normal for T3.
User :   The free and total are low normal for T4.
Doctor :   ok
Doctor :   did you got a antibody test ?
User :   yes. She said they weren't "that high." But remember, I've had hypothyroidism for 17 years.
Doctor :   as there is a condition known as hashimoto thyroiditis
User :   So I don't think that's the issue, here.
User :   yes, I supposedly have that.
Doctor :   so its known to have both hyper and hype elements in it
Doctor :   were you not told about that
User :   Do you know why BOTH TSH and T3 could be low? Other than pituitary and some other illness?
Doctor :   i dont see any other cause
User :   I've never had hyper. And I don't now. Consider the T3 and T4 being low, as mentioned.
Doctor :   ok
User :   So in your view, even with low T3 and low normal T4, the synthroid should be reduced?
Doctor :   Well if you want we can have you referred to our expert endocrinologist opinion. there is a fee for it BUT your this chat money will be refunded
User :   yes, I think I need that. This is a complex Q.
Doctor :   its called as a specialist opinion
User :   I'm sorry, I thought that's what I'd asked for.
Doctor :   yes i am a General physician and can only help you in my expertise
Doctor :   dont worry i will send you the link
User :   thanks
Doctor :   and our team will contact you and your THIS chat money will be refunded
User :   thank you
Doctor :   hold on a min please
Doctor :   do you see it on your screen ?
Doctor :   do you see in on your screen ?
Doctor :   Are you there
User :   you are sending it via email? is that what you mean? This chat is over then?
User :   ??
Doctor :   sorry we just faced a technical difficulty
Doctor :   you will see on your screen
Doctor :   on right hand side
Doctor :   you have two options, either we can set up a phone call for you from the specialist or you can send in your query via email
Doctor :   whatever you are comfortable with ?
User :   >>
User :   chat over?
Doctor :   you got the link
Doctor :   ?
Doctor :   of our specialist ?
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