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Suggest Treatment For Severe Headaches, Hand Tremors And Hypopituitarism After Injury

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Posted on Tue, 6 Oct 2015
Question: I have hypopituitarism with head injury as a possible etiology. (an mri ruled out a tumor several ago-other testing ruled out auto-immune) Recently, I have had severe headaches, hand tremors and routine labs which revealed border line hyperthyroidism. Can this be related to the hypopit? My endocrinologist ordered a brain MRI which we are still awaiting results for. Would treatment for hyperthyroidism the same if I am hypo pit? If not, please explain why.

BTW I am a female, I just noticed I marked male..dont know if that makes a difference but I didn't want to confuse you.
doctor
Answered by Dr. Shehzad Topiwala (1 hour later)
Brief Answer:
Thyroid

Detailed Answer:
I have noted the corrected gender.

I follow what you are saying. Sorry to note the headaches and other symptoms.

Hand tremors are unlikely due to hypopituitarism.

The treatment of hyperthyroidism remains the same regardless of whether you have hypopituitarism or not.

If you truly turn out to have complete hypo pit then the TSH levels in the blood will be low. Typically TSH is used to guide treatment of hyperthyroidism along with Free T4 but in this instance your doctor will have to manage the condition using free t4 levels only.
Endocrinologists are trained to handle such problems.

So in essence the treatment approach is the same but the loss of TSH as a laboratory test marker for follow up is a possibility
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (1 hour later)
I'm sorry, I forgot to tell you that I take 10-20 mg of prednisone daily for the hypopit. If that is the correct dose for me, shouldn't my TSH T3 T4 be within normal range? Thanks so much for your help.
doctor
Answered by Dr. Shehzad Topiwala (6 hours later)
Brief Answer:
Follow up

Detailed Answer:
10-20 mg of prednisone is quite high for daily replacement doses. Please discuss this with your endocrinologist as to how you can gradually lower these doses to 'physiological' ones to minimise side effects.

So again if you have complete panhypopit then you would have also been on thyroid hormone replacement with XXXXXXX thyroxine. Taking higher than necessary thyroxine doses results in hyperthyroidism due to excessive medicine dose.
But you could also develop spontaneous 'endogenous' hyperthyroidism du to conditions like thyroiditis or an over-active thyroid gland. These require different types of testing.

Taking prednisone has different effects on TSH T3 and T4, but it is not as if your thyroid is guaranteed to stay completely fine while you take prednisone.
For example, if you have partial hypo pit and your Thyroid axis is unaffected, and if you are not getting enough prednisone then in such cases, sometimes the TSH rises abnormally and moderately. Taking adequate amounts of prednisone or hydrocortisone can normalise the TSH in many such cases. But if it does not then it is important to consider a primary defect in the thyroid gland. You might then benefit from treatment with XXXXXXX thyroxine.
However, if you take higher doses of prednisone such as the kind you are on now, it tends to lower the TSH , T3 and T4. This does not indicate the red for treatment right away because the best way forward here is to bring your prednisone doses towards 'replacement' levels and then recheck thyroid labs once stable to see if there is indeed a thyroid problem too.
These are fairly complex issues which will require the expertise and experience of an endocrinologist to dissect out over the course of several weeks and visits.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Suggest Treatment For Severe Headaches, Hand Tremors And Hypopituitarism After Injury

Brief Answer: Thyroid Detailed Answer: I have noted the corrected gender. I follow what you are saying. Sorry to note the headaches and other symptoms. Hand tremors are unlikely due to hypopituitarism. The treatment of hyperthyroidism remains the same regardless of whether you have hypopituitarism or not. If you truly turn out to have complete hypo pit then the TSH levels in the blood will be low. Typically TSH is used to guide treatment of hyperthyroidism along with Free T4 but in this instance your doctor will have to manage the condition using free t4 levels only. Endocrinologists are trained to handle such problems. So in essence the treatment approach is the same but the loss of TSH as a laboratory test marker for follow up is a possibility