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What Does This Thyroid Test Result Regarding Sheehan's Syndrome Indicate?
Question: I have recently been diagnosed with Sheehan's syndrome. I am 45 years old and had a blood loss of 4L with my last child, eight years ago. The insulin tolerance test in July 2014, showed that my growth hormone did not respond, however my cortisol was good.
My TSH has been continuing to climb with each blood test since December; from 2.68; 2.83; 3.06; 3.16; 3.27.
In May my results were:
TSH: 3.16, T4 10.4, FSH: 2.8, LH:4.2, Estradiol 2331 pmol/L
In July my results were:
TSH: 3.27, Free T4 13; FSH 20; LH 4; Prolactin: 4
I was told that my test results indicated that I'm past menopause. Would you agree with that?
Also, from what I can understand my estradiol results are high - Is that the case? Should I be concerned?
Also: Is hypopituitarism progressive? Basically can it get worse that it is now?
Thanks for your help.
XXXXXX
My TSH has been continuing to climb with each blood test since December; from 2.68; 2.83; 3.06; 3.16; 3.27.
In May my results were:
TSH: 3.16, T4 10.4, FSH: 2.8, LH:4.2, Estradiol 2331 pmol/L
In July my results were:
TSH: 3.27, Free T4 13; FSH 20; LH 4; Prolactin: 4
I was told that my test results indicated that I'm past menopause. Would you agree with that?
Also, from what I can understand my estradiol results are high - Is that the case? Should I be concerned?
Also: Is hypopituitarism progressive? Basically can it get worse that it is now?
Thanks for your help.
XXXXXX
Brief Answer:
Hi XXXXXX
Detailed Answer:
Good day.
Noted your concern.
In sheehan's syndrome, based on the type of pituitary cells estroyed, one or multiple pituitary hormones can be lost. The most crucial hormones go last as body tries to preserve them. The least required hormones ( least importnat) go first. Hence GH is often first to go and ACTH ( cortisol) and TSH are last to go.
In your case, TSH is looking normal. Please do not worry about mild icrease inn TSH. It is a dynamic hormone which change from day to day and hour to hour. The levels are in normal range and hence can be considered normal. In Hypopituiraism, TSH will not rise when the Free T4 falls ( normally, when Free t4 falls, TSH should rise).
Your FSH of 20 is consistent with menopause onset and after full menopause often the levels go beyond 40. However, if the FSH producing cells are damaged , then the rise will not be so robust.
I didnt see an estradiol level with your july reports. In meopause, estradiol levels should fall. Hence it is important to get a level along with FSH and LH.
Yes, hypopituitarism can be progressive based on the severeity of initial insult. Having said this, i have seen plenty of patients who have only lost partial pituitary function after Sheehan's. Only time will tell this. Quite interested to know about your ACTH values and cortisol response after insulin tolerence test. DO you have a report to attach?
Hope i have answered your question. Happy to answer more if you have any
Regards
Binu
Hi XXXXXX
Detailed Answer:
Good day.
Noted your concern.
In sheehan's syndrome, based on the type of pituitary cells estroyed, one or multiple pituitary hormones can be lost. The most crucial hormones go last as body tries to preserve them. The least required hormones ( least importnat) go first. Hence GH is often first to go and ACTH ( cortisol) and TSH are last to go.
In your case, TSH is looking normal. Please do not worry about mild icrease inn TSH. It is a dynamic hormone which change from day to day and hour to hour. The levels are in normal range and hence can be considered normal. In Hypopituiraism, TSH will not rise when the Free T4 falls ( normally, when Free t4 falls, TSH should rise).
Your FSH of 20 is consistent with menopause onset and after full menopause often the levels go beyond 40. However, if the FSH producing cells are damaged , then the rise will not be so robust.
I didnt see an estradiol level with your july reports. In meopause, estradiol levels should fall. Hence it is important to get a level along with FSH and LH.
Yes, hypopituitarism can be progressive based on the severeity of initial insult. Having said this, i have seen plenty of patients who have only lost partial pituitary function after Sheehan's. Only time will tell this. Quite interested to know about your ACTH values and cortisol response after insulin tolerence test. DO you have a report to attach?
Hope i have answered your question. Happy to answer more if you have any
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks so much for your quick reply.
I'm attaching all of my most recent lab test results. Please let me know if there is anything there that I should be aware of.
I appreciate your help; having believed this has been happening for years it's both relieving and a bit overwhelming to try and figure out what's happening next and how to deal with it all.
I have had many symptoms of hypothyroidism since January; I'm gaining weight, while only eating 1200 calories a day; I exercise whenever possible, but when I do regular workouts, I seem to hit a wall, then I'm completely exhausted for weeks or months - very frustrating since I am a very active person with three children.
I look forward to hearing from you.
Kind regards,
XXXXXX
I'm attaching all of my most recent lab test results. Please let me know if there is anything there that I should be aware of.
I appreciate your help; having believed this has been happening for years it's both relieving and a bit overwhelming to try and figure out what's happening next and how to deal with it all.
I have had many symptoms of hypothyroidism since January; I'm gaining weight, while only eating 1200 calories a day; I exercise whenever possible, but when I do regular workouts, I seem to hit a wall, then I'm completely exhausted for weeks or months - very frustrating since I am a very active person with three children.
I look forward to hearing from you.
Kind regards,
XXXXXX
Brief Answer:
Hello
Detailed Answer:
Thank you very much. The reports are very much reassuring. You had a robust cortisol response to insulin tolerance test. However, the GH response was poor. Besides, the IGF-1 was low. Quite consistent with GH deficiency. You do not have hypothyroidism.
In fact, Adult GH deficiency can lead to weight gain, tiredness, abnormal cholesterol profile etc. You may discuss with your endocrinologist about low dose GH( growth hormone) replacement on a trial basis.
It is worth doing the a Synacthene test ( for cortisol) and a Thyroid profile next year.
Regards
Binu
Hello
Detailed Answer:
Thank you very much. The reports are very much reassuring. You had a robust cortisol response to insulin tolerance test. However, the GH response was poor. Besides, the IGF-1 was low. Quite consistent with GH deficiency. You do not have hypothyroidism.
In fact, Adult GH deficiency can lead to weight gain, tiredness, abnormal cholesterol profile etc. You may discuss with your endocrinologist about low dose GH( growth hormone) replacement on a trial basis.
It is worth doing the a Synacthene test ( for cortisol) and a Thyroid profile next year.
Regards
Binu
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
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