• question-icon

    What does this thyroid test result regarding sheehan's syndrome indicate?

default
Posted on Wed, 3 Sep 2014 in Thyroid Problem and Hormonal Problems
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
doctor
Answered by Dr. Binu Parameswaran Pillai 7 hours later
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
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Binu Parameswaran Pillai 57 minutes later
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
doctor
Answered by Dr. Binu Parameswaran Pillai 2 hours later
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
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1418 Questions

premium_optimized

The User accepted the expert's answer

Share on

Recent questions on  Insulin tolerance test

doctor1 MD

Hi Doctor, I am Male 31yr, 6'1" & 90 Kg. I am suffering from problem of severely low testosterone since I used Anabolic Steroid Cycle during...

doctor1 MD

Hi Doctor, My question to doctor specialist in treating male sex hormone (Andrologist) Doctor, I am suffering from low testosterone problem from...

doctor1 MD

I'm a 32 year old fit, active male, non-smoker, vegan, 5'10", 165lbs. Libido was almost nonexistent, low drive for anything (work, life, etc)...

doctor1 MD

i have significant reduction of temperature upon moderate exercise ( 2 mile walk) I have had one serum cortisol test done at 8:50 a.m. at 792...

doctor1 MD

What does a blood cortisol level of 563 nmol mean? I had Crainiopharyngioma as a child and have symptoms which are getting worse over the years...

Get personalised answers from verified doctor in minutes across 80+ specialties

176 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Questions Answered By Dr. Binu Parameswaran Pillai
  • Q - How do steroids affect puberty?

  • Q - Suggest diet plan for muscle building

  • Q - What causes early morning shaking spells?

  • Q - What does this thyroid test result regarding sheehan's syndrome indicate?

  • Q - Can Oxy Elite-pro usage cause abnormal thyroid test results?

  • Q - What causes low TSH levels?

  • Q - What are the side effects of Cortisone?

  • Q - How to increase levels of aldosterone naturally?

  • Q - Could hashimoto's disease display a normal TSH level?

  • Q - What causes swelling in body with bow leg and bow elbow?

backtotop2