Advice regarding atypical hypothyroidism with surpressed tsh and low t4 and t3

[Klaus4000]

Hello everyone! I am a 27 year old male who have been struggling with symptoms of hypothyroidism since June. However, my endo have told me that thyroid medication is not an option yet because he thinks that my current thyroid state is probably just a transient case of hypothyroidism.

My thyroid problem was discovered by chance in March. At this point I had some blood tests done that showed suppressed TSH, normal free T4 and elevated free T3, and I was then referred to further examination for hyperthyroidism. Since then I have regularly had blood tests done and there has been a continuous decline in free T4 and free T3, while TSH has been unchanged and thus suppressed throughout the whole period. Thus, my thyroid test results have been as follows:  

March
TSH: 0.01
FT4: 19.5
FT3: 8.9

April
TSH: 0.01
FT4: 12.5
FT3: 5.3

June
TSH: 0.01
FT4: 11.1
FT3: 3

End of July  
TSH: 0.01
FT4: 6.8
FT3: 2.1

* Lab normal reference ranges: (TSH: 0,3-4); (FT4:10-26); (FT3: 3,3-6,1)

* In addition, normal antibody levels detected.

As shown by my last blood test, my current t4 and t3 values ​​are too low, which currently gives me many disabling typical symptoms of hypothyroidism. However, my endo has concluded that thyroid medication is still not an option. His medical hypothesis is that I probably have had some prior inflammation in my thyroid gland which resulted in a temporary high metabolism (I never felt any hyper-related symptoms) and that my thyroid after a transitional period with hypothyroidism probably will soon stabilize again, when my TSH starts to increase, which, however it has not yet, in spite of my current low values ​​t3 and t4.

Since I don't know much about all this thyroid stuff and have only been to a brief consultation with an endocrinologist, I would very much like to ask for advice and some answers to the following questions:

- How low is my current t4 and t3 values ​​compared to typical cases of hypothyroidism?
- Is it normal for TSH to remain suppressed when t4 and t3 values ​​are as low as they are in my case?
- And if yes, how long does it usually take before TSH starts to increase?
- Is secondary hypothyroidism with pituitary dysfunction a possible assumption in my case?

Thanks in advance for your time - and sorry if I'm not strictly following the rules of the language in which i'm writing but English it isn't my native language.

[Super_sally888]

hello,
given that this has been going on for 5 months already and you are feeling progressively worse, and are very obviously hypothyroid, it may be a case for a second opinion if this dr won't treat you.

He obviously doesn't appreciate just how awful and what poor quality of life people with hypothyroid have.

The obvious approach would be to totally ignore TSH values for hereonout and to start treating you to bring FT3 and FT4 up to at least mid-range and/ when you feel good.

Treatment will likely start with a t4 medication only.  However, if T4 goes up with this medication but T3 doesn't, then you may need a combo medication with both t3 and T4 (dessicated thyroid or the man-made T3/T4 drugs).

If there is no change in TSH by the next visit and the Dr won't treat you, you probably need a different doctor.  Make sure to emphasise to this Dr just how bad you are feeling.

[Barb135]

Hi Klaus... it would seem that you might need a different doctor, since your present one is refusing to recognize your possible symptoms of hypothyroidism.  Could you please tell us what symptoms you do have?

It's impossible to compare one case of hypothyroidism to another because we all feel differently with varying levels of FT3 and FT4; however, since your July FT3 and FT4 are actually below the reference ranges, it's pretty obvious that your thyroid is doing nothing...

It's very likely that you have Secondary/Central hypothyroidism, since your FT3 and FT4 are as low as they are, yet your TSH is remaining suppressed as it is.  The pituitary gland "should" be trying to stimulate the thyroid to produce hormones and it is not.  This indicates an issue in the pituitary/hypothalamus axis, not the thyroid gland, itself.

Many doctors think it's impossible for the pituitary gland or the hypothalamus to malfunction and that's totally incorrect.  You should insist upon further testing to determine if you have a pituitary adenoma or some other condition that's keeping your pituitary from producing the TSH necessary to stimulate your thyroid.

[Klaus4000]

Thanks for your reply!
My symptoms include: total lack of energy, confusion and inability to think clearly, muscle pain and stiffness; feeling cold, thinning of hair and eyebrows, feeling bloated from water retention.

I also started gaining weight/fat easy in May, but since I was prepared for this to happen due to knowing I might had a slowing metabolism, I have been trying to fight against by cutting my calories. The past 3 weeks I have actually been down to only eating 800 calories per day, and I'm just barely maintaining my weight with exercise everyday - and the exercise is pure torture due to extreme fatigue and brain fog.
    
My doctor actually do not refuse to recognize my symptoms of hypothyroidism. But he thinks it's most likely just a transient state of hypothyroidism. Therefore he have decided that I should wait another 3 weeks from now and then get new blood test to see if the TSH have started to increase. I'm not sure what he will suggest for further examination in case my TSH is still suppressed in 3 weeks.