Recently diagnosed with hypothyroidism

[yekcal]

Hello, I am a 43 WF suffering the past 3+ years from mood swings, sensitivity to heat, fatigue, depression, weight gain/inability to lose weight, night sweats, and recently 24-26 menstrual cycles. I also currently take medication for a prolactin excreting pituitary tumor - .5 mg of Cabergoline every Monday night.

I have asked multiple times for a complete thyroid panel but was always told that my levels were fine. :(

At my physical in November I all but begged for a complete panel again and he agreed! Here are the levels from the lab.

TSH         4.20 -- .30 - 3.00 mcU/mL
T3 Free    3.26 -- 2.5 - 3.9 picogram/mL
T4 Free    .85   --  .58 - 1.64 nanogram.dL

I have been prescribed 100 mcg of levothyroxine per day with levels to be rechecked in January.

My question is threefold. One, is this appropriate treatment given my numbers? Is this medication the best currently available with the least amount of side effects given the cabergoline I will continue to take? Finally, did the pituitary tumor potentially cause this issue and should I have more frequent blood tests and/or thyroid scans?

I did post this to the doctor's forum last night but wanted to hear from fellow "sufferers" also!

THANKS in advance!!

[goolarra]

I don't know a lot about your prolactin issue.  However, both LazyMoose and I did comment above that if the labs you posted are UNmedicated labs, 100 mcg is a pretty hefty starting dose.  It's often better to start out low with thyroid meds and increase slowly as tolerated.  25-50 mcg to start is a more reasonable approach, depending on your age, other health issues and how long you've been hypo.  It takes a given dosage 4-6 weeks to reach its potential in your blood.  So, we have to adjust dosage, wait 4-6 weeks, retest, re-evaluate symptoms, repeat until we get it right.  Since you have a known pituitary issue and there's a possibility your TSH is being effected, I'd be especially conservative about starting dose.

[yekcal]

Well, I appreciate the responses I've gotten. I guess this isn't as heavily visited as I had thought.

Guess I will just start with what's been recommended by my doctors and figure out what works via trial and error. :(

[yekcal]

Thank you again for the link. That was a very interesting study. In my case, though, my elevated prolactin had existed and been controlled for many years.

However, it would appear that the pituitary issues I have could have started the tyroid issues I'm beginning. :)

Thanks!

[yekcal]

My prolactin was discovered to be "slightly" elevated in 1998. It was in the 50s. I was started on 25mg of bromocriptine cut in half each night. I got pregnant the next month (which was the reason I was diagnosed, sub fertile for 5 years prior). Once my daughter was born in 99, I began to see an endo locally. He ordered my first MRI sometime within the next year but it was not until 2008, when I had medication to relax, that they were able to get a clear enough picture to discern the tumor. I have no idea what it's size is. Stanford doc, Dr. Katznelson, said surgery/radiation was not necessary but that I would take medication for the rest of my life.

As far as I know, I am unaffected by the tumor as long as I take my medication. I've gone on to have 2 more children. It's only within the last few years that I have become afflicted with weird things.

During this same visit (Nov 15th), my cholesterol was 144 (higher than normal), my HDL was 42 (much lower than normal) and my LDL was 83 (much higher than normal). My glucose is okay at 95 but it's usually considerably lower. The lab forgot to run the HbA1C which I was really wanting to have. My estradiol was 51 picogram/ml, FSH was 4.8 miu/ml, and LH was 2.0 miu/ml. The labs were drawn on Day 1. My cycles have been progressively shorter for the last year. Since 2009, I was 29-32 days. Last year, I started moving down by a day every cycle. Now I'm at 25 days. My PCP does not believe I'm menopausal but thinks I could be starting the process. My endo in the past has not been inclined to investigate my thyroid issues. He does a very good job with my pituitary tumor but is pretty laid back when it comes to intervention. Since this usually meshes well with my lifestyle desires, it's been hard to "light a fire" under him. I did call his office today to let him know what the recent labs showed.

Thank you for the article reference. I will look at tomorrow. Looks very interesting.

[yekcal]

THANKS for your response.

As far as I know, this is the first time my TSH has been high. I have had the panel run multiple times over the years. I've always been told it was "normal". This is the first time I've been given actual numbers.

The cabergoline is relatively recent (since 12/11) and my elevated prolactin symptoms are actually way better with the new medication.

Thank you for your description of how everything "works". While I know lots about elevated prolactin, I know nothing about thyroid. :)

[goolarra]

Sometimes questions posted to the expert forum are referred here if there is overflow.

I agree with Moose...if the labs you posted are unmedicated, 100 mcg of levo seems a little excessive.  Your FT4 is on the low side, but your FT3 looks good, and it's FT3 that correlates best with symptoms.

Your meds question is a difficult one.  There are basically three choices of meds (generically speaking...brand names abound) - synthetic T4, synthetic T3/T4 combos and desiccated (porcine T3/T4 combo).  All have advantages and disadvantages and which works best is something we all have to discover for ourselves.  A lot depends on how well we convert T4 to T3.  If we convert well, T4-only meds will work for us.  If we don't, some form of T3, either synthetic or desiccated has to be added fo symptoms relief.  Active ingredients in all meds are the same.

I take T4 only.  Many of our members have found they needed to add some T3 eventually.  Some of us only do well on desiccated.  T4 only is arguably the easiest and cheapest, and if we convert well, delivers the steadiest supply of T3 to our cells.  That's why it's often the first choice in meds.

"I'm really curious to know if my pre-existing tumor "messed" up my thyroid since the pituitary is involved with thyroid as well. "  It's doubtful that your pituitary tumor messed up your thyroid.  It's a lot more likely that your tumor could be arificially elevating your TSH (which is a pituitary hormone).  However, with your relatively low FT4, it's quite likely there is some thyroid dysfunction.  When TSH is high, if the thyroid is working properly, FT4 levels ought to be high as well.  If TSH is high, and FT4 isn't, that represents your thyroid's inability to respond to the pituitary signal.  Conversion of T4 to T3 is a separate metabolic process, not a thyroid process.  

One disclaimer:  I know nothing about cabergoline or how it might affect thyroid labs and/or function.  Did the onset of your symptoms correlate in any way with beginning this med?  If not, did this med change your symptoms in any way?  

[stella5349]

I need more info on the pituitary issue with you. Is there a tumor? Has the prolactin effected the FSH/LH hormones and your Oestregen? Have you underwent any radiation therapy on the pituitary? At the time you had the diag on the prolactin, your doctor ran an extensive hormone panel to see where the secretion was. How long ago were the tests done determining this pituitary issue?


In my opinion, there must have been evidence that the thyroid had to have shown something at the time the pit issues was found. Whether the thyroid was the direct cause I can't say and knowing more about you with that issue is important. You could find this article very interesting.

http://www.thyroidscience.com/cases/jokic.wang.7.2011/jokic.wang.7.11.pdf

[yekcal]

Thanks for the response.

So perhaps a better question instead of "medication" would have been...which of the several brands of synthetic and natural seem to work better with the least side effects? Understanding that each person is different, just trying to get a cross section of what people are taking. :)

About the TPOab and TGab, I have some bloodwork that got missed so I'll ask if those can be added to my next draw. I'm really curious to know if my pre-existing tumor "messed" up my thyroid since the pituitary is involved with thyroid as well.

Thanks again for responding. :)
yekcal

[LazyMoose]

1)One, is this appropriate treatment given my numbers?

If those lab #s from November were you without thyroid med, I would say they are starting you out high at 100mcg of levothyroxine. Your T4 is so - so, but your T3 looks better, which is important.

2)Is this medication the best currently available with the least amount of side effects given the cabergoline I will continue to take?

Thats a hard question, there are only two types of thyroid med Synthetic and natural from dried porcine (pig) thyroid. Of course several brands available in both types of med. But they really are not medication. Both are replacement thyroid hormone that your cells consume.

3)Finally, did the pituitary tumor potentially cause this issue and should I have more frequent blood tests and/or thyroid scans?

You can test to see if you have autoimmune thyroid.  Hashimoto (with antibodies attacking the thyroid gland) is the cause for most hypothyroid. Dr should have tested TPOab (anti-bodies) and TGab (anti-bodies) with your blood draw. If you test above the limit (its not a range) then you know you have elevated thyroid antibodies turning against the gland. Common here with us.

[yekcal]

Okay I don't know what's happened. Very new to community...just discovered it yesterday while searching for information. But I "know" that I posted my question to the Doctor's Forum for Thyroid issues last night and now it looks like I've posted both questions to the Thyroid Disorders Community. :(

If I've reposted, I'm sorry. I'm trying to get both expert and fellow help.

Thanks for helping a newbie!
:)