MRI & Pituitary Question

[RenKat]

I need the advice of this group.  
My insurance has been so bad, I have no endocrinologist, in network that is anything other then a diabetes doctor.  My out of network has been good, but expensive.  In a recent  primary visit, and a lab draw to avoid the high cost of out of network discussion of labs, he fixated on a low TSH and a low T4.  

He dismissed that I had been diagnosed having Hashimoto's and super high TPO's 10 years ago, and questioned the credibility of a surgeon that did not remove the entire thyroid (2013), even though I relayed that his concern was damaging my vocal chords.  

He asked extensive questions of my birthing experience, which was when I began thyroid meds (Hypo).  It was a breach birth, very complicated, with only a midwife, through the health department 27 years ago.  

He ran other blood work, and ordered an CTof the brain, mentioning something called Sheehan Syndrome.  When the original order for a CT returned denied, it mentioned brain tumor.  

Monday, we discussed the numbers, provided below.  He hopes for a missing pituitary gland, as he says its the simplest way to treat.  However, he mentioned he is not the one that should be doing this.  I explained there will be no competent specialist in Tampa Bay, that will accept my insurance, should it be something worse.  An MRI is on order, and has been approved.

Part of me wonders that this isn't just a way to run up tests and things, to garner more money.  I have no symptoms of a brain tumor whatsoever.  I am tired, stressed out, and can't lose weight.  SOS.  

I do know, that I would never consider any surgery on my brain, so the thought to even proceed seems pointless.
Here are the labs:

3 OCTOBER 2018                                                     2 OCTOBER 2018

FSH:  69.0.   Normal                                
LH:  21.3.     Normal
TSH:  0.02.        Range:  0.40-4.50                             TSH:  0.01
T4, Free:  0.07.  Range:  0.8-1.8                                 T4, Free:  0.9
T3, Free. 4.8.     Range:  2.3-4.2. H                             T3, Free:  4.8. H
Ferritin:  38.       Range:  10-232
Iron, total:  54.    Range:  45-160

The TSH and T4, Free are always low.  I am currently on 50 mcg Levoxly 5 days, 75 Levoxyl 2, and 25 mcg Cytomel 7 days a week.  I am 10 lbs heavier, at 145, then last October, at 135

So, thoughts anyone?  Thanks in advance.

[gimel]

I answered on your latest post.

[gimel]

I expect that you are not on enough.   Your FT4 is lower than optimal for many people, but your high FT3 is somewhat puzzling since you still have symptoms that are frequently related to hypothyroidism.  There are some reports of low ferritin or low/high cortisol impairing transport of T3 into cells.   All tht is why  I suggested getting the additional tests done and to supplement adequately for iron before making any changes to your meds, in order to avoid adding additional variables.  

[RenKat]

Hi, Gimel. Sorry for the delay in reply. It has been crazy. So, to follow up. They refused to do the saliva test, only the morning cortisol.

10/23/2018:  Cortisol:    8.5.     (2.5-25 Range)
                        Rt3, total:   6.3 L. (7.5-19 Range)

11/7/2018      Cortisol:   17.5.      (4.0-22.0 Range)

September 2018 labs:  
TSH:   0.02.    (.40-4.50). L
T4,Free:  0.7. (0.8-1.8). L
FSH. 69.0
LH. 21.3
Iron, total:  54.  (45-160)
Ferritin:  38.        (10-232)

My out of network provider thought an adrenal supplement would help and cortex, a steroid.  I did not take either.  A new primary provider found my case "mystifying", but felt I was correct in not taking  the steroid.
I am quite tired, to be honest.  Now, with the Cytomel shortage, I am really freaked.  
So, it's time to switch to Armour.  
I am out of Florida,  
The out of network will write for Armour.  I am not sure how I will handle labs without insurance....

Big Question.  
How much Armour?
I am still on the same crappy regime:  50 Levoxyl 5 days a week, 75 Levoxyl 2 days a week and 25 mcg Cytomel 7 days a week.
All answers appreciated.

[gimel]

I am also at loss for why that doctor would ignore the thyroid issue and look at the pituitary.    I think you need  a new doctor that recognizes that hypothyroidism is not just "inadequate thyroid hormone", but instead is "insufficient T3 effect is tissue throughout the body, due to inadequate supply of, or response to, thyroid hormone.    Your Free T4 is lower than optimal for many people, yet your Free T3 is above range, and you still have  some symptoms that are frequently hypo related.    

This makes me think you need to get some additional tests done.  Specifically, I suggest a Reverse T3 test along with Free T3 from same blood draw.   Also it would be good to get a diurnal saliva cortisol panel done.  Note doctors usually will not order anything other than a morning serum cortisol, which is Total Cortisol and not as revealing as the saliva tests for free cortisol.  Also, if not tested for Vitamin D and B12 those should be done and then supplemented as needed to get D to at least 50 ng/mL, and B12 into the upper end of its range.    Ferritin is also important and your level of 38 is way too low.   You should supplement with a good iron supplement like VitronC to raise it to at least 100.  If it were me I think I would try to get these done before considering any other change.  

[RenKat]

Thank you for your response, gimel.  The idea of a tumor is so off the rails, seriously.  I have decided not to get this MRI, even though it is covered by my insurance.  Looks like I am back to out of network.  So, do you think I am on too much medication, or not enough? And possibly, not processing the t3?  Anyway, thanks.  And the quest begins again...

[Red_Star]

Sheehan's syndrome is rare. It's unlikely you have this as your other hormones are normal.  Hashimoto's thyroiditis can be triggered by childbirth.

T3 does suppress TSH if you take enough of it. Once TSH is suppressed, no thyroid hormone is being produced from the thyroid gland...if it is still able to produce thyroid hormone that is. I take 50 mcg daily but my TSH is not suppressed so my thyroid gland, while damaged to some degree, is still producing hormones too. An average healthy thyroid gland secretes about 100 mcg of thyroxine per day.

[RenKat]

Thank you for this response.

[Barb135]

What does it mean when you say: "He hopes for a missing pituitary gland, as he says its the simplest way to treat."?

[RenKat]

He said that if the pituitary gland was “knocked off” during the birth of my daughter, supplemental hormones could help. I asked what if a tumour? He said surgery, to which I freaked. His reassurance that it was a through the nose procedure was anything but reassuring. The last time a primary played Endo, and dropped my medication by 25mcg, i was sick for the entire month of May. That was this year. Flat out, truly sick.  I feel less confident in any of these doctors, anymore.

[gimel]

First thing we need to know is  what time of the day did you take  your thyroid meds and what time was the blood draw?

[RenKat]

When the blood was drawn, i had not take my second dose os cytomel since 4 pm the previous day, or my t4 dince 9 am the previous day.