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Thyroid or Pituitary

Dr.Lupo;
I am having a hard getting a definitive diagnosis . My initial visit with an Endroconologist diagnoses me with Hypothyroidism secondary to an anterior pituitary adenoma. She told me to find another Endroconologistbecause her specialty is fertility issues. I went for another opinion with Endrocologist #2 and she said I had Hashimotos. Then 2 years later she told me I did not have Hasimotos "just Hypothyroidism"  An MRI aand Lab tests diagnosed the pituitary adenoma by Endoconologist # 1.

I now see a GP and my latest Lab results are:
TSH  0.15
T-4 Total  6.15
Free T-4 0.7
Calcium 11.9
Iron 163

I have gained 20 # since diagnosis 10 years ago but I exercise daily, strength train  and eat healthy.  

Question really is; I have really poor health Insurance with my work $200.00 max per office visit and $ 500.00 per MONTH deductible so I have to plan my visits and tests carefully. Do I push for Pituitary tests or Thyroid?
I am currently on Synthroid 0.50 and Cytomel 2.5mcg daily. My GP ordered Synthroid 0.75 a week ago bu I cannot get ahold of him to see if I should continue the Cytomel since he did not initially order it so I am taking doses as I have for the past several years. My Endo currently says "Lab fine keep taking same dose" About 6 months ago she dropped Cytomel dose down to 2.5mcg because she said I was "toxic" on T-3.
I have lost alot of hair in the past year and have normal Hypo symptoms fatique, dry cracking skin constipation fluid retention, severe carpal tunnel symtoms and depression/memory loss. I am a 52 year old professional female  
I also have Thyroid Nodules and had them biopsied in Dec 2006 .

Can you help with which direction I should take?    Thank-you for your time Dr. Lupo    
3 Responses
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97953 tn?1440865392
MEDICAL PROFESSIONAL
Seeing the original labs would be helpful.  To diagnose secondary hypothyroidism - the TSH needs to be low along with a low T4 and/or  T3.  The presence of an adenoma does not mean the pituitary is not functioning properly and most pituitary adenomas do not cause secondary hypothyroidism.  Would make sure the prolactin has been tested and that a follow-up MRI confirms a stable sized adenoma.

The benefit of cytomel is best judged by the patient -- ie compare symptoms on combo T4/T3 with those of synthroid alone and see if it is worth taking the combo.   The labs are not that bad, but the TSH is a little low -- but if this is really secondary hypothyroidism, then the TSH is not a reliable gauge.

Would test TPO antibodies - that would help clarify the Hashi question -- OR look back at the FNA biopsy report from 12/06 to see if it mentioned hashi (lymphocytic thyroiditis).
Helpful - 1
Avatar universal
A related discussion, high tsh was started.
Helpful - 0
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A related discussion, Low end of reference range TSH, FT3 & FT4 was started.
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