Patient: Would a pituitary problem show up in thyroid panel?I’m a 33 year old female. I’m 5’3″ and weigh around 49KG.Had my thyroid tested privately as the NHS will not perform more than TSH if it’s within normal ranges.FT4, FT3 are lower than expected for my TSH.TSH 0.49 (0.27-4.2)FT4 14.5 (12.0-22.0)FT3 4.1 (3.1-6.8)Also, TgAb and TPOAg are both negative.Been having hypO/ER symptoms. Fatigue, brain fog, nausea, hunger and shakes just an hour after eating a full meal, headaches, muscle weakness in thighs and upper arms, palpitations, buzzing legs, lightheaded when standing, aches in upper back, cough, constant dry cracked lips, sweaty hands, chills, cold intolerance, and more. Have been feeling awful for a while but recently this has all gotten worse and my performance at work has suffered.I haven’t been diagnosed with any medical conditions in past apart from slight iron-deficiency anaemia last year which was quickly rectified with iron pills which I no longer have to take.Could I have a pituitary problem or something else?Many thanks.
Doctor: Hello,Thanks for the query to ATD for an opinion,The symptoms of fatigue, brain fog, nausea, hunger and shakes j ust an hour after eating a full meal, headaches, muscle weakness in thighs and upper arms, palpitations, buzzing legs, lightheaded when standing, aches in upper back, cough, constant dry cracked lips, sweaty hands, chills, cold intolerance, –all these symptoms generally favour a hypothyroid cause but considering the fact that your thyroid profile is absolutely normal and you have been maintaining a normal BMI ( body mass index), and as these symptoms have not been chronic but have just started recently, it can be safely devised that there is no chronic disease and definitely not pituitary related. Pituitary is a centre for forming hormones which signal formation of target hormones from their respective glands and hence any insult in pituitary in form of a space-occupying lesion or pituitary adenoma shall cause a multitude of hormonal imbalances. As your blood tests have been normal and you have not been diagnosed with any disease, pituitary as a cause is unlikely.There are two possible reasons of similar symptoms the body and they are:-1. Dyselectrolytemia or electrolyte deficiency which can be corrected with adequate water, salt and sugar intake which can take care of muscle soreness , cramps and generalised body ache and weakness.2. Premenstrual syndrome(PMS) in your reproductive age group, which can start 7 days prior to the onset of your menses and can also last for a week after the end of menses. This PMS symptoms can be easily tackled with lifestyle changes and often NSAIDS for pain relief. PJS generally is classically seen presenting with cause, headache, vomiting, mood swings, increased appetite, decreased concentration, sore breasts and lower abdominal ache with mild abdominal cramps.You may discuss the differential diagnoses with your physician and take an informed approach towards your symptoms,I hope I have answered your query in detail,Wishing you good health,Regards
Comments / Follow Ups
Patient: Thank you for taking the time to read and reply to my question.
My recent (last month) ureas and electrolytes, liver function test, CBC, GFR and creatinine were all good so it’s not a problem with U&E’s. Also, I have been feeling these symptoms since last year when I went to the doctor and she found slight anaemia. The symptoms have steadily become worse since last Aug and in the last month, unbearable and forcing me to find an answer.
I have suffered, along with most woman, with PMS (cramps, headaches, hunger, tiredness) since my menses began but nothing major and has never affected my life or stopped me from doing anything. It’s just a part of being a woman.
But, I’m feeling like this all month so it can’t be PMS.
The query that I’m having with my thyroid results are wether or not I could have a TSH deficiency caused by my pituitary or another gland which is affecting my pituitary?
My TSH is on the low end which should mean that enough thyroid hormones are being produced but they are on the low end of the range too. This results shows that my pituitary isn’t releasing enough TSH to bring my thyroid hormones levels to where they need to be for me to feel normal.
Am I making sense?
Thanks for the follow up,
You need to understand that TSH is always released in respond to the levels of free T3 and T4 in the body following a feedback mechanism. if the levels of thyroid production is low or lesser than the body requirement then TSH would increase to more than 5 and not below 1 levels. Your levels simply indicates that there is no hypothyroidism or decreased thyroid hormones which causes these symptoms. So in the bargain, pituitary is functioning absolutely fine because if there would have been TSH deficiency then free T3 and T4 levels would have been above normal.
Now as all tests have been normal , i suggest you meet a neurophysician for a consultation and more likely such cases are often found to be stress related either physical , psychological , emotional or social. You must seek an opinion and evaluation.
Patient: Thanks for your reply.
In your reply you said that if there was a TSH deficiency then there
Doctor: Its like high TSH = low T3/T4.
lOW /NORMAL TSH = NORMAL OR HIGH T3/T4.