If a patient has decreased levels of T3 and T4 thyroid hormones with normal TSH level, can we say that he/she has hypothyroiditis?
What can be the cause of this situation?
Or the dosage is correct, the patient has hypothyroidism, certainly from central level.
Thank you Dr for your answer, I think it was correct, it was done in Pasteur Center of Yaounde
In the attachment you see a test with 2 healthy subjects. The TSH was measured every 1/4h. Especially with borderline results you have to consider that the TSH is a weak test. In 2014 Dietrich et al suggested to look after the ratio TSH/FT4 ( EHK 2014:63:93-99 in German language). Look after the cortisol and DHEA also, best done several times a day. The level of vitamin D3 also influences the hormonal production. The clinical signs are important. With clear signs of hypothyroidism I start a test treatment with low increasing thyroid hormones; I prefer Armour thyroid.
First of al I believe you must look for free hormones. Hypoproteinemia or, more than that, a TBG deficiency may be the cause of low total thyroid hormones while the free ones may be normal.
Many drugs may influence the level of thyroid hormones so you can also see if and what is the patient taking.
It may be a pituitary or even a hypothalamic deficiency - a TRH test may help you to diagnose that. Adrenal function also may have an influence so I agree with Dr van Montfort that you have o look cortisol also.
Last, but not least - is the deficiency important? If not I think you can retest in 6-8 weeks before starting other investigations.
Best regards
I agree with Carmen. Not only drugs can lower the levels of the thyroid hormones. Food supplements also can do that, f.i. OPC. And what about endocrine disrupting chemicals?
The clinical signs are the most important guidance.
In this cases we can say that the patient has central (secondary) hypothyroidism, for exampl after the removal of pituitary adenomas.
could you provide exact values of TSH, T3 and T4 please?
Did you measure total or free Thyroid hormons?
Thanks for the question. Thyroiditis typically leads to a spillage of hormones into the blood. So T3 and T4 should be high and TSH suppressed. Your patient seems to have central hypothyroidism and needs a scan of the pituitary and a full pituitary profile, especially the cortisol axis. But before the scan, I would repeat the thyroid functions to verify the result. [ All this advice assumes that the measurements are free T4 and free T3 and assuming that the patient is not on any thyroid influencing medications. Regards
T3 and also T4 can also be reduced in starving or critical illness. We need more Information for assessment. btw, there is no hypothyreoiditis., probably your are asking if it is hypothyroidism.
In this cases patient has the possibility of secondary hypothyroidism
I think it is important to check free T4 , in addition , think about Secondary Hypothyroidism ,then if secondary Hypothyroidism , we should check other hormones such as Growth hormone, and the more important is Cortisol level.