Updated Blood Work (Suspect Pituitary Issues)
So I've posted previously about my blood work problems and I just got a call from the endo with my updated stuff. I'd appreciate some comments, just so I can start to make sense of all this. To start, I'm 21 years old, primal/paleo since June 2011, moderately active (lifting, running, racquetball, walking) and I get adequate sleep. My symptoms are listed above, here, and here.
After my initial results (in the first link), my PCP put me on armour thyroid and testosterone compound. My symptoms were not improving, and new ones starting popping up, so I went to an endo. She said that the automatic prescription of hormones was a bad idea, took me off for a month, and re-tested. Here are the results with the ranges (early morning, fasted):
TSH: 2.3 (.4 - 4.0)
Free T4: .79 (.8 - 1.8)
Free T3: 1.8 (2.3 - 4.2)
Total Testosterone: 374 (250 - 1100)
Free Testosterone: 51.2 (35 - 155)
Prolactin: 6 (2 - 18)
FSH: 6.8 (1.4 - 18.1)
LH: 2.0 (2 -6)
My first thoughts: I went from being "normal TSH/Free T4 but low free T3" to "low free T4 AND low free T3." The nurse described this as a very "abnormal pattern" and the doctor suspects pituitary problems. She has ordered a TRH test and an MRI of the pituitary gland. I expected this.
The nurse said that my total testosterone was "normal" (it did go up a bit from August), but I pointed out that I am an otherwise healthy, 21 year old that lifts weights and eats VERY healthy, I shouldn't be at the bottom of the range. She understood my concerns and is going to bring that up to the endo. That may also be related to the pituitary dysfunction (methinks).
I don't know how to interpret the Free T, prolactin, FSH, or LH. Can anyone explain those?
EDIT: after some online snooping around, the low LH, mid-low range FSH, and low-range Free and total testosterone ALSO point to pituitary or hypothalamus problems. I think I'm getting closer to nailing this thing...
Last edited by CoS; 01-27-2012 at 03:19 PM.
No thyroid or pituitary wonks out there?
This is disappointing. I guess I should have titled the thread something ridiculous like, "Paleo doesn't work! Herp Derp!"
I've had zero pituitary function for 18 years now. Have you actually been diagnosed with a pituitary disorder?
BTW, serum testosterone is a very inaccurate way to measure it. Saliva method is much more accurate.
No, which is why I'm getting the TRH and MRI. I expect a diagnosis within the month...Has diet/exercise had any affect on your pituitary?
Originally Posted by mikebike
Brief update: My MRI came back negative. So now they are doing blood work for thyroid panel, thyroxine-binding globulin, testosterone, estradiol, IGF, CBC, and BMP. I think they're checking for the Big C.
How long were you taking the Armour? Once you start supplemental thyroid hormones, you're not supposed to stop (that's why most doctors are very, very careful before they prescribe). It's possible that this has screwed up your lab results because your T4 and T3 are MUCH too low--which would make sense because once the body senses incoming hormones, it lowers it's own production. I'm not a physician, but it looks as though your thyroid may have been slowed by the Armour and then further slowed when you stopped taking it.
Your T4 and T3 levels are much too low, and your T3 regulates many bodily functions, including metabolism. You need a doctor who knows how to address all this, and I'd be suspicious of any doctor who just took you off thyroid meds without any indication of where the problem is.
The problem is that the doctor that put me on Armour to begin with wasn't a specialist, and didn't even try to find the problem. Just started throwing hormones at it. I was on it for 3 months, at 30 mg, never increased. I've now been off for 6-7 weeks.
So my endo, who took me off, is trying to find the source of the problem. The reversal of your suspicion: why would you give someone thyroid medication if you don't know if the thyroid is the primary problem? Same with testosterone. It signals to my body that I should stop producing T, which is counter-productive when trying to figure out why my levels were low to begin with.
Being taken off thyroid medication isn't the issue here, it is the problems and poor blood work I had prior to beginning armour....all of my symptoms during the summer.
Last edited by CoS; 02-08-2012 at 01:12 PM.
I got my latest lab results. Kind of extensive, only giving values for the abnormals, will list others and I will provide if you want.
Free T4 - .99 (.8-1.80) N
TSH - 2.9 (.40-4.0) N
Free T3 - 2.2 (2.3-4.20) L
Sodium, Potassium, Chloride, CO2 = all within range
Fasting glucose - 88 (70-100) N
BUN, Creatinine, BUN/CREATININE ratio, and GFR=all within normal range
Calcium - 10.1 (8.5-10.4)
TBG - 14.8 (12.7-25.1) N (but I think its low in range)
Red Blood Cell Count - 3.87 (4.40-5.8) L
Hemoglobin - 12.3 (13.8-17.2) L
Hematocrit - 35.5 (41-50) L
WBC, MCV, MCH, MCHC, RDW, PLATELET, ABS NEUTRO, ABS LYMPH, ABS MONO, ABS EOSINO, ABS BASO, NETURO, LYMPH, MONO, EOSINO, BASO = All in normal range.
Estradiol - <30 (0-54) N
HCG, serum - <5 (<5) N
Cortisol,AM - 22 (4-22) N, but I think high in range.
IGF - pending
Thoughts? I've started eating a bit more carbs, and I'm feeling stronger and more energetic (not bouncing off the walls, but better.) Still no sex drive, still cold, bad mood/swings, sore, etc.
Disclaimer: I am not (yet) a physician, nor do I play one on television. Anything written herein should not be taken as medical advice, and is certainly no substitute for talking with your physician.
As a secondary disclaimer, endocrine is neither easy nor a personal strength, so this is all probably worth what you're paying for it, but I think your anemia (not enough red blood cells, most often measured with hematocrit/hemoglobin) is actually the biggest issue here. It's not normal for someone your age to be anemic at all, especially not eating Primally. What was your MCV? I'm new to the discussion, so apologies if this is an old issue that has already been explained.
On a side note, I wouldn't get too terribly fixated on things that are at one end or other of a normal range yet. Is it possibly abnormal? Yes, but hormones are very tricksy (technical term) and the timing, the lab, and your astrological sign and current moon phase (just checking you're still awake) can impact all these lab measurements, and the ranges are typically a statistical thing and may be somewhat arbitrary (I don't think anyone would do anything if your AM cortisol were 23, for example). Definitely worth keeping an eye on, especially since it looks like you may unfortunately be in for repeated lab work, but you don't really have to be smack in the middle of the range to be "normal".
Best of luck. Hope you feel better soon.