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What Does Borderline Low TSH Level Indicate?

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Posted on Mon, 5 May 2014
Question: I have been diagnosed with Hashimoto's disease (TPO=241) (T4= .80), but my TSH was .50. From what I understand, TSH levels are usually high with Hashimoto's. Could the borderline low TSH indicate a problem with my Pituitary? I have also had several infections in the last 5 months (which is unusual for me) and frequent headaches with pain directly behind my eye and/or temple. I also have thyroid nodules, one of which is solid with somewhat circumscribed margins. Both over 2 cm.
doctor
Answered by Dr. Shehzad Topiwala (4 hours later)
Brief Answer: Thyroid Detailed Answer: Your understanding of Hashimoto's is correct. Further your analysis of the potential pituitary problem is also worth considering. But before you embark upon an extensive evaluation of the pituitary, please bear the following in mind: Sometimes, TPO can be false positive, meaning you really dont have Hashimoto's but your blood tests positive for these antibodies. Secondly, a high TPO level with seemingly normal TSH and T4 implies that although you have this tendency towards developing Hashimoto's, it has not yet affected your thyroid gland enough to cause an elevation in TSH. So now it is important to know the lab's normal range for T4 to see if the T4 value is below normal. It would be useful to recheck TSH and Free T4 again. I have noted your headaches. Regarding thyroid nodules, they are fairly common in women and as we grow older. The vast majority are benign. Often, when people have Hashimoto's they have a 'pseudo-nodule' type appearance on ultrasound, meaning they really do not have nodules in their thyroid gland but one gets this impression on ultrasound due to the effect of TPO on the gland. If a good radiologist is able to discriminate between true nodules and pseudo nodules in your instance then you can proceed accordingly. Pseudo nodules requires no further assessment. True nodules, especially with yours measuring 2 cm require thorough evaluation of risk factors, consideration of thyroid biopsy, pattern of growth over the years amongst other things. It would be best for an endocrinologist to address this in person.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala (10 hours later)
The normal range at the lab are as follows: TSH: .358 - 3.740 TPO: .76 - 1.46 I am certainly symptomatic of Hashimoto's. Something is definitely wrong. Here are my symptoms: Extreme Fatigue, Hair Loss, some bouts of constipation, headaches behind the eyes. I have developed the following infections in the past 4 months (I am rarely sick). I had Bronchitis, H1N1, a sinus infection that didnt respond to 2 rounds of oral anti-biotics- they finally gave me two injections of antibiotics to clear it up; finally, a recent bladder infection. In between these illnesses, I have been getting low grade fevers (usually later in day after exerting myself). I now have a sore throat, cough with raspy voice-- but do not have a cold. Here is my Ultrasound results: Right lobe: 2.2 x 2.1 x 4.9 cm. The large heterogeneous central area of the right lobe and has both solid and cystic components. There is a somewhat circumscribed margin. It is measuring about 1.6 x 1.1 x 1.8 cm. Caudal to this is a more solid-appearing nodule that is measuring 2.3 x 1.1 x 1.3 cm. Both of these nodules have blood flow on color DOPPLER. The right lobe appears very hypervascular on color DOPPLER. Left lobe: 1.9 x 1.8 x 4.6 cm. There are some focal areas of heterogeneity within the left lobe. There is a dominant nodule that has a cystic component within it. The left lobe also appears very hypervascular. Thank you in advance.
doctor
Answered by Dr. Shehzad Topiwala (12 hours later)
Brief Answer: Follow up Detailed Answer: I reviewed the reports. I did not see the free T4 or Total T4 normal range. It is quite decisive Regardless, based upon what you are experiencing as well as the ultrasound findings, you will be best served by seeking a comprehensive endocrine assessment. Some of your symptoms are suggestive of adrenal insufficiency to in addition to possible pituitary problems. I strongly encourage you to seek prompt care from an Endocrinologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (12 hours later)
I am sorry, I was mistaken: The Free T-4 Range is .76 - 1.46. Mine was .80. Does that tell you more?
doctor
Answered by Dr. Shehzad Topiwala (18 hours later)
Brief Answer: Second Follow up Detailed Answer: I see. it is important evaluate for a condition called Secondary Hypothyroidism in which hypothyroidism is caused by pituitary problems and not due to intrinsic problem with the thyroid gland
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Shehzad Topiwala

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What Does Borderline Low TSH Level Indicate?

Brief Answer: Thyroid Detailed Answer: Your understanding of Hashimoto's is correct. Further your analysis of the potential pituitary problem is also worth considering. But before you embark upon an extensive evaluation of the pituitary, please bear the following in mind: Sometimes, TPO can be false positive, meaning you really dont have Hashimoto's but your blood tests positive for these antibodies. Secondly, a high TPO level with seemingly normal TSH and T4 implies that although you have this tendency towards developing Hashimoto's, it has not yet affected your thyroid gland enough to cause an elevation in TSH. So now it is important to know the lab's normal range for T4 to see if the T4 value is below normal. It would be useful to recheck TSH and Free T4 again. I have noted your headaches. Regarding thyroid nodules, they are fairly common in women and as we grow older. The vast majority are benign. Often, when people have Hashimoto's they have a 'pseudo-nodule' type appearance on ultrasound, meaning they really do not have nodules in their thyroid gland but one gets this impression on ultrasound due to the effect of TPO on the gland. If a good radiologist is able to discriminate between true nodules and pseudo nodules in your instance then you can proceed accordingly. Pseudo nodules requires no further assessment. True nodules, especially with yours measuring 2 cm require thorough evaluation of risk factors, consideration of thyroid biopsy, pattern of growth over the years amongst other things. It would be best for an endocrinologist to address this in person.