Question for my sister

[Guest guest]

Hi all. Just looking for some input as to my sister's lab results.

She has Sjogren's disease and possible lupus like syndrome. The docs

have monitored some of her labs for the last couple of years because of

her autoimmune disorders as well as the fact I have Grave's and my mom

had rheumatory arthritis (and died from resulting vasculitis). Here are

some #'s:

5/00 T4 8.0 (4.5-12.5) TSH .89 (.35-5.5)

8/01 TSH 1.2

9/03 T4 4.9 TSH .38 T3 94 (85-205)

This last time she was had one dose of prednisone the night before labs

because of sinusitis. I know TSH can drop slightly in time no way would

the prednisone effect the T4 and T3 that fast. She had levels done in

12/02 that we are searching for in the mean time. She has constant

joint pain but is negative for arthritis. She has fibromyalgia symptoms

for years but they seem worse lately , she notices more hair loss, and

feels more bloated. (she has IBS also) Maybe Elaine will pipe in on

this one. I was thinking maybe hypothalamic or could her TSH just be

sluggish to lower T4 levels just like we Grave's patients. Her TPO was

normal at less than 10. I want her to go to an endo to get the rest of

the antibodies done. There is definitely a trend here as her levels are

dropping and her symptoms are worsening. She is of course thinking her

body is going to pot but I told her just like me if your levels are too

low the symptoms in itself will make you think you have a bunch of

problems like arthritis, fibro, etc. Just curious what your thoughts

are. Iannuzzi

[Guest guest]

Hi ,

Good to hear from you.

Prednisone can dramatically lower TSH so I'm not sure I'd believe that last

result. TSH is normally secreted in small pulses with secretion peaking at

night. Prednisone would stop the normal peak and cause a quick drop in TSH and

this would cause a lowering of T4 since the TSH wouldn't be around to cause

adequate thyroid hormone production.

She should have the TSH repeated while not on prednisone. If it is still low,

then central hypothyroidism would be suspected if FT4/FT3 are also still low.

Then she'd need a TRH test to see if this is the case.

Hope this helps, elaine