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Question: Please see attached reports, shall I start taking eltroxin/thyroxin. If yes , how much ?
Nowadays I feel quite exhausted and sleepy all the time. When I last tested my prolactin around 2 weeks back it was normal
I am taking cabergoline 0.5 mg once in two weeks (but not that regular always, because of bad side effects, I don't know it also causes pain in my gallbladder area, although it operated).
Nowadays I feel quite exhausted and sleepy all the time. When I last tested my prolactin around 2 weeks back it was normal
I am taking cabergoline 0.5 mg once in two weeks (but not that regular always, because of bad side effects, I don't know it also causes pain in my gallbladder area, although it operated).
Brief Answer:
You should be started on thyroxine
Detailed Answer:
Hi XXXXXXX
Welcome back to HCM. Thanks for posting the question. I truly understand your concerns.
I have gone through the reports. You need to be followed up with a good endocrinologist. Meanwhile I will help you with the management.
Your T4 and T3 are low and TSH is higher side of normal. Usually we expect higher level of TSH when T3, T4 is low. Your inappropriately elevated TSH is due to pituitary surgery. You need to be on thyroid hormone replacement. Before starting on medications, you should do a free T3 and free T4 (to rule out a rare cause of thyroid binding globulin deficiency). The usual dose to start with is 100 mcg of Eltroxin and dose is titrated based on freeT4 values on review.
Additional tests you may do is a morning 8 am serum cortisol, which could be low in case of post pituitary surgery - which could be another cause of tiredness.
Untreated hypothyroidism can cause elevation in serum prolactin. You are taking only a very small dose of cabergoline. So I will suggest you to stop cabergoline altogether and wait for 2 months for thyroid function to normalise. I hope prolactin also to be normal by then. If it is still high, we can consider restarting on cabergoline.
Hope this will clear your doubts. If you need any further clarifications, I will be happy to help you.
Regards
Dr Ajish TP
Consultant Endocrinologist
You should be started on thyroxine
Detailed Answer:
Hi XXXXXXX
Welcome back to HCM. Thanks for posting the question. I truly understand your concerns.
I have gone through the reports. You need to be followed up with a good endocrinologist. Meanwhile I will help you with the management.
Your T4 and T3 are low and TSH is higher side of normal. Usually we expect higher level of TSH when T3, T4 is low. Your inappropriately elevated TSH is due to pituitary surgery. You need to be on thyroid hormone replacement. Before starting on medications, you should do a free T3 and free T4 (to rule out a rare cause of thyroid binding globulin deficiency). The usual dose to start with is 100 mcg of Eltroxin and dose is titrated based on freeT4 values on review.
Additional tests you may do is a morning 8 am serum cortisol, which could be low in case of post pituitary surgery - which could be another cause of tiredness.
Untreated hypothyroidism can cause elevation in serum prolactin. You are taking only a very small dose of cabergoline. So I will suggest you to stop cabergoline altogether and wait for 2 months for thyroid function to normalise. I hope prolactin also to be normal by then. If it is still high, we can consider restarting on cabergoline.
Hope this will clear your doubts. If you need any further clarifications, I will be happy to help you.
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
I'll get my cortisol tested.
My FT4,FT3 were normal. I lost the report but I got tested a month back. What is the best time to take eltroxin ? Empty Stomach ?
Do I need to take testosterone inj. as well as my libido is effected as well ?
My FT4,FT3 were normal. I lost the report but I got tested a month back. What is the best time to take eltroxin ? Empty Stomach ?
Do I need to take testosterone inj. as well as my libido is effected as well ?
Brief Answer:
Empty stomach, check testosterone
Detailed Answer:
Hi XXXXXXX
Welcome back.
You have to take Eltroxin in the morning empty stomach.
You should check your morning 8 am testosterone and LH before starting on testosterone therapy. If your testosterone levels are below 3 ng/ml, your loss of libido will improve with testosterone therapy.
Regards
Dr Ajish TP
Empty stomach, check testosterone
Detailed Answer:
Hi XXXXXXX
Welcome back.
You have to take Eltroxin in the morning empty stomach.
You should check your morning 8 am testosterone and LH before starting on testosterone therapy. If your testosterone levels are below 3 ng/ml, your loss of libido will improve with testosterone therapy.
Regards
Dr Ajish TP
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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