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What Causes Continuous Fatigue?
Question: My TSH level is 1.23, Free T4 was 0.83 and free T3 2.6. I am fatigued continuously. An endocrinologist indicated my levels are normal. From my research, I have concerns and need help. I have felt fatigued all my life. Also have a small 7mm cyst on my thyroid.
Brief Answer:
Thyroid
Detailed Answer:
I am sorry to note your symptoms of continuous fatigue.
Yes your blood tests for thyroid look fine.
I would like to know the results of your
CBC
CMP
25 hydroxy vitamin D
Prolactin
8 am serum cortisol
The CBC and CMP will help us ensure if your liver, kidney, calcium, glucose and electrolytes are normal. Abnormalities in any of these are known to cause fatigue
Low vitamin D can result in non specific muscle/bone problems and so is worth checking
Prolactin is an indirect test to see if there is a pituitary problem to explain your fatigue.
The early morning cortisol test helps to rule out adrenal insufficiency as a potential cause of your tired feeling.
Thyroid labs like the kind you have are sometimes seen in a condition called Secondary hypothyroidism. The above tests will give some insight as to whether or not you possibly have this.
Can you let me know the normal range for the free T4 on your laboratory report?
Regarding the 7 mm cyst on your thyroid, it is nothing to worry about. Standard guidelines suggest there is no need to do anything with a 100% cyst in the thyroid. Chances of cancer is negligible.
It is the solid nodules in the thyroid with certain characteristics that require further testing
Thyroid
Detailed Answer:
I am sorry to note your symptoms of continuous fatigue.
Yes your blood tests for thyroid look fine.
I would like to know the results of your
CBC
CMP
25 hydroxy vitamin D
Prolactin
8 am serum cortisol
The CBC and CMP will help us ensure if your liver, kidney, calcium, glucose and electrolytes are normal. Abnormalities in any of these are known to cause fatigue
Low vitamin D can result in non specific muscle/bone problems and so is worth checking
Prolactin is an indirect test to see if there is a pituitary problem to explain your fatigue.
The early morning cortisol test helps to rule out adrenal insufficiency as a potential cause of your tired feeling.
Thyroid labs like the kind you have are sometimes seen in a condition called Secondary hypothyroidism. The above tests will give some insight as to whether or not you possibly have this.
Can you let me know the normal range for the free T4 on your laboratory report?
Regarding the 7 mm cyst on your thyroid, it is nothing to worry about. Standard guidelines suggest there is no need to do anything with a 100% cyst in the thyroid. Chances of cancer is negligible.
It is the solid nodules in the thyroid with certain characteristics that require further testing
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The normal range for free T4 is 0.8-1.8 ng/dL
AM cortisol = 11.4. Reference range 4.0-22.0
Prolactin. 8.8. Reference range 2.0-18.0 ng/mL
FSH 2.6. Reference range 1.6-8.0
LH 3.7. Reference range 1.5-9.3
Glucose 75 mg/dL
Creatinine 0.99 mg/dL
AM cortisol = 11.4. Reference range 4.0-22.0
Prolactin. 8.8. Reference range 2.0-18.0 ng/mL
FSH 2.6. Reference range 1.6-8.0
LH 3.7. Reference range 1.5-9.3
Glucose 75 mg/dL
Creatinine 0.99 mg/dL
Brief Answer:
Follow up
Detailed Answer:
Indeed they look fine
I agree the free T4 is on the lower side of the normal range but it is still normal considering the TSH is normal too.
The fact that prolactin is normal as well , makes secondary hypothyroidism extremely unlikely
The morning cortisol, although not robust, is interpreted in the light of clinical presentation (such as low blood pressure, weight loss, lethargy) and some other lab data such as low sodium and high potassium.
if the index of suspicion is still high, then a test called ACTH stimulation test is performed to confirm the diagnosis of adrenal insufficiency
FSH and LH are best interpreted in the context of a testosterone level
I see the glucose and creatinine are fine too.
Were the CBC, and liver function tests normal?
Follow up
Detailed Answer:
Indeed they look fine
I agree the free T4 is on the lower side of the normal range but it is still normal considering the TSH is normal too.
The fact that prolactin is normal as well , makes secondary hypothyroidism extremely unlikely
The morning cortisol, although not robust, is interpreted in the light of clinical presentation (such as low blood pressure, weight loss, lethargy) and some other lab data such as low sodium and high potassium.
if the index of suspicion is still high, then a test called ACTH stimulation test is performed to confirm the diagnosis of adrenal insufficiency
FSH and LH are best interpreted in the context of a testosterone level
I see the glucose and creatinine are fine too.
Were the CBC, and liver function tests normal?
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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