Low TSH, increased Synthroid

What if the pt has Sheehan's Syndrome? Then a low TSH means a malfunctioning pituitary and low T3/T4 levels.

Yes. Patients who have survived thyroid cancer. They are at or near total suppression.

but wouldnt they have and elevated TSH?

i would think it is a pituitary issue.....but there would be other blood work to doc a need, such as low T4

Yeah, I was thinking perhaps a pituitary thing too. This is not for my own medical advice, btw. Just something I saw in the hospital that confused me (pt with low TSH, synthroid increased at that time--no T3 or T4 drawn, and no good endocrine hx documented that i could find).

Will look into it further.

What was the T3/T4 when you measured it? The TSH alone doesn't really tell you much. Also, how did the pt present and what was the PE like-- these are kind of important clues that you all have to put together.

Also, if you're not sure, you really need to be asking a physician before fooling around with someone's thyroid.

What was the T3/T4 when you measured it? The TSH alone doesn't really tell you much. Also, how did the pt present and what was the PE like-- these are kind of important clues that you all have to put together.

Also, if you're not sure, you really need to be asking a physician before fooling around with someone's thyroid.

Hi Silas,

I'm still working as an RN in a surgical setting, so my finding this was more incidental than anything. I would have loved to have ordered a repeat TSH, T3/T4, but I can't do that (and there was no recent T3/T4 result) . The patient has an endocrinologist who is not affiliated with the hospital, so I don't have access to her detailed thyroid history. As far as PE goes, her post-op status is probably somewhat different from her usual presentation/though she IS brady, and that seems to have been the case pre-op as well. Based on that, a little research on low TSH/thyroxine replacement (seeing that it is not, in fact, completely strange with certain conditions and based on certain histories), and trust that her endocrinologist is on the ball, I let it go and gave her her ordered synthroid without asking questions.

I can't wait to work as an NP. Curiosity around these things isn't really encouraged in my work environment since it is so busy, and it's sometimes frustrating to not have open opportunities to discuss my pt's--the pt's I'm caring for--in a way that helps me learn or satiates my curiosity.

Oh well. At least I have books. And you folk that take a moment to share your thoughts. Thanks!