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Low or normal TSH, low free thyroid hormones

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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This combination is most frequently seen in patients with other non-thyroid illness.

In the patient who is not systemically unwell then the low TSH may reflect pituitary pathology with secondary hypothyroidism. It is important to make this diagnosis because:

  • the associated hypoadrenalism may be fatal
  • pituitary tumours may cause severe local damage

The investigation should include:

  • short Synacthen test
  • FSH, LH and sex steroid determinations
  • MRI of the brain

Patients who have recently been treated for hyperthyroidism may have residual suppression of TSH levels for up to a year. Such patients who have low TSH and low free thyroid hormones are hypothyroid and should be treated as such.


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