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Q. I have pain in my forehead and lower abdominal pain with fatigue and irritability. Why?

Answered by
Dr. Zulfiqar Ahmed
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 29, 2020 and last reviewed on: Nov 05, 2020

Hi doctor,

I have had a headache in my forehead almost every day, along with fatigue, irritability, and mood swings. Symptoms have gotten worse over the past year. I have pain in my lower abdomen sometimes and have had cysts on my ovaries in the past few years. I also have heavy bleeding around day three and four of my period. Abnormal hormone lab results: FT3 was low (2.6 pg/mL), FT4 was low (0.73 ng/mL); however, TSH was normal, FSH was high (13.7 mIU/mL), progesterone was low (0.87 ng/mL), and cortisol was normal in the morning and evening, but low around noon (0.6 ng/mL) and low around night.

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Hi,

Welcome to icliniq.com.

Thanks for your query.

Have you done your thyroid tests ever before?

As you mentioned, your thyroid hormones are on the lower side, along with one of the cortisol levels. I will advise you to repeat the thyroid function tests in two weeks and do prolactin levels. Also, I think you should do a cosyntropin stimulation test, which is done in the morning to check if there is an increase in cortisol after giving ACTH, which is a better test to check cortisol.

Your test might be due to a hypo pituitary problem. Hypopituitarism is a condition in which the pituitary gland (a small gland at the base of the brain) does not produce one or more of its hormones or not enough of them to function normally. Hormones produced by the pituitary include prolactin, adrenocorticotropin hormone (ACTH), growth hormone (GH), thyroid-stimulating hormone (TSH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH); each hormone has its particular effects.

  1. Prolactin – little or no milk production, fatigue, loss of underarm and pubic hair.
  2. ACTH – fatigue, low blood pressure, weight loss, depression, nausea, and vomiting.
  3. GH – short stature, low energy, weight gain, decreased exercise tolerance, anxiety, and depression.
  4. TSH – constipation, sensitive to cold, weight gain, and muscle soreness.
  5. LH and FSH – in women, irregular or no periods, infertility; in men, weakness, loss of body and facial hair, erectile dysfunction, and infertility.

Causes of hypopituitarism have been linked to tumors, radiation exposures, surgery, meningitis, and other diseases; in many individuals with the condition, the reasons are not known.

But before going on to check all these hormone levels, I will advise you to repeat thyroid function tests. If it is still lower with normal TSH, then you need to do it.

  • Cosyntropin test.
  • IGF-1 (Insulin-like growth factor 1) levels for GH (growth hormone).
  • Prolactin.
  • Depending upon the results, you may later need to do MRI (magnetic resonance imaging) brain.

Thanks.


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