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 investigation should include:
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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