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CPE-001 · synthetic case FX-008
Low FT4 with inappropriately mild TSH elevation and pituitary history
Pituitary history. FT4 is low and TSH is only slightly high.
Purpose: Prevent missed central dysfunction when TSH is not low.
Inputs the engine received
Patient
- Age and sex
- 46, male
Context
- Known pituitary or hypothalamic disease
- Yes
Symptoms
- Fatigue
- Present
Laboratory
- TSH
- 5.2 mIU/L (ref 0.4–4.5)
- FT4
- 0.5 ng/dL (ref 0.8–1.8)
What the engine reports
Possible central hypothyroidism identified. Assess adrenal function before thyroid hormone replacement planning when clinically indicated, because unrecognized adrenal insufficiency may create significant safety risk.
Detected clinical pattern
Possible Central Hypothyroidism Pattern — Safety Review Required
FT4 is low with TSH not appropriately elevated for the degree of low FT4; pituitary/hypothalamic context and adrenal safety must be assessed.
- Etiology / context: Pituitary/Hypothalamic Cause Possible
Why this pattern was identified
- TSH not appropriately elevated for low FT4. FT4 0.5 ng/dL (ref 0.8–1.8) with only mildly elevated TSH 5.2 mIU/L (ref 0.4–4.5) in a patient with pituitary/hypothalamic context.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Assess morning cortisol/ACTH and adrenal safety before thyroid hormone replacement in suspected central disease.
- 2Evaluate additional pituitary axes as clinically appropriate (gonadal, adrenal, growth hormone, prolactin).
- 3Consider pituitary MRI when pituitary disease is suspected or supported by the clinical context.
Evidence and rule trace · 1 rules
PR-HT-03Possible Central Hypothyroidism Pattern
Inputs: FT4 0.5 ng/dL (ref 0.8–1.8) · TSH 5.2 mIU/L (ref 0.4–4.5) · Pituitary/hypothalamic context documented
Low FT4 with TSH not appropriately elevated for the degree of low FT4.
Evidence
- EV-ENDO-HYPOPIT-2016 · Fleseriu M et al. Hormonal Replacement in Hypopituitarism in Adults. J Clin Endocrinol Metab. 2016;101(11):3888-3921.
Physician adjudication required. For clinician review only. This output identifies clinical patterns and safety considerations from the documented inputs. It does not establish an autonomous diagnosis or treatment plan. Physician confirmation is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Thyroid-function testsMove the sliders or type values
- below range
- within range
- above range
- below range
- within range
- above range
Zones are drawn from your reference intervals. The engine, not the map, decides the pattern.
Laboratory values and reference rangesUse your lab's own interval
µIU/mL and mIU/L are numerically identical.
Interpreted against the reporting assay's upper limit.
Only used in the thyrotoxicosis pathway.
Patient context
Medications and exposures
Symptoms and physical findingsSupportive only: never classify on their own
Symptoms
Signs and decompensation red flags
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FX-004
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FX-005
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