T Nation

30 Y/O, Erratic TSH, Low T, FSH

Bio

- 30 years old
- Male
- Height: 6'3"
- Weight: 235 lbs now steady. (Previously went from 200 up to 250 lbs purposefully)
- Waist: 39 inches
- Health conditions: Minor childhood knee condition.
- Drugs: 5 doses of Ativan 1.5 years ago. Never AAS. Never hair loss drugs. 
- Non-smoker. Almost no alcohol in previous 2 years.
- Training: Training for 2 years. Sedentary previously. Doing 5/3/1 every other day presently. Have tried taking a week off with no observable effect. Fatigue, concentration and depression predated training.
- Supplements: 3000-4000 iu/day Vit D. Was taking 3g/day fish oil for several months but stopped. Occasionally melatonin to sleep. Only 3mg 1-2 times in previous 3-4 months.
- Diet: Eating 3 full home-cooked meals presently (meat, veggies, sometimes fish, fruits). Was eating caloric excess to gain weight.
- I use iodized salt in cooking but don't add salt when eating.

Symptoms

- Chronic fatigue. Always feel tired. Don't feel rested upon waking.
- Lack of motivation
- Insomnia: Difficulty going to sleep. Waking in the middle of the night.
- Frequent urination during the night. 1-2 times, sometimes as high as 4-5.
- Severe depression when I was working. Manageable depression presently.
- Difficulty concentrating, brain fog
- Facial and body hair normal (beard, hairy torso, legs)
- Fat distribution: Almost exclusively on torso, especially abdominals. Pinch test essentially fails on arms/legs. Has always been this way.
- Testes ache: Yes, left testicle regularly aches. Don't think there is any correlation with fevers. No size/shape abnormality. They were physically examined by doctor without comment.
- Low libido
- Sometimes get cold hands and feet.
- Body temperature: Erratic. Usually around 97.7 when waking. Often 98.3-98.4 in afternoon/evening. Sometimes 98.6.
- Low libido (worse in passed year).
- No more spontaneous or nocturnal erections (worsened in passed year).
- Difficulty getting and keeping strong erections.

Labs

I had 3 blood tests done over 2 years. In total I had many specific tests done. I will start with the most important ones (no saliva cortisol, rT3. Waiting on Vit-D25). Please ask if there is something specific you want to see. I may have had it done but not listed.

Notice erratic TSH, low Total T, high-ish E2, high DHEA-S, high prolactin, high cholesterol, low HDL.

Lab R, test 1 (Jan 2013, 9am) [fasting]

- E2 (method unknown): 166 pmol/L, <=206
- Total T: 12.52 nmol/L, 2.80-21.60
- Bioavail-T (calculated?): 6.28 nmol/L, 3.6-11.30
- Albumin: 41 g/L, 38-52
- SHBG: 29.3 nmol/L, 13.3-88.5
- DHEA-S: 10 umol/L, 2.7-10.0
- Prolactin: 12.7 ug/L, 2.6-13.1
- FSH: 2.3 IU/L, 1.3-18.5
- LH: 3.0 IU/L, 2.5-16.3
- TSH: 4.45 mIU/L, 0.4-4.40
- Thyroxine free: 13.0 pmol/L, 8-18
- T3 free: 5.2 pmol/L, 3.5-5.7
- Cortisol random: 354 nmol/L, 120-535
- Cholesterol total:L 5.09 mmol/L, 1.15-4.70
- Triglycerides: 1.68 mmol/L, 0.1-1.7
- HDL: 0.96 mmol/L, 0.9-1.8
- LDL: 3.37 mmol/L, no reference range
- Ferritin: 163.9 ug/L, 23.9-366
- Iron saturation: 0.35 ratio, 0.26-0.42

Lab J (Oct 2012 2pm)

- TSH: 1.85 mU/L, 0.4-4.5
- Total T: 9.6 nmol/L, 6.8-20.0
- SHBG: 24.0 nmol/L, 10.1-51.3
- Bio-T (calculated): 5.29 nmol/L, 3.15-9.84
- Free-T (calculated): 220 pmol/L, 131-406
- Ferritin: 356 ug/L, 15-350
- B12 544 pmol/L, 140-700

Lab L (Nov 2011, 9am) [fasting]

- B12 275 pmol/L, 133-675
- TSH 2.57 mUI/L 0.45-4.65
- Cholesterol: 4.27 mmol/L, 3.10-5.20
- Ferritin: 103 ug/L, 25-336
- HDL: 1 mmol/L, 1.05-2.2
- LDL: 2.95 mmol/L

Lab J (June 2013, 8:30 am)

  • TSH: 2.30 mU/L (0.4-4.5)
  • fT4: 16.4 pmol/L (9.0-26.0)
  • FSH: 2.4 U/L (1.6-11.0)
  • LH: 5.3 U/L (0.8-6.1)
  • Prolactin: 15.3 ug/L (2.7-16.9)
  • Estradiol: 84 pmol/L (55-165)
  • TPO Antibody: 13.5 IU/mL (0-35)
  • TotalT: 11.6 nmol/L (6.8-20) – About 334 ng/dl
  • SHBG: 21.0 nmol/L (10.1-51.3)
  • Calculated FreeT: 288 pmol/L (131-406)
  • Calculated BioT: 6.92 nmol/L (3.15-9.84)
  • PSA: 1.0 ug/L (0-4)

— reserved #2 for future additional information ----

— reserved #3 for future additional information —

Have you read the thyroid basics sticky?

E2 and prolactin are both a concern and combined could explain some of your HPTA repression.

[quote]KSman wrote:
Have you read the thyroid basics sticky?

E2 and prolactin are both a concern and combined could explain some of your HPTA repression.
[/quote]

I have read the thyroid basics sticky. Is the takeaway that I should try iodoral?
I think my ft4 and ft3 are okay (?) which I don’t think is consistent with the TSH on those same lab results.

What should I do about E2 and prolactin? Can either be “root causes”?

I will be doing some more blood work to repeat the thyroid and hormone tests. I will also be adding thyroid antibody tests. Is there anything else I should test for? Magnesium? Selenium?

Do you have known iodine intake? Note that your status is the end results of months or perhaps years if iodine intake. Temps do not look all that bad. But TSH could be compensating reasonably well for low iodine status.

[quote]KSman wrote:
Do you have known iodine intake? Note that your status is the end results of months or perhaps years if iodine intake. Temps do not look all that bad. But TSH could be compensating reasonably well for low iodine status.[/quote]

I use iodized salt when cooking but I can’t really quantify how much iodine I am getting on a daily basis.

If taking vitamins, select a product that has iodine.

[quote]KSman wrote:
If taking vitamins, select a product that has iodine.[/quote]

Thank you for responses. Do you have any advice on what to do from here? Do my test results suggest any particular course of action? My tentative plan is to try SERM (Nolvadex?) for 2 weeks and then taper off, maybe combined with anastrozole, to see if I feel substantially better. Alternatively I might try hcg stimulation.

Also, does Centrum contain enough iodine per tablet?

Vitamins contain 150 micrograms of iodine or none. That plus iodized salt can prevent iodine decline, but cannot do iodine replenishment. If you are going to take a vitamin product, might as well have iodine.

SERM or hCG do the same thing, activates LH receptors. Do not combine or take high amounts of either.

Use 1/2 mg/week in EOD divided doses anastrozole during and after this restart.

I think that you need to do more labs to see why TSH is so high. T levels do not explain the depth of your symptoms. High TSH is the red flag. Still wondering about rT3

Still may be a case of low iodine. Not seeing solid 98.6 temperatures.

I will probably be doing a blood test next week and have results the following one. I will wait until get those before deciding to do anything.

I have updated the post with new test results. Negative for hashimoto’s.

I am no longer sure what to do. I have seen a few doctors and they all say there is no indication of any problem. Cholesterol is a little high and thyroid a little hard but nothing to worry about. They say testosterone and thyroid levels are not responsible for my symptoms.

I am going to try to get a sleep study done, maybe I have sleep apnea.

Check the adrenals

ACTH
C peptide
Cortisol
Insulin
Rt3

What tests did they run for hashimotos just tpo? An added tgab test plus a tsi test for diagnosing graves

Can you get a four point cortisol test?

You do not have low T. It isn’t high but doesn’t constitute trt.

What are your symptoms?

I had AM blood cortisol, not sure I can get saliva maybe urine (is it worth it if I had blood cortisol?)
I can’t get RT3 through public health system (if it’s very useful I will pay out of pocket).
How useful are ACTH and C peptide? What do they do?
Hashimoto’s was only tpo. Doctor told me tgab and tsi were not needed based on my symptoms.

Can you explain why my T isn’t low? Nearly every medical journal I have read says that 300 ng/dl is the lower limit, some say 350. My readings were 280, 356 and 334. That seems pretty close to the limit to me.

Main symptoms: Fatigue, no “vigor”, low concentration, low motivation, no libido, no longer getting morning wood, moderate erectile dysfunction, knee joint pain (may be due to injury). I move around like an old man. Fatigue and knee pain make bending down and using stairs much more difficult and tiring than it should be for someone my age.

rT3 would be expected to depress body temperatures. However your body temps do not strongly indicate that. Low iodine would raise TSH, but high fT3 would not be expected. rT3 can increase TSH to compensate for fT3 blockage and increase fT3 in some cases, but temps would be lower.

You do not use much iodized salt and you are running out of options. Iodine might be a inexpensive thing to try, low expectation of anything harmful.

Bromine can block the effects of iodine in the body. If you take iodine and feel worse and/or you or your breath smells like dead fish, the iodine is displacing bromines and levels in your blood increase as you excrete the bromine. You can get bromine in your body from medications, food additives etc. Bromine contamination is rare, but one guy had good evidence during his IR.

Bullshit… Ft3 pooling begins with high rt3 and my ft3 slowly went out of range with ft4 following slowly. My rt3 is high. Please do not profess to be a thyroid expert cause you are not…

Rt3 would be a valid blood tests for anyone with thyroid problems… Period…

And he isn’t running out of options he just needs someone. (A doctor) who knows what he is doing.

Bullshit… Ft3 pooling begins with high rt3 and my ft3 slowly went out of range with ft4 following slowly. My rt3 is high. Please do not profess to be a thyroid expert cause you are not…

Rt3 would be a valid blood tests for anyone with thyroid problems… Period…

And he isn’t running out of options he just needs someone. (A doctor) who knows what he is doing.

All of your symptoms even the joint pain, thyroid issues, fatigue, sleep problems point me in the direction of Lyme disease. Often when one gets diagnoses of fibro, adrenal fatigue, chronic fatigue, ms, Lou garigs, Als, Parkinson’s it is indeed late stage Lyme that has opened the doorways to these other problems. I am by no means saying you have it but I have just ordered the labs myself and I am seeing alot of people whit multiple hormonal issues and pains on this site who display many symptoms. If you would like to get tested for Lyme Igenex in California is the best Lyme testing facility anywhere. You would have to pay out of pocket but I feel it is worth the piece of mind.
I am just a regular guy like you who just watched a 14 year old girl go from paralysis to walking because she was treated. There are over 100 co- infections and Lyme doesn’t live in the blood so the testing is not 100 percent effective. The fry test which is expensive is prolly the best test but I think 1 step at a time.

The little girl was told it was all in her head until she was in a wheel chair.

I have just ordered the labs myself and I’m only trying to help.

Iodine isn’t going to fix your pain… Iodine fucked me up