T Nation

32, Update: Back to Normal Levels, but High TSH and CK (Had High SHBG, Low Free T)


#1

Hello, fellows.

Update: 27 March, 2018

  • Age: 32
  • Height: 6’1" / 186 cm
  • Waist: 33
  • Weight: 210 lbs / 95 kg
  • Describe body and facial hair: Hairy chest, legs and arms. Leg and arm hair is not thick and a bit blonde. A little bit on the back. Started balding at 22, have been shaving my head for 6-7 years now. Full, thick, but half grey beard.
  • Describe where you carry fat and how changed: Carrying fat mostly around the waist (sides and lower back).
  • Health conditions, symptoms [history]: None
  • Rx and OTC drugs, any hair loss drugs or prostate drugs ever: No
  • Diet: Currently at 4500 kcal. Since my post from beginning of February, I have bumped my caloric intake to 3500, then to 4000, and last week to 4500.
  • Describe diet: high carb diet. Protein: 220-260, Carbs: 400-500, fat: rest, usually up to 150. Clean food.
  • Describe training: nSuns 5/3/1 6 days/week. Training is 2 compound exercises followed by some accessories. Takes about 1.5 hours in total.
  • Testes ache, ever, with a fever?: Very, very rarely, cannot recall under what circumstances.
  • How have morning wood and nocturnal erections changed?:
    For the past few weeks, I have been getting nocturnal erections. I don’t remember getting those previously, at least no in the last few years. I was quite surprised the first time it happened, as I woke up in the middle of the night with a boner, lol. I was getting morning wood previously, and still do.
  • Supplements: Optimen multivitamin, Vitamin D, Creatine, ZMA, Omega-3

Lab Results 27 March, 2018

  • leukocytes: 7.1 /nl, range: 4.2–9.1
  • erythrocytes: 5.1 /pl, range: 4.6–6.1
  • Hemoglobin: 9.1 mmol/l, range: 8.5–10.9
  • hematocrit: 0.46 l/l, range: 0.41–0.52
  • MCV: 89.9 fl, range: 82–98
  • MCH: 1.77 fmol, range: 1.59–2.00
  • MCHC: 19.7 mmol/l, range: 19.0–22.5
  • thrombocytes: 235 /nl, range: 150–400
  • cholesterol: 4.58 mmol/l, range: <6.50
  • HDL-cholesterol: 1.81 mmol/l, range: >0.91
  • cholesterol/HDL: 2.5 ratio
  • LDL-cholesterol: 2.64 mmol/l, range: <3.37
  • LDL/HDL-risk index: 1.5 ratio
  • triglycerides: 0.58 mmol/l, range: <2.28
  • ASAT (GOT): ↑ 61 U/l, range: <50
  • ALAT (GPT): ↑ 51 U/l, range: <50
  • gamma-GT: 17 U/l, range: <60
  • CK (creatine-kinase): ↑↑ 517 U/l, range: <190
  • urea: ↑ 9.52 mmol/l, range: 2.77–8.10
  • creatinine JAFFE: 88 μmol/l, range: <124
  • GFR (MDRD-formula): 91.5 ml/min/1.73m², range: >60.0
  • albumin: 44 g/l, range: 35–52
  • PSA ECLIA: 1.09 μg/l, range: <4.0
  • albumin: 41.6 g/l, range: 35.0–52.0
  • TSH ECLIA: 3.04 mU/l, range: 0.27–4.20
  • LH: 5.6 IU/l, range: 1.7–8.6
  • FSH: 4.5 IU/l, range: 1.5–12.4
  • estradiol (17-beta-estradiol): 111.9 pmol/l, range: 41.5–158.5
  • testosteron: 17.6 nmol/l, range: 8.64–29.00
  • testosteron, fee (ISSAM): 0.283 nmol/l, range: >0.125
  • DHEA-S ECLIA: 5.8 μmol/l, range: 4.2–11.7
  • SHBG: 50.8 nmol/l, range: 18.3–54.1
  • IGF-1 (somatomedine C) CLIA: ↑ 38.1 nmol/l, range: 11.5–32.0
  • cortisol: 391.9 nmol/l, 6am–10am: 165.6–507.8 nmol/l, 4pm–8pm: 69.0–328.4 nmol/l

Changes since my previous post on 7 February:

  • I have taken iodine for about 2 weeks, 1000 mg in total. Now I take the 150 mcg daily dosage and also take iodized salt.
  • I started taking creatine (1 scoop / day).
  • I am getting slightly more sleep.
  • I have bumped my caloric intake considerably, and am gaining weight (90 to 95 in 1.5 months).
  • I stopped taking probiotics and ashwagandha.
  • I have been measuring my morning temperature. I varies in the range 97.2–97.9 F / 36.2–36.6, with an average of 97.5 F / 36.4 C.
  • I have stopped drinking altogether. I used to drink socially, 1-2 times per week, a few drinks every time.

Original post: 7 February, 2018

I have recently had my blood tested, and got some surprises.  Any help is most appreciated.

Diet: low-carb (targeted keto), 500-1000 cal deficit
Routine: 3 days gym, 3 days cardio.
Weight: 90 kg, 186cm/6"1', 10-12% BF.
Symptoms: nothing major to speak of.
Supplements: Ashwagandha (!), Optimen, Omega-3, Vitamin D, ZMA, Probiotics.


Test done on 02.02.2018, around 10am.  I had a few drinks the night before; other than that I don't drink more than a few drinks a month.  The day before the test I had some stress, not much sleep the previous nights, etc. due to other circumstances. I am only posting what seems to be relevant here, all other markers are well within range.

* Blood sugar: 5.6 mmol/l, range: 3.5-6.1
* Cholesterol total: 5.85 mmol/l, range: 3.5-6.2
* **Triglycerides: 0.6 mmol/l**, range: 0.6-2.0
* **Urea: 11.0 mmol/l**, range: 3.2-7.4
* Albumin: 45.9 g/l, range: 35-50
* HDL- cholesterol: 1.96 mmol/l, range: 1.04-2.0
* LDL- cholesterol: 2.9 mmol/l, range: 1.81-4.1
* **АSАТ: 44.0 U/l**, range: 0-34
* ALAT: 43.0 U/l, range: 0-55
* Magnesium (Mg): 0.78 mmol/l, range: 0.66-1.07
* TSH: 1.41 mU/l, range: 0.35-4.94
* FT4: 12.98 pmol/l, range: 9.01-19.05
* FT3: 4.13 pmol/l, range: 2.62-5.7
* FSH: 5.42 mIU/ml, range: 1.5-12.4
* Progesterone: <0.165 nmol/l, range: 0.7-4.3
* Prolactin: 173.2 mIU/l, range: 86-324
* Estradiol: 83.57 pmol/l, range: 28.0-156
* **Free Testosteron: 0.184 nmol/l**, range: 0.204-0.637
* Albumin: 45.9 g/l, range: 35-50
* **SHBG: 77.78 nmol/l**, range: 14.5-48.4
* Testosterone: 16.65 nmol/l, range: 7.58-31.4
* **Bioavailable Testosterone**: 4.6 nmol/l, range: 4.78-14.9
* 25OH Vitamin D: 41.3 ng/ml, range: 20.0-43.0
* PSA-Total: 1.09 ng/ml, range: 0-4
* DHT: Not Ready
* Zinc: Not Ready


I redid some of the tests the following day, in a different lab.  I was somewhat stressed due to the previous day's lab results:

* Albumin: 48 g/l, range: 35-55
* Somatothropin: 1,56 ng/ml, range: < 3,0
* **Insulin: 6,02 uU/ml**, range: 3,0-25,0 uU/ml
* **SHBG: 61,2 nmol/L**, range: 10-57
* **Estradiol: 37,45 pg/ml**, range: <39,8
* DHEA-SO4: 293 ug/dl, range: 80-560
* Testosteron: 6,65 ng/ml, range: 2,41-8,27
* **Free Testosteron: 0.0922 ng/ml**, range: 0,09-0,30
* Cortisol: 18.63 ug/dl, range: am: 4.3-22.4 ug/dl; pm: 3.09-16.66 ug/dl
* **IGF: 651 ng/ml** (updated 9 February, 2018)

Update on Thyroid (19 April, 2018)

  • TSH: 2.17 mU/l [0.27–4.2]
  • fT3: 5.16 pmol/l [3.08–6.78]
  • fT4: 16.73 pmol/l [11.6–21.9]
  • Thyroid peroxidase antibodies: 11 kU/l [<34]
  • Thyroglobulin antibodies: 11 IU/ml [<115]

I also had ferritin tested: 222 ug/l [30–400]

So, TSH is getting lower after the iodine replenishment (1.4 -> 3 -> 2.2). Before IR, fT3 was 4.13 [2.62–5.7] and fT4 was ~13 [9–19]. Given the different ranges (different labs), they seem close to one another.


#2

KETO RAISES SHBG. Women who have PCOS, which is caused by low SHBG, are encouraged to change to a Keto diet, because it raises SHBG and decreases free testosterone.

High e2 can also cause shbg to increase, but more than likely yours is because your diet.


#3

Age=32
waist size?

Elevated E2 + lower FT increases SHBG that then reduces FT and increases TT with non-bioavailable SHBG+T so that TT overstates your status.

Source of E2 is FT–>E2. As FT is low, FT–>E2 is low, so the reason for high E2 is then reduced liver clearance which can be from some meds etc or a liver condition. Was AST/ALT tested?

With low FT, FT–>DHT will be low.

Progesterone is below reporting threshold. But not undermining your cortisol production. progesterone–>cortisol in the adrenals. DHEA-S also shows decent adrenal function. Low fat diets can shift hormone levels.

You seem to have deep hypothyroidism.
Now why? Prolactin is not causing this.

FSH is often a better indicator of LH status than LH lab results. Your FSH is not low and I think that the problem is with your testes? Do they ache? Hanging OK? Smaller?

Have you used any oral 5-alpah reductase inhibitor drugs for hair loss? In a few guys, that wrecks everything quite fast.

You could feel better now taking 1/4mg anastrozole now twice a week. But this will not fix your low T.

You have a lot of reading to do. Nothing below is trivial.

TSH better near 1.0
fT4 should be near midrange ~15, 12.98 is too low.
fT3 better nearer to 5.0
Problem can be from an iodine deficiency caused by not using iodized salt. See below re “oral body” temperatures to learn more. Post your temperatures and history of sources of iodine etc.

Do not test GH directly as it move a lot minute to minute. IGF-1 indicates your GH status.

Exercise with low T plus low thyroid function requires adrenalin to overcome natural energy and adrenal fatigue can result. See the thyroid basics sticky and see references to starvation diets, rT3, stress, adrenal fatigue and Wilson’s book.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#4

Thank you very much, KSman! Your help is most appreciated. Please, find below answers to your questions. I am going to keep reading your posts.

I have had my thyroid examined, it was fine.

I have also consulted with two two endocrinologists. Both told me I was fine, and that my Keto and supplements are to blame for the “mild” discrepancies in the results. WTF?!

AST/ALT
AST and ALT were indeed tested—AST is high. Values are

  • АSАТ: 44.0 U/l, range: 0-34
  • ALAT: 43.0 U/l, range: 0-55

Testes
I don’t have shrunken, aching, or “not normally” hanging testes.

Waist Size
Waist size has been about 33 in for years, at least the past 18 months or so, with slight variations depending on whether I am cutting or bulking.

Iodine
I read your sticky and since I don’t supplement iodine, and I may well be deficient.

Thyroid in the Family

My family has a history of thyroid issues. My mother has hashimoto’s, my sister’s thyroid is broken and she’s is currently being treated prior to having it removed. My grandfather also had problems with his thyroid gland.
In other words, I wouldn’t be surprised at all if I have some thyroid-associated anomalies.

Symptoms
I have been saying that I don’t have any symptions. But the more I keep reading and thinking, the more I am led to believe that my healthy lifestyle and good diet (meats, nuts, veggies, eggs, no junk, etc.) are able to counteract some of the problems.
I may be focusing too much and nitpicking, since I am honestly quite concerned (though not anxious), but some examples:

  • Libido is lower than it used to be 6-7 years ago.
  • I seem to be having a harder time gaining muscle that some years ago.
  • Lately, I have had to go pee at night. I was attributing this to the higher water consumption (3-4 liters/day) with keto, but I also put Himalayan salt in my water, and that doesn’t seem to affect my nocturia. In fact, even if I don’t drink much water on some days for whatever reason, I still have nocturia.

Hair
I am bald. I started balding when I was 23-24, by 26 I was already shaving my head.

Drugs
I do not take any oral medications, for hair loss, or otherwise. I remember using some hair-loss product 6-7 years ago, in the form of a liquid in ampoules that is rubbed against the scalp. Used that for a month, no effect.


#5

Body temps are the bottom line for thyroid.

Low iodine intake increases TSH and high_TSH+time leads to thyroid nodules, a lack of selenium disables production of enzymes that clean up free radicals generated as part of normal thyroid hormone production processes. That can lead to damaged cells and the immune system can then interpret the mess as foreign and then you are auto-immune.

You need selenium in a multi-vit with iodine and iodized salt to avoid pathology.


#6

Thanks again, mate.

I am catching up, reading the comprehensive information that you have written. I am going to measure body temperature and report.

Regarding iodine: I don’t supplement, and I have bought into the mountain zen magic salt crap. I am going to do a replenishment as per your suggestions.

Regarding selenium: I have been eating at least a few kerns of Brazil nuts every day for the past almost two years. In addition, my multivitamin contains selenium (about 80 mcg per day).


#7

Selenium status is good!


#8

Would the ups and downs of t and e2 if injecting weekly cause lower temperature as well?


#9

Update on IGF-1 and Body Temperature

I got my IGF-1 test from 3 February: 651 ng/ml. I am having a hard time finding a reference range, but from the little I could find on the Internet, this seems very high.

I measured my temperature today, though with a digital thermometer (I ordered a mercury one, and will measure with it once I get it).

  • 7am, immediately after waking, while still in bed: 36.4 C / 97.5 F
  • 10:30am: 36.4 C / 97.5 F
  • 4:30pm: 36.4 C / 97.5 F (average of 3 diff. measurements done one after another).

#10

It does no good to test temps later in the day as temps will start dropping towards the evening, 12 noon is best time to check pm temps. Forget digital thermometer, your results are useless.


#11

Cheers, mate. I am sorry, but that’s all I’ve got. I have already ordered a mercury thermometer, and will retest as soon as I get it.


#12

I have just updated my original post with new bloodwork and changes.

  • I have started getting crazy nocturnal errections.
  • I am eating at +1000 kcal. Since my post from beginning of February, I have bumped my caloric intake to 3500, then to 4000, and last week to 4500.
  • I have been doing a heavy, 6-day lifting program (nSuns 5/3/1 deadlift)
  • I had been doing keto on a heavy deficit prior to my previous blood tests from beginning of Feb., whereas I am now on a high-carb diet.

Changes and questions:

  • TSH up to 3 from 1.4 mU/l (is this expected?)
  • SHBG back within range (was high)
  • Free T back within range (was low)
  • IGF-1 much lower (still a bit higher than upper limit)
  • ASAT, ALAT, and urea still high
  • Morning temperature varies in the range 97.2–97.9 F / 36.2–36.6, with an average of 97.5 F / 36.4 C.
  • Creatine kinase very high (overtained?)

@KSman
Would very much appreciate it if you could take a look? In particular, I am very concerned about the elevated TSH and CK levels.

Lab Results 27 March, 2018

  • leukocytes: 7.1 /nl, range: 4.2–9.1
  • erythrocytes: 5.1 /pl, range: 4.6–6.1
  • Hemoglobin: 9.1 mmol/l, range: 8.5–10.9
  • hematocrit: 0.46 l/l, range: 0.41–0.52
  • MCV: 89.9 fl, range: 82–98
  • MCH: 1.77 fmol, range: 1.59–2.00
  • MCHC: 19.7 mmol/l, range: 19.0–22.5
  • thrombocytes: 235 /nl, range: 150–400
  • cholesterol: 4.58 mmol/l, range: <6.50
  • HDL-cholesterol: 1.81 mmol/l, range: >0.91
  • cholesterol/HDL: 2.5 ratio
  • LDL-cholesterol: 2.64 mmol/l, range: <3.37
  • LDL/HDL-risk index: 1.5 ratio
  • triglycerides: 0.58 mmol/l, range: <2.28
  • ASAT (GOT): ↑ 61 U/l, range: <50
  • ALAT (GPT): ↑ 51 U/l, range: <50
  • gamma-GT: 17 U/l, range: <60
  • CK (creatine-kinase): ↑↑ 517 U/l, range: <190
  • urea: ↑ 9.52 mmol/l, range: 2.77–8.10
  • creatinine JAFFE: 88 μmol/l, range: <124
  • GFR (MDRD-formula): 91.5 ml/min/1.73m², range: >60.0
  • albumin: 44 g/l, range: 35–52
  • PSA ECLIA: 1.09 μg/l, range: <4.0
  • albumin: 41.6 g/l, range: 35.0–52.0
  • TSH ECLIA: 3.04 mU/l, range: 0.27–4.20
  • LH: 5.6 IU/l, range: 1.7–8.6
  • FSH: 4.5 IU/l, range: 1.5–12.4
  • estradiol (17-beta-estradiol): 111.9 pmol/l, range: 41.5–158.5
  • testosteron: 17.6 nmol/l, range: 8.64–29.00
  • testosteron, fee (ISSAM): 0.283 nmol/l, range: >0.125
  • DHEA-S ECLIA: 5.8 μmol/l, range: 4.2–11.7
  • SHBG: 50.8 nmol/l, range: 18.3–54.1
  • IGF-1 (somatomedine C) CLIA: ↑ 38.1 nmol/l, range: 11.5–32.0
  • cortisol: 391.9 nmol/l, 6am–10am: 165.6–507.8 nmol/l, 4pm–8pm: 69.0–328.4 nmol/l

#13

Nice drop in SHBG. Probably from changing your diet from keto to higher carb. Hopefully someone will chime in about your thyroid.


#14

12 Noon: I suggest mid-afternoon to avoid the influences of eating lunch and associated travel and activities.


#15

CK, AST/ALT up from lifting. Muscle damage or soreness is the cause. You would need to stop lifting for 7 days and be fully recovered to get labs that are useful.

TSH: You were taking iodine supplements. I discussed this earlier in this thread. TSH result not useful. No problem.

Do you have more energy? Improved clarity of though? Better mood? That can be from iodine.


#16

I have not noticed any significant change in my energy levels. I would say that energy and mood are slightly better.

I am going to retest in a month or so (also for T3 and T4).

One question: should I test free T3/T4 or just T3/T4?

Thanks so much, KSman!


#17

Yeah, really happy with that.

I was about 90 kg eating at 2500 kcal. Now I am 95-96 and I eat 4500 kcal. I must have been starving before, which may have had a contribution to the SHBG.


#18

Test TSH if not on high iodine, but past TSH may be useful/
Test fT3, fT4 - [T3, T4 not needed]

Remember that oral body temperatures are often best indication of status.


#19

Thanks, KSman.

I have been measuring my morning temp for the past 6 weeks or so. It fluctuates in the range 97.2–97.9 F / 36.2–36.6, average is 97.5 F / 36.4 C.


#20

There is no point in knowing what fT3 was before you [hopefully] changed the game.