T Nation

Analyze my Thyroid Function (updated 1/25/18 in OP)

Update: 1/25/18
I’ve been treating elevated rT3 for several months with 25 mcg Cytomel daily. Labs were pulled. The results were perplexing.

TSH: 1.65 uIU/mL (0.450-4.500)
fT4: [Low] 0.80 ng/dL (0.82-1.77)
fT3: [High] 5.1 pg/mL (2.0-4.4)
rT3: 12.9 ng/dL (9.4-24.1)

The fT4 results were not unexpected, no surprise there. The reverse T3 is going down nicely, which was also expected. However I was surprised by my TSH reading. I was expecting it to be close to 0. My physician doesn’t seem to be phased by this and says that it’s normal. I am surprised that my dose of synthetic T3 hasn’t cratered TSH due to the feedback loop. Is there something else going on? It appears that my thyroid is still producing T3 and the addition synthetic T3 that I am taking is complementary to it. All labs were pulled after my daily dose was administered. Perhaps that may be why my fT3 looks elevated. I will retake labs before taking any medication next time around to verify this.

Looking strictly at the numbers, I should be hyperthyroid, but I’m asymptomatic in that department. No arrhythmia or palpitations to speak of. I don’t have an increase in resting heart rate or blood pressure from baseline. I don’t have elevated body temperatures. Haven’t experienced any sensitivity or anything unusual. My body temperatures have gone up to 98F to 98.6F on average, and morning temperatures are in the 97.xx range.

My symptoms in the OP on the other hand were all eliminated. This has changed my life. Feeling back to normal now. Would highly recommend to try this for someone in the same boat. I’ve been looking for an answer to my fatigue and overall decreased quality of life for so many years and it seems that I’m on the right track. Makes me wonder how/why I’ve waited so long.

Original Post
My main symptom is exhaustion. I don’t feel like I have the energy or desire to do anything. I wake up feeling slightly less tired than going to bed the night before. Losing body fat is also a challenge. My metabolism appears to be slower, especially when compared to my activity level. No history of drug (street or prescription) or alcohol abuse. Hands and feet always cold.

Fasted labs:

RBC 5.6 (4.14-5.8)
Hemoglobin: 16.7 (12.6-17.7)
HTC: 48 (37.5-51.0)
Glucose: 86 (65-99)
Albumin: 4.8 (3.5-5.5)
Globulin: 2.3 (1.5-4.5)
AST: 28 (0-40)
ALT: 22 (0-44)

TSH: 1.8 (0.45-4.5) uIU/mL
fT4: 1.3 (0.82-1.77) ng/dL
fT3: 3.7 (2-4.4) IU/mL
rT3: 27.5 H (9.2-24.1) ng/dL
TPO: <6 (0-34) IU/mL
Thyroglobulin Antibody: <1 (0-0.9) IU/mL

Temperatures (oral thermometer):

9am - 97.56F (wake up)
12pm - 98.01F
3pm - 97.30F
6pm - 98.05F
9pm - 97.40F

Iodine use:

Iodized salt on everything. Multi with 200mcg selenium and 150mcg iodine daily.

Rt3 is the culprit effectively negating your good ft3 number. Are you chronically stressed physically or psychologically/emotionally? Immune system issues? What does your diet look like on a daily basis? Be specific.

As far as I know, I don’t have any diagnosed or undiagnosed immune system issues. CBC/CMP always comes back fine. I’m rarely sick.

My typical diet is 40/30/30 carbs/fat/protein, averaging approximately 2400-2700 calories daily of whole, clean foods, weighed and tracked. Some junk food once in a while (iifym). Moderate intensity lifting 3 days a week, 30-60 min per session. Light cardio 2-5 days per week, up to 60 min per session. I have to keep up this level of activity to not gain a lot of body fat, even adjusting caloric intake to decreased activity level.

I have had an anxiety disorder for many years though. I suppose that qualifies as stress. I’ve felt this level of tiredness and lived like this for years. Finally decided to seek help for constant, never ending exhaustion.

Is the level of prolactin something to be concerned about? (It’s close to the top of the range. I made sure not to have sex, or cuddle puppies for at least 48 hours prior to blood draw. Is there an optimal level of prolactin for males?)

Is there a permanent way to bring down rT3? What type of treatment works for this? I wonder what @KSman thinks of this.

Anyone else?

I am no thyroid expert like some others here. But I have a son who suffers from an extreme case of hyperthyroidism so I have done a bit of reading on the subject so I will try. Assuming I understand what I read. The elevated rT3 is not that concerning in context of the rest of the thyroid function unless it is repeated. While you have elevated rT3, your ft3 is ok. Your T4 (tested as fT4) is what becomes T3. Low TSH (hyperthyroidism) creates elevated T3 and T4 which creates abundant energy. In your bloodwork this is not the case. TSH is 1.8 and many here argue 1.0 is the ideal so your TSH is actually a little higher (hypo in that as thyroid is inverse). So with TSH a littler higher than “ideal” though still at a good place and ft4 is good and so is ft3 I do not see a worry about your rT3 and would consider it an outlier of data (unless repeated).

Now to your concern, Your E2 is high, generally people here advocate a 22-24pg/ml range for the best felt benefits. In addition you should find losing fat to come easier with E2 in the advocated range. You could also stand to donate blood to lower your HTC as that will only rise in the long term assuming you have been on trt less than a year.

@ksman , please feel free to correct any misunderstanding I have with regard to thyroid function.

You’re cold because rt3 is blocking ft3 function. The other possibility is if our HCT gets too high, our blood becomes thick and viscous. Yours is approaching high, but I wouldn’t be concerned with it yet and shouldn’t be making you cold. I would still keep an eye on this number however.

Your e2 is slightly high, but estrogen is synergistic with vasodilating mechanisms and it being slightly high shouldn’t make you cold. Some men get cold with LOW e2 because of this. All of your other thyroid markers look good except for rt3. All markers have the potential to fluctuate and do fluctuate, but if on average, your rt3 is where it is, it is blocking some of your ft3’s function, which could effectively make you feel as though your ft3 is low.

rt3 gets high any time stress is high, whether it be physical, psychological/emotional or immunological. When I asked about your diet, I wasn’t referring to your macro’s, I was referring to specifically what foods you’re eating. If you have any kind of food allergy or sensitivity, that can cause systemic chronic inflammation which is another stress that can cause rt3 to increase.

fT3 is the only active hormone, T4 is not active, but is a reservoir for fT4–>fT3.

When fT3 is above midrange and body temps are low, we suspect that rT3 is elevated and blocking some fT3 action making one hypo. And your hands are cold. Your outer eyebrows might also be sparse. Meanwhile almost all doctors will look at your labs and say that things are perfect - most docs do not test or understand rT3.

fT3 is the thyroid feedback signal and as rT3 is interfering, TSH is elevated to compensate.

You need to consider stress factors in your life. See these terms in the thyroid basics sticky.

  • TSH, fT3, rT3
  • stress, illness, inflammation, chronic, acute
  • adrenal fatigue
  • cortisol
  • Wilson’s book <-- read this

As part of the above, cortisol can be elevated from stress but later cortisol can be low. A number of 10 is well below optimal.

Your history of medications is needed and some can affect prolactin. Prolactin is secreted during sex and when hugging babies, puppies kittens etc. So avoid for net lab work.

When on TRT LH/FSH–[TRT]–>zero, do not test again.

Liver function can affect E2 levels, AST/ALT look fine.

I have updated the OP. Please take a look and chime in. I’m no expert of course, but based on my research I’m getting some strange results. I’d like to hear your thoughts on this as well @KSman.

My bad look at the wrong labs, it looks like things have improved. fT3 is still making you slightly hyperthyroid, need to being fT3 to 75% or 3/4 of the range. When fT4 is low and fT3 is high it means you’re converting T4–>fT3 efficiently. TSH should be closer to 1.0, your TSH has shown improvement.

Updated labs with 25mcg cytomel daily.

TSH: 1.65 uIU/mL (0.450-4.500)
fT4: [Low] 0.80 ng/dL (0.82-1.77)
fT3: [High] 5.1 pg/mL (2.0-4.4)
rT3: 12.9 ng/dL (9.4-24.1)

No longer have too high of rT3 (it’s probably still continuing to clear out). Confused as to why the TSH is still above 0 though. More info at the top of OP.

Glad I found this thread as I am about to begin a similar treatment. You said you’re only taking 25mcgs a day? Is that broken up into multiple doses? It looks like it maybe took a couple months to lower your RT3 - is that correct? At this low dose how long did it take for you to start to feel better?