T Nation

Another Crazy Case... KSMAN


After reading others posts and lurking here for a period of time, Iâ??ve finally decided to ask those of you with experience on what you recommend. Thank you in advance as this post is somewhat long.

-age 44
-height 5â??11â??
-waist 40â??
-weight 224lbs
-describe body and facial hair Little to no body or facial hair
-describe where you carry fat and how changed Most of the fat is carried around my waist.
-health conditions, symptoms [history] I have had appendix and gallbladder removed. Surgery on right wrist. Complete fatigue with brain fog. Loss of muscle tone.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever I have been on several SSRIs over the years. Treated for anxiety and depression. I am prescribed Celexa. I take multivitamin, fish oil, kelp, additional vitamin C, vitamin D, magnesium.
-lab results with ranges
06/30/14 Labs
WBC 9.2 (4.5-11.0)
RBC 6.41 (4.69-6.13) High
Hemoglobin 18.5 (14.0-18.0) High
Hematocrit 55.3 (40.0-54.0) High
MCV 86 (80-99)
MCH 28.9 (26.0-34.0)
MCHC 33.4 (32.0-35.2)
RDW 12.2 (11.0-14.0)
Platelets 306 (150-450)
MPV 7.7 (6.6-12.2)
%Neut 56
%Lymph 34
%Mono 4
%Eos 4
%Baso 2

Neut 5.20 (1.5-9.5)

Lymph 3.16 (1.5-5.00)

Mono .33 (.10-1.00)

Eos .38 (0.00-0.30) High

Baso .15 (0.00-0.20)

Sodium 138 (136-145)
Potassium 3.9 (3.6-5.2)
Chloride 101 (100-108)
Co2 25 (21-31)
Anion Gap 16 (10-20)
Glucose 93 (77-115)
Bun 19 (7-18) High
Creatinine .93 (0.67-1.17)
Calcium 8.4 (8.5-10.1) Low
Total Protein 8.3 ( 6.4-8.2) High
Albumin 4.3 (3.5-4.5)
Alkaline Phos 89 (50-162)
SGPT/ALT 56 (12-78)
SGOT/AST 27 (10-33)
Bilirubin TOT 0.77 (0.00-1.00)
T3 Free 2.79 (2.18-3.98)
T4 Free 0.86 (0.76-1.46)
TSH High Sens 2.26 (0.35-3.76)
Vitamin B12 589 (211-946)
Vitamin D 25-Hydroxy 23.5 (30.0-100.0) Low
Testosterone, Serum 112 (348-1197) Low
Free Testosterone (Direct) 5.7 (6.8-21.5) Low
LH 2.6 (1.7-8.6)
FSH 1.4 (1.5-12.4) Low
After these labs the Doc requested a sleep study and an MRI of the pituitary. Due to my busy schedule I did not have these done at the time. I did however, begin to donate blood. Time passed and I decided that I better follow up with the Doc and see there were any changes in the labs.
08/13/15 Labs
WBC 8.3 (4.5-11.0)
RBC 5.53 (4.69-6.13)
Hemoglobin 15.1 (14.0-18.0)
Hematocrit 45.9 (40.0-54.0)
MCV 83 (80-99)
MCH 27.3 (26.0-34.0)
MCHC 32.8 (32.0-35.2)
RDW 12.9 (11.0-14.0)
Platelets 303 (150-450)
MPV 8.0 (6.6-12.2)
%Neut 50
%Lymph 35
%Mono 5
%Eos 7
%Baso 2

Neut 4.17 (1.5-9.5)

Lymph 2.93 (1.5-5.00)

Mono .43 (.10-1.00)

Eos .58 (0.00-0.30) High

Baso .20 (0.00-0.20)

Sodium 140 (136-145)
Potassium 3.9 (3.6-5.2)
Chloride 104 (100-108)
Co2 25 (21-31)
Anion Gap 15 (10-20)
Glucose 109 (77-115)
Bun 16 (7-18)
Creatinine 1.00 (0.67-1.17)
Calcium 8.9 (8.5-10.1)
Total Protein 7.3 ( 6.4-8.2)
Albumin 4.0 (3.5-4.5)
Alkaline Phos 61 (50-162)
SGPT/ALT 75 (12-78)
SGOT/AST 31 (10-33)
Bilirubin TOT 0.63 (0.00-1.00)
T3 Free Not tested
T4 Free 0.75 (0.76-1.46) Low
TSH High Sens 2.99 (0.35-3.76)
Testosterone, Serum 104 (348-1197) Low
Free Testosterone (Direct) 3.9 (6.8-21.5) Low
I completed the sleep study. The findings were slight/mild sleep apnea. The MRI showed that the pituitary is an unusual shape but does not appear to be enlarged. A structure 3x4mm was observed above the pituitary. They recommend another MRI with thinner cuts. The Doc asked again for additional labs.
08/26/15 Labs
Iron 45 (65-175) Low
TIBC 437 (250-450)
Iron Sat 10 (20-50) Low
T3 Free 2.88 (2.18-3.98)
T4 Free 0.78 (0.76-1.46)
TSH High Sens 4.19 (0.35-3.74) High
UIBC 392 (150-375) High
Cortisol- AM 13.3 (6.2-19.4)
Estrone Serum 77 (12-72) High
FSH 1.7 (1.5-12.4)
Hemochromatosis- No Mutation Identified
LH 3.2 (1.7-8.6)
Prolactin 10.6 (4.0-15.2)
Transferrin 349 (200-370)
Testosterone Serum 108 (348-1197)
Free Testosterone Direct 4.2 (6.8-21.5)
The Doc now says that another detailed sleep study should be completed with an additional MRI to examine the structure above the pituitary.

-describe diet -breakfast lunch and dinner. I am not on any type of diet.
-describe training- minimal training but active
-testes ache, ever, with a fever? Some ache after vasectomy but rare.
-how have morning wood and nocturnal erections changed- I have not had morning wood for years and nonturnal wood is rare and infrequent.

Any ideas???


Additional results from 08/13/15 labs

Cholesterol 160 (50-200)
Triglycerides 137 (20-170)
HDL 27 (40-60) Low
LDL Direct 106 (0-100) High

I normally have high triglycerides. I normally don’t cook with salt but do eat processed foods at times. I take kelp and sometimes have a couple of drops of Lugols.


If you have not been using iodized salt, you are iodine deficient.

Check your oral body temperatures:

  • when you first wake up, should be 97.7-97.8, higher OK, 97.3 is a problem
  • also see if you get 98.6 mid-afternoon

Read the thyroid basics sticky.


  • gain weight
  • can’t loose weight
  • dry skin
  • general hair thinning
  • sparse outer eyebrows
  • lack of energy
  • brain fog
  • common symptoms with low-T

TSH should be nearer to 1.0
T3, T4, fT3, fT4 should be mid range or a bit higher, do the math.

Please ignore normal ranges.

Keep on top of hematocrit

TRT will make hematocrit worse!

Your labs suggest iron deficiency, don’t see that with low-T, high range ferritin and high hematocrit.
Very odd from my limited point of view.

Have you had an occult blood test?

You need TRT and transdermal is probably not going to work with your state of thyroid.
Focus deeply on the thyroid and iodine issues.
You can ping me on the ‘ksman is here’ thread.

You may be able to get off of the SSRI’s. In any case, Wellbutrin would let your brain be more normal. You would have SSRI withdrawal issues.

Should be testing estraDIol E2
Not estrONE E1

You should get a good broad spectrum probiotic and take for one month.
Suggest ultimateflora.com/products/ultimate-flora-adult-50-25-billion/
Adverse gut flora can take E2 metabolites and convert then back to active forms that are then reabsorbed.
E1 seems very high for low T levels!

Multiple issues, don’t miss any of them.


You are absolutely right about the thyroid.
97.3 AM temp
97.4 afternoon temp
97.4 AM temp
97.6 afternoon temp

Is it normal to see so many fluctuations in the numbers? I’m new to this and suspect its a thyroid/secondary hypo issue. The Doc is saying that my sleep pattern could be the cause of many of the results. What would your recommended approach be to all of this? The Doc said that I can begin TRT once additional sleep studies and another MRI completed? The Doc doesn’t want additional issues to start by placing me on T right now.


TRT will not change results of MRI detecting an adinoma or lesion.

Problem might be that doc gets confused.

Have you read the thyroid basics sticky?

Temperatures drop at night and increase during the day. You don’t have fluctuation issues, just low temps.

I created a forum thread yesterday “hormones and health” see if that is useful.


I did read the thyroid sticky. I will read the other one you posted also. The fluctuations I meant were more related to lab numbers. I understand the low temps and how they relate to thyroid function are related to your informative post. I suspect that bromine may have been a strong issue as I used to consume Mt. Dew by the gallon. I stopped some time ago after learning that it contained brominated vegetable oil.

The Doc called and sent in a script for synthroid. I’m not sure at this point if I want to start taking it. I’ll continue to take iodine and monitor my temps.


Your body changes by the hour and the day. Some lab number noise is normal.

Specifically, I suggest that you try a high iodine dose IR to flush out bromines. This may make you stink and feel unwell as you excrete bromines. When that is done, your whole thyroid-metabolism picture may change. Then it would be a new game.


My temps are stable now. I still have the same issues as many others on here- where to turn for help. I live in a remote rural area and don’t have access to decent medical facilities.

Heres my update.

Doctor told me to start drinking alcohol (lucky me I thought) and decided to run test after test. I had a follow up MRI that confirmed the structure near the pituitary. They (idiots) don’t believe its an issues as it appears to be a microadenoma.

Following KSMANs advise, I have had various occult samples that were negative. My iron levels are low and I’ll post labs below. Now the DRs want to have an endoscopy and colonoscopy done prior to starting TRT. The main DR is holding firm that my low numbers are based on a sleep disorder.

Sodium 136 L=136 H=145
Potassium 4.1 L=3.6 H=5.2
Chloride 103 L=100 H=108
C02 26 L=21 H=31
Anion Gap 11 L=10 H=20
Glucose 109 L=77 H=115
BUN 19 L=7 H=18 High
Creatinine 1.11 L=0.67 H=1.17
BUN/Creat 17 L=7 H=25
Non-AA Gfr 72
AFR Amer Gfr 87
Calcium 9.0 L=8.5 H=10.1
Total Protien 7.3 L=6.4 H=8.2
Albumin 3.9 L=3.5 H=4.5
Alkaline Phos 67 L=50 H=162
SGPT/ALT 78 L=12 H=78
SGOT/AST 36 L=10 H=33 High
Bilirubin 0.55 L=0.00 H=1.00

Iron 48 L=65 H=175 LOW
TIBC 401 L=250 H=450
Iron Sat 12 L=20 H=50 LOW
UIBC 353 L=150 H=375

Cholesterol 48 L=65 H=175 LOW
Triglycerides 637 L=20 H=170 HIGH- may be after heavy drinking.
HDL 23 L=40 H=60 LOW
LDL Direct 97 L=0 H=100

PSA 0.49 L=0.00 H=4.00

T3 Free 2.93 L=2.18 H=3.98
T4 Free 0.81 L=0.76 H=1.46
TSH High Sensitivity 3.88 L=0.35 H=3.74

WBC 9.6 L=4.5 H=11.0
RBC 6.14 L=4.69 H=6.13
Hemoglobin 16.8 L=14.0 H=18.0
Hematocrit 51.5 L=40 H=54.0
MCV 84 L=80 H=99
MCH 27.4 L=26.0 H=34.0
MCHC 32.7 L=32.0 H=35.2
RDW 12.4 L=11.0 H=14.0
Platelets 301 L=150 H=450
MPV 8.5 L=6.6 H=12.2
%Neut 58
%Lymph 30
%Mono 5
%EOS 5
#Neut 5.58 L=1.50 H=9.50
#Lymph 2.86 L=1.50 H=5.00
#Mono 0.47 L=0.10 H=1.00
#EOS 0.47 L=0.00 H=0.30
#BASO 0.17 L=0.00 H=0.20

Estradiol 18.7 L=7.6 H=42.6
SHBG 11.8 L=16.5 H=55.9

Testosterone Serum 92 L=348-1197
Free Testosterone 2.9 L=6.8-21.5

I feel like a zombie. I think a few of the elevated numbers were from consuming alcohol to excess. That has stopped and is rare. I’m concerned about the low iron and obviously the hormone numbers.

Any ideas?


Sodium is low. Need some salt.

You have a degree hypothyroidism. This is affecting your quality of life.

Eat red meat to increase iron.
Your hematocrit is worrying. If you have blood removed, you loose more iron.
If you do TRT you will have to have blood removed.

Glucose was fasting?
Insulin sensitivity may be poor.
Get lab work to get better picture.
Cholesterol is getting too low, 180 is ideal
Low SHBG can also indicate a diabetic state.

Brain fog is from low thyroid function and low testosterone.
You may be at risk of diabetes. Check A1C
You need to resolve these issues.
You need more iron and that may drive RBC and hematocrit higher.
Suggest thyroid meds and TRT with blood removal. Be vigilant of HTC and RBC.

Diet: Avoid sugars, find out what low glycemic index foods are.


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