T Nation

Asymptomatic Subclinical Hypothyroidism


#1

What shoud one check for to determine the cause of subclincal levels of hypothyrodism if:
a) body temp is normal (according to this sticky).
b) cortisol is normal (right smack in the middle of the reference range).
c) none of the symptoms mentioned in Thyroids Basics Explained are present (Dry skin, Brittle nails, Low body temperatures, General hair loss..etc).

TSH
4.54 (0.27 - 4.20) uIU/mL

fT3
3.6 (2.0 - 4.4) pg/mL

fT4
1.24 (0.93 - 1.70) ng/dL

Anti-Tg
0.48 (0.00 - 4.11) IU/mL

Anti-TPO
0.00 (0.00 - 5.61) IU/mL

Cortisol:
8.30 (3.7 - 19.4) ug/dL


#2

Would appreciate your input KSman


#3

Most probably iodine deficiency.


#4

yes, discuss your sources of iodine
not using iodized salt? verify packaging.

Your TSH could be compensating for low iodine.
High TSH does create some dangers. You need ample selenium to protect the thyroid now and if/when supplementing iodine. Get a multi-vit that lists iodine+selenium

AM cortisol <10 is not good
should be done at 8AM, ~1 hour after waking


#5

Iodized table salt i would say is my main source of iodine. Always has been. I've also always used more salt than the average person. Almost all the food I’ve eaten since birth contained iodized salt.

Not sure what you mean by verify packaging. Salt I use says “Sea salt IODINE: 70-100mg/kg salt. Plastic container.

Any recommendations. You meantioned Iodoral in your sticky. Should I go with that?

Not sure if it was you that provided the link. It says that high amounts of chemical forms of iodine such as potassium iodine (e.g. Iodoral) is toxic, hence harmful to the liver. Kelp is suggested as a safer source of iodine. What are your thoughts on that?


#6

Alrighty, I’ve just learned that supplementing with iodine will actually bring TSH levels up. Way up in most cases. The reason being that the high amount of iodine that has been introduced to your system will need high amount of TSH to get the iodine to be delivered to the thyroid glands by way of sodium iodine symporter.
What I am wondering now is, doesn’t that defeat the purpose since I am taking the iodine in order to “decrease” my TSH levels? Or will the TSH come down to normal levels once I stop supplementing with iodine, having now been treated? If that is the case then how long is treatment? How do I know when to stop?


#7

Ok…let me summarize my questions for ease of understanding

  1. Taking iodine supplements to treat my elevated TSH would, in fact, raise my TSH levels. How is that considered a treatment?

  2. How long should I be on an “iodine treatment”?

  3. Is it safe to start TRT with my thyroid condition (lab results above)?

  4. Can I start TRT and iodine treatment at the same time…simultaneously “fixing” my testosterone and thyroid issue?

That’s it for now. Let me know if more detail is needed


#8

I guess i'm not going to get any help on this one.


#9

If you assume that TSH is the only and total issue, you are right. But that is wrong. Thyroid controls the energy production by mitochondria inside your cells as part of a control loop that managed body temperatures. So body temperatures are a more valid measure of things than TSH. It is fT3 that is getting the job done so we are very interested in fT3 levels. Note that fT3 can be blocked by rT3, so labs alone are not the complete picture, but temperatures are the bottom line.

So you can see that TSH is but one player on the field and TSH is not the score.

Many here have used high dose iodine and you are free to use less.
Have you studied the thyroid basics sticky?
Body temperatures and your energy levels are your guide and I suggest a two week course.

This forum is very active lately and I find it hard watching 20 football games at once and can't always get to things on time. I do all of this in my spare time and the wages suck :slight_smile:


#10

lol your dedication here, needless to say, is beyond appreciated KSman.

I did read the sticky and my temp is normal (according to the sticky), 98.4 at night. 97 waking up. Hence, the title of this thread.

I don't have any of the symptoms you mentioned in that sticky. That is why i am wondering what is causing my high TSH. My fT3, like you can see above, is normal.

Or do you think there is no need for alarm? What do you suggest i should try in order to get the levels down?


#11

98.6F mid-afternoon?
or higher?

Your hypothalamus is either reacting to lower body temperatures or is not seeing the thyroid hormones clearly. Your fT3 is well above midrange, supporting the 2nd option. This can be rT3, but obviously not a major amount. This is very rare http://pituitary.ucla.edu/thyrotroph-tsh-secreting-adenomas and even if that was going on, its still asymptomatic.

You may simply be wired differently.
The risks for you is high thyroid activity from high TSH. You need selenium to protect from free radical damage/inflammation that is normal for some of the chemistry going on. Nodules could form and they can lead to hyper symptoms and predisposes to cancer.


#12

Actually 98ish

So no need for "iodine therapy"?
OK to start TRT with my thyroid levels?


#13

With your high fT3=3.6, mid-afternoon [peak] body temperature less than 98.6F is a problem; indicating that something is preventing proper response to fT3.

?AM? Cortisol=8.6 is low and might be a factor.

98ish is not going to resolve this

Other than cortisol and fT3, CoQ10 deficiency is a technical possibility. Do not see your age here. Statin drugs can lower CoQ10.

How are your energy levels? Muscles get pain during effort or get sore easily? If you feel OK, go forTRT.


#14

I heard during my research, not sure where, i think it was stopthethyroidmadness.com, that optimal thyroid levels (in a perfect world) should be: fT3 at the upper normal range (such as my case) and TSH around 1.2.
Based on that, i though my fT3 is perfect and that i just need to figure out why my TSH is so high.

Or do you mean my fT3 is high in relation to my symptoms?

I'm 33. I take no medication at all.

My energy levels are OK. Just get lazy a lot but i'm thinking that's psychological due to low T.
Muscles don't get sore easily...but then, i haven't really worked them in a while, except mabye climbing a flight of stairs, which doesn't get them to become sore.

Just a few questions:

1. Does low T cause TSH levels to rise?
I am thinking maybe that could be the reason my TSH is high, because T levles are below the lab ranges.

2. What problems do you think I could have starting TRT with elevated TSH (hypothyroidism)?

And the most important question…

I would like to attempt a HPTA restart. I read your sticky. My question is…

3. Looking at my lab results below, which method do you think I should start…hCG+SERM (of course taking SERM depending if the hCG works) or just SERM?

TT 216ng/dL (286 - 802)
fT 34.17pg/mL (34.51 - 107.78)
E2 32.6pg/mL (7.6 - 43.0)
SHBG 16.0nmol/L (14.5 - 48.4)
LH 4.0mIU/mL (1.7 - 8.6)
FSH 3.5mIU/mL (1.5 - 12.4)
Prolactin 16.7ng/mL (3.46 - 19.4)


#15

E2 is way to high and part of why T is low.
SHBG is low relative to E2 and suggests something else is involved.
Prolactin suggests that it may be a factor too.

Never do hCG+SERM. Do one or the other with anastrozole.

A restart will not work if reason for E2 is not resolved or post restart will be anastrozole forever.

E2 can be elevated by liver problems and AST/ALT should be tested. Avoid sore muscles and training.

Prolactin can be elevated for 1-2 days after sex or cuddling puppies, kittens, babies.

Hypothyroidism typically lowers T levels, so restart is in doubt.
Low T may lower thyroid hormones and vice-versa. Complicated and not well understood.

SERM's increase E2 levels and T-->E2 inside the testes cannot be controlled by anastrozole.

I am sure that this is confusing. At this point, it would be good for you to be on 0.5mg/week anastrozole in divided doses. Test AST/ALT.


#16

I'm at %29 body fat (even though i don't even look overweight). Could that be the reason for the elevated E2?

What i meant by hCG+SERM was to do hCG for 4-6 weeks and if that works, do SERM for 4-6 weeks to get the "hypothalamus and pituitary in the game". Just like what is suggested in the sticky...or just do SERM (Nolvadex for 4-6 weeks) and if things go back to normal (it's a succesful restart), i continue with my life and pray my body will keep up by itself - meaning: no hCG.

AST 24.9u/l (≤40)
ALT 40.2u/l (≤41)

Well prolactin test was done i'd say 40-45 hours after sex. And at the time, i was living with 9 cats...although i didn't cuddle with them, just occasional petting.

What would be the ultimate goal with 0.5mg/week anastrozole? Obviously bring down the E2, but what about the main problem...T? Will i be aiming to increase T levels by decreasing E2? Is that possible? And how long should i be on anastrozole?


#17

Anastrozole can be used to modulate E2 to a more favorable level. Your body fat is driving a lot of T-->E2 as fat has a lot of aromatase.

If you lower E2, LH/FSH and T should improve, but extent not predictable.


#18

So where does the HPTA restart protocol come in? Or is the anastrozole suggestion you mentioned supposed to be the restart protocol for my case?


#19

Is used as part of HPTA restart and you would probably cruise on it afterwards given your current state.

At age 33, you should attempt to fix this. If that fails, do TRT.


#20

Well KSman, i am trying to fix this. That's why i am here, to find a way to fix this. But so far, i am not getting any solid advice on how to fix it, unfortunately.