Hashimotos + Low T

[galgenstrick]

Anyone else have this? Is there a relationship between hashimotos and low T? Is it possible to correct the Low T though only thyroid hormone with this autoimmune disease?

I've read the thyroid stickies, and some of it only seems to apply to people with functioning thyroids. But for those of you dependent on medication, what was the treatment that helped you the most?

My thyroid levels November 2016:

TSH: 0.05 (0.45-4.5)
FT3: 3.00 (2.00-4.4)
FT4: 1.73 (0.82-1.77)

Since this test I've drecrease my desicated thyroid slightly: so I lowered my T3 dose by 2.25mcg and lowered my T4 dose by 9.5mcg.

My T levels last June:

Total T: 417.8 (348.0-1197.0)
Free T: 11.7 (9.3-26.5)

Since these results in June I've been feeling even worse. Zero libido, angry and short fuse all the time, barely any sleep at night, gaining fat and nearly no strength or muscle on Starting Strength program, anxiety, sore joints and muscle, stiff and hard to even tie my shoes.

I have a brand new endocrinologist who ordered new thyroid, testosterone and glucose tests. The results should be in next week. After that visit I've been reading up on here. I do know he is checking my total T, free T and bioavailable T. I don't know if he's checking my FSH, LH or prolactin. That's probably the next step if T is low still. I didn't even ask him to check my T, but after hearing my symptoms he ordered the test, perhaps I lucked out since my other endos wouldn't even check my T level if I begged them. I had to order them myself...

Anyways, I hope to get some advice on this so I can make the most educated choices.

[jimgainz]

Hi there – your situation is very similar to my own. I've been struggling with low T symptoms for a while – and went on and off various forms of therapy (HCG, androgel, Clomid).

Recently, I had an appointment with an antiaging doctor who ran a complete set of labs – and my TSH was 4.1–so he recommended getting a full set of thyroid lab ( mind you, my Endo laughed at this and said I was wasting my time and money). Well, what do you know - turns out I have Hashimoto's as indicated by the thyroid antibodies. My testosterone, free testosterone, as well as T3 and T4 were very similar to what you have posted - however it was the thyroid antibodies which were way out of range, plus a family history of Hashimoto's that lead to the diagnosis.

Long story short, I went on TRT – currently doing Androgel at three pumps/ day and it's like a night and day difference. I feel like my old self most of the time.

You asked if TRT can help with the low thyroid issue – and the answer is it does not in that it cannot improve your thyroid levels. However, you will definitely have more energy, feel better and sleep great.

In my case, my Endo wanted to retest me in 4 months. He did a thyroid ultrasound to see if the Hashimotos caused any nodules. It did not. He said if it did, he would have put me on a low dose of synthroid.

He also checked for low D and low B12 - both of which are important for people with autoimmune disease. My results were low normal but he advised upping the dose to get them to mid range.

My main low thyroid symptoms still persist - sensitivity to cold, dry skin and I crash early (8:30 pm or so I can barely keep my eyes open). But the supplemental T has been a tremendous asset in every way - sleep being one of them.

Again, my numbers were very close to yours and I can say without a doubt that TRT has been very positive so far. I'll have to figure out the thyroid issue one step at a time.

[galgenstrick]

That's awesome to hear. I was diagnosed when I was about 15 (30 now). My antibodies have always been through the roof. I guess what I'm getting at is if the thyroid condition can cause low T, not the other way around.

As far as regulating thyroid, I haven't found that certain numbers help more than other. I feel crappy no matter what. I've also tried the gluten free diets and other things sometimes recommended for Hashimotos. It has been extremely frustrating to me that doctors always point to my thyroid whenever I have a complaint, if my TSH is slightly high or slightly low they just tell me to change my dose and the symptoms will go away instead of looking at anything else. I feel like it's splitting hairs to have a TSH of 1 vs. 2 or 3. Especially considering daily fluctuations and the thyroid gland breaking down -- it's a moving target and I'd never expect to maintain a perfect number for FT3, FT4, or TSH.

I'm really glad the TRT is working for you, that give me hope.

[KSman]

fT3 is the active hormone and is a bit below mid-range and could be improved. I would not have decreased T3 dose. However, when taking thyroid meds, serum levels change after dosing, so the numbers can be hard to judge. Body temperatures may provide a clearer picture.

fT4 is high normal. T4 is a reservoir to support fT4-->fT3.
I am calling this impaired fT4-->fT3 conversion.
This is sometimes seen with and caused by low ferritin.

Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

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

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.

Please check oral body temperatures and you might consider this as a medication guide.

Both low thyroid function and low T can mess with your mood. Estrogen dominance can make guys bitchy and short tempered.

Are outer eyebrows sparse?
Do you get cold easily?

Were you iodine deficient for years prior to Hashimotos?

Labs:
TT
FT
E2
LH/FSH <-- do not start TRT before doing this
prolactin if <25
PSA is >40
CBC
hematocrit
ferritin
AST/ALT
AM cortisol

[galgenstrick]

Thanks for the reply!

I'll get my temperature first thing tomorrow morning.

As for iodine-- I've read it's a bit controversial for Hashimoto's patients to take iodine because it's shown to trigger and autoimmune response. Some studies showed that that was only the case if you are selenium deficient, so it's hard to tell.

My endochrinologist did my last lab before taking my thyroid medication in the morning so he could check my bodies T4 to T3 conversion. BTW I've had my T3 at the very top of the range before, and felt just as terrible as I do now. Not to say that's a bad thing, but minor tweaks to my meds don't seem to do much for my mood or training in the gym.

Was I iodine deficient before? Doubtful, I've always used iodonized salt and is contained in my multi vitamin.

Sparse outer eyebrows: no
Sensitive to cold: not really, but mostly get hot flashes and cold sweats randomly.

I'll post all my lab results as soon as I get them. I will also ask to get tested for anything he may have left out that's on your list. I don't know exactly what he ordered.

-age: 30

-height: 6'0"

-waist: 34"

-weight: 210

-describe body and facial hair: full facial hair, very little chest hair. Thin hair on stomach.

-describe where you carry fat and how changed: always carry on chest and love handles.

-health conditions, symptoms [history]: Hashimoto's Thyroiditis. Anxiety, short fuse, anger, sever insomnia, no desire to do things like I used to. These are mostly new in the past couple years

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Levothyroxine, Armour Thyroid.

-- real dangers! see this http://propeciahelp.com/overview49

-lab results with ranges: Coming soon

-describe diet [some create substantial damage with starvation diets]: last year or so have been in a caloric surplus -- 200g protein per day, moderate fats and carbs. Approx 3500 calories.

-describe training [some ruin there hormones by over training]: Starting Strength for the past 4 months. Before that I did a 4 day split. Limited cardio

-testes ache, ever, with a fever? No

-how have morning wood and nocturnal erections changed: yes, they are gone since last year.

[galgenstrick]

Lab results in:

TT: 467 (300-1080)
FT (calculated): 108.3 (47-244)
Bioavailable T (calculated): 248.3 (100-680)

Thyroid:
TSH: 7.56 (0.4-5)
FT4: 0.98 (0.90-1.70)
T3: 111.8 (80.0-200)

Thyroid is a little low, however he had me check the values before taking my medication in the morning so not surprising. He wanted me to stop taking T3 and increase my T4 from 112 to 150mcg. Not sure if that's a good idea either since he didn't even check my FT3 levels...

I don't trust the calculated T values, maybe I Should? Even still, they are very low for a 30 year old. Of course endo told me they're normal. I've left a message with him and hopefully we can talk about the numbers. I've also made an appointment with my PCP for a second opinion who also knows about all the problems and symptoms I'm dealing with.

Any suggestions?

[KSman]

Suggestions? Did you get the requested body temperatures?

TSH=7.56 is horrible. Where are the body temperatures?

fT4 is well below mid-range, you are under medicated.
T3 is well below mid-range, you are under medicated.

There is absolutely no justification in reducing or stopping T3 medication.

Things were a lot better November 2016

Please read my earlier post(*s) and follow all leads.

See the finding a TRT doc sticky that I suggested.

[galgenstrick]

Agree on TSH. This is the first time I've had a serum test BEFORE taking my thyroid meds. Normally I was instructed to do the serum test 5 hours after medicating. That explains some of it. The endo increased my dose of T4 38mg. I've called him and left a message to ask why he wanted to drop the T3.

Temperature was very low, so I ordered a new thermometer to check against. It measured 96.3 this morning.

I found a TRT clinic that seems pretty good. The cost is $120/mo which includes lab tests, office visits, test cyp., Needles and AI + HCG if needed. From the others I've looked at, this is half the price at least.

They did serum tests today to see where all my levels are currently at. I don't know if they included LH/FSH and prolactin, but if not I will get those ASAP. The test did include the other items on your list of things to test before starting.

[KSman]

At age 30, you need to get LH/FSH tested to try to find out why you have issues at this age. If LH/FSH are low, you need prolactin to see if that is a cause. Low-T can be a symptom of a pituitary adinoma and at your age, you have a cause, its not age related.

[galgenstrick]

I really appreciate the info. It's been consistently low for the past 9months at least since my original test. But doesn't seem to have gotten worse. I'm wondering if it's just part of the autoimmune disease.

What I've tried:
Weight loss
Weight gain -- I tried to put on muscle slowly but it ended up being fat with minimal strength increase
Multi vit including therapeutic dosages of zinc
Resistance training -- I lack the ability to get stronger on Starting Strength program
Fish oil
Playing with thyroid dosages, I've been hyper and hypo and normal and it never seems to make a difference
Anti inflammatory diet
Anti depressants
Anti anxiety drugs
Sleeping pills

I will get my LH/FSH and prolactin levels checked for sure before starting TRT. Anything else you recommend checking? I'd like to be sure I make the most educated decision.

[galgenstrick]

One more question. Is there any way to tell if Insomnia is due to Low T or if my low T is from the insomnia? And can chronic insomnia account for a >50% reduction in total and free T levels over 2 years?

I've tried everything to get sleep at night and nothing works. My anxiety is way too high, even when I have nothing to be anxious or stressed about. My life is very easy going but I'm stressed, irritable and anxious for no reason all the times...

[galgenstrick]

Morning temp today = 96.8
Afternoon temp today = 96.6
Second thermometer = 97.1 afternoon - same time as previous measurement. That's quite a discrepancy -- I'm not sure I trust any of these cheap thermometers..

Also, I forgot to mention:

I'm weaning off caffeine. I have been using caffeine pills since about the time my symptoms started. Seems like an obvious thing to cut out and see what happens. I was up to 400mg caffeine from pills + tea every day. I'm currently down to 150mg with no tea.

While I don't think caffeine has directly caused my insomnia because I've only taken it to get out of bed, it has likely heightened my anxiety throughout the day which can lead to insomnia for sure. Perhaps it's that simple. Caffeine leads to anxiety leads to insomnia leads to low T. Who knows, but worth a try. I wouldn't be surprised if I'm especially vulnerable to this given my wide fluctuations in thyroid hormones on top of it.

[jimgainz]

A lack of a deep sleep can't absolutely lower your testosterone. In fact, testosterone is only produced in Stage 4 REM sleep. This is why many folks to stay up all night because of work, or can't sleep have Low T issues.

[galgenstrick]

Update here.

Morning temp = 96.9
Almost 0 sleep last night, still having mirtazapine withdrawls (insomnia) and adjusting to new thyroid dose.

New blood results are in and talked with my Doc over the phone. Hopefully she'll send them over to me so I have all the numbers to list here. She only gave me my total T over the phone.

TT = 362
FT/FSH/Prolactin/SHBG = Coming soon

I also got test cyp. in the mail today.... before even getting a scrip for it?? WTF - these clinics are pretty sketchy... I will not be starting TRT until I've attempted to clean up my life a bit in the next few months.

---

Last couple nights I don't think I slept more than an hour or 2. I was pretty wired, perhaps from the increase of T4.

My caffeine dose is now 50mg for the next 3 days, then I'll be cutting it completely while I try to turn things around for myself.

Edit: screw it, I'm going off caffeine cold turkey tomorrow. I've tapered down quite a bit had a headache yesterday but felt fantastic today on only 100mg.

---

I'll be cutting all supplements (except D3 and selenium) for about a month, then reintroduce them one at a time to see how they affect my sleep and anxiety levels.

I've stopped weightlifting this week and possibly next week as well depending on my sleep. There's definitely a chance I've been in an overtrained state for a while now since my sleep has been non-existent. I'm not making gains anyways, so it will be just a minor setback.

I'll keep logging my progress here.

[galgenstrick]

Morning temp = 97.4 seems to be going up steadily with new thyroid dose.

Sleep was again really crappy. Anxiety very low, and actually has been lower than it has been in a long time which is great. I feel like if I can just get a couple nights of good sleep that will begin balancing out my hormones and it will be easier from there.

Based on the half life of the mirtazapine I was on, it's still in my system. Insomnia is a common withdrawal symptom from that. I'd say another 3 days and it will be completely out of my system.

Today will be my first day in a very long time with 0 caffeine.

[galgenstrick]

Morning temp = 97.6

Sleep: better than last couple night but still crappy, woke up wide awake at least 4 time.

Going to Dr. tomorrow to discuss a sleep study and my low T concerns.

Anxiety stress and depression have improved noticably with removing caffeine so far. Anxiety is no where near where it should be though.

[galgenstrick]

Morning temp = 97.6 again

Sleep was definitely improved last night. Day 3 without caffeine and energy levels are more stable. Sleep was much deeper than its been in over 3 years. I still woke up at least a few times for unknown reasons. If the waking up improves a bit and the sleep is a consistent thing, I'd be pretty confident in my T improving.

[galgenstrick]

Morning temp was a little lower 97.1

Woke up at least twice. The second time was about 5am and I was really up, couldn't get to sleep again.. I feel like my sleep quality is improving. I'm dreaming more for sure. Wish I could just sleep through the night though..

Still going through caffeine withdrawals, but they're getting a lot better. Perhaps something like melatonin will work for me now. I'd didn't do a damn thing for me before going off caffeine.

Booked an appointment with a new endo, also an appointment for a sleep study in March.

[galgenstrick]

Another day without caffeine and it's really having some profound effects.

Sleep is a lot deeper, it's not perfect and still broken up a bit, but I dream a lot more, have vivid dreams that I can remember the next day, and it's harder to wake me up from sleeping.

A bit groggy in the mornings but I expect that will pass in a few weeks. I'm aiming to drink a liter of water after getting up to help with this.

My anxiety, depression, and anger that I've had for the last 2 years is nearly gone now.

Libido is slowly returning

I will be very curious what's my T levels are in a couple month. I would bet this was a huge part of my problem

I really encourage anyone thinking of going on T replacement to drop caffeine for a while and see how they respond. I was only taking 200-500mg /day (considered a safe dose) and dropping it has made a world of difference.

[galgenstrick]

Finally got the rest of my lab results!

FSH: 1.8 (1.5-12.4) mIU/mL
LH: 2.2 (1.7-8.6) mIU/mL
Prolactin: 7.4 (4.0-15.2) ng/dL

Not sure what to make of these. Advice is appreciated