Treat thyroid with a trial of thyroid supplement before looking at cortisol which will be normal. Let me guess…naturopath ? How can you even make that statement without knowing her free T3? A very premature statement. Her symptoms are classic. Normal levels are not healthy levels for
her
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No, not naturopath. MD. I agree that information is not similar to knowledge or experience. This does not mean I hastily jump on the first suggestion on treatment (at least not without having followed a person for some time). Especially since we are talking about a presumtive lifelong treatment. And you, are you educated in the field? Your opinion seem a bit one-dimensional (not meant to be rude).
Re TPO this may indicate a predisposition of hypothyroid, but could mean nothing. That being said, I would never rule out the lowest dosage trial treatment for 3 months - when all other options have been ruled out. For all I know, the description fits several diagnoses (exhaustion disorder, malnutrition or even psychiatric illness has to be ruled out).
See, now we are heading for a slamfight re thyroid. Told you so… Leaving this thread - now. See you in other threads!
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Well, argument or not, I still appreciate everyone’s input. Really, the best information comes out of heated arguments on the forums.
My wife has decided to try 30mcg levothyroxine, she started yesterday. She will get blood work in 4-6 weeks showing
TSH
FT3
FT4
TPO antibodies
She will also get a complete fasted anemia checkup.
Is there recommended blood work to test for malnutrition? I wouldn’t be surprised if she was. She eats very few calories because the claims she gains weight too easily.
Do you have experience treating “normal lab ranges” with thyroid? Do you think 30mcg is a good place to start? I don’t have Cytomel right now, but I can get it if needed.
Final response in all politeness. Please bear in mind that malnutrition might simulate hypothyroid symtoms (and in serious cases even give rise to secondary effects on thyroid tests - not present here). Dieticians often consider test of P/S-albumin as a measure of nutrition status. In healthy individuals, I would also consider a value in the lower margin to be malnutrition.
Yes, I tend to appreciate argumentation - but thyroid issues always draw the attention of extremes. “I am suffering from thyroid issues - no matter what anyone says”. And - since doctors/caregivers often have a hard time to confirming the patient, or even come up with a differential diagnosis - people seek the answers they like on internet forums… 
I’m just trying to be the voice of reason here…
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Extensive experience. That is a low dose and pure T4 which dose not make a lot feel better. Try using a T4/T3 combination such as armour or NP thyroid at a decent dose. 1 grain of armour or NP has 38 mcg of T4 and 9 mcg of T3. Have her call Tier 1 and talk to Angie
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How did the sleep study go?
A lot of troubleshooting going on in this thread. I know a little bit about female HRT I have been on TRT for over 7 years and my wife has been on HRT for 5. I also have sleep apnea and use a BiPAP machine. A machine I would highly recommend if a CPAP is prescribed. I am pretty good at hacking those machines so I would be happy to help if you want to adjust her machine numbers.
Other comments,
I did not see much wrong in your wife’s blood test but there was room for lots of improvements with the right doctor.
I also did not see anything wrong with her thyroid numbers. This forum has a couple of thyroid zealots. Years ago I wasted several hundred dollars buying blood tests that were not needed from recommendations from forum members here. So be careful.
You did not give us much other info on your wife. Age, weight, activity level. Based on her bloods she is not premenopausal. If she is overweight and sedentary that could be the cause of her being cold all the time.
Still no results in sleep study. It was completed though!
I hear you on the blood tests. I have wasted quite a bit as well. But some were worthwhile.
She is 40, 140lbs, not overweight. she is not super active due to low energy. She tried weightlifting 3x per week and walking every day for about 4 months and it didn’t change anything for her as far as mood and energy. Diet is very healthy. Fish, eggs, vegetables, beans, salads, etc. once in a while we will get something unhealthy on a weekend when we go out with friends or whatever.
I feel all the tests you have done so far have been good ones. You two are learning. Not being overweight and still having circulation issues (that is usually where the cold extremities come from) is a concern worth talking to her doc. How are her lipids and A1C. What about blood pressure?
Anyway, all women are different here is my wifes happy place with her HRT I hope it gives you a data point to consider.
Her HRT protocol consists if T cyp injection which I give every Monday, 10mg/day Anavar an oral steroids for joint pain from having arthritis and osteoporosis and Oxytocin daily to bring back sexual desire from being postmenopausal.
Yes, we have a good doc she is the best.
Update on this.
Sleep study showed no apnea
They did say she had hypersomnia
They checked ferritin
35.9ng/ml (12-306ng/ml)
They prescribed her to take ferrous gluconate 65mg/day with vitamin C for 3 months. One month off, then retest.
She is still taking 30mg levothyroxine but not feeling anything from that. It’s only been 3 weeks though.
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She doesn’t get any virilization with such high T? The range is a bit deceptive in those graphs. It appears she is about ~18X over range for FT. I would guess she feels pretty good, and if she isn’t getting sides, I guess it is probably fine.
I think my concern would be that once you get androgenic side effects, there’s no reversing them. But I could be completely wrong about that, I don’t have much experience with hormones in women.
Nope no sides whatsoever. In fact when we got this blood test back I suggested she cut back by a 1/3rd. She did for 4 weeks and asked to go back up. Her HRT doctor has no issues with these high numbers and they test everything in her blood work. She suffers from RA, osteoporosis, and colitis.
Both RA and osteop are in remission and she says she feels 20 years younger with no joint or bone pain.
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So you don’t think high T acne would go away? She has always had oily skin but has no acne anywhere.
Not sure about deeper voice.
Not sure about enlarged clit. I do get to check that weekly. haha
These are the only 3 things I’ve read about when women take T to look out for. Are there others?
Her blood is still thin as water with a hematocrit of 44
Facial hair would be another.
How long has she been on this protocol?
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4 years for the T, 2 years for the Oxy, and 1 year on Anavar.
You got most covered. The other thing I can think of as a negative for women is more body hair, and male pattern baldness. Now with her T levels, she would be at the levels of a hypogonadal man. Most hypogonadal men will lose their hair slower than a higher T man (depends on DHT levels too). If she has the genetics to be someone who only would have had good hair until she was early 20s (had she been born a man) it might be an issue. If she is your age, and even has average hair genetics, it will probably hold out. Also, at a certain point nobody looks good anyways. Feeling a lot better from late 60s until close to 80 would be worth the trade off IMO. Most women with good hair in their 80s are wearing wigs anyways.
If there isn’t change in body / facial hair by now and she feels good, I would stay the course.
She is 62 and has thick black hair. about 25% has turned silver. She does not dye the silver out I like it. Neither one of us would win a beauty contest. I will say before HRT her boobs were flat and laid against her belly. Now they are plump and no longer sag. It is quite a turn on for this old man. I wish HRT did something that dramatic for me like grow my dick another 4" haha
How many times do we tell other member here it is how you feel not a number on paper. I think it is the same with a woman and HRT. That said I know no other women on HRT so I only have 1 point of reference.