T Nation

Scalloped Tongue?

So, I’ve got these teeth marks on the sides of my tongue. It’s known as a scalloped or crenated tongue and from my “extensive” research, it comes from the tongue being too large to fit properly in between your teeth. It appears to be linked to hypothyroidism, food allergy, hormone imbalance, sleep apnea, and some other less common conditions. I figured all of these potential causes could be rooted in my HRT protocol. I’ve had this scalloped tongue thing for at least two years, but maybe longer. It seems to have appeared after I started HRT. I’m not sure on the exact time frame though. I’m just wondering if anyone else on TRT or other forms of HRT has experienced this same thing. If you are wondering, just look at your tongue in the mirror and see if you have indentations on the side. You could also google “scalloped tongue” to see some images.

Not sure if it’s related, but I also developed elevated blood pressure after I started HRT. It was up to around 138/75, but I’ve controlled it down to about 128/70 with 5 mg Lisinopril. BTW - Hematacrit hovers between 45 and 47 so I’m good in that department. Could the higher blood pressure and swollen tongue be from an allergic reaction maybe or possibly from sleep apnea??

I’m currently on 70mg Test Cyp per week (divided into EOD doses), 1mg Anastrozole per week (divided into daily doses), 200 iu HCG EOD, and 2 grains Armour Thyroid daily. My hormone levels are good I think:

T - 1000 ng/dl at midpoint (Baseline was 196)
E2 = 25
TSH = 1.56 (Baseline was 4.5)

If you check out my older posts, you can see more detailed blood work if needed. They are summarized in my post titled “RBCs to high??”

Thanks everyone for any insight you may have.

How well is your thyroid function been managed?
All hypo symptoms gone?
AM body temp 97.7 or higher and 98.6 in the afternoon?
Any iodine intake from iodized salt and/or vitamins listing iodine+selenium?

Post thyroid labs?


This is a great question. To summarize, I’m not sure exactly. Below are the results from my most recent Thyroid Panel. I was taking 200 mcg of T4 daily leading up to this test. I have since switched to 2 grains of Armour Thyroid daily in an effort to reduce free T4 to mid range and increase free T3 to the upper quartile. I am under the impression that this will likely reduce reverse T3 production and make my treatment more effective.

As for symptoms, I’ve eliminated the symptoms that are most important to me: fatigue and the need for long afternoon naps, difficulty waking up, very slow digestion and all the problems accompanying that, and significant water retention. These problems have pretty much vanished. I still have a scalloped tongue and vertical ridges on my fingernails which have both been linked to hypothyroidism. I also have a pretty low heart rate, that is often in the low 50 BPMs, sometimes in the 40s. However, I am very fit and exercise religiously, so my low heart rate could be from that I guess.

I just took my temperature at 7:55 am, about an hour and a half after waking up, after breakfast and coffee. I took three readings: 96.4, 96.1, 96.5 (I used a typical digital thermometer). So, as you can see, my body temp is still very low despite the improvement in TSH and symptoms. I do not take iodine supplements. However, I use iodized salt on my food at least once per day… not too much though.

I’m already on a pretty high dose of Thyroid medication, so I’m kind of baffled.

I’ve always been somewhat confused about the interactions between Thyroid hormone and Testosterone. As I increased my Thyroid dosage, my testosterone blood levels increased, and I’ve had to subsequently reduce my testosterone dosage. Conversely, when I introduced exogenous Testosterone, my TSH increased, and I had to increase my Thyroid dosage. I’m wondering if my T levels are so high that my body needs super high levels of Thyroid hormone to balance everything out. Is it possible that high levels of testosterone are blocking the thyroid hormone from getting into certain tissues. Do they share receptor sites?? Should I keep increasing my Thyroid hormone until the scalloped tongue goes away, or should I decrease my testosterone dosage?? Or am I totally off track here. Below is a more detailed breakout of my T Levels

Total T - 1076 (250 - 1100)
Free T = 245.9 (35 - 155) High??
E2 = 23 (<= 39) Damn near perfect!

Call me antsy, but it’s been a few days, and there’s not much action on this one, so… BUMP!

KSMan, any further insight based on the additional info I provided above? I’m going to try the iodine supplements as suggested in the stickies. One question I have is how does this work exactly, if I’m already taking thyroid medication? I’m assuming I might see an improvement in symptoms. Can I assume that I might be able to slowly reduce my Armour dosage?

Thanks again!

Iodine is not very critical for you.

T increases/restores metabolic rates and demands. So many things can change.
T3 drives basal metabolic rate and supports above.

Your fT3 is ample to support normal body temperatures. I need to suspect that rT3 is blocking fT3. The fix for this is T3 only medication to drive down TSH and T4, reducing T4 production and T4–>rT3. Armour is better but not good enough. Compounding pharmacies can provide sustained release T3. That is a compounding pharmacy only drug in USA.

You need to get you doc on board, those body temps make you hypo and the fact that TSH>1.0 means that your hypothalamus thinks the same.

Have you read Wilson’s book on adrenal fatigue?

Thanks for the feedback KSMan. That makes a lot of sense. I have not read Wilson’s book on adrenal fatigue. I will check it out. I will also order a blood test on my own for rT3 to confirm. I will talk to my doc about T3 only, but I doubt he will prescribe it.

Should I also look at cortisol?? I recently switched to Armour about 2.5 weeks ago. Should I give it more time to see if it can help with reducing the conversion to rT3?

To stop T4–>rT3, you need a lot less T4. That requires enough T3 to repress your own T4 production and TSH then needs to be a lot lower. TSH is up because rT3 is also blocking fT3 at the hypothalamus.

Adrenal fatigue eventually can wear down cortisol levels and DHEA-S may also become lower than optimal.

Thyroid is very complex and most doctor do not seem to get very deep or thoughtful. T3 receptors have been identified, no T4 receptors have been identified. T4 is a reservoir for making T3, and rT3. fT3 gets the job done and when there is enough and you are hypo, all of these issues that I refer to need consideration. You might ask a compounding pharmacy if they make up time release T3 and if they can suggest a doctor near you who understands it use.


I got my hands on some research chem T3. Over the past several days, I’ve ramped up the t3 dosage as follows: 100 mcg, 150 mcg, 200 mcg, and now 250 mcg per day! (I’m spreading this dose out every four hours throughout the day) I’ve increased at this rate in an attempt to normalize my body temps with no luck at all. My heart rate and body temps do go up a tiny bit a few hours after each dose, but then fall back down pretty quickly. I’ve found that my body temp the first thing in the morning is often below 96 deg (around 95.7 or 95.9). I’ve been able to get up to 97.9 deg in the evening after consuming large amounts of T3 over the course of the day.

From what I understand, most people who are trying to clear their rt3 have to take pretty high doses of T3 to feel okay (usually between 75 and 150 mcg), but they will still feel slightly hypo until their rt3 clears at approximately 8 to 12 weeks. When their rt3 finally clears, they typically experience a short period of hyperthyroid crisis due to their high doses of T3. They usually have to stop taking T3 for a day, and they resume at “normal” doses of T3 in the range of 25 mcg per day or less. At this point they are able to get their body temps up easily… but not until this point. I’ve read several anecdotal accounts that follow this same pattern.

I’m wondering if this aligns with your understanding of the T3-only protocol for clearing rt3. I’m also wondering if my research chem T3 is a bad batch since such a high dose seems to be doing little to nothing.

BTW - I plan on lowering my T3 dose to about 125 mcg per day until rt3 clears in 8 - 12 weeks, so that when if does, my heart doesn’t explode!

Thanks for any insight you might be able to share.

Your understanding seems good!

Is the product good? Always a possible unknown.

Thermometer is good?

Try a dose at bed time. Note temperatures in AM and any problems sleeping.
If labs cannot see fT3 …

Thanks for the confirmation. I bought a second thermometer. Both are giving similar readings, so I’d say they’re accurate. I just received some generic cytomel from a trustworthy overseas pharmacy. I’m going to take that instead of the liquid RC T3 over the next few days to see if I got a bad batch. I’ll continue to post my results here.

As for how I feel, currently I’m not feeling that great. I’m feeling a little more hypo than when I was on the Armour. I’m kind of hoping the liquid T3 was bunk, and the cytomel will make feel better.

It’s been a few days since I posted here, and I’ve made some changes to my plan, so I figured I’d give an update. I decided to do a little experiment. I took my rectal temperature to see if there was a significant difference between it and my oral temperature. To my surprise, my rectal temp measured about 99 deg in the evening… while my oral temp was still giving me temperatures that hovered just above and below 97 deg in the evening. I didn’t eat or drink within 30 min of the oral measurements, and I made sure the thermometer was placed snugly under my tongue. It seems that i have a colder than average mouth, but my core temp is right on spec. I concluded that my body temp is not a problem, and I’ve since stopped using it to gauge my dosage.

Secondly, I replaced the research chem T3 with an overseas pharm T3 (a generic Cytomel, a.k.a Tiromel). Results are similar to the research chem T3. It seems to address most of my physical symptoms of hypothyroidism; however, mentally/emotionally, I’ve been a wreck. I cannot go on like this for 3 months… no way. So, I decided to try something different.

I checked out the protocol advice on Stop The Thyroid Madness. According to this website, I was probably under-dosed on Armour Thyroid at 2 grains/day. They recommend between 3 and 5 grains per day. So, for the last few days I’ve been on 4 grains Amour per day. I feel great. I’m hoping that over time, my rT3 problem will be mitigated due to the fact that at 4 grains, I’m only consuming about 154 mcgs of T4 vs my previous 200 mcgs of Synthroid. Also, Armour at 4 grains contains about 50 mcgs of T3. This much T3 will shut down my natural production of Thyroid hormone… which means even less T4 >> rT3 conversion. I am going to give this protocol 6 weeks and then test my Thyroid levels. I feel good right now, so I don’t think compliance is going to be a problem this time.

As for my Scalloped Tongue, it seems to be improving but it is not gone. In the morning it’s not visibly scalloped anymore which is an improvement. Toward the end of the day, it seems a bit more swollen and scalloped. Switching from T3-only back to 4 grains of Armour hasn’t reversed this progress… it’s maybe even gotten a bit better.

That’s all for now. Any advice is welcomed.

Interesting and good to see you getting proactive and motivated.

While you may suppress TSH and TSH driven T4 production, the T4 in Armour can still fT4—>rT4