T Nation

Thyroid Advice with TRT?

I have tested my thyroid several times on these 2 years and a half of TRT.
TSH has been between 2 and 3.6 all the time I’ve tested it, while fT3 and fT4 always consistent. fT4 between 0.9 (Range 0.89 - 1.76) and fT3 between 3.0 and 3.2 (Range 2.4 - 4.2). Reverse T3 < 15, which is supposed to be optimal, and thyroid antibodies were fine.

I’ve spoken about it to 3 doctors (Dr Saya and Dr Kominiarek were 2 of them) and they all told me my thyroid was fine. I know everyone is saying TSH should be around 1 etc, but it seems my TSH is mostly affected by stress, while fT3 and fT4 are staying consistent.

What would you do then? Trying to supplement with NDT to bring TSH down and ft3 and fT4 up? I’ve tried Levothyroxine before TRT and it made me feel terrible, with constant muscle soreness.

@dbossa what are your doctors positions on NDT supplementation?

How much levothyroxine did you take? It doesn’t really have any side effects unless you go hyperthyroid.

Your levels are OK, but they could be optimized a little. T4 in the mid range, and T3 in the high range is optimal for blood levels. You body seems to be doing alright converting T4 to T3, so perhaps you were just taking too much levo.

If you can get it, I would recommend trying 15mg of Armour thyroid in the morning while fasted and 2 hours before eating, and see where that gets you. Take any other supplements in the afternoon or bedtime because they can interfere with the thyroid absorption.

It was taking 100 mcg per day, half an hour before eating, but I may be wrong. It was August 2017.

I can get Armour thyroid from my doctor, but I have to wait until mid-may to see how my increased TRT dose is affecting my body. I usually change one thing at a time.

I do have several of symptoms of hypothyroidism and it seems my body is not doing great in terms of regulating body temperature. I usually feel cold or too warm when other people are fine.

Are there any legit over the counter NDT available? I’ve read most of them are ineffective these days, apart from Thyroid-s from Thailand, which seems to be out of stock right now.

Wow, 100mcg is way too much. That’s a dose for full blown thyroid disease. You need 25mcg, maybe less.

I may remember it wrong, because at that time I was just taking what the doctor was suggesting, without double checking.

Gotcha. I don’t know much about over the counter. I never had an issue getting a script, but I also have full blown thyroid disease…

How is your skin, nails and hair? When I go hypo, my toe nails get super brittle. And my hair gets brittle and thins out. Your skin can also get a yellow tinge to it.

These might be more severe symptoms though.

I have brittle nails, dry skin, really thin hairs and I’m usually pale.

Does NDT shuts you down by the way?

It does not. It’s a feedback loop. Body checks to see if you have enough hormones in your blood, if not, the pituitary gland releases TSH to trigger your thyroid to create more. If there is enough, then it doesn’t need to release as much TSH.

When on Synthetic or NDT, it keeps your blood levels elevated and your pituitary gland is not signaled to pump out TSH.

As soon as you stop taking the hormones, the pituitary gland will behave exactly as it did, pretty much immediately.

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I would try a compounded T3/T4 combination.

Maybe a little high for a starting dose, maybe not. What is your bodyweight?

My doc needs to order it from a compounded pharmacy? Isn’t it easier to start with 15mg of armour as @galgenstrick said?

You could do that and many do. I don’t know about would make it easier. A prescription is a prescription. Personally, I like to customize the dose to the individual patient, so that is what I do.

Seeing my values, what dose would you start me with?

Bodyweight? Aside from the previously mentioned, other symptoms?

194 pounds. I’m usually sensible to medications and supplements.

OK, 22mcg/145mcg. Re-check in four weeks.

What about Armour, if the doc doesn’t prescribe the compounded one? Which dose would you prescribe for it?

30mg, titrate upward from there.

Thanks. Do you have your patients taking the whole dose in the morning or do you divide it in one dose in the morning and one in the early afternoon?

Most do fine with one dose in the am, there are a few that take a supplemental T3 in the afternoon.

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@highpull @galgenstrick doctor told me my TSH of 3.6 and my T3 uptake of 25% (Range 24% - 39%) are fantastic and he won’t prescribe any thyroid medication, especially Armour thyroid.

Any way to buy it online without a prescription? Or do I have to go through another doctor and do the whole round of labs etc?