T Nation

Thyroid, Iodine, and Lab Work


#1

Hi all,

I have been experiencing low T symptoms for about 3 years now and finally getting around to doing something about it. I am pretty certain that T replacement is what I need but wanted to make sure I am addressing other potential issues first. My labs are below and I welcome any advice you have.

Note: I did Iodine therapy for 2.5 weeks, 50mg a day of Iodoral, before the labs. Throughout the therapy, I did not have any gut problems or bad gas and I made sure to take selenium as well. I have had dry skin for what seems like forever. Brain fog and low energy I've had for about 3 years. I have been using salt with iodine for years, but got concerned when my starting morning temperature was 97.9, and oddly, my temperature at noon was 97.4. After the 2.5 weeks, there was no meaningful difference in temperatures. However, the brain fog and low energy symptoms improved!

AGE
43

HEIGHT
73 inches

WAIST
37 inches

WEIGHT
230lbs

BODY AND FACIAL HAIR
slightly above average body hair, intermediate to advanced facial hair

FAT LOCATIONS AND CHANGES
stomach, love handles, butt, a little in the chest

HEALTH CONDITIONS, SYMPTOMS
brain fog, memory loss, low libido, low energy/tired a lot, hard to lose weight, probable undiagnosed BPH

RX AND OTC DRUGS
No long-term Rx use, daily Claritin for 2 months every spring

LAB RESULTS WITH RANGES
see below

DIET
high protein, moderate carbohydrate, low-moderate fat, everything is tracked in Fit Day

TRAINING
upper/lower split with compound lifts EOD, occasional easy cardio on off days

TESTES ACHE?
never

MORNING WOOD AND NOCTURNAL ERECTIONS
both

LAB WORK
Cortisol (Saliva) 6.1 ng/mL 3.7-9.5 (morning)
Cortisol (Saliva) 1.9 ng/mL 1.2-3.0 (noon)
Cortisol (Saliva) 0.6 ng/mL 0.6-1.9 (evening)
Cortisol (Saliva) 0.6 ng/mL 0.4-1.0 (night)

WBC 3.9 --- 3.4-10.8 x10E3/uL
RBC 5.12 --- 4.14-5.80 x10E6/uL
Hemoglobin 15.4 --- 12.6-17.7 g/dL
Hematocrit 46.3 --- 37.5-51.0 %
MCV 90 --- 79-97 fL
MCH 30.1 --- 26.6-33.0 pg
MCHC 33.3 --- 31.5-35.7 g/dL
RDW 12.6 --- 12.3-15.4 %
Platelets 217 --- 150-379 x10E3/uL
Neutrophils (Absolute) 1.6 --- 1.4-7.0 x10E3/uL
Lymphs (Absolute) 2.0 --- 0.7-3.1 x10E3/uL
Monocytes(Absolute) 0.2 --- 0.1-0.9 x10E3/uL
Eos (Absolute) 0.0 --- 0.0-0.4 x10E3/uL
Baso (Absolute) 0.0 --- 0.0-0.2 x10E3/uL
Immature Grans (Abs) 0.0 --- 0.0-0.1 x10E3/uL
Glucose, Serum 92 --- 65-99 mg/dL
BUN 16 --- 6-24 mg/dL
Creatinine, Serum 1.09 --- 0.76-1.27 mg/dL
eGFR If NonAfricn Am 83 --- >59 mL/min/1.73
BUN/Creatinine Ratio 15 --- 9-20
Sodium, Serum 136 --- 134-144 mmol/L
Potassium, Serum 4.4 --- 3.5-5.2 mmol/L
Chloride, Serum 95 LOW!!! --- 97-108 mmol/L
Carbon Dioxide, Total 26 --- 18-29 mmol/L
Calcium, Serum 9.4 --- 8.7-10.2 mg/dL
Protein, Total, Serum 7.1 --- 6.0-8.5 g/dL
Albumin, Serum 4.8 --- 3.5-5.5 g/dL
Globulin, Total 2.3 1.5-4.5 g/dL
A/G Ratio 2.1 --- 1.1-2.5
Bilirubin, Total 1.2 --- 0.0-1.2 mg/dL
Alkaline Phosphatase, S 55 39-117 IU/L
AST (SGOT) 42 HIGH!!! --- 0-40 IU/L
ALT (SGPT) 32 --- 0-44 IU/L
Cholesterol, Total 234 HIGH!!! --- 100-199 mg/dL
Triglycerides 89 --- 0-149 mg/dL
HDL Cholesterol 56 --- >39 mg/dL
VLDL Cholesterol Cal 18 --- 5-40 mg/dL
LDL Cholesterol Calc 160 HIGH!!! --- 0-99 mg/dL
Iron Bind.Cap.(TIBC) 405 --- 250-450 ug/dL
UIBC 316 --- 150-375 ug/dL
Iron, Serum 89 --- 40-155 ug/dL
Iron Saturation 22 --- 15-55 %
Testosterone,Free and Total
Testosterone, Serum 318 LOW!!! --- 348-1197 ng/dL
Free Testosterone(Direct) 6.5 LOW!!! --- 6.8-21.5 pg/mL
Hemoglobin A1c 5.4 --- 4.8-5.6 %
T4,Free(Direct) 1.29 --- 0.82-1.77 ng/dL
DHEA-Sulfate 118.9 --- 102.6-416.3 ug/dL
TSH 2.240 --- 0.450-4.500 uIU/mL
LH 2.6 --- 1.7-8.6 mIU/mL
FSH 2.9 --- 1.5-12.4 mIU/mL
Prolactin 4.6 --- 4.0-15.2 ng/mL
Prostate Specific Ag, Serum 0.5 --- 0.0-4.0 ng/mL
Estradiol, Sensitive 18.2 --- 8.0-35.0 pg/mL
Magnesium, Serum 1.9 --- 1.6-2.6 mg/dL
Insulin 2.9 --- 2.6-24.9 uIU/mL
Ferritin, Serum 44 --- 30-400 ng/mL
T3, Triiodothyronine,Free,Serum 3.5 --- 2.0-4.4 pg/mL
Sex Horm Binding Glob, Serum 30.0 --- 16.5-55.9 nmol/L


#2

With good fT3 and low body temperatures, what is your reaction to the issues re stress, accidents, infections, inflammation and rT3?

I don’t see prolactin or E2 as direct causes of your secondary hypogonadism. But I think that your waist size is part of the problem.

What has the result been of weight loss attempts?

Low energy: What happens with strenuous exercise? Thinks go OK or can body panic?


#3

“With good fT3 and low body temperatures, what is your reaction to the issues re stress, accidents, infections, inflammation and rT3?”

Subjectively, reaction to stress is average to good. I don’t work a crazy job nor had a recent traumatic event. Haven’t had any recent infections to gauge. Unsure about inflammation. Would it be beneficial to get a food allergy test done as well as rT3?

"I don’t see prolactin or E2 as direct causes of your secondary hypogonadism. But I think that your waist size is part of the problem.

What has the result been of weight loss attempts?"

Yup, the waist is too big. It used to be very easy for me to lose weight, now it’s a bit harder. Have fluctuated for the past 15 years between 195 and 250. Don’t know the official definition, but I’m probably a yo-yo dieter, although I’ve had recent bouts (within the last 4 years) of leanness that I was able to maintain for more than a year.

“Low energy: What happens with strenuous exercise? Thinks go OK or can body panic?”

Definitely feel better.


#4

Nothing really jumps out from you labs in terms of something that suggests cause/effect/fix.

Your observation that iodine improved metal functioning does suggest that your thyroid function has improved. Your ft3 and fT4 are really good. Your TSH is high, but TSH can be come exaggerated by iodine for a while and time between that and labs is not posted.

Yes, rT3 might explain the discrepancy that we see between fT3 and body temperatures. Are you following body temps or was a spot check?

Do you have any hints of food/digestive problems? Your iron and CBC does not suggest a GI blood loss, often seen with some food/digestive conditions.

Speaking of GI, any digestive complains?

The one thing that sticks out in the labs is that your DHEA-S is getting low. You might try 25mg. Many age management docs would want to see your DHEA-S levels twice your current level. Note that some guys respond oddly and DHEA supplements can increase E2, thought to be happening in the adrenal glands.

Are you getting any essential fatty acids in your diet/supplements?

Your low body temps and low T are driving your weight problems and body fat contributes to hold you there. If rT3 is not an issue, you then need to directly manipulate your body. A trial of thyroid hormones just to see how your body and temperatures respond would be an interesting data point.

As for T levels there are these options:

  • SERM restart, Nolvadex preferred, not Clomid. There are many details.
  • hCG injections
  • basic TRT

I think that correcting your T levels would be of great benefit and your weight and cholesterol would also go down.

The end point in improved metabolic balance. There are many factors and above I have addressed the obvious. fT3 regulates body temperature by regulation of metabolic rate of mitochondria that make ATP, the universal currency of energy inside your cells. If CoQ10 levels are lacking, mitochondrial health declines. I think that you can get CoQ10 tested. You could also try 50mg ubiquinol [note spelling!] form of Coq10 and see if you feel any different and watch temperatures. You would want to make that a single change for the experiment.

You can take a high potency B-complex multi-vit that has good selection of trace elements including iodine and selenium. Most enzymes have metal atoms at their core that are catalytic reaction sites.


#5

I checked temps before the therapy, then EOD during. I was considering another round of IR then a move down to maintenance, but ubiquinol sounds more promising and cheap enough. Would I run it like IR, or is there a standard protocol that you know of?

I don’t appear to have digestive issues. I eat a good amount of fibrous veggies. Also eat yogurt, and supplement resistant starch EOD. As for EFAs, 3gm of combined EPA + DHA every day.

For thyroid hormones, would Armour or Synthroid be a good place to start, or something else?