T Nation

Thyroid/TSH Question for TRT


#1

34 years old on TRT for 6 weeks now. Lab work shows potential hypothyroid. Pre TRT test 293, current on TRT test 697.

TSH: 5.17 (ref. range - 0.450 - 4.50)
T4: 6.1 (ref. range - 4.5 - 12.0)
T3: 36 (ref range - 24-39)
Free Throixine Index: 2.2 (ref range - 1.2 - 4.9)

All of my thyroid panel is within the stated ranges except my TSH. My PA called me today and said i was hypothyroid because of this. I have only been on TRT for 6 weeks, but have no symptoms of being hypo…

Does anyone have any experience with this? Advice would be helpful so if i am better prepared to make sure i this is handled correctly.


#2

Forget in-range, the ranges are stupid.
TSH should be closer to 1.0
T3, T4, fT3, fT4 should be near mid-range.

T4 is low re mid-range
T3 is high re mid-range, which suggests possible elevated rT3 blocking fT3
rT3 can be elevated by stress, see the Thyroid Basics sticky.
Training when T and or thyroid function are low is a major stress.

Get fT3, fT4 and rT3 tested as well as a thyroid auto-immune panel.
Has doc palpated your thyroid for size, lumps/nodules or asymmetry?
Thyroid sore? Difficulty swallowing?

It is better to test fT3 and fT4, skip T3, T4
Free Thyroxine Index is obsolete
fT3 is the active hormone, T4 is a reservoir for T4–>T3 conversion.

Is your condition caused by or made worse from iodine deficiency?
What has been your history of using iodized salt?
Are outer eyebrows sparse? If so, for how long? Review old photos.
Do you feel cold easier now?

When do you feel your hormones started to go wrong?
How has training been affected? - time line for that?

Labs:
fT3
fT4
rT3
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
AST/ALT

We do see a lot of thyroid issues in this forum, suggesting that thyroid can affect sex hormones.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • 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.


#3

Thanks for the detailed response and link to the stickies. They were immediately helpful and informative. The updated labs are also appreciated. Now i know what tests to take to figure this out.

I eat well- but have never used a lot of salt (though i do use iodized salt, just not often). My eyebrows are normal and have not changed. Temperature-wise, i have not noticed a difference in feeling cold easier.

I would not describe my training “going wrong” but i have worked more over the last 6 months that made it difficult for me to stick my regular training schedule. I have just recently (past 6 weeks) gotten back to my standard training splits.

I will also get thermometer and begin to monitor my body temperature. That makes sense here and is easy enough to do.

After reading your post and the sticky- should i get an iodine supplement and begin taking it (considering i may be deficient here as i do not take in a lot of salt regularly).

Thank you again for the reply.


#4

A multi-vit that contains trace elements including 150-180mcg iodine and 100-200 mcg selenium would be a good foundation. You may need more iodine than that for a while, lets see what your body temps indicate.


#5

Excellent. I will get that thermometer today and begin taking temps tomorrow.


#6

Also- the PA advised to come off TRT for 4 weeks before i retest my blood levels. If i bring in a mult-vitamin with the idone and selenium and begin logging my temps- is coming off TRT also necessary?


#7

Have you asked the PA what the reasons are for stopping TRT?
And retest what?

Sometimes with a thyroid problem, a guy can feel worse as the body cannot keep up with the increased/restored metabolic demands of restored T levels. Otherwise the directive makes no sense.


#8

In the initial test, i do not think the thyroid panel was originally ordered. This was in december. I began TRT and got retested a few weeks ago with the thryoid panel and that is what i posted in this forum, which show the new levels. When speaking to her- she advised to come off TRT to be clean of everything to retest to see my thyroid levels, and this is where i got confused…

By retest i mean when i get my labs done again in 4-6 weeks to get my update panels.

*for what it is worth, i also do not feel bad in anyway and have been seeing some moderate improvements in my training and life.

Ideally, i’d like to stay on and bring in the stated vitamins and begin temp moderating then when i get my labs again, see where they are from there with the recommended thyroid screenings from you and the sticky.


#9

The request is stupid.

If a young virile male, good T levels, has a thyroid problem, they do not request castration or drugs that lower T levels so they can test thyroid again. They are thinking that TRT has cause the thyroid problem which is impossible.


#10

Appreciate the information.

That led to my confusion as i did not think those two (TRT and Thyroid) would be related.

And the negatives of just quitting TRT cold after 8 weeks are not something i am prepared to deal with at this point.


#11

Stopping TRT will not feel very good. Your T levels will probably be lower than pre-TRT. You are not showing any E2 lab results. E2 will be higher than ore-TRT which will interfere with recovery.

Have that conversation with the PA!


#12

Updated Lab results:

Results One: 2/10/17; Results Two: 3/28/17

Thyroid:
TSH 5.17 / 2.53
Thyroxine (T4) 6.1 / 6.1
T3 Uptake 36 / 38
FTI 2.2 / 2.3
T3: 91 (lab two only)
fT4 Direct: 1.29 (lab two only)
Reverse T3: 15
Triiodothyronine Free 3.0 (lab two only)
Testosterone:
Total: 842.7
Free: 33.3
F+W Bound: 280.6
IGF-1: 174
Estradiol: 12.8

I stayed on my TRT and the only real change was I started taking a kelp/iodine supplement and eating 4 brazil nuts a day for selenium. This cut my TSH in half in the 6 weeks.

Any other advice on these updated labs would be greatly appreciated and well received.


#13

You have not stated what your TRT protocol is?

E2 is way too low and can create mood, energy, joint and libido problems.
If taking anastrozole, reduce dose by 50%.

Please provide lab ranges.

It is better to test fT3 and fT4, skip T3, T4
Free Thyroxine Index is obsolete
fT3 is the active hormone, T4 is a reservoir for T4–>T3 conversion.

Your only added iodine is from the multi-vits? 150mcg?


#14

My trt is 100mg per week of test cyp. I inject once per week. And i am not taking anastrozole or anything else along those lines. I am only on the test cyp once per week. My estradiol lab range through labcorp is 8.0 - 35.0 pg/ml and my test came back at 12.8.

I got the advanced thyroid panel done on my second test last week: fT3 is 3.0 with a lab range of 2.0 - 4.4 pg/ml… My fT4 is 1.29 with a lab range of 0.82 - 1.77 ng/dl… Mr rT3 is 15.0 with a lab range of 9.2 - 24.1 ng/dl,

I only added and changed two things in my diet since my initial lab results 6 weeks ago: I added in a kelp supplement that i purchased at my local grocery store and i started eating brazil nuts for breakfast. There are no other dietary changes or supplements that are different.