Finally Got my Full Panel...Way Low Testosterone

On the thyroid side, look close at the labs and notice how low the FT4 lab is compared to the FT3 lab; based on where they sit in relation to the reference range. FT4 hovers in the 20% range, FT3 in the 50% range. The first suspicion I have is that FT3 is struggling to get into the body, so T4 shifts course and increases conversion to Reverse T3. So of course the missing link is Reverse T3. Elevated and/or low ratios of Reverse T3 is usually a marker for other issues, pointing towards areas like the adrenals, iron, electrolytes, and/or injury, sickness, or situations where your body needs to conserve energy and ATP.

Vettester Chris said:

On the thyroid side, look close at the labs and notice how low the FT4 lab is compared to the FT3 lab; based on where they sit in relation to the reference range. FT4 hovers in the 20% range, FT3 in the 50% range. The first suspicion I have is that FT3 is struggling to get into the body, so T4 shifts course and increases conversion to Reverse T3. So of course the missing link is Reverse T3. Elevated and/or low ratios of Reverse T3 is usually a marker for other issues, pointing towards areas like the adrenals, iron, electrolytes, and/or injury, sickness, or situations where your body needs to conserve energy and ATP.

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I'm not saying you are wrong, and I agree it would be nice to know Reverse T3 - but for argument sake and my overall understanding - With Total T4 & T3 low, isn't it impressive that free T3 is mid-range? I think his body may be optimizing his low total levels to produce the active form (Free T3). Also since he is now on 50mcg Synthroid - future tests may not tell complete picture - as you would expect all of the numbers to increase and TSH to decrease. I really think his doctor jumped the gun by prescribing Synthroid without further tests to confirm what is going on.
T4 = 6.6 (4.5 - 11.7)
T3 = 1.2 (0.8 - 2.0)
Free T4 = 1.1 (0.9 - 1.7)
Free T3 = 3.3 (2.0 - 4.4)

Note Vitamin D is 25 (30-100), and anti-TPO is 8 (<34)
I wonder what these numbers would look like if he got Vitamin D to 50+. Again assuming he was not taking Synthroid, as that is hiding any improvements Vitamin D may be providing.

Nosupermodel - how many IUs of D3 are you supplementing now and when did you start? Any idea when you will recheck your Vitamin D levels?

I do not know how many IU's I am taking. I can look on the bottle when I get home. Its just a pill from Vitamin Shoppe.

John O'Connor said:

I'm not saying you are wrong, and I agree it would be nice to know Reverse T3 - but for argument sake and my overall understanding - With Total T4 & T3 low, isn't it impressive that free T3 is mid-range? I think his body may be optimizing his low total levels to produce the active form (Free T3).

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It's only impressive if FT3 is getting into the cells of the body! T4 is the reserves. In a normal, active thyroid, you will see the Reserves (T4) are pretty steady in relation with the active T3, maybe a little higher or to the "Right" using Dr. Rind's scale.

Now, this could just easily be a case where the "demand" for T3 is at a higher rate than what can be produced, so essentially T4 is tapping out and trying to keep up. If so, then RT3 levels shouldn't be all that elevated, and some form of T4 or NDT treatment might be a good idea. However, there is a reason why Reverse T3 is part of our bio-mechanical system, and if it's elevated and/or at an unacceptable ratio to FT3, then that's a plain and simple marker noting that something isn't working right, thus prompting a shift in conversion T4 -> RT3.

This is one of the great regulation mechanisms in our body. All this taps into ATP & ADP, and how the body utilizes & conserves energy when needed! If Free T3 can't get into the body adequately, it will "pool". That's not me just thinking that's a cool concept, that's factual and it's science. So what's the first sign that someone might be pooling?? Well, in their labs when you see FT3 above the mid range, but FT4 in the tank, that's usually a good time to at least keep it open for discussion. Again, it could easily just be some form of overt hypothyroidism, and demand for T3 is high, but I would generally (not always) anticipate to see both FT4 & FT3 in the lower end of the range.

With OP's noted cortisol AM deficiency, this prompts me even more to look down that road (again, that's just science with every single human). As I stated in my post, the "missing link" is Reverse T3 ... Get a Reverse T3 assay and remove that speculation! Also, I would be interested in knowing NSM's body temperature upon waking, and possibly comparing it over a week's time (possibly do a 3x/day average comparison?)??

Chris...when you talk about there could be something else wrong, are we talking I might have something major wrong? Like Cancer or something? You guys are starting to scare me talking about something being wrong after seeing my thyroid panel. Or are we talking there is something wrong in the sense that it takes me forever to lose weight, but I put it on very fast. I also can weigh any where from 5-10 pounds heavier from the morning to the afternoon. Its crazy!!!

What about the Synthroid? Should I keep taking it and have my thyroid rechecked in another four weeks? Or should I stop all together and get retested in another 4 weeks and ask for the Reverse T3 test?

If there is something truly wrong I want to know. I have always felt that my body never worked at 100%. Always had a feeling that something was wrong.

NOSUPERMODEL said:

Chris...when you talk about there could be something else wrong, are we talking I might have something major wrong? Like Cancer or something? You guys are starting to scare me talking about something being wrong after seeing my thyroid panel. Or are we talking there is something wrong in the sense that it takes me forever to lose weight, but I put it on very fast. I also can weigh any where from 5-10 pounds heavier from the morning to the afternoon. Its crazy!!!

What about the Synthroid? Should I keep taking it and have my thyroid rechecked in another four weeks? Or should I stop all together and get retested in another 4 weeks and ask for the Reverse T3 test?

If there is something truly wrong I want to know. I have always felt that my body never worked at 100%. Always had a feeling that something was wrong.

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None of us, with the exception of Drs. Saya and Crisler, are physicians. Through our own experience and study we have come to recognize certain issues when we see them in others. No one is suggesting that you have cancer or any other serious, possibly life threatening, illness. We are not diagnosing, nor are we advocating you make any change without your doctor's approval. Chris has an enormous knowledge of thyroid and adrenal issues. Based on your lab results he is offering ideas that you should bring to your next doctor's appointment for a thorough discussion. The information you get here is to help you partner with your physician, to become an informed partner.

NOSUPERMODEL said:

Chris...when you talk about there could be something else wrong, are we talking I might have something major wrong? Like Cancer or something? You guys are starting to scare me talking about something being wrong after seeing my thyroid panel. Or are we talking there is something wrong in the sense that it takes me forever to lose weight, but I put it on very fast. I also can weigh any where from 5-10 pounds heavier from the morning to the afternoon. Its crazy!!!

What about the Synthroid? Should I keep taking it and have my thyroid rechecked in another four weeks? Or should I stop all together and get retested in another 4 weeks and ask for the Reverse T3 test?

If there is something truly wrong I want to know. I have always felt that my body never worked at 100%. Always had a feeling that something was wrong.

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NSM, NO, not at all being something major. That's the finicky part about the thyroid and how RT3 works in relation to FT3 ... The "majority" of times people will usually find that their cortisol or iron just needs balanced, that's all, or even a combination of needing more D3, or B12, Mag, in conjunction with keeping a steady supplement level of selenium.

And YES, RT3 will increase when the body is stressed, or you're sick, but this can happen with even a common cold. So next time you get the flu and you wonder why you have zero energy, YEP, this is your body taking proactive steps to get better.

As noted, get with a good doctor, get all the necessary labs, then you will be able to assess and put together a game plan!!

And YES, CW is absolutely correct. Anything I put up here, along with what other post, should be researched 50 ways and sideways, and then researched some more. This is just a place where people can share their knowledge and experiences. I have a particular viewpoint on how I see the thyroid, and how it functions thereof. However, there are other viewpoints, and when collaborated it can give someone a variety of different angles to look at when trying to improve their health.

Okay. Should I continue the Synthroid that I am on now and get retested in about 4 weeks. Or should I drop the Synthroid after 30 days and then get retested. I know I need to ask for a Reverse T3 test also.

I also wanted to know, my doc likes to check blood levels a week after last shot. But I take my shots on Monday and Thursday. Which I told him I was going to break it up that way. He said just do one shot then the week before you schedule your new blood work. Should I really do that, or just tell him, I did it the way he wants. If I don't do the one shot a week before which day would you recommend going in for the blood work considering I do shots on Monday night and Thursday night.

NOSUPERMODEL said:

Okay. Should I continue the Synthroid that I am on now and get retested in about 4 weeks. Or should I drop the Synthroid after 30 days and then get retested. I know I need to ask for a Reverse T3 test also.

I also wanted to know, my doc likes to check blood levels a week after last shot. But I take my shots on Monday and Thursday. Which I told him I was going to break it up that way. He said just do one shot then the week before you schedule your new blood work. Should I really do that, or just tell him, I did it the way he wants. If I don't do the one shot a week before which day would you recommend going in for the blood work considering I do shots on Monday night and Thursday night.

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Chris may have a different view, but I think its best to stop the Synthroid. Note it has a 6 day half-life, so you probably want to wait 2 weeks before blood draw to get accurate reading of your true thyroid levels.

As for your doctor's desire to check on day 8, just before your next injection. That would be your trough day (lowest level). And is the correct day to check if you are doing weekly injections. This is what all of the clinical guidelines advise, so that is why he is asking for that.

But try to explain to him since cypionate peaks at 48-72 hours, and it's half-life is 8 days, the E3.5D schedule is preferred by most experienced TRT users and doctors. Advise him that your level on day 4 when you have your blood drawn is technically your peak level for the week (not trough).

Not telling him what you are actually doing will likely confuse the matter. Try to educate him. And send him a link to this thread if he is open to it. Good luck!

I am headed back to get labs done again April 25th. I am going to get the doc to test everything out for me. I want to see where things are at with the Synthroid and the Arimidex I am taking. Then I will adjust from there.

OK, be sure not to take Synthroid the morning of exam. Really you should probably not take any medications/vitamins that morning. Its fine to take them immediately after the blood draw.

Did you ever figure out what your Vitamin D dose was on the Vitamin Shoppe bottle? Be sure to have that re-checked with everything else.


Chris - any thoughts on Nosupermodel continuing or not continuing Synthroid before his blood draw on April 25th.
Will taking or not taking Synthroid impact the Reverse T3 results?
These were his levels prior to starting Synthroid in early March.
TSH = 2.7 (0.27 - 4.2)
T4 = 6.6 (4.5 - 11.7)
T3 = 1.2 (0.8 - 2.0)
Free T4 = 1.1 (0.9 - 1.7)
Free T3 = 3.3 (2.0 - 4.4)
Anti-TPO = 8 (<34)
Vitamin D = 25 (30-100)

This thyroid deal has me worried. I was wondering is there a way to find a good endocronologist in my area? I am in the Dallas area.

I'd personally call and setup a phone consultation with Dr. Saya at Defy. One of the first steps IMO will be to look at the Reverse T3 lab and compare against Free T3. Some people just don't respond good at all with Synthroid, so maybe it's a case of transitioning over to a NDT medication, permitting the doctor doesn't see evident concerns with RT3, which "could" be a marker that FT3 isn't reaching the cells adequately.

If there's little or no concerns, a doctor might be inclined to start out a small dosage (1/2 grain - 3/4 grain) and titrate to a level that is optimal; both in lab results and well being. I don't know if there's a "good" Endo in the Dallas area(?), you might be looking long and hard!! Call Dr. Saya, he can help!! And just for the record, I don't work for Defy, I don't get kickbacks or anything for referrals! I just go by what I know and what I see. Like you, I'm just a guy who wants to deal with professionals who can truly help.

You can always check the A4M site, which will have physicians in your area. However, I would interview any of them first. If TSH is their first avenue for the thyroid, and they don't subscribe to anything to do with Reverse T3, then the interview is over!! No different than qualifying a doctor on testosterone, and he/she tells you estrogen isn't a factor!

I can't disagree with seeing Dr. Saya, as he is a great doctor. But - I hate the implication that a TSH of 2.7 is high, and you need a specialist to figure this out. I think any good doctor (primary or endocrine) would not put you on Synthroid with TSH of 2.7, and anti-TPO of 8 (<34). Also - improving your Vitamin D from 25, may improve your mid range TSH level. I'm not opposed to complete thyroid panel with reverse T3. But I think we are jumping ahead with suggesting he needs to see Dr. Saya to figure this out.

Ask your current doctor why they put you on Synthroid, without re-checking TSH first to see if the 2.7 TSH is always that high or if that was just a moment in time. TSH varies through the day.

Also ask your doctor for a referral to an endocrinologist if he/she is not experienced with treating thyroid related issues.

In some ways I'm impressed that your doctor is willing to treat you with TSH of just 2.7, as many doctors won't treat thyroid issues until it's double or triple that level. But force your doctor to explain his recommendation, or refer you to a specialist. No need to pay out-of-pocket, in this situation.

Chris - please answer my original question -
Will his Reverse T3 be impacted by taking Synthroid?
Would it be better to get off Synthroid for 2 weeks and then check Reverse T3 and everything else?

And Nosupermodel - I know this all make you nervous. Relax - you are in no way at risk of harm, using or not using Synthroid. I'm simply trying to emphasize that everything is ruled out appropriately. Stay positive!

John O'Connor said:

I can't disagree with seeing Dr. Saya, as he is a great doctor. But - I hate the implication that a TSH of 2.7 is high, and you need a specialist to figure this out. I think any good doctor (primary or endocrine) would not put you on Synthroid with TSH of 2.7, and anti-TPO of 8 (<34). Also - improving your Vitamin D from 25, may improve your mid range TSH level. I'm not opposed to complete thyroid panel with reverse T3. But I think we are jumping ahead with suggesting he needs to see Dr. Saya to figure this out.

Ask your current doctor why they put you on Synthroid, without re-checking TSH first to see if the 2.7 TSH is always that high or if that was just a moment in time. TSH varies through the day.

Also ask your doctor for a referral to an endocrinologist if he/she is not experienced with treating thyroid related issues.

In some ways I'm impressed that your doctor is willing to treat you with TSH of just 2.7, as many doctors won't treat thyroid issues until it's double or triple that level. But force your doctor to explain his recommendation, or refer you to a specialist. No need to pay out-of-pocket, in this situation.

Chris - please answer my original question -
Will his Reverse T3 be impacted by taking Synthroid?
Would it be better to get off Synthroid for 2 weeks and then check Reverse T3 and everything else?

And Nosupermodel - I know this all make you nervous. Relax - you are in no way at risk of harm, using or not using Synthroid. I'm simply trying to emphasize that everything is ruled out appropriately. Stay positive!

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First, throw out using that useless TSH lab as the 'Primary' marker for diagnosing thyroid issues. Use it as a 'Secondary' marker, along with the KEY labs of FT3, FT4, RT3, TPO & TgAb. Notice his doctor didn't check RT3 or the TgAb antibodies?? There's ONE (1) Great reason there to go see a specialist. I know WHY his doctor put him on T4, it was because he based it on the lower FT4 reading and probably the TSH (which IMO is about where it should be based on his FT4 (low) and FT3 (mid range) reading). Even his FT3 was sitting just mid-range, so it wasn't way up there, but the variance against FT4 should have prompted further investigation, and his doctor clearly isn't up to speed on that .. Thus, another GREAT reason to see a specialist!!

John - YES, on the T4 to RT3! Here's how it works ... T4 function as the Reserves ... Its primary duty is to convert down to T3 and Reverse T3 (Usually a ratio of 2:1 on conversion to T3 over RT3). However, once again when issues are evident that will affect FT3 with getting into the body, the T4 regulation process will UP the conversion significantly to RT3. So, to answer you, IF he's having an issue and seeing an increase in RT3, ADDING MORE T4 WILL ONLY END UP CONVERTING TO HIGHER AMOUNTS OF RT3, and the smaller amounts of T3-> FT3 conversion that make it through will only cause the 'POOLING' process to worsen "IF THAT'S OCCURRING??"

Lastly, here's a factual, 100% Real Life lab results of someone very close to me ... Female, Mid 40's, Peri-Meno
FT4 0.93........ Ref Range 0.82 - 1.77
FT3 1.7 ........................2.0 - 4.4
TSH 0.67 ..................... 0.450 - 4.50
(Hint: Estrogen Dominance)
I won't screw this thread up with getting too deep on these results, BUT I've seen many like it, and it makes all the sense in the world to me!! Most doctors might look at that TSH and presume she has Graves or leans towards hyper .. 180 from the facts!

NSM, for the life of it, get the missing labs and either take it to your doctor, or take it to someone like Dr. Saya, or a novel concept, take it to both and get two (2) opinions. Peace!

Thanks Chris. Good info - and proves the point that full Thyroid panel is needed to get complete picture.

NSM - get the blood work done (for now I guess stay on the Synthroid). And once you have those results - share them with Dr. Saya and/or other doctors to get a couple opinions. Keep us updated. Good luck!

I go back on the 25th. So I will request all labs. Hopefully they will do them all. I requested a sensitive on the estrogen and as you see I did not get it.

If they don't give me the labs I want I will go see an Endo. If I can find a good one.

Should I do the Synthroid the morning of my blood work? I typically take it first thing.

Don't bother with an Endo - they have about the worst track record on this site of any type of doctor. Seek out a TRT specialist like Defy Medical.

NOSUPERMODEL said:

I go back on the 25th. So I will request all labs. Hopefully they will do them all. I requested a sensitive on the estrogen and as you see I did not get it.

If they don't give me the labs I want I will go see an Endo. If I can find a good one.

Should I do the Synthroid the morning of my blood work? I typically take it first thing.

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Or ... You can easily order ALL of the labs you need with either Discount Labs (link at top/right of page) or Privatemdlabs.com, which takes you to the Labcorp facility of your choice.

I suggest NOT taking meds until 'after' you draw labs ... Also, I don't know if you posted or not, but how much Synthroid are you being prescribed? Has your protocol ever changed, and what significant changes have you felt on it compared to before? Based on your numbers, I can't imagine you're jumping through hoops, but curious if you ever have any hyper-sensations, cold or warm sensations, drastic changes from AM to PM, etc.? I kind-a came into this thread halfway through, so I'm playing Johnny Catchup on some of the details LOL.