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Moose, your FT4 is a tad below reference range, so call it 0% of Ref Range, and FT3 is at 64%. Do you take Cytomel T3 medication? If you don't take T3 meds then something isn't right (?). T4 could be on the low end and converting excessively to T3, and possibly T3 is pooling (?), explaining...

... And it's excellent for Anti- TPO enzyme autoimmune .. Many benefits!

Great thread, I've enjoyed reading and learning a lot with all the contributions and feedback. Keep it going Nash!!

In many cases, T4-T3 conversion issues can be nutrient issues and other imbalances. Adequate iodine and selenium can do amazing things, along with other supporting supplements like D3 and magnesium. Try it, you might be surprised to see the "cold hands" thing disappear pretty quick if iodine...

I agree with Madman. We're not here to bash on you friend, but there are factors and variables you're not thinking about, which could really impact you negatively .. It's not only what your hormone levels are presenting, but equally important to see how CBC's, metabolic profile, PSA, lipids...

As System Lord indicated, the thyroid "in range" can be quite misunderstood. I'd say 90% of the hypothyroidism guys on this forum were "in range". It's almost hard to "not" be in range ... We'll see it more often with autoimmune disorders and estrogen dominance with women, but most will always...

Here's the problem ... You've put everything all-in with testosterone as the "be all, end all", and you've hit a brick wall!! It's not, it's only one component of many. If your other hormones are off, if you have a thyroid issue, if your cortisol/dhea correlation is off, CBC's, metabolic...

"Anything I should be aware of or keep an eye on? Or change for that matter? Going to do IM for now. Quad quad, butt, butt, and rotate those 4. " Keep an eye on balancing the other variables upstream & downstream, start slow & grow into your protocol, and support it with a healthy lifestyle...

Here's how it works ... FT3 does its magic when it gets to the cells. If something is amiss, say iron or cortisol, FT3 won't adequately get to the cells, it will hit a roadblock, or better known as "Pooling", it just builds up. The body picks up on this real quick, thus the shift to Reverse T3...

They should treat the patient, not the number!

Something's going on, your RT3 is over the top! Elevated RT3 can be a marker for many things, ranging from a cold, flu, mild or major injury, or severe sickness /pathology. It can also shift when variables like iron, cortisol, and a combination of metabolic imbalances. Do you have other thyroid...

I agree with this 100%! Well said!

In adequate cortisol can no doubt cause T3 to pool, which will prompt an increase in RT3. It's the body's method to regulate and conserve energy when there's something wrong. You mentioned the low cortisol, but what does that mean? What's needed is to see your 4x circadian profile with AM, Noon...

Elevated RT3 is a marker for something else going on. It usually means FT3 can't reach the cells or adequately reach the cells (cortisol issues or iron issues), so in essence administering T3 could just mean you're feeding the fire. Find the cause of the RT3 and address it, that would be my advise.

Keep us posted how it turns out ... Thanks

You appear to have more than sufficient iron & ferritin. I agree with Rat on the adrenals ... 4x analysis is needed. The one AM serum lab you pulled is seriously lagging .. The AM needs to be in the upper 80%-90% area of reference range, then the other 3 (Noon, early evening, night time) need to...

Don't take your NDT medication before labs. Take it the day before, then take it immediately AFTER running labs in the AM.

You appear to be pooling ... FT3 is at 75% of reference range FT4 is at 14% of reference range FT3/RT3 ratio is slightly over 20, "BUT" I don't think there is all that much T4 being produced, as TSH is < 1.0. If more demand was put on producing T4, I think the RT3 would be even higher. I would...

IMO, a BUN result that is slightly over the top usually just reflects hydration, and/or can also happen when high amounts of protein are in your diet. If you're not experiencing any pain and/or issues, coloration difference in urine, etc., then it's probably no big deal, BUT, have your physician...

Canada, most of the talking points have been covered ... KEY emphasis by many is the labs. Without them there isn't all that much to contribute, but just speculation. On the antibodies, do you recall which set was positive (TPO or TgAb)? Either way, it will be good to see everything current...

Like the others, it's just a straw man conversation without labs. Also, are you currently on any thyroid meds and/or supplements? Please post your protocol and help us with some talking points...

Welcome to EM! Glad you joined, Omar!

Wrench, everything you are asking, I have thoroughly stated, answered, and repeated. 3rd and 4th paragraph in #12, 3rd paragraph in #18, etc. The chart you posted from Tired Thyroid even validates that "Available" T4 will convert to RT3 if FT3 is too high, or essentially if it's pooling and not...

That's the same thing as pooling. If you read the chart, it says “Available “ T4 will begin to conver to RT3. So what happens when you have below reference range T4? Simple, there's only a small amount of T4 available to convert to RT3. Read the first paragraph of my post in #18.

Excellent!! Your numbers are somewhat in the ballpark with mine. It's about balance, and you're finding that zone. I'm banking that with a little extra refinement you might just be able to ditch the AI all together. Great job!

Oh my, we really need a Hall of Shame section in the forum! 95% of severe hypothyroidism patients will fall somewhere in the reference ranges! SMH

Awesome post, thanks for sharing. It will be interesting to hear your thoughts on the peptides, along with the feedback on your revised protocol as it progresses. Keep up the good work!

No surprise there! You wouldn't believe half the stuff I had to deal with on my experiences with doctors /endos when I started out 10 years ago. Regardless of Primary or Secondary, treatment is the same. You're just simply replacing and increasing your testosterone serum levels with exogenous...

Low LH is Secondary, whereas it would be primary if the testicles/leydigs were not able to produce endogenous testosterone.

At 55yo, I wouldn't even put Clomid on the table as an option. Run with the cypionate, and as the wise ones stated, skip the Anastrozole. If E2 is a problem you can always include an AI down the road, and this is one of the reasons you will want to run labs in six (6) weeks after starting TRT...

Wrench, I suspect you're pooling. One (1) grain went from 12.5% to 91.6% of reference range. As my post stated, "don't be fooled by the Low RT3". That marker is a reflection of increased conversion of T4 to RT3, but as noted your T4 is sub-reference, there's just not enough T4 to convert...