Current Labs: Low T, Thyroid Issues

[dnfuss]

I'm 58 and symptoms have been getting progressively worse over the last couple of years. I have no motivation at work. Take no pleasure in any activities anymore. No erections, morning or otherwise. No sex drive whatsoever. I've had elevated blood sugars for many years and both parents Type 2 diabetics, so I've been on low-carb diet for several years and started on Glucophage about a year ago. Since hormones are all inter-related, I thought I should see an endo and check thyroid, etc. Now realize I should have just started with Defy and that's what I'm doing now. Endo ordered labwork, which I'm attaching. I asked for all the right tests, but some weren't done. Don't know if it's endo's fault or lab's. Also attaching a couple of tests from 2015 that I had. Spoke to endo about labs and said I should start on Androgel. Does not prescribe any other TRT meds except Clomid (no HCG, no compounded creams, no injections, etc.).

I know I need tests for SHBG, sensitive E2, and PSA (I had asked endo for them) and would like to re-test thyroid (TSH, free T3, free T4, reverse T3). I'll order them through Defy and post once I have them, but would appreciate any thoughts on what I've posted so far. Thanks!

 

[dnfuss]

New Labs

I'm 58 and symptoms have been getting progressively worse over the last couple of years. I have no motivation at work. Take no pleasure in any activities anymore. No erections, morning or otherwise. No sex drive whatsoever. I've had elevated blood sugars for many years and both parents Type 2 diabetics, so I've been on low-carb diet for several years and started on Glucophage about a year ago. Since hormones are all inter-related, I thought I should see an endo and check thyroid, etc. Now realize I should have just started with Defy and that's what I'm doing now. Endo ordered labwork, which I'm attaching. I asked for all the right tests, but some weren't done. Don't know if it's endo's fault or lab's. Also attaching a couple of tests from 2015 that I had. Spoke to endo about labs and said I should start on Androgel. Does not prescribe any other TRT meds except Clomid (no HCG, no compounded creams, no injections, etc.).

I know I need tests for SHBG, sensitive E2, and PSA (I had asked endo for them) and would like to re-test thyroid (TSH, free T3, free T4, reverse T3). I'll order them through Defy and post once I have them, but would appreciate any thoughts on what I've posted so far. Thanks!

Defy Medical had me order new labs, which I've just gotten back, and I'm scheduling a consult with them. Now that I have some more complete numbers, I'd appreciate hearing your thoughts. In addition to TRT issues, I'd especially like to hear views regarding my levels of Creatine Kinase, Calcium and Ferritin, and whether anyone thinks I have thyroid issues that should be addressed.

 

[Vettester Chris]

Thanks for posting. You did good with reaching out to Defy. That endo you were working with was no help, and just seeing that he was working with those silly index and uptake labs for testing the thyroid speaks volumes!

On your current labs, you have some problems taking place in thyroidville, and there's actually a few things from the previous labs that this could stem from ...

FT4 is at 50sh% of reference range, but then your FT3 is at 16%. This is putting adequate demand on TSH, which is responding, but what you're seeing is the bulk of T4 converting to Reverse T3. This is evident with your FT3/RT3 ratio, at 12.4 (20 or higher). Something is shifting T4 to convert at higher rates of RT3 (?). RT3 doesn't have to be over reference range to be problematic. Its serum levels can be reflected by the amount of actual thyroid hormone being produced.

If you added some Synthroid T4 and increased your serum to let's say 70% of reference range, you would then see even higher levels Reverse T3. T4 converts to T3 and Reverse T3, and depending on several variables with your health will be the factor with how much T4 converts to T3 or RT3.

The other factor to this could be iodine and selenium, but everything given, I think it's probably a few other things that's causing some problems. Your last iron serum was at 82, you will want to see that above 120 to make a difference with getting T3 into the cells; 135 could be ideal IMO. However, you have this high ferritin thing going, which I once had too. I'm a carrier for hemochromatosis, but was able to get everything sorted and controlled through blood donation. Have you been tested for this, and/or the MTHFR mutation? Something is off, the liver shouldn't be producing that much unless provoked.

The other thing that would be crucial to see IMO is a full adrenal profile. Not that cheesy single serum sample that the endo ran, but an actual 4x saliva kit, with cortisol and DHEA corrleation, plus an ACTH on top of it. I sense your AM cortisol might be below par, and that also is a KEY component with T3 and thyroid productivity. If you can get one done through ZRT or Canary Club, I will gladly (as will others) provide comments on the circadian profile, total burden, and how it compares with DHEA.

I'm sure others will comment on the other results, but your LH/FSH is definitely note worthy in comparison to your total test serum! You're producing some (not optimal) endogenous testosterone, so either there's some form of Primary Hypo in place (maybe 1 under-performing testicle? or something?), and/or something at the anterior pituitary needs reviewed? I'm sure the team at Defy will be all over it, plus you might need to check it out a little further with a Urologist. That Endo you mentioned ... You said he only does Gel and Clomid ... He didn't give you any Clomid by chance?

 

[dnfuss]

Thanks for posting. You did good with reaching out to Defy. That endo you were working with was no help, and just seeing that he was working with those silly index and uptake labs for testing the thyroid speaks volumes!

On your current labs, you have some problems taking place in thyroidville, and there's actually a few things from the previous labs that this could stem from ...

FT4 is at 50sh% of reference range, but then your FT3 is at 16%. This is putting adequate demand on TSH, which is responding, but what you're seeing is the bulk of T4 converting to Reverse T3. This is evident with your FT3/RT3 ratio, at 12.4 (20 or higher). Something is shifting T4 to convert at higher rates of RT3 (?). RT3 doesn't have to be over reference range to be problematic. Its serum levels can be reflected by the amount of actual thyroid hormone being produced.

If you added some Synthroid T4 and increased your serum to let's say 70% of reference range, you would then see even higher levels Reverse T3. T4 converts to T3 and Reverse T3, and depending on several variables with your health will be the factor with how much T4 converts to T3 or RT3.

The other factor to this could be iodine and selenium, but everything given, I think it's probably a few other things that's causing some problems. Your last iron serum was at 82, you will want to see that above 120 to make a difference with getting T3 into the cells; 135 could be ideal IMO. However, you have this high ferritin thing going, which I once had too. I'm a carrier for hemochromatosis, but was able to get everything sorted and controlled through blood donation. Have you been tested for this, and/or the MTHFR mutation? Something is off, the liver shouldn't be producing that much without being provoked.

The other thing that would be crucial to see IMO is a full adrenal profile. Not that cheesy single serum sample that the endo ran, but an actual 4x saliva kit, with cortisol and DHEA corrleation, plus an ACTH on top of it. I sense your AM cortisol might be below par, and that also is a KEY component with T3 and thyroid productivity. If you can get one done through ZRT or Canary Club, I will gladly (as will others) provide comments on the circadian profile, total burden, and how it compares with DHEA.

I'm sure others will comment on the other results, but your LH/FSH is definitely note worthy in comparison to your total test serum! You're producing some (not optimal) endogenous testosterone, so either there's some form of Primary Hypo in place (maybe 1 under-performing testicle? or something?), and/or something at the anterior pituitary needs reviewed? I'm sure the team at Defy will be all over it, plus you might need to check it out a little further with a Urologist. That Endo you mentioned ... You said he only does Gel and Clomid ... He didn't give you any Clomid by chance?

Chris, Thanks for the quick and very thoughtful reply.

No, I'm not on Clomid or anything else right now except Glucophage XR, 750 mg. X 3 (i.e., 2250 mg. total) once before bed, which I've been on for about a year to deal with dawn phenomenon elevated serum glucose. Fasting and post-prandial glucoses are now pretty good (85 to 95, rarely hit 100), but HbA1c is essentially unchanged.

I've had that high Ferritin and some other high values (Calcium, HBA1c, triglycerides, occasionally AST and ALT) that all point back to the liver and hormone issues. I am overweight by about 20 pounds and sedentary other than daily walking of about 30 minutes, which I know doesn't help. But even when I've been thinner and more active in the past, most of those numbers have gotten somewhat better but never really normal. Calcium, ferritin and HBA1c have been at similar levels for the past 20 years or so no matter what I've done.

I hope you're correct and Defy will help me start to turn some of this around.

 

[dnfuss]

Chris, Thanks again for all the great info. I have a few more questions:

The other thing that would be crucial to see IMO is a full adrenal profile. Not that cheesy single serum sample that the endo ran, but an actual 4x saliva kit, with cortisol and DHEA corrleation, plus an ACTH on top of it. I sense your AM cortisol might be below par, and that also is a KEY component with T3 and thyroid productivity.

The two ZRT 4x saliva tests I see are Diurnal Cortisol (Saliva) - 4x and Adrenal Stress Profile (Saliva). Which one should I get? If the test shows low AM cortisol, what are the treatment options?

Your last iron serum was at 82, you will want to see that above 120 to make a difference with getting T3 into the cells; 135 could be ideal IMO. However, you have this high ferritin thing going, which I once had too. I'm a carrier for hemochromatosis, but was able to get everything sorted and controlled through blood donation.

So the protocol would be donation to reduce ferritin followed by an iron supplement to raise the other iron values? Doesn't that raise ferritin back up, too, or does donation kind of even it all out?

You're producing some (not optimal) endogenous testosterone, so either there's some form of Primary Hypo in place (maybe 1 under-performing testicle? or something?), and/or something at the anterior pituitary needs reviewed? I'm sure the team at Defy will be all over it, plus you might need to check it out a little further with a Urologist.

I work in NYC and so could see Dr. Rotman, a urologist who posts to this forum. Should I try to do that before the consult with Defy so they'll have those results to review beforehand?

 

[Vettester Chris]

Chris, Thanks again for all the great info. I have a few more questions:



The two ZRT 4x saliva tests I see are Diurnal Cortisol (Saliva) - 4x and Adrenal Stress Profile (Saliva). Which one should I get? If the test shows low AM cortisol, what are the treatment options?
Get the Adrenal Stress Profile. It comes with the DHEA-s sample, which will be pertinent with the correlation analysis.


So the protocol would be donation to reduce ferritin followed by an iron supplement to raise the other iron values? Doesn't that raise ferritin back up, too, or does donation kind of even it all out?
Yeah, I know it sounds kind of jacked, but it's a bit of a balancing act to get it where you need it. My ferritin has been in the 1,400 area and tanked to the teens when I started donating frequently. You will see that your iron serum will drop as well. On your side of it, if you donate, I would just run some quick iron & ferritin labs shortly thereafter, see where you're at, talk with the doctor, possibly have a game plan with some good elemental iron to get serum levels up. IMO, it won't be terrible if ferritin is still up a bit (but coming down) as you aim to get iron serum in the low to mid 100's. * Reminds me, I'm overdue ...


I work in NYC and so could see Dr. Rotman, a urologist who posts to this forum. Should I try to do that before the consult with Defy so they'll have those results to review beforehand?
I don't know Dr. Rotman, but if he's posting here then he's got to be pretty good right! It's your call ... I don't think it's a bad thing having too much educational conversation to improve your health, as long as you're putting a plan into action ...

See above in Bold RED. Keep us posted.

 

[dnfuss]

See above in Bold RED. Keep us posted.

Chris,

I had the diurnal saliva cortisol done and the results seem to show high cortisol. I'd be interested in any thoughts you might have after looking at the report (attached).

 

[Vettester Chris]

Chris,

I had the diurnal saliva cortisol done and the results seem to show high cortisol. I'd be interested in any thoughts you might have after looking at the report (attached).

OK, good job on getting that done! Yes, cortisol is elevated, and DHEA is towards the low end. My take on this is that whatever stress your adrenal glands are enduring (?), it's putting a higher demand on Pregnenolone, which in turn takes away from DHEA production and other hormones. In a Cortisol/DHEA correlation (7 Stages of Adrenal Fatigue) it might fall into Stage 3 -Maladapted Phase 1.

Read through this online PDF link for more info. on this subject http://www.functionalmedicine.net/pdf/lesson57_insider_guide.pdf

Knowing this is elevated, it's time to find the cure and/or the cause?? I would imagine a physician would want to run further labs/exams, possibly ACTH, sodium, aldosterone etc., exam for addisons (?). Plus, at a glance, is there anything you are doing that is creating /impacting stress?? If you're an Aircraft Controller drinking 2 gallons of coffee, that could do it?

Both low and high cortisol will have an impact on thyroid hormone productivity, so an adrenal issue can be counterproductive on all aspects of your well being. Have you talked with your doctor? If so, are you getting any professional thoughts on this matter?

 

[dnfuss]

OK, good job on getting that done! Yes, cortisol is elevated, and DHEA is towards the low end. My take on this is that whatever stress your adrenal glands are enduring (?), it's putting a higher demand on Pregnenolone, which in turn takes away from DHEA production and other hormones. In a Cortisol/DHEA correlation (7 Stages of Adrenal Fatigue) it might fall into Stage 3 -Maladapted Phase 1.

Read through this online PDF link for more info. on this subject http://www.functionalmedicine.net/pdf/lesson57_insider_guide.pdf

Knowing this is elevated, it's time to find the cure and/or the cause?? I would imagine a physician would want to run further labs/exams, possibly ACTH, sodium, aldosterone etc., exam for addisons (?). Plus, at a glance, is there anything you are doing that is creating /impacting stress?? If you're an Aircraft Controller drinking 2 gallons of coffee, that could do it?

Both low and high cortisol will have an impact on thyroid hormone productivity, so an adrenal issue can be counterproductive on all aspects of your well being. Have you talked with your doctor? If so, are you getting any professional thoughts on this matter?

Chris,

Thanks for your thoughts and the link. Very informative!

I'm under plenty of stress, but I imagine most people are. Maybe I just react more strongly to it.

I recently started TRT with Defy, but didn't have the results of this study at that point. So I'm hoping Dr. Saya can address it during my consult in a couple of months. Until then I'll continue trying to learn as much as I can on my own.

Thanks, again!

 

[Vettester Chris]

Chris,

Thanks for your thoughts and the link. Very informative!

I'm under plenty of stress, but I imagine most people are. Maybe I just react more strongly to it.

I recently started TRT with Defy, but didn't have the results of this study at that point. So I'm hoping Dr. Saya can address it during my consult in a couple of months. Until then I'll continue trying to learn as much as I can on my own.

Thanks, again!

Yes, start with Dr. Saya. In the meantime take a look at the areas you can improve that will help reduce stress, e.g., better sleep, diet, shutting off the BS at work lol, exercise, too much caffeine, etc., ... Let me know how things progess.