Interpret Thyroid Labs - Fatigue Symptoms

[Mikeyp6679]

Just got back some follow up labs from Defy. I've been dealing with some fatigue issues for a while now. I'm not necessarily tired all day but I just have this fatigue like feeling where I don't have any energy some days and libido isnt back to where I want it. Workouts are pretty intense, life is stressful with work/kids etc, and sleep is not the greatest. I tend to wake 2am-ish and have a hell of a time falling back alseep most nights. I'll notice weight swings too despite no changes to diet and intensity of training program. Originally I was leaning toward adrenal problem and corresponding cortisol. I did do some salivary testing and I was definitely a little high on the diurnal rhythm curve throughout the day so i started meditating and following an adaptogen supplement protocol but not really any real progress...But now after seeing these Thyroid values...could there be something here to consider with the thyroid?

Free T3 - 1.3 pg/ml (ref 2.0 - 4.4)
Free T4 - .82 ng/dl (ref .82 - 1.77)

TSH was not tested this time but it always trends on the low end, 3 months ago was .883 uIU/mL (ref .45 - 4.5)

T is in check at 829 ng/dl
E2 is in check at 22 pg/ml
Free T at 18.6 pg/ml

Currently taking:
T Cyp 80 mg/week
Anastrazole .15mg 3x week


Thoughts?

 

[Sean Mosher]

That FreeT3 is pretty abysmal.
You must be exhausted.
What type of treatment are they recommending or are you undergoing for thyroid?

Adrenal function plays a factor too.
Any saliva-cortisol tests?

 

[Vince]

Get a complete thyroid panel. TSH, free T4, free T3, reverse T3 and both antibodies. You definitely have thyroid issues.

 

[Nelson Vergel]

I would stop the anastrozole, take Melatonin 5 mg and a phosphatidyl serine capsule before dinner, and recheck your thyroid in 4 weeks. Your TSH is low but so is your free T4, so I doubt it is hypothyroidism especially if you are having intense workouts. I agree with you that your symptoms may be adrenal (or stress- which is connected). The fact that you may have poor sleep quality explains it all.
Better sleep with Phosphatidylserine

Sleep - Ideas for Improving It

 

[Mikeyp6679]

Appreciate the feedback, guys. Yeah I'm exhausted to say the least. I've ordered a complete thyroid panel so we will see what the rest of the data suggests.

Cortisol panel was not that bad. I wasn't over producing too much and was still following the proper circadium rhythm of the rise and fall so I don't think i'm completely destroyed, YET. Workouts are early am prior to 7 am collection, for reference.

Current protocol consists of

Ashwaganda 450mg morning and night
PhosphatidylSerine 300mg at night
Magnolia Bark 250mg at night
Glycine 3g at night
5-HTP 250mg at night

I need to ditch the caffeine and stimulants next and focus on sleep. Might need to lower workout intensity for a week or so to see if i can improve things. The meditating is helping to calm my mind but its a slow process for sure. Thanks for the link, Nelson. Will give it a read after work.

 

[Vince Carter]

Your T3 needs to be treated, but then there's the question of Reverse T3, that's a glaring/questionable omission from your labs. To see FT4 low is quite common but your FT3 is abysmal as said by Sean. The adaptogens and cortisol aren't working or a focal point, until your FT3 is bumping 4.0 and reverse T3 is < 14, you're going to have a hard time with this issue.

I do not agree with injecting anastrozole use in to this equation. That has not one thing to do with why your Thyroid in the way it is.

 

[MarcoFL]

That low of FT3 can really cause poor sleep quality.

 

[Tman]

Your T3 needs to be treated, but then there's the question of Reverse T3, that's a glaring/questionable omission from your labs. To see FT4 low is quite common but your FT3 is abysmal as said by Sean. The adaptogens and cortisol aren't working or a focal point, until your FT3 is bumping 4.0 and reverse T3 is < 14, you're going to have a hard time with this issue.

I do not agree with injecting anastrozole use in to this equation. That has not one thing to do with why your Thyroid in the way it is.

...and whatever you do, change only one thing at a time, if possible.

 

[Mikeyp6679]

OK. Got some additional labs back. Should have a full picture now.

Free T3 - 1.3 pg/ml (ref 2.0 - 4.4)
Free T4 - .82 ng/dl (ref .82 - 1.77)

TSH - 1.180 uIU/mL (ref .45 - 4.5)
Thyroglobulin Antibody - <1 IU/mL (ref 0.0 - 0.9)
Thyroid Peroxidase (TPO) Ab - 12 IU/mL (ref 0-34)
Reverse T3 - 23.1 ng/dL (ref 9.2 - 24.1)


From what I can tell, the rT3 seems to be the issue here. Question is why the heck is it elevated in the first place and whats the best approach for flushing rT3 out of the system quickly. For treatment, I'm guessing the options would be T3, NDT, or supplements (zinc, selenium, tyrosine, Iodine)...or a combo of the sorts. Anyone care to share any experience with treating their high rT3?

As far as a cause goes, seems stress is a huge contributing factor...maybe the intensity of the workouts, lack of sleep and hectic life are not really doing me any favors. Vicious cycle. Also noteworthy, I have an autoimmune condition (Psoriasis) which in functional medicine can be tied to leaky gut.

I have a consult with Dr. Saya later today. I hope he has some good insight here.

 

[Vince Carter]

Right specifically talk to Dr Saya about the FT3 and Reverse T3. Treatment is T3...be ware of treatment with T4 alone as this usually doesn't work because people can't convert it to T3, for some reason, so a good treatment usually includes some blend of T4 and T3. Low dose that you probably titrate up 1-2-3 times per day watching out for any jittery or wired feeling.

 

[MarcoFL]

I would stick to T3 only until you clear out your RT3. Look up STTM reasons for high RT3. Cortisol or low iron issue.

 

[Vince]

You may want to supplement with some T4, I do like it on a lower range, if it gets too high it increases my reverse T3. Supplementing with T3 will lower your reverse T3, most preventative doctors tell you to keep it below 15.

 

[Systemlord]

OK. Got some additional labs back. Should have a full picture now.

Free T3 - 1.3 pg/ml (ref 2.0 - 4.4)
Free T4 - .82 ng/dl (ref .82 - 1.77)

TSH - 1.180 uIU/mL (ref .45 - 4.5)
Thyroglobulin Antibody - <1 IU/mL (ref 0.0 - 0.9)
Thyroid Peroxidase (TPO) Ab - 12 IU/mL (ref 0-34)
Reverse T3 - 23.1 ng/dL (ref 9.2 - 24.1)

Surprising to not see TSH elevated with such low Free T3 and high Reverse T3. It's almost as if it's a pituitary failure and a thyroid problem.

 

[Mikeyp6679]

So Dr. Saya was also surprised to see the optimal TSH. He said he has seen it but it is not common, does not believe pituitary failure.

Vince, you nailed it. I will be treating this aggressively according to him. We will be doing a T4/T3 combo titrating up. Need to keep an eye on the hyperthyroid symptoms. Will follow up with labs in 3 months to re-asses.

You guys see any benefit to the porcine/bovine NDT vs the synthetic t3/t4? I do see many reputable supplement companies producing bovine natural thyroid supplements. Im thinking things like cost/bioavailability/absorption rates. Just curious if anyone had any thoughts there.

 

[Mikeyp6679]

so its been a week and a half since Ive been on the t3/t4 combo treatment. I was told to start with 2 pills (9mcg/38mcg each) then titraite up after 2 weeks to 3 per day if no hyperthyroid symptoms - 2 in the am, 1 early afternoon.

Well i called a week in and said i still feel like crap, so I was told it would be safe to start titrating up. Well, I still feel like crap and I am noticing some very visible fat gain around the mid and water retention/swelling in ankles. If this treatment was to help, how long should I give it before I go back for more bloodwork and another consultation. Could the t4 just be converting to rt3, therefore not making my symptoms improve? In this case I suspect some t3 needs to be added? What say you guys?

 

[Vince Carter]

low dose and by your numbers you have a long way to go, patience is key which is tough to do. I would have preferred T3 only.

 

[Vtail]

low dose and by your numbers you have a long way to go, patience is key which is tough to do. I would have preferred T3 only.

Wouldn't T3 only push the T4 down even further? At what point does too little T4 become a problem? I'm dealing with similar issues - I thought I had a handle on how all this works, but the more I learn the more I realize I don't know . . .

 

[Mikeyp6679]

Thanks Vince. Patience is going to be tough with this. Dragging myself through life is getting old. This is still considered low dose? What would something aggressive look like? I think the t3 may have been a better choice in hindsight to drive down the rt3 but I guess every guy is so different it's probably hard to nail down in the first shot. I'm just really worried about the weight gain, water retention and last night was some pretty aggressive night sweats.

I've seen some guys add in some t3 to the NDT therapy with success. From what I'm reading many guys dont do well with t4 only.

 

[Vince Carter]

T4 solo treatment makes a huge assumption that you can convert it to T3 which is where it fails.

 

[Gman86]

Ya T4 only treatment just doesn’t make sense. I can’t picture any scenario where it would be ideal over NDT, synthetic T4/T3 combo, or T3 only.

I was on NDT only, at 2.5 grains, and my free T3 shot up to 7.3. While on nothing my free T3 was 3.7. On the 2.5 grains my RT3 shot up from 11 to 22. Looking back, I probably didn’t even need thyroid treatment. But anyways, if I could go back and do it again, I would of just started by taking 1/2 grain of NDT, and then getting labs done after a month. The reason I would only do a low dose before getting labs done, is because I would want to see if the low dose was just adding onto my natural production, or if it was enough to suppress my natural production, and leave me with a free T3 level below my baseline at 3.7. I also would test on the low dose to see if it raised my RT3 at all. If it didn’t, I could continue raising my NDT dose. If it did, I know I couldn’t go any higher with the NDT dose, and would have to drop the NDT and go on T3 only to get free T3 levels up.

Your case is tough, you have no clue where your free T3 level is, and no clue if the 2 grains has raised your RT3, and you’re about to increase to 3 grains. If the 2 grains is raising your RT3 already, going to 3 grains is just going to make you feel worse. You really need to stick with 2 grains and get some labs done, imo.

To answer your question about free T4, it’s not needed to feel optimal. I’m a member of the STTM fb group, and I’ve lost count of how many people on there are feeling optimal while on T3 only. Having mid range free T4 levels is ideal, due to it being like a reserve. So you can go longer periods without dosing, and still feel fine because your body has that reserve to pull from and turn into free T3. While on T3 only, you will have a low reserve of free T4, but as long as you don’t mind dosing daily, or multiple times per day, T3 only is perfectly fine.