Latest thyroid labs with "T" and E2

[OMI100]

2-21-2014 BLOOD DRAW
MRM brand DHEA and Pregnenolone
100mg micronized DHEA morning and - 50 mg - evening
50 mg micronized Pregnenolone in the morning
Total “T” – 691 – (348 – 1197)(LabCorp # 140103)
Free “T” – 10.8 – (6.6 – 18.1) (LabCorp # 140103)
DHEA – 441.2 – (48.9 – 344.2) (LabCorp # 004020)
Estradiol – 30.6 – (7.6 – 42.6) (LabCorp # 004515) ( 0.15 mg Anistrozle EOD)
SHBG – 36.8 – (19.3 – 76.4)
2-23-1014
Canary Club Diurnal Cortisol 4x (ZRT) results:
3.6 (3.7 -9.5) Morning
2.1 (1.2 - 3.0) Noon
1.3 (0.6 - 1.0) Evening
0.8 (0.4 - 1.0) Night
2-28-2014 QUEST BLOOD DRAW
Uric Acid – 5.3 – (4.0-8.0)
TSH – 0.01 – (0.4 – 4.5) (On NDT)
T4 Free – 1.1 – (0.8-1.8)
T3 Free – 3.8 – (2.3-4.2)
IGF-I LC/MS – 260 – (41-279)
Cortisol, Free, LC/MS/MS – 0.28 – (0.7-0.93) am
DHT, LC/MS/MS – 60 – (16-79 ng/dl)
C-Reactive Protein – 0.28 – (<0.8)
DHEA – 475 – (< or = 204)
E2 - <15 – (< or = 39) ( 0.15 mg Anistrozle EOD)(Not sure what test was taken)
Total “T”,LC/MS/MS – 557 – (250-1100)
Free “T” – 123.8 – (35-155)
VIT D 25-OH, D3 – 85 – (30-100)

Latest labs from last DR visit. He has me feathering my Armour down a bit as he felt my FT3 (if I recall correctly) was a bit high. Reduced to 6X165mg and 1X150mg with bloodwork next month.

Not sure what Quest E2 test he had marked, but it was not the sensitive one as far as I can tell. BIG differance between the LEF/LabCorp test#004515 and the Quest. I think LabCorp feels (my body) closer to the mark than the Quest test.

Seem to have low morning cortisol??

 

[Gene Devine]

Labs look good to me Orrin.

You sure can tell the micronized DHEA works!

 

[OMI100]

My Dr was bit hyper when I told him I was taking DHEA. I looked at my OLD labs and I was at 21 in Apri 2012....

 

[Vettester Chris]

Orrin, I personally think your adrenals need to be looked at further. I put the numbers on a Circadian profile so that you can see the trend with your cortisol. The AM is at the bottom (slightly below the ref range LOW), and you would IMO ideally want that in the 6.0 to 7.0 range (give or take). Think about it, there's a reason why the AM tops out at 9.5, then Noon is down to 3.0, and it gradually drops to the PM and levels out a bit. I personally would want to see how the pituitary function looks with an ACTH assay, along with Aldosterone and Renin, which might provide additional details for further discussion



Orrin, also, regarding your thyroid labs, were you taking you thyroid meds at the time of taking your labs?

 

[OMI100]

I take my thyroid meds in the morning around 0400 - 0430. I do not take my thyroid meds on morning of bloodwork, so those thyroid labs were no meds and no "T" prior to the bloodwork.

 

[HarryCat]

How do you feel? Are you experiencing any symptoms? If you fell OK and are meeting your goals in the gym, or wherever, then probably not worth chasing numbers from lab results.

 

[Vettester Chris]

Yes, Harry makes a point, how do you feel? The only thing I can offer further is that your FT4 is at the lower end of the range value, whereas the FT3 is towards the upper end. The point being is that FT4 would IMO look better if it were in the mid-range, and if there's adrenal insufficiency, this could be causing FT3 to pool. A Reverse T3 lab would help to determine this.

If you have some iron & ferritin labs, would be good to know.

 

[OMI100]

No idea what a "ACTH assay" is. Tell me more? Can I order one myself?

Looked at some old labs and did not see any tested for iron & ferritin. LEF has 2 test. 1. Ferritin and 2. Iron and Total Iron-Binding Capacity. Same test?

From LEF "Having high levels of reverse T3 is known as thyroid resistance and produces symptoms of low thyroid function (hypothyroidism). If you suffer from symptoms such as fatigue, weight gain, dry skin or hair loss and your traditional thyroid lab results are inconclusive, you might consider checking your reverse T3 level."

I am on NDT so my thyroid is shut down. My TSH is zero (O.K. 0.01). How would that impact RT3?

How do I feel... Get tired after gym/lunch and when I get home I need to crash for 30-60 mins. to charge up my battery.

 

[Vettester Chris]

Orrin, here's a link from PMD labs for ACTH. https://www.privatemdlabs.com/lab_tests.php?view=search_results&show=725&category=14&search=ACTH#725 As you know, TSH is the hormone produced by the pituitary, which is signaled via negative feedback loop by your thyroid gland. The Adrenocorticotropic Hormone (ACTH) is essentially the same mechanism in the pituitary, but it works in conjunction with the adrenals and cortisol production thereof.

On the iron ... See if you can get TIBC, iron serum, saturation%, and ferritin.

Yes, makes total sense that your pituitary is shutdown with TSH. It's the same as administering exogenous testosterone, whereas the HPTA will also be suppressed, better known as secondary hypogonadism. Exogenous thyroid medication will also suppress pituitary activity, or TSH production, in similar fashion as other hormones that respond with a feedback loop, e.g., LH, FSH, ACTH ...

Here's the scoop on RT3 ... Your NDT medication isn't the same T4:T3 ratio as what the human body produces, but it's something in the range of 4.5:1 or in that range. Some people add just a little T4 to get that ratio a little closer to baseline normal. Anyhow, your NDT is providing both T4 and T3 to your body, but up to 5x more T4 ... The job of T4 (storage) is to convert to T3, and also RT3 (in moderation). When the body is under stress, dealing with illness, and/or doesn't have the resources to get active FT3 to the cells, then the body will convert higher amounts of RT3 from the T4.

Looking at your labs, FT4 is at 30% of the reference range, your FT3 is at 78.9%. In your case, your T3 is way to the right of your T4. The suspicion is that your T3 'could' be pooling, thus you're seeing excess conversion of T4 to RT3. Your cortisol lab results just increase my suspicion. T3 won't effectively get to the cells with an adequate level of cortisol, and several other variables like iron. When it doesn't get to the cells, it builds up and is at a stand still, which is better known as pooling. Your labs at a glance present this possibility. Get the other labs and we can toss out some of the speculation.

Hope that helps ...

 

[HarryCat]

How do I feel... Get tired after gym/lunch and when I get home I need to crash for 30-60 mins. to charge up my battery.

You could try splitting you NDT dose into 2,3 or even 4 smaller doses over the course of the day, this will even out your T3 levels over the day and help prevent the late day crash.

 

[OMI100]

O.K I got the ACTH test info and will order. I have orderd from PML before. Good prices. Can you point me to the correct blood test(s). Also is the blood work done BEFROE taking thyroid meds in the morning?

 

[Vettester Chris]

Orrin, here's a link that will have some helpful advise on taking meds when labs are needed ... http://thyroid-rt3.com/stopping.htm .. There's also some really good information throughout that site, related to everything we're talking about on your thread.

In addition to the iron serum, TIBC, sat% & ferritin, look at magnesium, vitamin D-3, B12, potassium (might be on your metabolic panel) ... And of course the RT3. Again, the RT3 ratio will take out much of the speculation. Just make sure you note the unit of measurement on your RT3 when posting the results.

 

[OMI100]

TSH - 0.107 - (0.450-4.500)

Thyroxine (T4) - 7.6 - (4.5-12.0)

T3 Uptake - 33 - (24-39 )

%Free Thyroxine Index - 2.5 - (1.2-4.9)

Triiodothyronine (T3) - 145 - (71 - 180 )

Iron Bind.Cap.(TIBC) - 373 - (250-450)

UIBC - 263 - (150-375)

Iron, Serum - 110 - (40-155)

Iron Saturation - 29 - (15-55%)

T4,Free(Direct) - 1.28 - (0.82-1.77)

ACTH, Plasma - 13.9 - (7.2-63.3)

Reverse T3, Serum - 32.5 - (9.2-24.1)

Estradiol, Sensitive - 15 - (3-70) (LABCORP SENSITIVE #140244
Ferritin, Serum - 71 - (30-400)

Triiodothyronine,Free,Serum - 3.7 - (2.0-4.4)

SAME DAY AND TIME DRAW AS ABOVE.

Testosterone, Serum – 941 - 348-1197

Free Testosterone(Direct) - 27.9 – (6.6-18.1)

DHEA-Sulfate - 855.8 – (30.9-295.6)

Estradiol - 55.9 – (7.6-42.6) (LabCorp 004515)

FROM RECENT LABS

D3 - 85 - (30-199)
Potassium - 3.5 (3.6-5.0)

Have no idea whay the T and DHEA labs are where they are at now????
I do not take my NDT nor T cream on day of test.
No idea why the DHEA-S has spiked like that.
Also note that I did a standard E2 test and sensitive E2 test at the same time.
Blood was drawn at the exact same time.
Have no idea why the E2 spiked as compared to the other times with the same standard LabCorp test #004515.
Biggest change that I know off was that I stopped taking OXYBUTYNIN ER for BPH.
Did not seem to make much of a differance so why take it...

 

[OMI100]

Updated labs for T, E-2, DHEA and SHBG:
6 May 2014
Total “T” &#8211; 789 &#8211; (348 &#8211; 1197)
Free “T” &#8211; 19.2 &#8211; (6.6 &#8211; 18.1)
DHEA &#8211; 673.6&#8211; (48.9 &#8211; 344.2)
Estradiol &#8211; 56.1 &#8211; (7.6 &#8211; 42.6) Standard
Estradiol &#8211; 14 &#8211; (3 &#8211; 70) Sensitive
SHBG &#8211; 34.3 &#8211; (19.3 &#8211; 76.4)

 

[Vettester Chris]

Orrin, on the thyroid labs, we need the unit of measurements on the FT3 and RT3. Let me know.

 

[OMI100]

This should cover it (I hope).
Thyroxine (T4) - 7.6 - (4.5-12.0) - ug/dl
Triiodothyronine (T3) - 145 - (71 - 180 ) - ng/dl
T4,Free(Direct) - 1.28 - (0.82-1.77) - ng/dl
Reverse T3, Serum - 32.5 - (9.2-24.1) - ng/dl
Triiodothyronine,Free,Serum - 3.7 - (2.0-4.4) - pg/ml

 

[Vettester Chris]

Orrin, thanks for posting that information. Here's my take on it, you can research it further with your physician and make a determination on what course to take (if any) ...

As suspected from my earlier posts, you are experiencing a pooling issue with your Free T3. Your RT3/FT3 ratio is 11.4, whereas you would like to see this ratio >20, or IMO ideally even >25. This indicates that T4 is converting higher than desired levels of RT3, which the body's way of reacting to stress, sickness, pathology, and imbalances with the transport agents that enable Triiodothyronine to effectively reach the cells of our body, e.g., Cortisol, Iron, healthy RBC's are a few primary examples. The body has creative ways to put itself on 'hold' until homeostasis can be achieved, i.e., developing a fever when in contact with a flu virus. These are just simple defense mechanisms that the body has in place, this being one of them ...

This IMO is supported by a few factors ... As noted before, your FT4 and FT3 is definitely off kilter with each other. If everything is functioning properly, you would hope to see both FT3 and FT4 in the 50% to 80% area of the range value. On your latest labs, your FT4 is at 48% of range value, your FT3 is at: 71%. IMO, your FT3 is pooling, thus T4 is converting excess RT3. The reason ... Again, just my opinion, but I'd say it stems from the low cortisol (refer to the circadian profile), and chronic adrenal fatigue. Your aldosterone should also be addressed, as potassium is a bit low. This is just speculation, but I'm guessing if you can get your cortisol in a 'normal' range, especially in the AM, where it is most crucial, then other areas like DHEA will come down and balance out, and it also 'might' be the catalyst to get T3 moving in the right direction again, which could shift scales with your FT4, FT3 & RT3 level comparisons.

Just so you know, my story isn't too far off with yours. In my case, I had low AM cortisol, a little higher than yours, but still low. Also had low potassium. In similar fashion, my RT3 ratio was low and I had been seeing some pooling. In my case, I got on Isocort (it's impossible to get these days), and I also did a Circadian T3 treatment program in the AM to help increase cortisol. I won't bore you with specifics, but I suggest you research it a bit on the Net and places like STTM.com. I added 600mg/day of potassium as well. In addition to this, I take Selenium, Kelp, and currently at 1 grain of Armour/day. I can tell you I feel 10x better compared to before! You may need HC therapy, or additional exams with the adrenals, kidneys, and the metabolic profile. Also review some of Dr. Lam's information, along with Dr. Bruce Rind.

Lastly, just to rule it out, did you run any antibody labs at any point (TPO and TgAb)?

 

[OMI100]

TY Chris.
I will atar doing my research now....
BTW when I started seeing current TRT/Thyroid DR he did a full complete lab (11 vials) for everything and TPO and TgAb were checked and came back clear.
I go back at the end of the month so I will have some questions for him.

 

[Vettester Chris]

Orrin, good to know on the antibodies. If it all checked out, then you 'should' be GTG. Sometimes Hashis can still be a factor when lab values are in in the upper end of the range, but it sounds like things are fine on that part of it.

Let me know if you have any questions on anything I posted. Hoping others might have some comments as well on your labs. There might be other angles to consider.