TSH stable for 5+ years on 50mcg levothyroxine. Any reason to check Reverse T3?

[John O'Connor]

I've been steady on 50mcg levothyroxine for 5+ year now. TSH is always in the 1.0 - 1.3 range, so i haven't even checked Free T3, or Free T4 in last 5 years, and I've never had Reverse T3 checked.

I'm going for blood work on 4/13 and it will include TSH, Free T3 & Free T4.

Does anyone think I should bother checking Reverse T3 since my TSH has always been well maintained in the 1.0 - 1.3 range?

My most recent lab result called the test TSH 3rd Generation:
Here are the last 2 results. Note all of my prior results the normal range was (0.5 - 4.5).
2/26/16 (on TRT)
0.883 u[iU]/mL Normal range = (0.358 - 3.740 u[iU]/mL)

11/13/15 (pre TRT)
1.190 (same range as above.) I was not taking my levothyroxine as religiously as the 2/26/16 test, which could explain the difference. I may have missed 1 dose per week.

Originally diagnosed 5/18/2006:
TSH 3.8 (0.5 - 4.5)
Thyroperoxidase Antibodies = 800 A (0-40 IU/mL)

The following link references the other tests I'm having done on 4/13.
https://www.excelmale.com/forum/showthread.php?6540-Specific-Blood-Work-Questions

 

[Hammer]

I have been on levothyroxin for 10 years and have found that as long as I'm feeling and functioning at an optimal level to leave things alone. It took me several years to dial it in to where I felt great again. I found that as long as I am in a TSH range of 0.8 - 2.0 TSH with fairly good T4 and T3 levels I'm good to go. I've tweaked many times to get everything perfect and found that changing one little variable can shift my entire balance. Starting testosterone 5 years ago is an example of such a shift. It caused my TSH to drop reflecting that it positively impacted my thyroid function. Don't miss doses or it will result in changes in thyroid function. As far as the reverse T3 test, it wouldn't hurt but it would be more important to know what your T4 and T3 levels are independent of the total TSH to insure the T$ is converting to T3 properly. All said, if your feeling fine which you probably do since your original TSH level was only elevated to 3.8 (still in normal range but not optimal) you probably don't need further testing. That said, if you don't feel your best, get a complete thyroid panel done.

 

[HarryCat]

I agree with Hammer. If you are feeling good I wouldn't bother and I wouldn't change your protocol, but if you are having some lingering symptoms or feel a little off then it would be worth looking deeper into what might be going on.

 

[Vettester Chris]

Yeah, I'd like to know how you feel overall, and if you've had any recurring TPO attacks with your Hashis?

Regardless, even if things are decent, I highly suggest NOT to just go by the TSH results. Both Free T4 & T3 need to be included, and knowing your Reverse T3 ratio against Free T3 can only help you have a better awareness of how the big picture looks, and can possibly open the door to refine and optimize your program, if needed (?).

I will say this, 50mcg is a REAL small dosage in the scheme of things (approx. = 1/2 grain), and in most cases that I've seen & read it might not be enough to diminish the autoimmune attacks on the enzymes. However, I have seen some guys see great results with ramping us selenium in conjunction with small to medium dosages of thyroid meds, so it's different for everyone I guess!

 

[John O'Connor]

Chris - I'd say my only real original symptom was lethargy since age 25 (not crippling), and slight weight gain (10 lbs of weight in gut - othewise skinny). I bumped up to 75mcg in 2007 or 2008, and instantly dropped 10 pounds in 4 weeks without changing diet, or workout routine. But TSH dropped to 0.6 so doctor switched me back to 50mcg. And the weight stayed off for a long time and TSH numbers have always been good since. Any time they get slightly high its because I skip a dose, or get into a habit of eating 30-45 minutes after taking meds instead of waiting full hour - thus impacting absorption. But if I'm strict about taking my 50 mcg, and waiting hour to eat. My numbers are perfect.

Note my mom had Hashimotos's discovered very late, age 50+, and she claims her TSH levels were 115. She jokes her doctor whistled when he saw how high her levels were. Even the lab was shocked at the result, so the rechecked it with the same blood sample & also checked her T3 & T4 levels despite the doctor not ordering those yet. Ultimately she figures she was undiagnosed for 20 years.

That experience led her to tell me and my siblings to get checked. I first checked TSH in 2000, at age 31 and levels were 1.2. Next check was 2006 when I was diagnosed.

In 2000 I began having slight ED issues. I asked doctor to check testosterone levels, and he said my levels were normal (never saw actual levels). He referred me to a Urologist, who said it was "performance anxiety". He prescribed Viagra and low dose 25mg is all I needed to fully function. As years went by, I needed 50mg, but otherwise no big issue.

In 2012 I asked to have Testosterone checked. TT was 351 (250 - 1100), FT 53 (no range given). Doctor said, I was close, but not low enough to treat.

11/13/2015, had TT checked immediately following a 3pm doctors appointment.
4pm blood draw had TT at 204 ng/dL (300-890).

11/19/15, rechecked TT at 8am.
TT, 341 ng/dL (300-890).
FSH, 16.8 (1.5 - 12.4)
LH, 8.2 (1.7 - 8.6)

So finally diagnosed with primary hypogonadism. Upon learning this, I mentioned I had a left testicular varicocele (very common) since age 18. This explains the primary.

Now on TRT - no need for viagra, etc. Feel great. Gained 8 pounds of muscle 6-0, 183 got up to 192. Big gains in strength at the gym.

I'll start a new thread after getting results form next weeks blood draw. It will describe my full situation. As their is one more piece to this puzzle (taking Namenda since January for ADHD). Its working great, but studies show it lowers LH & FSH production. I had bumped my testosterone from 60mg to 80mg per week around the same time I started Namenda, and noticed drop in morning wood from 3-4 day/week to 1/week. I'm guessing it was due to high estrogen, but can't be sure. I'm rechecking all/full baselines (most were not checked in November). My last injection was 3/17, my blood draw will be on 4/13, so I should have good picture and baseline numbers to move forward. Note I've lost 8-9 pounds since going off T. I weighed 184 this morning. Primarily muscle loss. Strength at gym is also down. Can't wait to restart next week after blood draw. Also - I'll be switching to E3.5D when I restart. And might start HCG too.

 

[JPB]

Regarding Namenda no need to worry about its effect on LH and FSH since TRT will drop those levels to near zero.

 

[John O'Connor]

Yes, that is what I'm expecting w/ regular TRT use. But Namenda has completely changed my brain. My ADHD is 100% gone on this medication. What TRT does for me physically - Namenda has done the same for me mentally. I'm off of Adderall and use 1/3 the caffeine I did before starting Namenda. I literally pop right out of bed and feel great every single morning, which is totally new for me. I've never been a "morning person", but I'm literally a different person on this medication.

In essence both increase vitality but in different ways. My last cypionate shot was just 60mg/week on 3/17. I've since lost muscle, strength, etc. and really felt crash after 14-16 days off. But since then I can tell my natural testosterone production has kicked in (probably still 300-350), but just very interested to see what baselines of everything are, and it will be good for comparison with future blood work too. My own little experiment.

 

[JPB]

Oh ok I missed that you were attempting a restart. The restart can take several months to swing into effect, so be patient.