Thyroid labs help

[mike036]

I have had some numbers off. How did you get a script, an Endo? Was it a pain in the ass to get?

Sorry, the wellness place just prescribed bloodwork. I get my script for meds through MaleExcel. The meds come from a compounding pharmacy Anazao Health

 

[MouthBreather1982]

Thanks for your input. My dessictated thyroid comes from a compounding pharmacy and has 10mg selenium as selenomethonne/capsule. My iron was a little high, 185. My vit d was in a good range. I haven’t had cortisol checked. I am not sure about Vit A but there is a decent amount in my multi and also in my greens powder.

I speak perfect English but just woke up, so I don’t usually sound like I chill with Putin. Lol I must sound esl. That’s pretty awesome that it comes with selenium. My only guess, again as a layman is the preparation. Maybe try a different one

 

[Black Beard]

I am currently prescribed 180mg desiccated thyroid and am using 20mg/day test cyp. No GH
My free T3 looks good but my free T4 is low and Tsh above 3. I can never get my Tsh lower than 3. 180mg of dessicated thyroid is a pretty hefty dose equal to about 27mcg T3 and 114mcg T4.


Free T3 3.6 2 - 4.4
T3 142 71- 180
T4 5.2 4.5- 12
Free T4 .79 .82- 1.77 Low
TSH 3.39 .45- 4.5
Reverse T3 12.5 9.2- 24.1
T3 uptake. 22 24- 39 Low
Free Thyroxine 1.1 1.2- 4.9 Low
Index

You have hypothyroid Free T4 levels. This happens all the time with NDT only. Optimal replacement is primarily levothyroxine AKA T4 with T3 or NDT added if and as needed. It's very simple.


People with healthy thyroid generally hover around 1.4-1.7 Free T4. Free T3 can fluctuate more due to genetics, lifestyle and body comp (low carb/low calories = less T3. Being leaner = less T3, etc).


Not all tissues will reach a "euthyroid state" without optimal levels of both T4 and T3. T4 is not an "inactive hormone" contrary to popular belief. Having it optimal is very important for wellbeing.


Most patient's need 100-200 mcg daily on empty stomach to achieve that optimal level. Most only need 0-15 mcg T3 once Free T4 is optimized. Once you are fully optimized, you will have zero hypothyroid symptoms, period.


You are still hypothyroid in some tissues with such a low Free T4, so you won't feel right until that is addressed.

 

[nothuman]

I take a 25mcg/12.5mcg T4/T3 tab that I split in half and take in two doses each day. This is the best I have felt from a thyroid standpoint in years. TSH 1.4, FT4 1.2, FT3 3.2

 

[Black Beard]

I take a 25mcg/12.5mcg T4/T3 tab that I split in half and take in two doses each day. This is the best I have felt from a thyroid standpoint in years. TSH 1.4, FT4 1.2, FT3 3.2

Yeah, generally, FT4 can be a bit lower if T3 is a bit higher to compensate and some feel better with a lower FT4 to FT3 ratio. The T3 will peak about 2 hours after labs with return close to baseline at 24 hours. (if i recall the pharmacokinetic data correctly)

 

[nothuman]

Yeah, generally, FT4 can be a bit lower if T3 is a bit higher to compensate and some feel better with a lower FT4 to FT3 ratio. The T3 will peak about 2 hours after labs with return close to baseline at 24 hours. (if i recall the pharmacokinetic data correctly)

Yea I am used to my FT3 in the high 2's when I don't take any thyroid, with a FT4 of 1.4 and TSH around 1.5-1.8, and HEAVILY symptomatic.

 

[Black Beard]

Yea I am used to my FT3 in the high 2's when I don't take any thyroid, with a FT4 of 1.4 and TSH around 1.5-1.8, and HEAVILY symptomatic.

Yeah, the issue is relying solely or primarily on TSH to diagnose and titrate thyroid issues.


Can you imagine we started using LH/FSH to guide us with TRT? It's the same exact thing. Why are focusing on the pituitary messenger instead of the actual hormone. It's non-sense.

 

[nothuman]

Yeah, the issue is relying solely or primarily on TSH to diagnose and titrate thyroid issues.


Can you imagine we started using LH/FSH to guide us with TRT? It's the same exact thing. Why are focusing on the pituitary messenger instead of the actual hormone. It's non-sense.

Yea exactly. I had to self medicate since physicians only look at TSH. It obviously matters but so does the rest of the thyroid panel.

 

[Sully1234]

You have hypothyroid Free T4 levels.

Not all tissues will reach a "euthyroid state" without optimal levels of both T4 and T3. T4 is not an "inactive hormone" contrary to popular belief. Having it optimal is very important for wellbeing.

You are still hypothyroid in some tissues with such a low Free T4, so you won't feel right until that is addressed.

So what does T4 itself actually do aside from be converted to T3 that affects well being?

 

[Sully1234]

Can you imagine we started using LH/FSH to guide us with TRT? It's the same exact thing. Why are focusing on the pituitary messenger instead of the actual hormone. It's non-sense.

Amazing how endo's and internalists still do this shit. I am very average intelligence but even at 19 I had argued with nearly a dozen doctors over this lol.

 

[Black Beard]

So what does T4 itself actually do aside from be converted to T3 that affects well being?

1. Some tissues are better at using the T4 to make their own T3 instead of using T3 from the serum/bloodstream. 2. There are some effects that T4 has in the body and brain that T3 can't do. It's VERY heavy biochemistry talk like polymerization; etc. All you have to know is that T4 IS important and it's proven in studies and in my experience as well.


I see poor kidney function (lower GFR), mood and wellbeing without optimal Free T4 in patients, but without optimal Free T3 lipid levels, cognition and energy levels can suffer. (Likely that kidney prefers thyroxine AKA T4 and liver prefers triiodothyronine AKA T3, too put it into simple terms)



https://academic.oup.com/jcem/article/91/9/3389/2656451

(This is the first large data set to explore the relationship between fT4, fT3, and rT3 and psychological well-being in subjects on thyroid hormone replacement. Improved psychological well-being was found to correlate with higher fT4 levels. Not TSH, Free T3)


Generally, a healthy thyroid produces about 100 mcg T4 daily and 5-8 mcg T3 daily. The body produces about another 25 mcg T3 from T4 to T3 conversion.



The oral bioavailability of levothyroxine AKA T4 is about 60-80% when fasted. So 100 mcg only nets you about 60-80 mcg once absorbed in most people. Optimal dosage level for most people in my experience is 100-200 mcg daily (Fasted). You can do well with much lower dosages if your thyroid function isn't too impaired and you aren't shut down from exogenous thyroid hormone at higher doses like @nothuman


For liothyronine AKA T3, the bioavailability is pretty close to 100% even with food. Optimal for most people in my experience is 0-15 mcg. Some don't need any T3, but it has amazing effects in those that benefit from it (Improved energy levels, improved cognition/memory/well-being, improved hair and skin quality, and improved lipid levels). This lines up with the physiological amount secreted in healthy people.

 

[Sully1234]

1. Some tissues are better at using the T4 to make their own T3 instead of using T3 from the serum/bloodstream. 2. There are some effects that T4 has in the body and brain that T3 can't do. It's VERY heavy biochemistry talk like polymerization; etc. All you have to know is that T4 IS important and it's proven in studies and in my experience as well.


I see poor kidney function (lower GFR), mood and wellbeing without optimal Free T4 in patients, but without optimal Free T3 lipid levels, cognition and energy levels can suffer. (Likely that kidney prefers thyroxine AKA T4 and liver prefers triiodothyronine AKA T3, too put it into simple terms)



https://academic.oup.com/jcem/article/91/9/3389/2656451

(This is the first large data set to explore the relationship between fT4, fT3, and rT3 and psychological well-being in subjects on thyroid hormone replacement. Improved psychological well-being was found to correlate with higher fT4 levels. Not TSH, Free T3)


Generally, a healthy thyroid produces about 100 mcg T4 daily and 5-8 mcg T3 daily. The body produces about another 25 mcg T3 from T4 to T3 conversion.



The oral bioavailability of levothyroxine AKA T4 is about 60-80% when fasted. So 100 mcg only nets you about 60-80 mcg once absorbed in most people. Optimal dosage level for most people in my experience is 100-200 mcg daily (Fasted). You can do well with much lower dosages if your thyroid function isn't too impaired and you aren't shut down from exogenous thyroid hormone at higher doses like @nothuman


For liothyronine AKA T3, the bioavailability is pretty close to 100% even with food. Optimal for most people in my experience is 0-15 mcg. Some don't need any T3, but it has amazing effects in those that benefit from it (Improved energy levels, improved cognition/memory/well-being, improved hair and skin quality, and improved lipid levels). This lines up with the physiological amount secreted in healthy people.

Really appreciate the detail. One more question - Would that 0-15mcg of T3 in the morning for someone not currently on thyroid meds cause shut down?

I've seen people I view as experts go back and forth saying 12.5mcg will or won't be enough T3 to slow down thyorid production...

 

[Black Beard]

Really appreciate the detail. One more question - Would that 0-15mcg of T3 in the morning for someone not currently on thyroid meds cause shut down?

I've seen people I view as experts go back and forth saying 12.5mcg will or won't be enough T3 to slow down thyorid production...

Shutdown is person dependent, but yes, taking exogenous T3 will lower your endogenous Free T4/Free T3. T3 is more suppressive than T4. Taking low doses of T4 usually adds to your own production, but T3 can sometimes lower both your Free T4/Free T3 via negative feed back loop, like taking very low dose testosterone can make you end up with lower levels than you started with.


I've seen some people take 5-15 mcg without shutdown, it depends on the person. If you take it, you need to test your Free T4/Free T3 before and after you start, and note that T4 has a half life of about 7 days, so the shutdown can take a few weeks to see on paper.

 

[qbkilla]

Shutdown is person dependent, but yes, taking exogenous T3 will lower your endogenous Free T4/Free T3. T3 is more suppressive than T4. Taking low doses of T4 usually adds to your own production, but T3 can sometimes lower both your Free T4/Free T3 via negative feed back loop, like taking very low dose testosterone can make you end up with lower levels than you started with.


I've seen some people take 5-15 mcg without shutdown, it depends on the person. If you take it, you need to test your Free T4/Free T3 before and after you start, and note that T4 has a half life of about 7 days, so the shutdown can take a few weeks to see on paper.

You seem to have vast knowledge on thyroid, was wondering your take on my numbers? My Endo says I'm fine. People here have said I need a t3 test I'm boardelime hypo (while some say no).

June 2022
Tsh 2
T4 NA

August 2022
Tsh 3.5
T4 free .8(low)

Jan 2023
Tsh 5 (high)
T4 free .99

April 28
Tsh 1.8
T4 free 1.02

I do feel like I have been tired more than I used to be, chalked it up to age almost 40. On 3iu norditropin if that matters.

Metabolism is ok I maintain 185 lean eating 2900 calories (15.6xbw).

 

[Gambel]

@qbkilla Any idea why your TSH went from a 5 in January to a 1.8 in April?

 

[Black Beard]

You seem to have vast knowledge on thyroid, was wondering your take on my numbers? My Endo says I'm fine. People here have said I need a t3 test I'm boardelime hypo (while some say no).

June 2022
Tsh 2
T4 NA

August 2022
Tsh 3.5
T4 free .8(low)

Jan 2023
Tsh 5 (high)
T4 free .99

April 28
Tsh 1.8
T4 free 1.02

I do feel like I have been tired more than I used to be, chalked it up to age almost 40. On 3iu norditropin if that matters.

Metabolism is ok I maintain 185 lean eating 2900 calories (15.6xbw).

Generally, +3 TSH and sub <1.2 Free T4 are clues of hypothyroidism, especially if 1. You have symptoms 2. Your Free T3 is also low.


Generally speaking though, on 3 IU GH i would expect something like a 1.02 ng/dl Free T4 with +3 pg/mL Free T3, i would also expect less energy directly from the 3 IU in some people.


Were you taking GH in the first two labs? GH will always drop Free T4 and increase free T3. Letting me know if you were on it for the first two labs will lead us in the right direction with what is going on.


Personally, after a while on daily GH, i can get some fatigue which goes away by switching to three times weekly for a while, so i switch back and forth.

 

[bigzzz]

Shutdown is person dependent, but yes, taking exogenous T3 will lower your endogenous Free T4/Free T3. T3 is more suppressive than T4. Taking low doses of T4 usually adds to your own production, but T3 can sometimes lower both your Free T4/Free T3 via negative feed back loop, like taking very low dose testosterone can make you end up with lower levels than you started with.


I've seen some people take 5-15 mcg without shutdown, it depends on the person. If you take it, you need to test your Free T4/Free T3 before and after you start, and note that T4 has a half life of about 7 days, so the shutdown can take a few weeks to see on paper.

Would you only take t4 with gh(5-6iu) or also t3?

 

[Black Beard]

Would you only take t4 with gh(5-6iu) or also t3?

You should only need T4. HGH is very effective at making you convert into T3. T3 can make you flatter by decreasing nitrogen and glycogen in the muscles (but this can reverse after 2-3 weeks if you are on physiological amounts of T3).


@luki7788 has a few interesting posts about T4 use with HGH in bodybuilding.

 

[bigzzz]

You should only need T4. HGH is very effective at making you convert into T3. T3 can make you flatter by decreasing nitrogen and glycogen in the muscles (but this can reverse after 2-3 weeks if you are on physiological amounts of T3).


@luki7788 has a few interesting posts about T4 use with HGH in bodybuilding.

You mean by reversing after quitting the T3?

And T4 doesn't make you flat?

 

[Black Beard]

You mean by reversing after quitting the T3?

And T4 doesn't make you flat?

No, while on T3 at normal human doses, you will have lower nitrogen levels for the first 3 weeks which reverses on its own.

Nitrogen is one of the reasons AAS and HGH make us harder, pumped and 3D looking. Nitrogen and glycogen give you muscle hardness and shape

Hyperthyroidism messes with nitrogen and glycogen levels in skeletal muscle, that's why high dose T3 can make you flat.


Generally, T4 won't make you flat and optimal thyroid levels can improve protein synthesis. (Physiological doses 50-200 mcg daily)