High TSH

[armada]

Just got labs back. My only concern is the high TSH. T4 looks a bit on the low side, but I'm more worried about any negatives if my TSH stays high.

I've been on 160mg Test C per week for months and added 1.8 iu of GH (6 days per week) 2.5 weeks ago.

Amy advice?

Free T4: 0.98 (0.82 - 1.77)
T4: 6.4 (4.5 - 12.0)

Free T3: 3.9 (2.0 - 4.4)
T3: 122 (71 - 180)

TSH: 5.71 (0.45 - 4.5)

 

[Black Beard]

Just got labs back. My only concern is the high TSH. T4 looks a bit on the low side, but I'm more worried about any negatives if my TSH stays high.

I've been on 160mg Test C per week for months and added 1.8 iu of GH (6 days per week) 2.5 weeks ago.

Amy advice?

Free T4: 0.98 (0.82 - 1.77)
T4: 6.4 (4.5 - 12.0)

Free T3: 3.9 (2.0 - 4.4)
T3: 122 (71 - 180)

TSH: 5.71 (0.45 - 4.5)

You came to the right place .


TSH of 5 means your body wants more thyroid hormone. It's considered "subclinical hypothyroidism". We've had patients with TSH between 1-5 with bad hypothyroidism that responded to thyroid medication.

GH increases conversion of T4 to T3. That's great, but the body needs T4 for certain tissues that are not good at using direct serum T3.

Do you have symptoms like fatigue? cold intolerance?


Do you have IGF-1 labs ? Pre GH thyroid labs?


Broscience has been saying for years that T4 is a good addition to GH, which is impressive to say the least.

 

[whacked]

Yo BB

Little help w that last sentence? Tongue-in-cheek? Or not? Thanks for the clarification!

Ps - when you say our clinic what is it that you do?
Do you work in an HRT clinic? If so that’s awesome.

 

[Black Beard]

Yo BB

Little help w that last sentence? Tongue-in-cheek? Or not? Thanks for the clarification!

Ps - when you say our clinic what is it that you do?
Do you work in an HRT clinic? If so that’s awesome.

Not tongue in cheek.


Sometimes broscience has answers before the scientific community has data.


The studies show that GH depletes T4 by increasing it's conversion to T3. By adding T4 while taking GH, you address this issue. So Broscience has been saying this for years, which is impressive.


Another good example is how test prop/short esters cause less water retention. Nobody really knows why but this seems to be true.


I am a clinician who specializes in this field, that is all i will say due to privacy.

 

[armada]

You came to the right place .


TSH of 5 means your body wants more thyroid hormone. It's considered "subclinical hypothyroidism". We've had patients with TSH between 1-5 with bad hypothyroidism that responded to thyroid medication.

GH increases conversion of T4 to T3. That's great, but the body needs T4 for certain tissues that are not good at using direct serum T3.

Do you have symptoms like fatigue? cold intolerance?


Do you have IGF-1 labs ? Pre GH thyroid labs?


Broscience has been saying for years that T4 is a good addition to GH, which is impressive to say the least.

Thyroid labs while not on GH:

Set 1 (Spring 2019):

TSH - 3.14
Free T3 - 3.4
Free T4 - 1.15

Set 2 (Fall 2018 - Had been using 2iu GH daily up until 3 weeks or so prior to labs)

TSH - 2.04
Free T3 - 3.2
Free T4 - 1.18

I'm a little fatigued, but not any more than prior to taking the GH I don't have cold intolerance.

I purposely didn't get my IGF-1 tested on this past set of labs, as it goes through the roof even on 1.8iu GH. For years I've been using the same brand of pharma GH direct from a pharmacy - so there's not question there.

Even two weeks after I stop taking 1.5iu EOD, my IGF was still above the normal reference range. Prior to taking GH it was in the middle of the reference range.

I assume on 1.8iu ED right now IGF-1 is well above the reference range.

Like you said, I know GH causes more T4 to be converted to T3, but I've heard mixed reviews on whether taking supplemental T4 while on GH would be beneficial or not. Just because I'm adding in exogenous T4, does that necessarily mean more of it will be converted to T3? And if my T3 does rise from taking supplemental T4 on GH, I would not want to run the risk of becoming hyperthyroid with too high of a T3.

Do you have any insight if there is a long term from having elevated TSH, but all other thyroid values in the normal range?

Also, what are your thoughts on dessicated thyroid, as I've heard many have better results with that than T4 alone.

Thanks for your help.

 

[Black Beard]

Thyroid labs while not on GH:

Set 1 (Spring 2019):

TSH - 3.14
Free T3 - 3.4
Free T4 - 1.15

Set 2 (Fall 2018 - Had been using 2iu GH daily up until 3 weeks or so prior to labs)

TSH - 2.04
Free T3 - 3.2
Free T4 - 1.18

I'm a little fatigued, but not any more than prior to taking the GH I don't have cold intolerance.

I purposely didn't get my IGF-1 tested on this past set of labs, as it goes through the roof even on 1.8iu GH. For years I've been using the same brand of pharma GH direct from a pharmacy - so there's not question there.

Even two weeks after I stop taking 1.5iu EOD, my IGF was still above the normal reference range. Prior to taking GH it was in the middle of the reference range.

I assume on 1.8iu ED right now IGF-1 is well above the reference range.

Like you said, I know GH causes more T4 to be converted to T3, but I've heard mixed reviews on whether taking supplemental T4 while on GH would be beneficial or not. Just because I'm adding in exogenous T4, does that necessarily mean more of it will be converted to T3? And if my T3 does rise from taking supplemental T4 on GH, I would not want to run the risk of becoming hyperthyroid with too high of a T3.

Do you have any insight if there is a long term from having elevated TSH, but all other thyroid values in the normal range?

Also, what are your thoughts on dessicated thyroid, as I've heard many have better results with that than T4 alone.

Thanks for your help.

TSH of 3 or higher is considered subclinical hypo by the endocrine society. TSH can be a useful biomarker of thyroid function, but it misses many hypo patients. Imagine completely ignoring total/free testosterone and only looking at LH/FSH.

https://academic.oup.com/jcem/article/98/9/3584/2833082

A healthy thyroid produces about 100 mcg of T4 and 5-8 mcg of T3 daily. Conversion of T4 to T3 accounts for about 25 mcg of daily T3 production, combined with direct secretion you are looking at about 32 mcg T3 per day.


Most people feel best between 1.4-1.8 ng/dL for Free T4 and +3.5 pg/mL for Free T3.


The only advantage of dessicated thyroid is that it has added T3 for people who are poor converters or feel better with some T3 added. Synthetic thyroid is better most of the time since you can fine tune the ratio of T4/T3. The ratio of T4/T3 in dessicated thyroid is not physiological.


A good starting dose for people is about 100 mcg T4 to try and get between that 1.4-1.8 ng/dL window. Contrary to popular belief, well-being has been correlated to free T4 levels and not T3. The oral bioavailability of T4 is between 60-80% if taken correctly, so 100 mcg can be as low as 60-80 mcg after absorption.


It is an erroneous belief that T3 is the only "active" hormone. T4 is just as important as certain tissues are better at utilizing T4/converting it themselves than using T3 from the serum.



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


In regards to your situation, your Free T4 levels were already poor and i've seen patients with overt symptoms with the same Free T4 level and perfect TSH of 1. After treatment with Levothyroxine, symptoms resolved. I would consider taking T4 regardless of GH use in your situation if symptoms are present.

 

[nothuman]

Not tongue in cheek.


Sometimes broscience has answers before the scientific community has data.


The studies show that GH depletes T4 by increasing it's conversion to T3. By adding T4 while taking GH, you address this issue. So Broscience has been saying this for years, which is impressive.


Another good example is how test prop/short esters cause less water retention. Nobody really knows why but this seems to be true.


I am a clinician who specializes in this field, that is all i will say due to privacy.

Well we are grateful to have you here!

 

[whacked]

Nice. Thanks man

So for those of us on low dose GH for years (2-3iu’s daily) and not planning to get off, is T4 always suggested or only when T4 (or other?) is off?

Thanks

Not tongue in cheek.


Sometimes broscience has answers before the scientific community has data.


The studies show that GH depletes T4 by increasing it's conversion to T3. By adding T4 while taking GH, you address this issue. So Broscience has been saying this for years, which is impressive.


Another good example is how test prop/short esters cause less water retention. Nobody really knows why but this seems to be true.


I am a clinician who specializes in this field, that is all i will say due to privacy.

 

[whacked]

Agreed

Good stuff BB

Well we are grateful to have you here!

 

[Black Beard]

Nice. Thanks man

So for those of us on low dose GH for years (2-3iu’s daily) and not planning to get off, is T4 always suggested or only when T4 (or other?) is off?

Thanks

You go by symptoms, then lab values.


If you are feeling great and have energy on GH only, i would not mess with anything. Lethargy can be a side effect of GH though independent of thyroid hormone changes.


If something feels off and points to thyroid issues, get labs on TSH, Free T4/Free T3 and go from there.

 

[whacked]

Thanks BB

You go by symptoms, then lab values.


If you are feeling great and have energy on GH only, i would not mess with anything. Lethargy can be a side effect of GH though independent of thyroid hormone changes.


If something feels off and points to thyroid issues, get labs on TSH, Free T4/Free T3 and go from there.

 

[Smack]

TSH of 5 means your body wants more thyroid hormone. It's considered "subclinical hypothyroidism". We've had patients with TSH between 1-5 with bad hypothyroidism that responded to thyroid medication.

I've been dealing with and researching thyroid issues for years.

Do you really think TSH is the defining factor that should dictate treatment?

His Free T3 is towards the top of the range (where I'd want mine honestly) and has adequate free T4. Personally I would disregard that high TSH.

Your thoughts? Not being combative, I would like your thoughts - for OP's and my own sake

 

[Black Beard]

I've been dealing with and researching thyroid issues for years.

Do you really think TSH is the defining factor that should dictate treatment?

His Free T3 is towards the top of the range (where I'd want mine honestly) and has adequate free T4. Personally I would disregard that high TSH.

Your thoughts? Not being combative, I would like your thoughts - for OP's and my own sake

Not at all.


Using TSH is like using LH/FSH to diagnose hypogonadism. I believe it's the least useful measure of thyroid function. It can still provide some information in certain cases that the brain/body want more thyroid hormone.


Free T4/Free T3 is the ideal test. Looking only at TSH as is standard medical practice is like completely ignoring Total/Free Testosterone and only looking at LH/FSH to diagnose hypogonadism. TSH/LH/FSH are pituitary peptide hormones, they are just messengers. They can provide useful info but should not be the primary hormones tested.


I 100% am against TSH only testing. His Free T4 has room for improvement. Some people feel much better in the 1.6-1.8 ng/dL range, even as high as 2.0 ng/dL. Supraphysiolgical doses of T4 have been used to treat depression/bipolar disorder safely with no sides or hyperthyroid symptoms. There is more room for tweaking T4 levels than with T3 as the former is much less likely to cause hyper symptoms in excess. I've seen patients with a perfect TSH of 1 with worse Free T4 and Free T3 levels than patients with +20 TSH. Testing only TSH misses A LOT of hypothyroid patients. Back in the day, there was no TSH test and they went by symptoms.


"Adequate" is a relative concept. Some people feel amazing with total testosterone of 500 ng/dL and feel worse with higher levels. Others need +1,000 ng/dL to feel their best. Everyone is different and has unique genetic metabolism of hormones and receptor sensitivity to different hormones.

 

[Smack]

Not at all.


Using TSH is like using LH/FSH to diagnose hypogonadism. I believe it's the least useful measure of thyroid function. It can still provide some information in certain cases that the brain/body want more thyroid hormone.


Free T4/Free T3 is the ideal test. Looking only at TSH as is standard medical practice is like completely ignoring Total/Free Testosterone and only looking at LH/FSH to diagnose hypogonadism. TSH/LH/FSH are pituitary peptide hormones, they are just messengers. They can provide useful info but should not be the primary hormones tested.


I 100% am against TSH only testing. His Free T4 has room for improvement. Some people feel much better in the 1.6-1.8 ng/dL range, even as high as 2.0 ng/dL. Supraphysiolgical doses of T4 have been used to treat depression/bipolar disorder safely with no sides or hyperthyroid symptoms. There is more room for tweaking T4 levels than with T3 as the former is much less likely to cause hyper symptoms in excess. I've seen patients with a perfect TSH of 1 with worse Free T4 and Free T3 levels than patients with +20 TSH. Testing only TSH misses A LOT of hypothyroid patients. Back in the day, there was no TSH test and they went by symptoms.


"Adequate" is a relative concept. Some people feel amazing with total testosterone of 500 ng/dL and feel worse with higher levels. Others need +1,000 ng/dL to feel their best. Everyone is different and has unique genetic metabolism of hormones and receptor sensitivity to different hormones.

I agree with everything you said. Adequate was poor wording, especially in this instance, but what I meant was I'd be surprised given other labs that value would be of worry.

 

[armada]

TSH of 3 or higher is considered subclinical hypo by the endocrine society. TSH can be a useful biomarker of thyroid function, but it misses many hypo patients. Imagine completely ignoring total/free testosterone and only looking at LH/FSH.

https://academic.oup.com/jcem/article/98/9/3584/2833082

A healthy thyroid produces about 100 mcg of T4 and 5-8 mcg of T3 daily. Conversion of T4 to T3 accounts for about 25 mcg of daily T3 production, combined with direct secretion you are looking at about 32 mcg T3 per day.


Most people feel best between 1.4-1.8 ng/dL for Free T4 and +3.5 pg/mL for Free T3.


The only advantage of dessicated thyroid is that it has added T3 for people who are poor converters or feel better with some T3 added. Synthetic thyroid is better most of the time since you can fine tune the ratio of T4/T3. The ratio of T4/T3 in dessicated thyroid is not physiological.


A good starting dose for people is about 100 mcg T4 to try and get between that 1.4-1.8 ng/dL window. Contrary to popular belief, well-being has been correlated to free T4 levels and not T3. The oral bioavailability of T4 is between 60-80% if taken correctly, so 100 mcg can be as low as 60-80 mcg after absorption.


It is an erroneous belief that T3 is the only "active" hormone. T4 is just as important as certain tissues are better at utilizing T4/converting it themselves than using T3 from the serum.



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


In regards to your situation, your Free T4 levels were already poor and i've seen patients with overt symptoms with the same Free T4 level and perfect TSH of 1. After treatment with Levothyroxine, symptoms resolved. I would consider taking T4 regardless of GH use in your situation if symptoms are present.

Going to be starting synthroid soon to see how I feel in it. Planning to use 100mcg ED to see how I feel. Will get blood work after 6-8 weeks to see how my numbers change.

 

[Smack]

Not at all.


Using TSH is like using LH/FSH to diagnose hypogonadism. I believe it's the least useful measure of thyroid function. It can still provide some information in certain cases that the brain/body want more thyroid hormone.


Free T4/Free T3 is the ideal test. Looking only at TSH as is standard medical practice is like completely ignoring Total/Free Testosterone and only looking at LH/FSH to diagnose hypogonadism. TSH/LH/FSH are pituitary peptide hormones, they are just messengers. They can provide useful info but should not be the primary hormones tested.


I 100% am against TSH only testing. His Free T4 has room for improvement. Some people feel much better in the 1.6-1.8 ng/dL range, even as high as 2.0 ng/dL. Supraphysiolgical doses of T4 have been used to treat depression/bipolar disorder safely with no sides or hyperthyroid symptoms. There is more room for tweaking T4 levels than with T3 as the former is much less likely to cause hyper symptoms in excess. I've seen patients with a perfect TSH of 1 with worse Free T4 and Free T3 levels than patients with +20 TSH. Testing only TSH misses A LOT of hypothyroid patients. Back in the day, there was no TSH test and they went by symptoms.


"Adequate" is a relative concept. Some people feel amazing with total testosterone of 500 ng/dL and feel worse with higher levels. Others need +1,000 ng/dL to feel their best. Everyone is different and has unique genetic metabolism of hormones and receptor sensitivity to different hormones.

Sent you a PM.