has never been offered as an option, even when i inquired. there is no insurance coverage for it (with my current coverage). I am optimistic that once dialed in properly that it won’t be necessary (a fella can dream, right?)
Not sure if it’s been recommended to you or not yet but check out stopthethyroidmadness .com. There is a lot of thyroid info there to possibly help you understand thyroid better. Not sure I fully buy everything they say but there is a lot of good info.
Thanks Rise. I will definitely check that out. Just came back from my healthcare appointment and given my lab values she is not willing to up my Test dosage and would really prefer I take an AI to lower estrogen.
She also said TSH is elevated, T3 is great but T4 is low; results are pending on rT3 to see what to try next.
If rT3 is elevated, she will start T3 supplementation.
Until that happens, I will continue current T protocol without AI, but not expecting much of anything to change. Seems we are at an impasse
I am afraid you wont benefit from thyroid hormone supplementation.
TSH is not elevated.
TRT is known to increase T4 to T3 conversion,. T4 on the lower end is to be expected and doesnt need any treatment. FT3 is perfectly fine, rather on the high end.
‘There is no rationale for measuring reverse T3 to initiate or to adjust therapy…The risks of basing treatment decisions on reverse T3 levels include the use of excessive doses that may lead to a state of subclinical or even clinical hyperthyroidism.’
2 Likes
It is great that she wants to measure Reverse T3 because 95 percent of endos are totally clueless about Rt3 and dont even know what is that and that it plugs the receptors of t3
On the other hand even if elevated with so optimal ft3 I would be hesitant to supplement t3. Better to find what my cause the high reverse t3 and correct that
When would you consider TSH elevated? Over the clinical range?
I started TRT with very similar ranges to @rabbit_ears. After beginning TRT, checked again, TSH was now 5.010 (0.450-4.5000) with practically no change to ft3 (3.5 pg/ml 2.0-4.4) and ft4 (0.85 pg/ml 0.82-1.77). Began levothyroxine @ 25 mg daily which dropped TSH to 4.160 raised FT4 to 1.04 and no change whatsoever to FT3. I am now at 50 mg of levothyroxine but not sure levels as of right now. I have felt ever so slightly better when beginning levo but otherwise haven’t really felt much. I know I am on lower dosing based on dosing charts I’ve read and will be asking for a dosage increase though.
I know you don’t agree with the rt3 and you have provided literature stating that it shouldn’t but why do people who use it, and dose with t3 to combat it, feel better? I am not arguing and I am on the fence about it myself because of what you have posted but at the same time when people get results it makes me question why. Same goes for what is clinically elevated TSH versus those that don’t feel good at say, above 2, and lower it to closer to one with treatment and then feel better.
i am not the best one to answer this question by any stretch of the imagination; but what my nurse practitioner told me last night was that there is the clinical range of TSH (which you are above) and there is the optimal range of TSH which i believe she said was 1-2; so i believe you are still quite elevated
I’ll be interviewing Dr Barry Breger this Saturday on the subject of thyroid optimization. I’ll post a link as soon as it is uploaded.
3 Likes
I see I’m not the only one who thinks the suggestions are far out in left field
TSH is very high. I was at 5 and felt like death. That’s very high although TSH is a bad value to follow. I would take armour thyroid if I was in his shoes and he’ll know if that’s what he needs.
I had 5 TSH and TRT didn’t work for 3-4 months. I started thyroid and boom it started to work.
Thyroid bounces back way faster than T when we do a trial.
I agree try more T, but he definitely should work on that thyroid.
Why not find a new doctor. Query these forum guys and someone will know of a doctor in you area (maybe) or someone you can fly to and stop with the nonsense your doctor is doing
-
TSH can jump around quite significantly. Before supplementation re-test.
-
A TSH of 2.16 is anything but elevated. The median TSH of men is at 1.5 and a TSH of 2.16 places him around the 65th percentile. Only at TSH above 3.5 it has been shown that occult thyroid disease is starting to be present more frequently.
-
Subclinical hypothyroidism is defined as TSH above 5. Its just a definition, meaning that below 5 it can already be present but with lower probability. However, large studies have demonstrated only a limited benefit of thyroid hormone supplementation.
2 Likes
A TSH of 5 is a good reason to start an experimental trial of LT4 treatment, especially if you had remeasured TSH resulting in a similarly high level. In fact it would have been good to start this treatment first before going on TRT to see if it fixes also the low T.
You want to increase LT4 so that TSH comes down to below about 2.5. Also depending on symptom relief. Guess you will need between 100 and 150 mg daily of LT4. If it helps perfect, if not you can consider stopping. Good would also be to have anti thyroid antibody levels determined to have an idea why TSH is elevated. In case of Hashimotos disease LT4 therapy is known to slow down the disease progression.
As i said, my levels were similar to rabbit_ears prior to trt, post trt they went over 5.
But his levels were 2.89 and 2.16 pre-TRT and 2.78 on TRT. So regarding TSH nothing really changed.
johann;
you need to clarify the “he” you are talking about. You are talking about my results but in the meantime Rise80 hijacked this thread with TSH levels over 5; which compared to my minor elevation seems like quite a bit to a novice like me
1 Like
I’m sorry you veiwed that as hijacking your thread. Thyroid has been brought up a couple times and Johann disagreed your levels were elevated. I was only trying to better understand what he viewed as elevated and other thyroid issues and only used my levels for context.
just bugging you Rise; i dont actually view it as hijacking. We are looking for answers to the same questions
TSH is unreliable. We should focus on symptom resolution. Today my friend got his free ft3 checked and he has symptoms of low thyroid.
I’ve seen guys and gals wit low TSH but low fr3 and full of symptoms. My fiancé is a good example. TSH 1.1. She had all the symptoms. Doctor gave her addeeral.
She started thyroid and it healed all her ailments. Her fr3 was 3 out of 4.4 .
T4 is a horrible therapy. The reason most have thyroid issues is because t4 isn’t converting to t3 optimally in the first place.
Furthermore all this synthetic shit doesn’t really work. Majority of those who have experienced low thyroid will tell you they hated synthetic anything.
Dessicated is the way to go.
We musr Throw TSH out the window. It’s what insurance companies use as a gauge to cover or not cover thyroid therapy.
Your are mixing up a couple of things here.
Hypothyroidism is diagnosed using not only TSH, but always considering fT4 and fT3
If somebody has low TSH and low fT4/fT3 then of course they have hypothyroidism - its central/secondary hypothyroidism then. The pituitary simply doesnt pump out enough TSH to stimulate the thyroid gland to produce T4 and some T3. The treatment is of course thyroid hormone supplementation.
TSH is an excellent marker in case central hypothyroidism can be ruled out, thats the majority of cases (termed primary hypothyroidism). So in a situation when TSH moves upwards towards the higher end of the ref range than central hypothyroidism can be ruled out and clinical hypothyroidism is suspected (with normal fT4 and fT3). Its then always a problem of the thyroid gland itself, often due to an underlying disease such as Hashimotos disease. In such cases an experimental trial of LT4 is indicated, if symptoms dont subside a combination therapy consisting of T4/T3 is done (15% of cases). If symptoms dont subside than its simply not due to the thyroid gland.
Thats evidence based medicine.
3 Likes
Can you ask him about how to tackle thyroid in people with weak adrenals that cannot tolerate sufficient doses of T3?