I know many people with values similar to mine - normal TSH, FT4 and FT3 who got better with taking thyroid hormones. So I believe treating a piece of paper is absurd and the symptoms should be the deciding factor with the lab values serving for orientation. And we should consider optimal lab ranges, not “normal”
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Reference ranges for TSH vary from country to country and even within Germany. The upper limit lies between 2.5 and 5.0 mU/L (10). For years there has been a debate about whether to reduce the upper limit of all TSH reference ranges (11, e7). Based on study results in Germany, depending on the population and the test procedure, upper TSH reference values of 2.12 mU/L and 3.6 mU/L can be derived
This is from a quick google search. So you will get docs in germany happily treating at 2.5 TSH.
- Your understanding of how slightly off thyroid hormones impact life is nil. When you are slightly off this is the same as someone who has very little thyroid output. In fact patients whose thyroid is almost packing up have a better quality of life than a sub optimal thyroid patient because the super high TSH means they still have access to enough T3.
It is a crazy situation and the medical world still doesn’t get it BUT more docs are finally realising sub hypoT needs to be treated.
Now if this is caused in men by low testosterone levels then that needs to be addressed, but there is no way in hell here in the UK will men get this treatment. Over here you have to have super low testosterone to even start to be considered for treatment.
Your whole stance is wrong on sub optimal thyroid. What we need is for this condition to be recognised fully, then addressed as to the route causes. So in this case for David it may mean adding thyroid to his testosterone treatment. Only a trial will tell him and if this doesn’t work you would move on and do some more digging.
So come on David. You have a great opportunity to demonstrate here whether thyroid treatment will help or not. IF it does it will be good evidence for others reading this forum to start to address this issue properly. So update this thread with how you get on.
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Again this issue is a huge one in the thyroid world and the scientist who developed the test disagrees with how it is used.
Here are some good reading links:
http://www.thyroid.org/wp-
content/uploads/publications/clinthy/volume25/issue2/clinthy_v252_33_34.pdf
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I should point out that on prior lab work, my TSH was at 1.5, 2.6 and moved around a lot. Only since starting TRT has it dropped, probably due to better iodine re-uptake and increased ft3 concentrations. I will be getting new labs done this week to get a full idea of what is going on both from a TRT perspective, and thyroid/adrenals.
I will update this thread accordingly, so everyone can see my journey back to health.
Guys perfectly fine whatever you decide.
@marsaday
I am just wondering on what basis you recommend to try thyroid hormone replacement when TSH is perfect and fT3 - the active thyroid hormone - is perfectly centered within the reference. Your recommendation isn’t in agreement with the current evidence.
@vonko1988 Do you experience any positive effects of T3?
@anon8512651 Test and see. Just be careful with the ‚natural‘ thyroid hormones as they are not very well controlled when it comes to potency (not approved as drugs and therefore not controlled by health agencies)
Yes, I experienced a lot before I started feeling hyper like my cognition and ability to focus increased a lot, my clarity of thought, my energy, I was not feeling so cold anymore and I was much stronger in the gym.
I dont know why at one point everything fucked up and I got hyper.
Trialing thyroid hormones should be done on signs and symptoms. If someone is banging their head against a wall trying out anti depressants, or other pharma drugs trying to relieve certain symptoms and is getting no where then look at the thyroid again.
It is all about signs and symptoms. I remember a forum run by a psych Dr in the USA called Dr Merciano (if i remember correctly) and he said he always saw distress in patients when the TSH went over 2.
I have just asked Jim on another thyroid forum about the TSH issue and he has set up his own website to address this issue specifically. This will be very interesting reading for all those stuck on using the TSH as a marker for thyroid performance. He explains why the TSH is a poor marker. Basically the TSH does not elevate enough to produce the correct deiodinase response:
http://ibshypo.com/index.php/subnormal-tsh-secretion/
Also Johann i have my own life experience which directs me in my thyroid treatment. This is a summary.
Age 21 i became ill and was ill for 16 yrs. I was on various antidepressants because nothing seemed to help. They were the typical prozac, then seroxat at standard doses.
In that time i was never well physically. Mentally i felt a bit better about being so ill, but i was never depressed. My life was good generally. Aged 36 we tried for a baby and were struggling. My sperm count came back low and this got me doing some investigations into testosterone and thyroid.
The antiD tanked my testosterone, but even with bottom of the range levels at 10 pmol the Endo said i didnt have a testosterone problem. So i was scratching my head because it had to be this or thyroid.
Thyroid bloods were 3.7 TSH and FT4 12.
In the end i trialled NTH on my own. Guess what happened ? I got better straight away and within 2 weeks stopped the antiD - no withdrawal.
Now it took a longtime to get balanced and this is why i tried every protocol going. I have been a living experiment. Since 2013 life has been very balanced, we have a 5 y/o daughter conceived with IVF.
Last yr in November i started to be tired again and weak. I am now 48 and so basically aging is catching up with me, but i have a feeling (and this relates to what you have written about men with low testosterone above) that i was right all those years ago and i did need testosterone as well.
So now i am taking testosterone gel and HCG and i feel much better. I have a feeling i now need more T4 and this is ongoing as we speak.
I write this to help other patients tap into any knowledge which may help others.
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I am happy that it worked out that way for you, but keep in mind that your story is n=1 and today you would be offered treatment in the context of probably low T and low sperm count.
As a scientist with about 20 years experience in basic medical research, lab medicine and drug discovery I am surprised how many people come up with theories that aren’t backed up by current scientific knowledge based on basic research and well controlled clinical trials. Often the motivation is marketing of one persons opinion for financial reasons.
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Having seen a lot of patients doesn’t mean anything, other than that a doctor has been working for a while. It doesn’t actually meant that they know what they’re doing.For the record, I know nothing of the doctor and do not discount him, just this particular “diagnostic tool” which is in fact nonsense. It is meaningless, at most a coincidental occurrence. It’s like using a Sestamibi scan diagnostically in deducing hyperparathyroidism, in practice it is worse than useless.
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This paper shows you want is happening in thyroid treatment. It is slowly being hauled into the modern ages. All down to pressure from patients who now realise they have been totally misled by the medical world. This bringing together of knowledge in this specific area has only happened because of the internet. Change is taking place finally.
Broda Barnes died in 1988 aged 82 Broda Otto Barnes - Wikipedia
I am pretty sure BB knew what he was doing.
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What is your opinion on Armour and NDT? Would those be worth trying initially? My doctor offered those, as well as T4 (if needed).
Thanks for sharing, interesting read.
The paper relates to the treatment modality and to the monitoring rather than to the diagnosis of hypothyroidism.
I fully agree that TSH alone is insufficient to diagnose or monitor hypothyroidism. And I also fully agree that a certain part of patients treated with LT4 dont respond well and need a combination of T3 and T4.
But I dont agree that in a setting of TRT with its known stimulatory effect on T3 to T4 conversion, a diagnosis of (subclinical) hypothyroidism can be made only on the basis of fT4 using reference ranges established for healthy people not on TRT, while both, TSH and fT3 are in perfect range.
Let me ask you a question:
These are my results immediate before TRT and 9 weeks into TRT
FT3 range 2.8-7.1 pmol/l result 5.1
FT4 range 9.5-25.0 pmol/l result 14.9
TSH range 0.3-3.5 µU/ml result 1.45
FT3 range 2.8-7.1 pmol/l result 5.2
FT4 range 9.5-25.0 pmol/l result 9.2
TSH range 0.3-3.5 µU/ml result 1.29
fT4 is now below the reference range. Am I now hypothyroid?
When it comes to feeling cold; I used to feel always cold with T of about 300 ng/dl and now I am running around all day with only a t shirt in cold rooms at a T of about 600 ng/dl. And my body temperature hasnt changed at all.
@johann77 You keep yourself with TRT only at 600? I know it is very individual, but still… Tomorrow I will try half a grain NDT instead of T3. I know totally it should equal 12.5mcg of T3
By the way I took this NDT pills from a friend of mine who started TRT three months ago. I saw him last two months ago and now he looks totally different. He looked much more happy, energetic, very different aura and also without any training his belly is much smaller and his arms and back bigger. Just could not believe what a transformation. He injects 30mg ED.
Here is one of the papers that demonstrated lowered fT4 levels while maintaining levels of the biologically active fT3. Its a nice and clean study in the sense that T was administered to female men transgenders limiting cofounding factors.
‘Testosterone increased T3/T4 ratios (30 ± 9%, P =0.02), which probably reflects higher T4to T3 conversion.’
This is what @anon8512651 is describing and this is what is apparent in my lab results.
But again not trying to discourage you, just sharing thoughts here.
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I am not saying you need very high FT4 levels. Healthy people usually have Ft4 mid range and a Ft3 in the higher third of the range. TSH is around the 1 area.
I have learnt why testosterone helps thyroid today. It is because there is an increase in T4 to T3 conversion. This is useful to know.
Yours bloods and what is happening:
So before TRT you were colder but had good thyroid results. So the issue wasn’t the requirement for more thyroid hormone, but rather help with the uptake of the T3 - not even help with conversion.
After TRT you feel warmer and so maybe healthier ?
Your FT3 levels are almost the same, but FT4 has dropped. This shows something is working much better with your system now.
It is the uptake of the T3 !!
The storage of thyroid hormone (T4) is now dropping because it is being used up as it should be doing. The body is converting it into T3 and the cells are sucking this up. This process has speeded up and so you should have more energy and a higher temp.
This is all good and i am sure you can continue like this for a long time. However, a small concern is the fact your thyroid is not putting out more T4 to keep its general storage around your old level of 15. Longer term this maybe an issue as you age. As we age this gap between a good storage amount and the ability of the body to convert can close down so you may find Ft3 levels dropping off one day. This is where the addition of some T4 could help.
If you were unwell and had symptoms today i would say trial out some T4, but you don’t and you are feeling healthy, so all is good.
I am trying to work out why testosterone helps thyroid work better. You say it helps conversion, but i am betting it helps the uptake. Progesterone has this same effect.
Armour is NTH, its just a brand. So armour is a natural thyroid product like all the rest and they will use pig or cow thyroids to make their pills.
I have said it before, ALWAYS try T4 first when coming to use thyroid meds. If it works out it means you will have the cheapest and easiest product to access. Why deny yourself these options. If it doesn’t work out, try adding some T3. If this doesn’t work try NTH. After this you would try T3 only.
The NTH users and advocates have usually gone to NTH from T4 only. You cannot compare the two things. NTH is T4 + T3 in set ratio. Again this is something i don’t like. It is much better to be able to set your own ratio using T4/T3 if your body is needing that extra T3, which is missing from T4 only.
I would not disagree that doctors frequently fail to treat things correctly, personal experience changes how they treat things. I think we know a whole lot less about thyroid than we think we do. I just don’t agree with body temperature, waking or otherwise, being significant or useful. It’s a red herring.
I think it makes it work different, not necessarily better. Depends on the individual. My TSH initially doubled on TRT, but after a month or two it went back to where it was. My other numbers did not particularly change. I think thyroid and low test are linked, and one day we’ll find out that they are really just symptoms of a problem that we haven’t actually identified yet.
As much as I see with me thyroid and not high enough test and messed up cortisol are all interconnected very tightly
Yes low thyroid men often have testosterone issues. I am trying to educate my doc about this, but i am not sure he is connecting any dots on this issue.
I am pretty sure my issue comes from have an undescended testicle and so had an op aged 9.
I had a normal life until the age of 21. Went through puberty normally, have no issues with penis size or sexual function and was very active. Then aged 21 i had a body breakdown. Couldn’t breath properly, stamina dropped, strength dropped, fatty weight on the stomach wouldn’t budge, skin colour paled. I existed for 16 years and then i discovered thyroid hormones and regained 75% of my life. Progesterone gave me back the other 25% and now testosterone is completing the picture. I am not using progesterone anymore by the way.