Subclinical Hypothyroidism but What Else??

[bk13332]

First post guys, I’ve been reading and studying as much of this site as I can to become knowledgeable but my head is spinning.

I’m 45 years old and have been dealing with what I believe is low Testosterone levels. I have been physically active my entire adult life and was in close to the best shape of my life a little over two years ago. Now, I am 30 lbs overweight, no energy, sleep like crap, no libido, out of breath etc. I’ve been in and out of my doctor’s office numerous times over the last two years getting blood work done but was always told everything was ok. I now know better because of this site.

My most recent blood work 4/20/12:

Testosterone 445 Range 250-1100
Free Test 57 Range 35-155
Prolactin 12 Range 2-18
TSH 5.32 Range 0.10-5.50
FSH 1.2 Range 1.4-18.1
LH 2.7 Range 1.0-12.0


As a result of these tests my doctor said my Testosterone was fine but I was Subclinical Hypothyroid and started me on Levothroid at 50 mcg per day. I’m to be retested in 6 weeks. I told her my Test may be fine within their range but it more reflects that of an 80 year old man and my wife isn’t into old men…The doc claimed to understand my concern but thought that by getting my thyroid correct my Test would also rise (no pun intended)

My previous blood work.

3/4/11:

Free T-4 1.1 Range 0.8-1.7
T3 106 Range 50-170
TSH 3.5 Range 0.10-5.50

2/25/11:

TSH 3.91 Range 0.10-5.50
Testosterone 360 Range >200
Vitamin D 21 Range 20-100

11/29/10:

TSH 3.88 Range 0.10-5.50

9/15/10:

TSH 4.94 Range 0.10-5.50
Testosterone 268 Range >200

After my 2011 blood work my doc just told me to supplement with 1,000 iu of D which I have been doing.

I have access to all my tests on-line going back several years but it doesn’t look like they ever tested my Estrogren levels. I suspect I should request that for my next blood work?

I would appreciate any thoughts, suggestions or anything else that jumps out to you.

Thank in advance,

[bass]

it would be nice to do a complete male hormone panel as listed in our stickies. E2, SHBG, IGF1, etc... would have been more revealing. your TSH is definitely way up there and glad your doc is taking action. your test is not terribly low and if you correct TSH and maybe e2, SHBG you could see an increase in your test. my vit. D was at 30 or so, but been taking 10,000 iu ed and it nearly perfect at about 97 range 20-100, 1,000 iu may not do you much, many guys here are doing 5,000 ed and they are still low. another thing i like to mention, maybe hCG therapy to start with before going into TRT, as you may know TRT is for life. welcome here BTW.

[sparverius]

It looks like your doc is doing the right thing by treating the underlying problem and not just giving your a script for T and sending you on your way. Have patience and see if it works. TRT is a pain in the ass and it's not as good as the real thing- exogenous T shuts down a bunch of other hormones, which is why people use HCG and pregnenolone to try to mimic/supplement some of them. You don't want to get into TRT unless you have to.

[bk13332]

Thanks guys, I definitely will be more informed for my next blood work and will be able to request the suggested panel.

[steroid.com 1]

I would see an endo right away who specializes in Hypo/Hyperthyroidism; without question your TSH presents Hypothyroidism. I would like to see T4, T3, RT3 and antibodies as well. Note, many of the same symptoms of Hypogonadism are the same as Hypothyroidism. Also note, Hypogonadism can and will cause Hypothyroidism...many don't know that.

On 9/15/10 you were:

TSH 4.94 Range 0.10-5.50
TSH is way too high and a diagnosis should have been done.
Testosterone 268 Range >200
On some lab assays this would be clinically low Testosterone...my note above on Hypogonadism causing Hypothyroidism. You should have been fixed at this date IMO.


Your most recent blood work 4/20/12:

Testosterone 445 Range 250-1100
While in the lower end of the reference range I can tell you my Doc would put you on a TRT protocol with a goal of getting your Total T in the 800's. The problem is with your Hypothyroidism we can't tell if the symptoms are Thyroid or Testosterone related.

Free Test 57 Range 35-155
Again, in the lower reference range.

Prolactin 12 Range 2-18
Ok, best in the mid to lower range.

TSH 5.32 Range 0.10-5.50
Problem and need a clinical diagnosis as to why.

FSH 1.2 Range 1.4-18.1
Again, at the low end of the reference range.

LH 2.7 Range 1.0-12.0
Again, at the low end of the reference range and suggests Secondary Hypogonadism.

IMO, you need to find out what is wrong with your Thyroid not just be put on meds. Secondly, once corrected, evaluate your hormones and determine if a Secondary condition exists.

With TSH at that level you must feel like shit all the time.

[bk13332]

[QUOTE With TSH at that level you must feel like shit all the time.[/QUOTE]

That is the most accurate statement ever!

I live on the West Coast and have Kaiser Permanente. Kaiser is convenient for simple day to day bumps and bruises but the more complicated issues can become quite a pain in the ass. My biggest issue right now is I am on my 3rd general family doctor in a 5 year time period. My current doctor has “allegedly” ran my blood work by one of the Endocrinologist who suggested Hypothyroidism. I honestly wish I had found this site/forum a long time ago…I am currently waiting a referral to a different Endo. I picked a younger gal who is a competitive athlete and may be (hopefully) more up to date with current ideology on these issues.

I can’t thank you guys enough!

[steroid.com 1]

Interview your Endo and pick one that not only understands how to manage Thyroid issues BUT also understands TRT protocols for men; this will save you time and expense and put you in the right care. You may end up getting your Thyroid under control but not your Testosterone/Hormones.

"Suggesting Hypothyroidism" is going to get you fixed...find the Endo and try to find one that can do both and you will a happy man!

[kelkel]

Nothing to add to the above other than:

Testosterone Range should be: 348 - 1197 (new scale)
TSH should be .3 - 3.0 Refer to: http://thyroid.about.com/cs/testsfor...a/newrange.htm as well as: http://www.stopthethyroidmadness.com/ (GD's favorite other than porn)

[steroid.com 1]

^^^^What he said...especially that last point

[flatscat]

I think when you get your tsh straightened out, lose the weight with a good diet and start training and adding lbm, get your rest, and I think the t numbers will rise to a more respectable level and and you might be g2g without starting trt. But I would def get those things done and redo BW before you start adding testosterone.

[bk13332]

All good advice. I just went the morning for a much more complete blood work. It generally takes a day or two to get the results and then I'm supposed to meet with the Endo.

[steroid.com 1]

Excellent!

Get your results and post here in this thread complete with ranges.

[bk13332]

These are only some of the results from yesterdays blood work. I expect to get the rest back later today or Monday and the T results will not be until a few days.

I’m by no means an expert but it looks like my TSH is still high and my LH and FSH are very low (which means what?) Keep in mind I have been on Levothroid for approx one week but I’m not sure of its impact.

I will post the results as I get them.

TSH 4.83 Range 0.10 - 5.50

Free T4 1.2 Range 0.8 - 1.7

Tri-iodothyronine 105 Range 50 - 170

FSH 1.5 Range 1.4 - 18.1

LH <1.0 Range 1.0 - 12.0

Ferritin 300 Range 22 - 365

Estradiol <50 Range <50

[kelkel]

TSH still very high. Hypothryoidism can lead to low Testosterone. LH/FSH low. They respond to the hypothalamus releasing GnRH by pulsing out LH/FSH downstream to the testies. LH hits the leydig cells in the testies signaling your boys to basically convert cholesterol to testosterone. FSH deals with spermatogenises. Chronically low LH/FSH would indicate Seconday Hypogonadism.

Post up all results so we can dig deeper. GD above is great with Thyroid issues. Odd range on your TSH above.

[bk13332]

THYROPEROXIDASE ANTIBODY 54 Standard Range < 35

I dont like this one...

[bk13332]

Quick update;

Since my last post I was put in contact with an Endocrinologist who ordered an MRI of my pituitary and wanted it done prior to our first appointment. I had the MRI done and there were no abnormalities found.

I met the doctor and really liked her attention to detail and thoroughness. She actually encouraged me to do as much research as possible and to come with a list of all my questions for her. I must have spent an hour and half with her.

Anyway, as pointed out above, I have two issues going on. Hypothyroidism which I now know is Hashimoto’s disease. My treatment for this will continue at 25 mcg of Levothroid daily with a goal of getting my TSH level down to 1.0. I’m being re-tested in two weeks and we will adjust the dosage as needed.

She also wants my vitamin D tested again and we will adjust the supplement dosage accordingly.

I was diagnosed with Secondary Idiopathic Hypogonadism. What I found rather interesting is that she went over all my lab work but was the most concerned with my Free Test and wants to see that improve and get my level up to 100 pg/ml. (I was at 54.0 with the range of 35.0 – 155.0 pg/ml) I thought I was going to have to convince her that my levels were low but she flat out said my levels were closer to that of a 70 year old.

Also, she brought up Sleep Apnea and wants me tested for that before going down the road of TRT. If it turns out I have apnea she wants that addressed first. Either way, if my Free Test is not up to par then we will do a weekly IM treatment.

All in all I thought it was a very productive exam and she seems to be up to date with current trends (from my limited knowledge…)

Regards,

[Simon1972]

good luck, alot of your symptoms sound like mine i will follow this post and see how you go. im getting an MRI tomorrow to test for a pituatry tumor- they may be a cause for low fsh and lh levels. maybe bring clomid or nolvadex restart as an option to your endo for consideration. i asked vetteman if he could do a stickie on this topic- seems everyone is suffering low test/fsh/lh levels these days.

[kelkel]

Glad to hear you found what seems to be a concerned, knowledgeable doctor. Congrats! Develope that relationship and be totally upfront with her. Trust means everything.

[bk13332]

Hey guys,

I’ve got an update but also am looking for some insight. As you can tell I started project back in May. Since that time, I have addressed my diet/workouts and have lost 20 lbs. and I no longer suffer from sleep apnea. My Endo wanted me to have blood tests done after I accomplished the above.

My recent (from Monday) results are:

TSH = 4.57 0.10 – 5.50

LH = 1.8 1.0 – 12.0

Vit D = 54 20 – 79

Total Test = 497 250 – 1100

Free Test = 83 35 – 155

Previously, I attempted to address the TSH with 25 mcg of Levothroid. Unfortunately, the Levo caused me severe anxiety and I had to stop taking it. I brought up Amour Thyroid but the Endo shot it down saying it would cause worse anxiety…

I think I still suffer symptoms of low Test (although not quite as bad) and communicated that to the Endo. The Endo stated she feels my Free Test is within “appropriate” levels as her ideal range was between 90 – 100. However, she stated she would still treat me with TRT if I desire but she made it very clear that we would have to agree to not “push my T to inappropriate levels” for my age.

Any thoughts on whether or not to try TRT or should I just call it good? I know it is a subjective matter, and I alone, have to decide. I’m wondering, in your experiences, if I increase my Free from 83 to the low 100s if I would benefit a noticeable amount? The 26 point increase in Free T from my previous level has given my libido a slight boost but still not where I really want it. I feel my energy levels and strength also should be better.

I understand this is a life long endeavor but I would like to enjoy my life (physically and mentally) to the fullest extent.

Thanks in advance,

[steroid.com 1]

You still have Thyroid issues and that very well may be why you are on the lower end of the reference range for you Testosterone assays.

Hypothyroidism (in short) messes with the pituitary gland and suppress LH and FSH production resulting in lower androgen levels.

Correct the thyroid will correct the androgen deficiency.

BTW, you need to do some research on the diseases that Hypothyroidism can cause; things like cancer and cardiovascular disease rank at the top not discounting the really bad side effects as well.

Find an Endo that can help you.

TSH = 4.57 0.10 – 5.50
HIGH!

LH = 1.8 1.0 – 12.0
LOW and as a result of the assay above.

Vit D = 54 20 – 79
OK

Total Test = 497 250 – 1100
OK but could be better.

Free Test = 83 35 – 155
OK but could be better.