First Bloodwork - Thoughts?

[Jay Dubs]

44 year old, been feeling like crap for a year. Sleep is bad, fuzzy headed, and put on 10 pounds even though I have been eating cleaner, cut calories and starting to work out (had shoulder surgery). I just had my first blood work come back. I can't seem to edit the file, or even screen shot it. They sent it to me through the Spruce app, so maybe protected?

TSH with Reflex to free T4 9.43 0.40-4.50 mIU/L
T4 - Free 1.1 0.8-1.8 ng/dL
Testosterone - Free 50.9 45.0-224.0 pg/nL
B12 953 200-1100 pg/mL
FSH 5.1 1.6-8.0 mIU/mL
LH 1.9 1.5-9.3 mIU/ML
Vitamin D 46 30-100 ng/mL

Everything else was in range. My TSH always used to be high, but around 6 but my free T3/T4 were in range so they never treated it. 9.43 is well up. They were supposed to have done total testosterone, but apparently didn't as it wasn't on my results (Quest was a cluster when I went). Free T is low but in range so they want me to take another test to confirm. LH is barely in range. Could that be what is bringing my T down?

Anything I am missing?

Thanks!

[The Deadlifting Dog]

First thing first I would treat your thyroid.
That is most likely your reason for putting on weight.

No endo out there will let your TSH be over twice the top end of the range.

Many endos will tell you that having one of your hormones off can disrupt the rest of your hormones.
Your free T may improve if you fix your TSH.

I would also take some Vitamin D. Vitamin D is actually a hormone not a vitamin.

[kelkel]

What DD said above is spot on. Appears to be primary hypothyroidism which can cause low T.

[Jay Dubs]

I’m already on a high dose D3. I’m about to start levothyroxine so should I wait to retest on 6-8 weeks and see if my LH and free T have changed?

[charger69]

I’m already on a high dose D3. I’m about to start levothyroxine so should I wait to retest on 6-8 weeks and see if my LH and free T have changed?

It takes time for your T4 to change. I would say 3-4 weeks after you start your meds. I think 6-8 is pretty long.


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[The Deadlifting Dog]

I’m already on a high dose D3. I’m about to start levothyroxine so should I wait to retest on 6-8 weeks and see if my LH and free T have changed?

What do you consider a high dose of D3?
Your vitamin D is near the low end of the range.

[Youthful55guy]

Not sure I have much more to add than the advice already been give. I would not fret not having Total T, it's a worthless number. Free t is the only measure of T I look at. I would recommend watching your Free T as you ramp up thyroid hormone treatment, there are good studies that show it can increase SHBG production and that could lower your already low Free T even more. Not saying to not treat the hypothyroidism, but you will also want to consider starting TRT in parallel and then to further adjust your T dose to keep Free T in range, even if SHBG does increase.

[charger69]

Not sure I have much more to add than the advice already been give. I would not fret not having Total T, it's a worthless number. Free t is the only measure of T I look at. I would recommend watching your Free T as you ramp up thyroid hormone treatment, there are good studies that show it can increase SHBG production and that could lower your already low Free T even more. Not saying to not treat the hypothyroidism, but you will also want to consider starting TRT in parallel and then to further adjust your T dose to keep Free T in range, even if SHBG does increase.

Whoooooaaaaa. I had my thyroid removed. I am in the initial stages of dosing. They started me out at 125 mg. Tests came back with a 12 on the TSH ( range like .5-3.3). All the other tests were low as expected.
The Dr only upped it to 150. I think I should be at around 175-200.


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[Jay Dubs]

I’ve been taking 5000 iu of D3, plus there is more in my multivite. It may be an absorption issue. I am awaiting new blood tests, the endocrinologist thinks that I have an autoimmune disease or my pituitary is off. I am doing better being on the levo but just in the mood, memory, brain fog categories. Energy is still crap and I feel completely winded and exhausted. It’s just been 6 weeks on the meds though. I’ll get a much better idea after these labs, as they’ll have a broader hormone panel too.