# Need help understanding my labs (High TSH one month, Low the next, Positive TGab Negative TPOAb)



## garymaurizi (Sep 13, 2017)

Hi ThyroidBoards,

This is my first post so let me say Hello & Thank You for any help ahead of time. I have been dealing with a large number of health symptoms for the past 6 years and have had no luck getting treatment until recently I switched doctors and he's actually started to take me seriously and help and run some tests. Initially he just ran TSH and FT4 for my thyroid which came back with elevated TSH, then I paid out of pocket to run a thorough thyroid panel on the WellnessFX platform a few weeks later which seems to have come back relatively normal(though not optimal)? (However both came back with negative TPOAb and positive TGAb), I need help understanding these test results.

I don't understand why my TPOAb levels are negative yet my TGAb levels point to an autoimmune diagnosis? This seems to be uncommon? is this a definitive diagnosis of hashimoto's? The most severe of my symptoms are Chronic Fatigue, Brain Fog, Difficulty reading & learning, Difficulty specifically with short term memory, incredible difficulty waking up in the morning, yet I do have rare days where I feel energized, and rare nights where I just cant sleep, they are just not as frequent as the fatigue.

For the last 4 years I've had really bad stomach pains, cramps, bloating, constant gas, until 3 weeks ago the new Dr. prescribed ivermectin and nearly all of my stomach issues went away overnight. I don't know if this is related, but I still don't know what parasite was causing the issues -- I did a stool sample test for ova & parasites a week after taking the ivermectin, it might have been to late to find out? I don't have those results yet.

I've done a serious amount of research into trying to understand all of this, but it's difficult with the brain fog, from what I can understand an ideal TSH is around 1.46 mIU/L and mine was 4.540 in one test, and 2.25 in the second test a few weeks later.

From what I can tell an ideal Free T3 is somewhere around 3.7 and mine is 3, and ideal Free T4 is 1.515 and mine is 1.1?

From what I can tell the FT3/RT3 ratio should ideally be over 20, and mine's 17?

Also, from what I can tell the TT3/RT3 ratio should ideally be over 10, and mine is 4.82?

There's a quote from STTM that sounds like it might apply to my situation?

""If you have low FT4 and a mid-range or slightly higher FT3, it usually means the T4 is converting like mad to give you the T3 you do have, which means hypo." - http://stopthethyroidmadness.com/lab-values/

If anyone more enlightened on this topic could look through my lab results below and help me to understand what this means & where I should head from here, I would be extremely appreciative. My new Dr. initially prescribed 100mcg of T4/Levothyroxine along with 5mcg of T3/Liothyronine but he said it was really up to me if I take either of them, and what amount I start at. These seem like really high doses in comparison to others online for my levels?

Thank You so much, my lab results are below:

*CBC With Differential/Platelet (08/24/2017-LabCorp)*

*WBC:* 5.0 x10E3/uL [NORMAL] (REF: 3.4 - 10.8)

*RBC: *4.39 x106/uL [NORMAL] (REF: 4.14 - 5.80)

*Hemoglobin: *13.9 g/dL [NORMAL] (REF: 12.6 - 17.7)

*MCV:* 94 fL [NORMAL] (REF: 79 - 97)

*MCH: *31.7 pg [ [NORMAL] (REF: 26.6 - 33.0)

*MCHC: *33.8 g/dL [NORMAL] (REF: 31.5 - 35.7)

*RDW:* 13.9 % [NORMAL] (REF: 12.3 - 15.4)

*Platelets:* 280 x10E3/uL [NORMAL] (REF: 150 - 379)

*Neutrophils: *43 %

*Lymphs: *44 %

*Monocytes:* 12 %

*Eos: *1 %

*Basos:* 0 %

*Neutrophils (Absolute):* 2.2 x10E3/uL [NORMAL] (REF: 1.4 - 7.0)

*Lymphs (Absolute): *2.2 x10E3/uL [NORMAL] (REF: 0.7 - 3.1)

*Monocytes (Absolute): *0.6 x10E3/uL [NORMAL] (REF: 0.1 - 0.9)

*Eos (Absolute): *0.0 x10E3/uL [NORMAL] (REF: 0.0 - 0.4)

*Baso (Absolute):* 0.0 x10E3/uL [NORMAL] (REF: 0.0 - 0.2)

*Immature Granulocytes: *0%

*Immature Granulocytes (Abs):* 0.0 x10E3/uL [NORMAL] (REF: 0.0 - 0.1)

*Comp. Metabolic Panel (14)** (08/24/2017-LabCorp)*

*Glucose, Serum: *93 mg/dL [NORMAL] (REF: 65 - 99)

*BUN: *11 mg/dL [NORMAL] (REF: 6 - 20)

*Creatinine, Serum:* 1.00 mg/dL [NORMAL] (REF: 0.76 - 1.27)

*eGFR If NonAfricn Am:* 100 mL/min/1.73 [NORMAL] (REF: >59)

*eGFR If Africn Am:* 115 mL/min/1.73 [NORMAL] (REF: >59)

*BUN/Creatinine Ratio: *11 [NORMAL] (REF: 9 - 20)

*Sodium, Serum: *141 mmol/L [NORMAL] (REF: 134 - 144)

*Potassium, Serum: *3.8 mmol/L [NORMAL] (REF: 3.5 - 5.2)

*Chloride, Serum:* 98 mmol/L [NORMAL] (REF: 96 - 106)

*Carbon Dioxide, Total: *27 mmol/L [NORMAL] (REF: 18 - 29)

*Calcium, Serum:* 9.4 mg/dL [NORMAL] (REF: 8.7 - 10.2)

*Protein, Total, Serum:* 7.5 g/dL [NORMAL] (REF: 6.0 - 8.5)

*Albumin, Serum:* 4.6 g/dL [NORMAL] (REF: 3.5 - 5.5)

*Globulin, Total:* 2.9 g/dL [NORMAL] (REF: 1.5 - 4.5)

*A/G Ratio:* 1.6 [NORMAL] (REF: 1.2 - 2.2)

*Bilirubin, Total: *0.4 mg/dL [NORMAL] (REF: 0.0 - 1.2)

*Alkaline Phosphatase, S: *88 IU/L [NORMAL] (REF: 39 - 117)

*AST (SGOT): *65 IU/L [HIGH] (REF: 0 - 40)

*ALT (SGPT): *30 IU/L [NORMAL] (REF: 0 - 44)

*UA/M w/rflx Culture, Comp** (08/24/2017-LabCorp)*

*Urinalysis Gross Exam:*

*Specific Gravity: *1.012 [NORMAL] (REF: 1.005 - 1.030)

*pH: *6.0 [NORMAL] (REF: 5.0 - 7.5)

*Urine-Color: *Yellow [NORMAL] (REF: Yellow)

*Appearance:* Clear [NORMAL] (REF: Clear)

*WBC Esterase:* Negative [NORMAL] (REF: Negative)

*Protein:* Negative [NORMAL] (REF: Negative)

*Glucose: *Negative [NORMAL] (REF: Negative)

*Ketones: *Negative [NORMAL] (REF: Negative)

*Occult Blood: *Negative [NORMAL] (REF: Negative)

*Bilirubin:* Negative [NORMAL] (REF: Negative)

*Urobilinogen, Semi-Qn: *0.2 mg/dL [NORMAL] (REF: 0.2 - 1.0)

*Nitrite, Urine: *Negative [NORMAL] (REF: Negative)

*Microscopic Examination:*

*Microscopic Follows if indicated.*

*Microscopic Examination (See Below*

*WBC:* 0-5 /hpf [NORMAL] (REF: 0 - 5)

*RBC: *0-2 /hpf [NORMAL] (REF: 0 - 2)

*Epithelial Cells (Non Renal):* None Seen /hpf [NORMAL] (REF: 0 - 10)

*Mucus Threads: *Present [NORMAL] (REF: Not Est.)

*Bacteria:* None Seen [NORMAL] (REF: None Seen)

*Urinalysis Reflex: *This Specimen will not reflex to a Urine Culture.

*Lipid Panel** (08/24/2017-LabCorp)*

*Cholesterol, Total: *171 mg/dL [NORMAL] (REF: 100 - 199)

*Triglycerides: *90 mg/dL [NORMAL] (REF: 0 - 149)

*HDL Cholesterol: *52 mg/dL [NORMAL] (REF: >39)

*VLDL Cholesterol Cal: *18 mg/dL [NORMAL] (REF: 5 - 40)

*LDL Cholesterol Calc: *101 mg/dL [HIGH] (REF: 0 - 99)

*TSH Rfx on Abnormal to Free T4 ** (08/24/2017-LabCorp)*

*TSH: *4.540 uIU/mL [HIGH] (REF: 0.450 - 4.500)

*Thyroxine (T4) Free, Direct, S: *1.51 ng/dL [NORMAL] (REF: 0.82 - 1.77)

*Testosterone, Free, Direct (08/31/2017-LabCorp)*

*Free Testosterone (Direct): *2.6 pg/mL [LOW] (REF: 8.7 - 25.1)

*Magnesium, Serum (08/31/2017-LabCorp)*

*Vitamin B12: *1082 pg/mL [HIGH] (REF: 211 - 946)

*Magnesium, Serum: *2.2 mg/dL [NORMAL] (REF: 1.6 - 2.3)

*Folate (Folic Acid) Serum (08/31/2017-LabCorp)*

*Folate (Folic Acid), Serum: *19.4 ng/mL [NORMAL] (REF: >3.0)

*CEA (08/31/2017-LabCorp)*

*CEA:* 2.9 ng/mL [NORMAL] (REF: 0.0 - 4.7)

*AFP, Serum, Tumor Marker (08/31/2017-LabCorp)*

*AFP, Serum, Tumor Marker:* 1.2 ng/mL [NORMAL] (REF: 0.0 - 8.3)

*Sedimentation Rate-Westergren (08/31/2017-LabCorp)*

*Sedimentation Rate-Westergren:* 12 mm/hr [NORMAL] (REF: 0 - 15)

*Thyroid Peroxidase (TPO) Ab (08/31/2017-LabCorp)*

*Thyroid Peroxidase (TPO)Ab:* 17 IU/mL [NORMAL] (REF: 0 - 34)

*Thyroglobulin Antibody (08/31/2017-LabCorp)*

*Thyroglobulin Antibody:* 2.6 IU/mL [HIGH] (REF: 0.0 - 0.9)

*Panel 083904 (08/31/2017-LabCorp)*

*EBV Nuclear Antigen Ab, IgG:* 441.0 U/mL [HIGH] (REF: 0.0 - 17.9)

*EBV Ab VCA, IgG:* >600 [HIGH] (REF: 0.0 - 17.9)

*EBV Early Antigen Ab, IgG: *13.8 U/mL [HIGH] (REF: 0.0 - 8.9)

*CMV PCR (08/31/2017-LabCorp)*

*HIV 1 Ab: *Negative [NORMAL] (REF: Negative)

*HIV 2 Ab: *Negative [NORMAL] (REF: Negative)

*Final Interpretation:* Negative for HIV-1 and HIV-2 antibodies

*CMV PCR:* Negative, No Cytomegalovirus DNA Detected.

*CMV Abs IgG/IgM (08/31/2017-LabCorp)*

*Cytomegalovirus (CMV) Ab, IgG:* 6.40 U/mL [HIGH] (REF: 0.00 - 0.59)

*Cytomegalovirus (CMV) Ab, IgM:* <30.0 [NEGATIVE] (REF: 0.0 - 29.9)

*PSA Total+% Free (08/31/2017-LabCorp)*

*Prostate Specific Ag, Serum:* 0.3 ng/mL [NORMAL] (REF: 0.0 - 0.4)

*PSA, Free: *0.15 ng/mL [NORMAL] (REF: N/A)

*% Free PSA: *50.0% [NORMAL] (REF: ??)

*Calcium Serum (09/05/2017-LabCorp)*

*Calcium. Serum: *10.1 mg/dL [NORMAL] (REF: 8.7 - 10.2)

*Testosterone, Serum (09/05/2017-LabCorp)*

*Testosterone, Serum:* 610 mg/dL [NORMAL] (REF: 8.7 - 10.2)

*Mononucleosis Test, Qual (09/05/2017LabCorp)*

*Mononucleosis Test, Qual:* Negative [NORMAL] (REF: Negative)

*Rheumatoid Arthritis Factor (09/05/2017-LabCorp)*

*RA Latex Turbid.: *<10.0 [NORMAL] (REF: 0.0 - 13.9)

*C-Reactive Protein, Quant (09/05/2017-LabCorp)*

*C-Reactive Protein, Quant: *<0.3 [NORMAL] (REF: 0.0-4.9)

*Vitamin D, 25-Hydroxy (09.05/2017-LabCorp)*

*Vitamin D, 25-Hydroxy: *11.3 ng/mL [LOW] (REF: 30.0 - 100.0)

*Panel 083935 (09/05/2017-LabCorp)*

*HIV Screen 4th Generation wRfx: *Non Reactive [NORMAL] (REF: Non Reactive)

*Cortisol - AM (09/05/2017-LabCorp)*

*Cortisol - AM: *14.5 pg/mL [NORMAL] (REF: 8.7 - 25.1)

*Testosterone, Free, Direct (09/05/2017-LabCorp)*

*Free Testosterone(Direct):* 7.7 pg/mL [LOW] (REF: 8.7 - 25.1)

*Hepatitis Panel (4) (09/05/2017-LabCorp)*

*HBsAg Screen:* Negative [NORMAL] (REF: Negative)

*Hep A Ab, IgM:* Negative [NORMAL] (REF: Negative)

*Hep B Core Ab, IgM: *Negative [NORMAL] (REF: Negative)

*Hep C Virus Ab:* <0.1 [NEGATIVE] (REF: 0.0 - 0.9)

*Thyroid Panel (09/08/2017-Quest)*

*TSH:* 2.25 mIU/L [NORMAL] (REF: 0.45 - 4.21)

*Total T3:* 82 ng/dL [NORMAL] (REF: 80 - 181)

*Free T3:* 3 pg/mL [NORMAL] (REF: 2.3 - 4.2) (230 - 430 pg/dL)

*T-Uptake:* 34% [NORMAL] (REF: 24 - 36)

*Total T4:* 6.5 ug/dL [NORMAL] (REF: 4.5 - 11.8)

*Free T4:* 1.1 ng/dL [NORMAL] (REF: 0.93 - 1.71)

*Thyroid Peroxidase AB: *17 UI/mL [NORMAL] (REF: < 34)

*Free Thyroxine Index: *2.3 [NORMAL] (REF: 9.2 - 24.2)

*Reverse T3:* 17 ng/dL [NORMAL] (REF: 9.2 - 24.2)

*Anti-Thyroglobulin AB:* 2.6 UI/mL [HIGH] (REF: < 1.1)


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## joplin1975 (Jul 21, 2011)

It looks like you have the beginning of a thyroid disorder, but not a full blown one.

Your TPO results aren't technically negative -- you have antibodies, they are just really low. It just so happens they TgAB results were out of range that day. It's not uncommon.

Your best bet now is to try to find someone willing to let you do a trial of low dose thyroid medication. It might be difficult because, as I mentioned, you aren't in a full blown autoimmune yet.


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## Lovlkn (Dec 20, 2009)

Welcome to the board!

Regarding your elevated TGAb - have you had an ultrasound of your thyroid? If not. Request one to rule out anything suspicious. TGAb is a cancer tumor marker and it's best to have it checked out.


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## garymaurizi (Sep 13, 2017)

Thank You both so much for the responses.

I believe my GP is open and more than willing to work with me in regards to low dosing thyroid medication -- he gave me T4 and T3 immediately after the first TSH and FT4 results before I even ran the full thyroid panel myself.

I just don't really know where I should start with the doses of T4/T3 in my situation. He doesn't seem to know either, as I don't think he commonly doses people like me that are either 'subclinical' or wobbling one month to the next. He kind of insinuated that I'm just going to have to figure out the dose through trial & error, and that it's my choice if I start dosing this early in the progression (and this seems to be the case for nearly everyone anyway).

I will note that I have been doing a rather intense exercise "p90x classic" that's about 2 hours a day 6 days a week for the last 8 months, and I have noticed that everytime I take a break for about 4 days my energy levels come back up a significant amount, and then when I start exercising again immediately the next day I feel like a zombie. The first test that came back with a TSH 4.540 I was exercising daily, the second test I did I had taken a break for 4 days before getting the testing done. I don't know what this means but I do know that exercise is supposed to give you more energy not less. In the entire time doing this exercise I haven't been able to put on even 1/4lb of muscle a month, and the average is 1-2lb's a months (and I lift hard, and heavy).

My new GP said something along the lines of "You may have EBV circling in your blood causing chronic fatigue syndrome" I've read about the links between EBV, hashimoto's and hypo but I don't really know what he means by this, as I had EBV when I was 5 years old and I don't think it's ever been a problem since.

So I guess ultimately I could use some opinions if you think my symptoms are being caused by hypothyroidism at my current levels, and I could use some help in where to start dosing with T4 and T3, 100mcg of T4 and 5mcg of T3 seems like a high dose for someone wobbling between a TSH of 2.2 and 4.540?

I have read in multiple places that it IS good to start T4/T3 EARLY in the progression of hashimoto's or hypothyroidism as it can significantly delay further deterioration of the thyroid -- that the additional hormones can actually boost the immune system and help slow progression, and this makes a lot of sense to me, so I do want to start dosing. If it matters both my parents have thyroid disease that started in their 30's (im 31), Dad had graves and had to have his thyroid radiated with radioactive iodine, mom has hashimoto's and takes synthroid daily.

Thank You so much,

Gary Maurizi

PS. Thank You for letting me know that TGAb is a tumor marker, I did NOT know this. I will ask my new GP about this and I hope he is willing to refer me to get an ultrasound of my thyroid.


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## joplin1975 (Jul 21, 2011)

Dialing in thyroid meds is very much a trial and error process. You have to look at your labs in concert with your symptoms and give it a try.

The best way to start is by trying the lowest dose first and going from there. Start with 25mcgs of levothyroxine. Wait six weeks and get new labs.

And, yes, get that ultrasound!


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## garymaurizi (Sep 13, 2017)

Thank You so much!

This is exactly what I needed to know. I just wasn't sure how low of a dose to start with. 50mcg or 25mcg, but 25mcg seems like a good place.

Do you think I should avoid the T3 entirely until/unless I find I have a conversion problem? I do read a lot of people mention doing better on NDT or T4+T3 combination? or should I start with a super low dose of concurrent Liothyroinine? like 2.5mcg?

If things progress further in the future I think I may end up wanting to switch to NDT, I like the idea that it replaces all of the thyroid hormones, not just T4/T3.

Thank You!

Gary Maurizi


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## joplin1975 (Jul 21, 2011)

Stay away from t3 meds unless you've gotten your free t4 ina good place AND your free t3 is low. But one thing at a time - try the t4 meds first and go from there.

Do many thyroid patients need t3 meds? Yes. But many does not = all. If you don't need them and you take them, you can do experience some really unpleasant symptoms.


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## Lovlkn (Dec 20, 2009)

> *Vitamin D, 25-Hydroxy: *11.3 ng/mL [LOW] (REF: 30.0 - 100.0)


Are you planning to add some vitamin D? A doctor can prescribe 50K IU weekly for 12 weeks then retest. It takes that high a dose to increase levels. If he does not want to prescribe you could buy OTC Vit D supplements. Mine was also found low many years back - I now supplement 5K IU daily just to stay in 3/4 of the range.


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## garymaurizi (Sep 13, 2017)

I am definitely going to ask my new GP about Vitamin D.

The odd thing is that he mentioned Testosterone and vitamin B12 prescriptions but my B12 was marked high? I am starting to wonder if he has even seen the latest lab results yet.

PS. I just found out that I had my TSH and FT4 tested on 11/04/2016 and my TSH was 2.200 uIU/mL and FT4 was 1.34 ng/dL so now I have this test that first shows my numbers 'in range/but not 'optimal'? and then the second test showing my TSH significantly elevated, and then the latest test show similar numbers to the first 'in range/ but not 'optimal'?

It's like it's flip/flopping.

the 11/04/2016 test was before I started the intense "p90x classic" exercise routine(Close to normal), then there's the 08/24/2017 test where I had been exercising straight for months 24-48 hours before the test (Elevated TSH), then theres the 09/08/2017 test where I had taken a break from exercise for 5 days before getting tested (Normal). I'm starting to suspect maybe the elevated TSH was a result of the intense exercise? I've read a few sites and a medical study that indicate intense exercise can alter thyroid levels but it doesn't say how, to what extent, or how quickly? I wonder if a 5 day break after months straight of exercise is enough to lower the TSH back down again assuming it was raised due to exercise and FT3 depletion? I have read that TSH moves very slowly.

I think the TGAb test proves there's definitely some auto-immune component involved and I will have thyroid issues at some point if it's not the cause of my symptoms currently?

I could use some thoughts on the above.

Thank you so much,

Gary E. Maurizi Jr


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## joplin1975 (Jul 21, 2011)

Your labs aren't quite flip-flopping. But there are changes. That's normal, both with a normally functioning thyroid and with a diseased thyroid. Exercise, stress, and loads of other environmental factors can contribute to changing labs.

TSH does move very slowly. Free t4 less so and free t3 moves relatively rapidly. That's why we don't pay a ton of a attention to TSH.

What you have to focus on is overall trends in your labs and your symptoms. Changes can and will happen.

Thyroid disease can lower testosterone and low testosterone can stress out a thyroid. Because you have antibodies, it seems reasonable to assume your thyroid is the cause. But my advice would be to fiddle with one thing at a time.


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## Lovlkn (Dec 20, 2009)

Let's see what the ultrasound reveals. Nodules can mess with lab results.

Do you consume alot of any one thing? Soy for example.

What supplements do you take?


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## garymaurizi (Sep 13, 2017)

Thanks Everyone for all of the help.

I actually go in for a CT scan of my head/brain neck/thyroid chest and gut on wednesday. I don't have an ultrasound set up yet but I do plan to do this asap (I'm not sure if a CT scan can show thyroid nodules, etc?).

I recently gained access to ALL of my lab results going back to 2010 and found some other issues not mentioned in my initial posting, and never mentioned to me by my old GP. (He specifically ordered testing for testosterone without telling me multiple times yearly, each time got results showing it was very low/below reference range, and never even mentioned it).

I apparently have EXTREMELY low Free Testosterone levels(way below reference range), but low-within-range Total testosterone levels (and have since 2012). For example, in one test I had 324 ng/dL Total serum testosterone levels but only 2.6 pg/mL Free testosterone levels (that's with a reference range of 8.7 all the way up to 25.1 pg/mL).

I know this can go hand-in-hand with hypothyroidism in men, and I'm still doing my research trying to understand the links. I understand the pituitary gland is responsible for stimulating both the thyroid and testes/production, I wonder if that means I should be researching more into the pituitary axis/functioning?

I started my thyroid meds T4 at 100mcg T3 at 5mcg prescribed dose two days ago. (It may just be me, but the T3 seems a little peeky already / quick acting).

I did also find out I had a severe vitamin D deficiency, and started supplementing with 5,000IU Vitamin D.

The thing that alarms me is that my GP wants to treat my low testosterone levels with TRT/exogenous testosterone injections, and I really don't like this idea, I'm still pretty young (31) and though I dont think I plan on having kids in the future, the side effects scare me, and even further, it just seems like treating the symptoms all the while making no real effort to discover and cure the root cause of both issues? I definitely like the idea of symptomatic relief, but not if it means shutting down my body's natural testosterone production in this instance.

We haven't tested my SHBG levels, FSH/LH Levels, GH levels, DHT levels, Estrogen/Estradiol Levels, Etc. Is it reasonable for me to insist on testing ALL of these things before resorting to something like testosterone replacement therapy in conjunction with thyroid replacement therapy?

Any and all thoughts or guidance is welcomed, I'm trying to learn as much about both of these conditions and how they relate as possible.

Thank You so much,

Gary E. Maurizi


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## joplin1975 (Jul 21, 2011)

I don't know about all the other tests you are asking about -- just things I haven't dealt with.

I do know, thanks to my husband, that adjusting to testosterone treatments can be as challenging as adjusting to thyroid meds. So, as I said above, I'd really push you to considering adjusting ONE med (T vs. thyroid is your choice) versus fiddling with both at the same time.


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## Lovlkn (Dec 20, 2009)

Agreed. Do one drug at a time otherwise - if you have adverse or positive reaction you will not know from which drug it came.

I met a guy who took testerone and loved it. Said he felt 18 again. However his brother in law was prescribing and took him off due to new studies that concerned him about the side effects. The guy I spoke with said going off was a huge disappointment


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## creepingdeath (Apr 6, 2014)

Wait for your thyroid issues to be fixed and the testosterone will snap back to where it should be .

Be patient because it can take years.


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