# New to board, would like some opinions on recent test results



## atryko (Sep 10, 2011)

Hello, first time poster here. I am a 33 year old male, happily married with 2 young sons. I have been hypothyroid since age 12. I have been on the same dosage of Synthroid (mostly generics) of 112 mcg since I was diagnosed.

The last few years I have started to start showing more of the hypothyroid signs again: more tired, sluggish, weak, joint pain everywhere (shoulders, hips, elbows, knees, ankles, & lower back especially), super dry skin in spots (almost looks like psorasis). I've gone to my general doctor a few times regarding the pain (mostly the back pain) because I had assumed I had just injured myself. I've always been prescribed some rx anti-inflammitories and called it good. Even thought it never really helped.

But, finally (after a positive ANA test) my regular doctor sent me to a rheumatologist. After some more testing, it was suggested I go on 2000iu a day of Vitamin D, and that I might have to consider Testosterone replacement. I thought I would post my test results to see if anyone would concur that this would help my symptoms based on my tests? Thanks in advance for the help!

T3, Total 98 (80-200)
TSH 1.27 (0.35-5.00)
Free T4 1.1 (0.7-1.9)

Anti-TPO <0.5 (0.0 - 5.6)
Anti-Tg 6.5 (0.0 - 4.1)

Vit B12 652.6 (200-1100)
Testosterone, total 276 (300-1080)
Testosterone, free 70.5 (47.0-244.0)
SHBG 14 (11-80)

Vit D, Total 32 (30-100)
D3 30
D2 2


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## northernlite (Oct 28, 2010)

A FT3 would be a better test but my thought is you could use a little more T4 medication. You probably will have trouble convincing your doctor of that. Your TSH is good by most standards but a lot of us like it under 1.0. Your FT4 is under the midpoint of your range, most of us try to get it above the midpoint. If you increased your T4 that would go up and should bring up your total T3 and hopefully your FT3 as well.

I would ask the doctor to try 125 mcg Synthyroid for a couple months and see if you see improvements in your symptoms.

I would guess the testosterone could also play into how you feel but can offer you no advice on that.


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## Andros (Aug 26, 2009)

atryko said:


> Hello, first time poster here. I am a 33 year old male, happily married with 2 young sons. I have been hypothyroid since age 12. I have been on the same dosage of Synthroid (mostly generics) of 112 mcg since I was diagnosed.
> 
> The last few years I have started to start showing more of the hypothyroid signs again: more tired, sluggish, weak, joint pain everywhere (shoulders, hips, elbows, knees, ankles, & lower back especially), super dry skin in spots (almost looks like psorasis). I've gone to my general doctor a few times regarding the pain (mostly the back pain) because I had assumed I had just injured myself. I've always been prescribed some rx anti-inflammitories and called it good. Even thought it never really helped.
> 
> ...


Hi there and welcome!










Your Total 3 is in the basement and that is not good because the Total is comprised of bound, unbound and rT3 hormone. Unbound (FT3) is your active hormone which is available for cellular uptake.

Here is info on that; it will be important for you to get the FREE T3 test.

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.
http://www.drlam.com/articles/hypothyroidism.asp?page=3

And your FREE T4 is low. The mid-range of the range provided by your lab is 1.3; it is better if your FT4 is above the mid-range as this is what converts to FT3.

I feel you are undermedicated.

And at this point in time, I seriously recommend a sonogram of the thyroid if you have not ever had one. It is always a good idea to check for cancer.

Testosterone replacement will be a strong consideration for you but I am sitting here thinking that you may benefit from an increase in your Synthroid "or" the addition of Cytomel to your current regimen "or" a switch to Armour which is T3 and T4.

What happened w/the positive ANA? It is "suggestive" of many things so I wonder if the doctor followed up on that and did further in-depth testing?

You may wish to read this and discuss w/your doctor.
http://labtestsonline.org/understanding/analytes/ana/tab/test

If your body does not have sufficient FT3; you do become symptomatic and I believe this is the crux of the situation.


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## atryko (Sep 10, 2011)

Thank you for the replies! Regarding the positive ANA test, that is why I was referred to the rheumatologist. Sounds like there are several individual portions of an ANA test, and the only one that was positive would/could be an indication of scleroderma. But, the rheumatologist did not believe I have scleroderma, based on his physical checkup, symptoms, & family history.

He ordered some of the tests above (anti-thyroid, testosterone, and vitamin D) to see if something else was causing my pain. My regular doctor had the thyroid test above done after I visited the rheumatologist. Obviously, he missed/skipped the Free T3 test. Which leaves me where I am today. Taking my same ole Synthroid dosage, vitamin D, & anti-inflamitories (Meloxicam, prescribed by my regular doctor).

Regarding the sonogram, I don't recall having one performed back when I was first diagnosed. I've also never visited an endocrinologist. My doctor(s) have always given me the physical test to check for pain & swelling. And, there's never been either. I'll admit though, that my neck has always been a bit sensitive. I've never been very tolerant of tight-necked shirts.

One other thing I thought to mention, when I was first diagnosed...I also had high triglycerides (they are fine now), low bad cholesterol (120's & 130's), but also low good cholesterol (it was in single digits back then, now I believe in the teens or low-20's).


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## Andros (Aug 26, 2009)

atryko said:


> Thank you for the replies! Regarding the positive ANA test, that is why I was referred to the rheumatologist. Sounds like there are several individual portions of an ANA test, and the only one that was positive would/could be an indication of scleroderma. But, the rheumatologist did not believe I have scleroderma, based on his physical checkup, symptoms, & family history.
> 
> He ordered some of the tests above (anti-thyroid, testosterone, and vitamin D) to see if something else was causing my pain. My regular doctor had the thyroid test above done after I visited the rheumatologist. Obviously, he missed/skipped the Free T3 test. Which leaves me where I am today. Taking my same ole Synthroid dosage, vitamin D, & anti-inflamitories (Meloxicam, prescribed by my regular doctor).
> 
> ...


The fact that your cholesterol is good is a bright and shining star!! So few can say that so kudos to you!

Yes; a sonogram would truly be a very intelligent thing to do.

Inadequate FT3 can and does lend it's self to inflammation.

Pain
Chronic pain will significantly suppress D1 and upregulate D2, resulting in a reduction in tissue T3 without a change in TSH. Thus, the significant cellular hypothyroidism is not detected by serum TSH and T4 testing (116-119). This cellular hypothyroidism, which again is undiagnosed by standard blood tests, increases the risk of the associated fatigue and depression seen with chronic pain (116,117,229).

Narcotic pain medication can, of course, alleviate pain and thus potentially improve the diminished tissue T3 levels seen with chronic pain; but narcotics also suppress D1 but not D2, so such treatment is ineffective at reversing the suppressed tissue T3 levels (116-118,229). Thus, for those with significant chronic pain or using significant amounts of narcotic pain medicine, it must be understood that such a condition is associated with low tissue thyroid levels not detected by standard blood tests. Tolerance to the inhibitory effect of narcotics on TSH secretion and T4 to T3 conversion does not occur (116,119). Expert pain specialists understand this and recommend T3 supplementation to patients with significant pain or on narcotic pain medications (229).

http://nahypothyroidism.org/deiodinases/

This article also discusses chronic pain.
http://www.endfatigue.com/health_articles_d-e/Diet-thyroid_hormone_deficiency.html


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## atryko (Sep 10, 2011)

So, I went back to my doctor for a follow-up to discuss my Thyroid meds & potential for testosterone therapy. I did not do my due diligence, I did not print and bring any of the above references to give to my doctor. So, I could not speak very intelligently regarding my Thyroid. My doctor was very hesitant to consider upping my Synthroid meds, he wanted to try Androgel first. His thinking was that my low testosterone was more likely causing my fatigue, and also didn't think the pain would/could be related to my Thyroid (considering my levels were "normal). He is afraid by upping my Synthroid, that he might push me to Hyper.

I decided to go along with his advise, on the promise that if the Androgel didn't help, then he would up the Synthroid. So, I find out my insurance won't cover any of the bill. Talk about discouraging! I've decided not to shell out the $350 dollars to "try" something out. I think I will phone my doctor's office, and ask for him to up my Synthroid (up to the next level, 125mcg) as he started to suggest, before he changed his mind to the Androgel. I guess it might be time to find a new doctor if he won't do it.

I apologize for my post primarily being a rant. Does anyone have any references that show that hypothyroid problems can cause low t? Honestly, I'm not really feeling any of the typical low t symptoms besides the fatigue (which is also a hypo symptom). So, I don't know if the low t test could be due to being under-medicated on my thyroid meds. I'm just a little lost and confused at the moment. Thanks for listening to my rant!


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## atryko (Sep 10, 2011)

Quick update from yesterday. My doctor is not comfortable upping my Thyroid meds (before trying the Testosterone replacement). But, offered to refer me to an Endo. Does anyone have any thoughts? I assume this is probably my best route?


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## lainey (Aug 26, 2010)

Changing the ratios of testosterone/estrogen can impact the free thyroid hormones and therefore the TSH. In the case of testosterone, your frees would likely go up and your TSH therefore down (estrogen binds thyroid hormone, and has the opposite effect).

I agree with your doctor--you should bring the testosterone into a better place in the range first, because this will impact the thyroid numbers. Afterward, you can see if you still need a dose increase.


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## Andros (Aug 26, 2009)

atryko said:


> So, I went back to my doctor for a follow-up to discuss my Thyroid meds & potential for testosterone therapy. I did not do my due diligence, I did not print and bring any of the above references to give to my doctor. So, I could not speak very intelligently regarding my Thyroid. My doctor was very hesitant to consider upping my Synthroid meds, he wanted to try Androgel first. His thinking was that my low testosterone was more likely causing my fatigue, and also didn't think the pain would/could be related to my Thyroid (considering my levels were "normal). He is afraid by upping my Synthroid, that he might push me to Hyper.
> 
> I decided to go along with his advise, on the promise that if the Androgel didn't help, then he would up the Synthroid. So, I find out my insurance won't cover any of the bill. Talk about discouraging! I've decided not to shell out the $350 dollars to "try" something out. I think I will phone my doctor's office, and ask for him to up my Synthroid (up to the next level, 125mcg) as he started to suggest, before he changed his mind to the Androgel. I guess it might be time to find a new doctor if he won't do it.
> 
> I apologize for my post primarily being a rant. Does anyone have any references that show that hypothyroid problems can cause low t? Honestly, I'm not really feeling any of the typical low t symptoms besides the fatigue (which is also a hypo symptom). So, I don't know if the low t test could be due to being under-medicated on my thyroid meds. I'm just a little lost and confused at the moment. Thanks for listening to my rant!


I certainly agree w/that because low testosterone can impede the efficacy of your thyroxine replacement. Smart doc; he knows his stuff.

Are you saying the Androgel costs $350???

What a mess this is. I really do think your doctor is correct in his thinking.

I do see what you mean though as to which comes first, the cart or the horse.

Please let us know the outcome re your decision-making process.


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