Hi, I’m a 40 year- old hypothyroid male, and I was wondering if someone could clarify a few things for me. I’ve been on a mix of t3 and t4 since 2016. Everything was great at first, but after a year on it, my symptoms returned. The main ones being intermittent constipation, extreme lethargy, and the inability to lose weight. I’ve read a few things about conditions that may cause thyroid meds not to work properly. I’ve had my levels tested, and they’re “fine” according to my new endocrinologist. But I take that with a grain of salt. She says I should never have gone on meds in the first place. I was positive for TPO antibodies, my TSH was 3.6, and my t4 was at the bottom of the range. The symptoms I was having begged to differ. I hate it when doctors treat numbers instead of symptoms. Rant over.
I’ve read that systemic inflammation can cause t3 not to interact with the receptor properly, or cause receptor desensitization . I know I have some systemic inflammation, as I have rheumatoid arthritis. My ferritin is over range 476, and the range was 140-400. And my iron and liver function was normal, and I was not sick when I tested the ferritin. Also my vitamin D and folate were also low. 18 and the range was 30-85. Not sure if that has anything to do with the t3 not working, but I’ve read that most people with Hashimoto’s also have low vitamin D. But it’s not clear as to whether it’s a cause of or a result of.
I’ve also read that adequate levels of testosterone are necessary for thyroid hormone to work properly. I’m hypogonadal as well. My levels were recently tested at 265 ng/dl Range 300-965 ng/dl. I know that inadequate levels of testosterone can make it difficult to lose weight, but is it because of the thyroid connection, or through a different pathway? The article didn’t cite any references regarding the testosterone thyroid hormone connection, and I haven’t been able to corroborate that assertion. Lastly gluten. I’ve read that gluten can cause systemic inflammation beyond the gut to those whom are intolerant. I can’t confirm that definitively either. I do know that I went gluten free last year and lost a ton of weight. But was that because I eliminated the gluten, or because removing gluten containing foods restricted my caloric intake to a point that was able to lose weight? Thank you to anyone who may be able to shine some light on these questions!
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ejg700
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Hi ejg700. I'm a 52 year old male and take NDT and Testosterone. Without Testosterone I can only take 60mg NDT per day where as with I can take 180mg per day. Your symptoms sound like you are just low thyroid (T3) as you're probably not converting the T4 to T3 very well . Have a read of the Stop Thyroid Madness web site/books - very helpful. Always remember Endos are complete morons, they have to pass a special moron exam to get in. I've yet to meet an endo or a Gp that has hashimoto's disease. But I bet they would change their tune if they had to live with your initial blood test results.
More importantly .
Find out if you have celiac disease - its a simple blood test, and if you do, you need to be 100% gluten free.
Do not start Testosterone replacement Therapy (TRT) unless you really really need to. Your testis stop producing Testosterone and will probably take 18months to recover somewhat (not complete) after ceasing TRT . (we males use testosterone for everything, from sense of direction/navigation, memory, anti depressant, muscle mass etc etc. And life is not good without it.)
Having said that I really like TRT I'm seeing other 50 year old men getting old and loosing their hair, loosing muscle mass and I cant wait to hit the pool or go for a jog even with a thyroid issue.
I would start by finding a GP that will prescribe NDT or import it privately if you really have to, but you are better off having a GP to look after you. Daily NDT will cost you about what you probably spend of coffee every day - so it's not cheep but it's not that bad either.
I found my GP by ringing around the compounding chemists asking if they sold NDT and who was writing the scripts.
Sorry I repeat myself here - Exhaust the NDT options before considering Testosterone .
jamesal0 The situation here in the UK is different from Australia. We have next to no 'retail' compounding pharmacies in any case, but NDTs are unlicensed in the UK and NHS guidance to GPs is that the prescribing of thyroid extract products is not supported, so currently it is less likely to be prescribed within the NHS than even T3. If a patient admits to buying NDT (or T3) online, or even source it from a privately issued prescription, the NHS GP is not obligated to manage the patient's condition and offer testing as you suggest - some may and some won't. And of course if patients don't admit to being on other than levothyroxine their thyroid blood test results won't necessarily correlate. But the other important factor is that NDT is not the wholly grail of thyroid meds, despite STTM's assertion that it is, and some people - me included - do no better on it, and some do very badly. It isn't a one size fits all situation.
The four main deficiencies are Vit B12, folate, VitD & iron. A common cause of these deficiencies is inadequate gastric acid caused by years of low thyroid hormone, that is not only required for good digestion/absorption, but helps prevent nasty pathogens, etc from living in the gut.
Red blood cells require adequate iron, Vit B12 & folate to be formed. Vit B12 can only be absorbed in the small intestine by the activity of hydrochloric acid and protease (stomach enzyme).
Folate (B9) works with vit B12 to help create/regenerate red blood cells and make iron work properly. It also participates in the homocysteine cycle & adequate levels are required to keep this regulated as high levels are considered a significant risk factor in cardiovascular disease but also disrupting thyroid metabolism.
Good iron levels are important as contain enzyme thyroid peroxidase required to produce thyroid hormones. Due to possible inflammation, your high ferritin level is no guarantee of available iron. The only way to determine this would be a full iron panel. Low iron levels may decrease good conversion deiodinase activity resulting in unbalanced reverse T3 levels.
Vitamin D is a pro hormone & huge topic, being frequently low in Hashi sufferers due to gut issues, elevated cortisol (active vitD synthesis depends on cholesterol which gets used up making stress hormones), being overweight (vitD gets taken up by fat cells), not eating/digesting enough fats (vitD is fat-soluble), inflammation (as although helps to alleviate inflammation by immune system modulation, it also reduces vitD utilisation), genetic polymorphism and blocked vitD receptors (VDR’s).... to name but a few.
(Equally cholesterol may be high due to the body’s metabolism responsible for eliminating becoming slowed through low thyroid hormone).
Also, VitD regulates insulin secretion, sensitivity & balances blood sugar so deficiencies can be associated with insulin resistance (which adversely affects thyroid physiology in several ways.)
All hormones work together & low testosterone levels are common in men with low thyroid hormone levels, due to slow conversion rates of progesterone to testosterone, high prolactin levels and/or high/low hormone-binding globulin levels, etc. Although low testosterone levels can lower the D1 activity (reduced FT4/FT3 conversion) and influence levels of other hormones, it is not recommended to supplement additional until thyroid hormones are working well as this alone often encourages all sex hormones to just rebalance themselves.
Re inflammation - yes, any autoimmune condition can promote inflammation which can have a profound effect on thyroid metabolism/physiology, doing all that you say and more. Many members have felt conditions improve after switching to a g/f diet.
Re iron & nutrients, remember a doctors “normal” level may not be enough to ensure even optimal thyroid hormone levels to work well on an intracellular level.
If you were previously symptomatic, with positive antibodies, low FT4 levels & a rising TSH, I would agree you needed thyroid hormone replacement. If you post recent thyroid hormone test results complete with ranges (numbers in brackets), members will comment.
I note from your previous post you were taking 100 mcg L-T3? This can affect your pituitary function, how much TSH you secrete, it can down-regulate your axis which means you produce less TSH than normal for specific fT3, fT4 levels. A knock on effect is that this can reduce T4 to T3 conversion. This may not have happened, it depends on how much and for how long you suppressed your TSH. As a consequence you may now need T3 medication. It's also possible you had this problem orginally as you said your initial introduction of levothyroxine made you worse.
Symptoms of weight gain and lethargy are a bit vague and could be due to many disorders. However, since you found little benefit on 100 mcg liothyronine (Cytomel) this suggests you have some form of resistance to thyroid hormone (RTH). It's clearly not genetic as your problems came on relatively recently as regards your lifespan. An overlooked cause of RTH is hormone disruption caused by endocrine disrupting chemicals (EDCs), these can affect peripheral thyroid hormone action with minimal effect on the pituitary (and hence normal blood tests). The USA has an especially high burden of these, in particular PBDE flame retardants, due to the litigation culture in your country, especially in California. So, if your initial symptoms were due to hypothyroidism and you need to take 100 mcg Cytomel but do not get hyper signs then endocrine disruption is a possibility.
To come back to the original question. Inflammation can affect thyroid hormone action but the studies showing this are vague and usually involve people at death's door. The body protects itself in critical illness by adjusting thyroid hormone activity. I don't know of any evidence that ordinary day to day illnesses such as rheumatoid arthritis cause major thyroid hormone effects, and certainly not require patients to take 100 mcg L-T3. If this happened everyone with these illnesses would be hypothyroid.
Hypothryoidism seems to cause low iron and vitamin D levels. Curiously, your iron is high. Low vitamin D can cause symptoms very similar to hypothyroidism. It makes very good sense for you to up your vitamin D levels with prudent sun exposure and high dose vitamin D supplements. Reports of various deficiencies that 'stop T3 working' are silly. If they did indeed 'stop T3 working' the pituitary would stop responding to thyroid hormone and TSH would skyrocket. The same argument applies to claims that some deficiences 'stop T4 to T3 conversion'.
I don't know anything about testosterone and thyroid. Certainly, being overweight affects the testosterone / oestrogen balance, this is why obese men develop 'man boobs'. Also, low testosterone leads to less muscle mass and more fat around the middle as we see in elderly men. Whether hypothyroidism is causing low testosterone or vice-versa I don't know. It's not a subject I've looked into. I would caution against very low calorie dieting, it reduces T4 to T3 conversion, which is why these diets don't work. The best approach seems to be a moderate calorie sensible diet with plenty of regular exercise.
A small number of hypothyroid patients respond to gluten free diets, they usually test positive for a gluten antibody (sorry I can't remember the specific test). Since you had a substantial response it makes sense to get tested and perhaps resume your gluten free diet. (I'm not in favour of all thyroid patients going gluten free, it's not necessary for most patients). Whether you weight loss was due to a gluten problem or change in diet we don't know. Going gluten free would reduce your carbohydrate intake, if this led to you losing 'tons of weight' would depend on what your new diet was like.
I'd suggest you try and take a logical step by step approach. There are websites that put out a lot of nonesense about hypothyroidism, they usually promote expensive consultations and remedies whilst citing hundreds of vague references in the knowledge that it is impossible to check each reference. Take it stepwise and use common sense, don't trust websites that are revenue orientated.
No statins. I do massive amounts of cardio, so despite not having the best diet, I have decent cholesterol, HDL 85 ml/dl, and total is 190. I just got my latest test results back. Perhaps they are a little low? I had taken my last dose of NDT 15 hours previous to the draw. I was taking 25 mcgs of T3 and one grain of Greater Pharma Thiroid NDT in the morning, and one grain NDT in the evening. My endo now has me on 125 mcg levo in the morning, and 25 mcg of t3. Half in the morning, half in the evening. These results were taken previous to the change. Free T4 (0.4 ng/dL) Range 0.8 - 1.6 ng/dL. T3 Free (2.6 pg/mL) Range 2.0 - 4.4 pg/m and TSH: (0.39 mU/L) Range 0.30 - 4.20 mU/L.
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Glad I found this support :) It has been a very hard 6 months. 
