TSH and SHBG

[Hendie]

Does anyone know much about SHBG please? I’ve had a few blood tests and all coming back with high SHBG levels (over 200 but does not state how much over as the lab just reports ‘over’). Doc is fixating on my TSH level (0.005) saying they think I’m over medicated but my T3 and T4 are within range and I know that taking NDT suppresses my TSH. I’ve been on HRT oestrogel for a good few months and wanted to try adding testosterone cream but the private doctor won’t prescribe whilst I have high SHBG, they want me to see an endo but then I know the endo won’t like that I’m taking NDT and we go around that merry go round. I feel fine, not over medicated, liver and other tests all fine, just want to try testosterone as my levels are low and I’m hitting a brick wall with the docs. Any help appreciated.

[jamesal0]

Hi Hendi this article seems to cover it off in layman's language.

blog.insidetracker.com/sex-...

"estrogen or thyroid hormone treatment can cause higher than normal SHBG levels in women"

J

[Hendie]

Thank you for replying, I’ve read that article and scoured the web - that article is a good one. The problem is she believes the TSH is causing it and whilst on NDT I’m not going to be able to increase my TSH.

[jimh111]

SHBG goes higher as thyroid hormone levels increase but the relationship is imprecise as SHBG levels vary considerably between individuals.

SHBG is just one marker for thyroid status so you need to check for other hyperthyroid signs and symptoms such as pulse, tendency to sweat and a fine hand tremor. It’s a good idea to try reducing your dose a tiny bit every so often to see if you are still OK on a lower dose.

[Hendie in reply to jimh111]

Thank you, I feel fine but agree with trying a reduction, I’ve also lost weight recently (diet and exercise) so perhaps I can get by with less. I’ve reduced my amount today and will see how low I can go 😁 I was told that reducing my NDT won’t increase my TSH though as the T3 still suppresses the TSH?

[jimh111 in reply to Hendie]

TSH is lowered by T4 and T3, the amount TSH falls depends on the dose. Many people who need liothyronine or NDT have a TSH that is low (for given fT3, fT4 levels) and so their TSH falls easily. It's better to have a TSH that is within its reference interval but this is not always possible. The approach I take is to try to stay on the lowest dose that makes me better. There are risks with a very low TSH and perhaps higher risks with being clinically hypothyroid. So, it is not always possible to be risk free. This occurs in all branches of medicine not just thyroid, risks have to be balanced.

[Clara4741]

BHRT Testosterone could actually help to bring the SHBG down unless it is a genetic issue of course. I currently have the same issue because I am on T3 Medication and am just starting to work with a BHRT Doctor. She said that if Testosterone were high enough then high SHBG wouldn't matter, as I wouldn't feel the negative effects of it. Trust yourself and your instincts and don't let these so-called Experts (not!!) make you feel you don't know your own mind. Shame on them! I have always had a suppressed TSH even when I was on NDT as opposed to T3 only...it is just the way it is and you won't feel better having treatment withdrawn or reduced if that is what happens to your TSH.

[Clara4741]

P.S. The optimal range for SHBG is 100. 120 max. Mine too has come back off the range before and also been 169 and latest one 219 on a test that gave a number when it was over 200.

[Hendie in reply to Clara4741]

Sadly my labs (both nhs and private) don’t show anything detail 200 and it’s always just said over 200 which is really annoying. I’ve been paying a Bupa Menopause doc and they’re the ones who won’t prescribe until my SHBG is reduced or an Endo says it’s ok to prescribe (she said she’s confirmed with their senior who said the same). Which doc do you use please? My testosterone is low and I have all the symptoms of low. Super frustrating as it’s just delay after delay to try to feel normal.

[Hendie in reply to Hendie]

Ps I’m on oestrogel and Utrogestan and have been since April (patches prior to this from Jan 22)

[Clara4741]

I don't think I can say on here but she is an Integrative Functional Medicine Doctor and I have only had 1 session with her so far, so am not sure I would recommend just yet! You definitely need to ditch anyone in the conventional NHS or Private domain and find a Functional Medicine Practitioner or Doctor. I wouldn't worry about not knowing how high over 200 your SHBG is. You should say to your current Doctor that it could be genetic. The fact they aren't offering a plan to help you shows they don't know what they are doing frankly, so move on!

[Hendie]

Yep it’s super annoying. I guess they want another Doc to say it’s ok to prescribe as they need to cover themselves but just saying they don’t know is not the best and just delays my treatment. Thanks for your reply and it’s good to know I’m not the only one struggling with this, I hope you get sorted too.

[diogenes Remembering]

You will find this article right up your street:full text links also is with TUK in archives

Thyroid . 2017 Apr;27(4):484-490. doi: 10.1089/thy.2016.0426. Epub 2017 Feb 6.

Biochemical Markers Reflecting Thyroid Function in Athyreotic Patients on Levothyroxine Monotherapy

Mitsuru Ito 1 , Akira Miyauchi 1 , Mako Hisakado 1 , Waka Yoshioka 1 , Akane Ide 1 , Takumi Kudo 1 , Eijun Nishihara 1 , Minoru Kihara 1 , Yasuhiro Ito 1 , Kaoru Kobayashi 1 , Akihiro Miya 1 , Shuji Fukata 1 , Mitsushige Nishikawa 1 , Hirotoshi Nakamura 1 , Nobuyuki Amino 1

Affiliations expand

PMID: 28056660 PMCID: PMC5385443 DOI: 10.1089/thy.2016.0426

Free PMC article

[Hendie]

Thank you I’ll look it up 👍

[RatherBeSleeping]

Hi Hendie! I'm having a similar issue and wonder if you learned anything you can share about how things worked out for you and the relationship between SHBG and thyroid/estrogen/testosterone.

[Hendie in reply to RatherBeSleeping]

I went to a different Doc and managed to get them to prescribe testosterone regardless of my SHBG levels. They acknowledged that the meds could be impacting it and went off my symptoms instead.