Monotherapy With T3 and Shbg

[Atako]

Hi guys today i picked up my lab tests.

I am on T3 monotherapy and take 5mcg of T3 at 6:30 AM (last 5 mcg dose taken 24 hours before):

TSH 3,97 µUI/mL (0.38 - 5.33)

FT3 3,02 pg/mL (2.16 - 4.85)

FT4 0,80 ng/dL (0.61 - 1.30)

T4 7,51 µg/dL (4.50 - 10.90)

T3 1,03 ng/mL (0.60 - 1.81)

SHBG 50,9 nmol/l (10 - 57)

Surely we will have to increase the dose, because even if 24h have passed since the last dose of T3, the TSH still remains high, but given my shbg values ​​I would like to divide the dose into 3 daily doses (ex. 2,5 mcg 6:30 AM - 2,5 mcg 12:30 AM - 2,5 mcg 6:30 PM) to keep the shbg as low as possible.

My free testosterone remains low and I'm afraid if I increase the dose once a day (ex 10mcg at 6:30AM) my shbg will skyrocket and it blocks my testosterone even more.

I have low libido and erectile dysfunction

what do you think?

Thanks

[radd]

Atako, 

I assume total testosterone is adequate? If not have you had LH and FSH tested?

TSH does lag behind the variations of thyroid hormone but your TSH results are still too high for someone medicating. How long have you been taking 5mcg T3? 

Results show FT3 at 32%, FT4 is 28% through range and Totals 47%. FT3 will be showing slightly lower than an average reading but FT4 levels should be correct. 

Given your issues and high in-range SHBG I wouldn’t aim to raise T3 levels with increased med doses but split the 5mcg dose you are already taking to prevent any spikes that risk encouraging the liver to produce yet more binding proteins. Also raise T4 levels with some Levo and encourage conversion with selenium, good diet and healthy living. I also take a mitochondrial support that helps cellular function where T3's action happens.

This should raise both thyroid hormones slowly encouraging other hormones and the associated transporter proteins to correlate. If you have Hashi are you addressing autoimmune low grade inflammation with gluten free diet? What about iron and other essential nutrients?

[Atako in reply to radd]

Hi radd, thanks for reply. Yes my Total testosterone is 680ng/dl. I'm taking 5mcg of T3 for 1 Month. Yes splitting the dose is just what I'm doing, I believe that SHBG are stimulated above all by a single high dose. I thought of dividing the dose in this way by increasing even slightly the total amount taken:

2,50mcg at 6:30 AM

2,50mcg at 12:15 PM

2,50mcg at 6:30 PM

My goals are two:

1)Keep shbg low with smaller doses divided throughout the day. Making production look as natural as possible.

2)Lower the tsh and increase FT3, keeping the two values as constant as possible

Thanks

[radd in reply to Atako]

Atako,

SHBG has the highest binding affinity for testosterone but I assume you know there are other carriers also. They generally follow the same pattern and one is CBG that if elevated will reduce your free cortisol. 

Optimising thyroid hormones slowly will help reverse these processes. What is the cause of your hypothyroidism?

[Atako in reply to radd]

radd,

subclinical hypothyroidism. My thyroid produces plenty t4 but I have a poor conversion of t4 to t3

my exams without taking any medication:

TSH 5,30 µUI/mL (0.38 - 5.33)

FT3 2,52 pg/mL (2.16 - 4.85)

FT4 0,82 ng/dL (0.61 - 1.30)

T4 9,05 µg/dL (4.50 - 10.90)

T3 1,02 ng/mL (0.60 - 1.81)

For this reason I switched to monotherapy with T3, For years I have been on levothyroxine without ever solving the problem. Because my problem wasn't levothyroxine!