This is my first real post on this forum. I'd appreciate if experienced members could take a look at my labs and history and let me know what they think.
I'm a 46-year-old male from Canada but living in France for the past 10 years. I've had deteriorating health issues for close to 5 years (likely longer) and only recently did I figure out that most of my symptoms we coming from hypothyroidism and low cortisol (crushing fatigue, muscle weakness, low body temp, poor sleep, dry skin, blurred vision, weight loss, irritability, etc.) Worse in the morning, generally better in the pm.
I was able to source NDT (Thyroid-S) independently (doctors have been useless) and started taking it in March. I saw marked improvement after 10 days, and as I increased from 1 grain to 3 gradually I felt better than I had in a really long time, but that didn't last. I had a good 6 weeks or so before starting to feel worse again. I figured it was perhaps because of conversion issues as I have high RT3 (0,36 ng/ml (0.17 - 0.44)), so I decided to start taking T3. I gradually switched from the NDT to T3-only. At the moment I'm taking 100 mcg / day split in 5 doses 25mcg 730am 25mcg 1130am 25mcg 330pm 12.5mcg 10pm 12.5mcg 330am.
So this includes a dose at 330am because I have low cortisol and I'm trying the Paul Robinson's CT3M.
Right now I'm using sketchy Indian T3 from bodybuilding websites - it's definitely T3 but I think it might be underdosed vs what's advertised. I have Tiromel on the way.
While some of my symptoms have improved since May, I honestly feel like crap and at this point I'm not sure even sure T3 is helping.
Other symptoms have not improved or even gotten worse, I have severe vocal fatigue after a normal amount of conversing, my throat really hurts at the end of the day. This was definitely not as bad before starting T3.
I know it can take time to clear RT3. I'm not sure what the best move is, because I also have really high SHBG and low testosterone, which is probably only getting worse because of the T3 I'm taking.
I had 2 different 4-point saliva cortisol tests over the past 18 months, with a slight increase on the second on, but still low cortisol (both tests were prior to starting thyroid meds) :
feb 8 2023
8am 0.2280 µg/dL (0.113 - 0.803)
8:30am 0.2750 µg/dL (0.2 - 1.076)
10am 0.2070 µg/dL (0.083 - 0.574)
8pm 0.0040 µg/dL (0.032 - 0.322)
jan 18 2024
8am 0.268 (0.127-0.373)
8:30am 0.451 (0.223-0.729)
2pm 0.070 (0.054-0.206)
8pm 0.034 (0.001-0.079)
They are 2 different labs which explains the different ranges, I now realize is a bad idea to change labs.
I had a synacthen test which was normal.
These are lab results from before I started taking any thyroid medication:
RT3 0,36 ng/ml (0.17 - 0.44)
TSH 1.64 (0.27 - 4.2)
FT3 3.09 (2 - 4.4)
FT4 1.22 (0.93 - 1.7)
B12 400 pmol/L (145-569) - latest md I consulted said this lab's range is ridiculously too low
Selenium 129.9 (70 - 150)
Anti-TG : 16 UI/mL (<115 IU/ml)
TPO : 17 UI/mL (< 34 IU/ml)
TSH antireceptor 1,43 UI/L (< 3.1 IU/L)
Theses are my latest labs, taken while I was taking NDT, before I started T3 :
Blood cortisol 8:10am : 15.50 (7.4 - 23.30)
Saliva Estradiol (Estrogen) 3.37 (0,4 à 3,3 pg/mL)
Prior to starting T3, the last doctor I saw was an expensive "functional medicine" doc which seemed knowledgeable at first but I'm not too sure anymore. He prescribed DHEA (20mg /day) as he said this would help lower SHBG and raise testosterone, but nothing about the hypo or low cortisol symptoms. I started taking the DHEA plus other supplements he has prescribed (zinc, B12, CoQ10, berberine, glutamine). Within 7-10 days of taking the prescribed stack my fatigue had worsened and I had really bad leg pain, so I dropped the DHEA and zinc, took about 3 weeks for leg pain to subside.
I wasn't sure whether the DHEA was the cause because I had read it could lower cortisol, but I think the zinc might also be part of the problem since I read it could also lower cortisol in a much more potent way than DHEA. I tried DHEA last week for 3 days and it definitely has a negative impact. I'm wondering if it's perhaps converting to estrogen (which seems already high on saliva lab) instead of testosterone.
Could this also be indicative of low copper? I have low-normal zinc but can't seem to tolerate supplementing for some reason...
Someone reached out on another forum saying I could perhaps try Proviron to help lower my SHBG and hopefully free up my testosterone.
I'm taking ACE and pregnenolone but honestly can't say that it's helping at all, my temps are all over the place, I feel cold as soon as ambient temps are not hot or if I'm not moving. My BP is normal at 120/80 or slightly below, my HR has increased slightly since taking T3 which is a good thing as it was super low - sometimes low 50s.
I'm waiting on some HC cream which I think I'll be trying out soon and ditching the ACE, would appreciate input from anyone using that as well.
Thanks for reading this long post, and let me know if you have any advice. I also have more labs available, I just included what I felt was pertinent.
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Oliduder
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I assume you're saying RT3 wasn't high because it's "in range", but I've learned to not trust the lab ranges. If you look anywhere else 0,36 ng/ml (36 ng/dl) RT3 is considered pretty high.
RT3 is not tested in France, the lab employees had to search for it for a full 5 minutes when I asked for the test, this one test alone cost me 140 EUR. I wouldn't expect their range to tell me anything.
The reason I didn't try levo is because as I explained I started feeling much better on NDT, but that didn't last, so I assumed the T3 in the NDT initially made me feel better, but then the extra T4 eventually increased RT3 and negated the benefit.
just incase you aren't aware, of this Oliduder : high shgb can indicate thyroid hormone levels in the body have been too high (for the individual) over the longer term . (endo's will sometimes look at it if they suspect people are taking more than they admit to and deliberately lowering their dose for a few days /wks before thyroid blood tests)
so if your shgb has gone up since taking thyroid hormone , that is a likely why ~ and lowering the amount of thyroid hormone replacement should therefore be expected to lower your shgb.
The SHBG lab was done after taking NDT for a couple of months, could that alone be causing such high SHBG, I mean it's really quite high... and bioavailable testosterone is really low almost below range. I hadn't taken any T3 at that point.
rT3 is a huge red herring! There are many, many causes of high rT3 and only one of them has anything to do with thyroid, and that is when your FT4 is too high. Your FT4 was only 45.45% through the range. Not high enough to convert to excess rT3. So your rT3 level had nothing to do with your thyroid or your NDT.
In any case, rT3 is not a problem. It is inert, so doesn't cause symptoms, and only stays in the system for about 2 hours before being converted into T2. And it does not block T3 receptors as used to be thought. It has its own receptors. So really not worth spending all that money on testing it. And you really won't feel any better for clearing it because it is not causing you problems.
My experience of taking DHEA is that it allllll converted to testosterone! I had to stop taking it.
It would be unusual to have low copper and low zinc when hypo. Usually hypos have one too high and the other too low. But best to get it tested before taking any copper.
Your B12 is low, but not much point in just taking one isolated B vitamin. The Bs all work together and need to be kept balanced. So, you'd be better off with a good B complex, one containing methylcobalamin (B12) and methylfolate. B12 should be at least 550.
I was able to source NDT (Thyroid-S) independently (doctors have been useless)
Doctors would be useless where NDT is concerned. Most of them have no idea what it is, anyway. But also NDT is illegal in France, so the majority wouldn't dare prescribe it. And if they did, you'd have to go to Belgium to buy it.
Thanks for your reply. Do you have a source (study?) for that info on RT3? It goes against most info I found and what's being discussed on other forums. For all I know you might be right but at this point everyone is saying something different so it's really difficult to know what's true.
If RT3 isn't what's causing my symptoms, I have a feeling it's much more related to adrenals than anything else as my symptoms correspond a lot more to adrenal dysfunction.
"Doctors would be useless where NDT is concerned" - At this point I feel like they're useless where most things are concerned....
you'll find some useful references in here , can't remember if this is a complete/ up to date list as its while since i put it together : healthunlocked.com/thyroidu.... pooling-an-outdated-concept-list-of-useful-posts-which-explain-why-reverse-t3-blocking-t3-receptors-is-not-a-thing-.
It's heavy going but it might give you the information you need.
I know that a lot of people still cling onto the idea of rT3 being the villain because it's a handy scapegoat for desperate people. But science and knowledge moves on.
Yes, you're right, doctors are useless where thyroid is concerned, and that's true it the majority of countries - if not all of them! It's lack of education that is the problem. They just don't learn much about it in med school - and most of what they learn is false!
I have only just read your post. Please where do you get your Cortisol saliva 4 points tests done in France. I live here want to get one. Only available in Belgium?
A lot of stuff to think about and I think you need to simplify.
The cortisol test in 2024 is ok. The curve is declining as the day progresses, so good there. Ok it could be a little higher in the morning, but it is common to be a bit lower in cortisol if you have thyroid issues. I don't think you need to look too closely at cortisol.
You must try T4 first before introducing T3. It complicates things if you throw in the T3. You have also used a lot of T3 in the NTH. I am a believer in using small amounts of T3 with the T4 as the base dose. Similar to Dr Blanchards protocol (google him). He feels 5mcg per day of T3 is a huge dose, so that gives you an idea what his protocol involves.
I myself did exactly what you have done. started NTH back in 2012, got up to maybe 5 grains. Good at first, then not so good. To high too fast. Ended up moving over to T4 and T3, then T4 only. Throw in some T3 only protocol over the years as well. I have been stable and on 125 T4 only pretty much for 10 years I think. I have used small doses of T3 in that time (6.25mcg per day), but it is not a regular thing and sometimes the T3 helps, other times it does nothing. I might use it once every few weeks now.
Recently I have found out splitting my T4 dose in two doses per 24h has brought huge benefits, so you are always learning with this stuff.
I also now take testosterone and have been on it for about 4 years. It has been a big help.
I am 52, so of a similar age. I feel your issue is testosterone mixed with thyroid.
You need to go slow and form a set routine where you get some stability with your first hormone. As you are on thyroid you need to focus on this and get it stable to some extent. Thyroid will boost the testosterone as well.
Try get some T4 and stop the NTH. I would be looking at taking 100 T4 and then get tested after 4 weeks. See how you feel in this time.
Removing any hormone is as useful as adding it in. It's a great way to help confirm whether something is working for us or not working. eg, do you feel better if you stop the NTH for a period ? Have you tried just stopping the NTH for a week to see how you respond ? If you get some positive responses it means the body is starting to "breath" without the T3 complicating things. Natural pathways will start to fire on their own and will start to use up the T4 content in the body. This happens when we remove thyroid hormones (it has with me).
Then going forward if I remove the hormones for too long I will decline. So another indicator I do need the thyroid hormones, but maybe not as much and maybe not the T3.
This is just a very poorly written summary of my own experiences with thyroid hormones, but I hope you get what I'm trying to convey.
So ideally try a switch over to T4, see if you can get some stability. Maybe use max dose of T3 per day of 6.25 (1/4 tablet). This will take time, but over 4 months you should make some progress.
Next get bloods once a bit more stable and hopefully in a slightly better place and see where testosterone is.
High SHBG is very normal as we age and the body is doing the correct thing. It is the protein which holds the testosterone in the blood and moves it around the body. If we are low in testosterone the body holds it for us. It is doing a rationing job.
I would say your SHBG is very high, but your other testosterone bloods sort of don't fit with really low testosterone. So you want to discount the effect of T3 on the SHBG level as mentioned by others. And try get stable, or feel a bit better on a better thyroid protocol.
Regarding testosterone. Yes SHBG is high. But total testosterone is top of range. Free T and bio available T are low in range. So you have a lot of testosterone, just not able to use it. Has the T3 caused this issue ?
Your FSH level is lower and this is the signal to make sperm, so your body is making this normally (indicating testicles are good). The LH signal is mid range and is the signal to make testosterone. If you have a high LH level it means the body is not happy with the testicule output so indicates there is a problem. High LH and a mid or low testosterone level indicate testicular problems. You are not in that camp. Yes the free T is low, but that is because it is being rationed by the SHBG. You are actually making decent amounts of testosterone.
Please make one change at a time with your routine. How do you know what is doing what ?
If you are taking loads of supplements try and simplify and then stick to a protocol and then remove or add the bigger hormones. It is the hormones which will do most of the heavy lifting. Vitamins and minerals are like additives in a petrol engine, but it's the petrol we need to focus on.
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