Advice on labs, high RT3, high SBHG, low T

[Oliduder]

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)

Blood Estradiol 24.3 (11.3 - 43.2)

Saliva DHEA 326.8 (68 à 397 pg/mL)

Blood SDHA (DHEA) 6.45 (1.2 - 8.98)

SHBG 114 (18-54)

ANDROSTANEDIOL GLUCURONIDE 39.8 (8.5 -80)

PREGNENOLONE 79 (40 - 120)

IGF1 101,0 ng/ml (72 -225 median 139)

Free cortisol (urine) : 26 µg/24h (N: 6 - 62 µg/24h)

Free testosterone : 39,7 pmol/l (N: 30,0 - 87,0pmol/l)

Bioavailable testosterone : 3,0 nmol/l (N: 2,7 - 12,0)

Total testosterone 7.88 (2.49 - 8.36)

24h urine iodine : 122 µg/l (N: ­>100 µg/l)

Sodium 140 (136-145)

Potassium 4.4 (3.4 - 4.5)

Vitamin D 56 (30-60)

Vit B9 1843 (1187 - 2854)

Iron 16.1 (5.8 - 34.5)

Transferrin 2 (2-3.6)

TIBC 50 (50-90)

Transferrin saturation 32% (20-40%)

Ferritin 168 (30-400)

FSH 3.4 (1.5 - 12.4)

LH 5.4 (1.7 - 8.6)

Prolactin 10.2 (4.04 - 15.2)

Vit A 2.23 (1.46 - 2.84)

Vit B6 110 (51 - 183)

Zinc 12.8 (11 - 24)

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.

[SlowDragon Administrator]

Results BEFORE taking any thyroid hormones

Free T4 (fT4) 1.22 pmol/L (.93 - 1.7) 

Ft4 at 37.7% through range

Free T3 (fT3) 3.08 pmol/L (2 - 4.4) 

Ft3 at 45.0% through range

Why did you not simply start on levothyroxine

RT3 wasn’t high

No thyroid results when on NDT ?

That’s a very high dose of T3 you are taking

[Oliduder in reply to SlowDragon]

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.

[Oliduder in reply to SlowDragon]

Thyroid labs on NDT were:

TSH 0,14 µUI/mL (0.27 à 4.2)

FT3 3,28 pg/mL (2.00 à 4.40)

FT4 1,28 ng/dL (0.93 à 1.70)

[mintgreenish in reply to Oliduder]

hi did u take last dose ndt and test 8 to 12 hrs after last dose.?

[Oliduder in reply to mintgreenish]

Honestly can't remember... I guess I should've?

[tattybogle]

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.

[Oliduder in reply to tattybogle]

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.

[SlowDragon Administrator in reply to Oliduder]

NDT contains T3

[tattybogle in reply to Oliduder]

i don't know any specifics about how high thyroid hormone makes shbg go , just that it does.

3 grains NDT usually contains 27mcg T3, so , you had been taking a significant amount of T3 at this point.

( 1 grain of most makes of NDT contains 38mcg T4 and 9mcg T3... apart from ERFA which contains marginally less).

my knowledge of testosterone is ....extremely limited .... so can't help with that bit .sorry

[greygoose]

Hi Oliduder, welcome to the forum.

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.

[Oliduder in reply to greygoose]

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....

[tattybogle in reply to Oliduder]

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-.

[tattybogle in reply to tattybogle]

there is also one in a reply from helvella in here : healthunlocked.com/thyroidu...

[Oliduder in reply to tattybogle]

Thanks a lot I'll give it a read!

[greygoose in reply to Oliduder]

I don't have any sources anymore since my computer crashed two months ago, but have a look through the posts and responses of diogenes:

healthunlocked.com/user/dio...

He was a researcher who wrote a lot of scientific papers and talked quite a bit about rT3.

You could also do a search for rT3 amongst the articles of Dr Tania Smith:

thyroidpatients.ca/?s=rT3

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!