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Dessicated thyroid: how much should I take?

I wrote about this in another forum as a part of another question but I feel I'd better continue the discussion here. My symptoms included fatigue and brain fog. Here are my results from a few months ago:

T3 free 3.4  in  2-4.4
T4 free 0.89 in  0.76-1.46
TSH 1.657 in 0.358-3.74

My doctor put me on half a grain of dessicated thyroid and I took it for a month and then stopped. The reasons: worsened sleep quality and depression (and some anxiety too). I've read that if the dose of thyroid medicine is low it can cause depression so it seems I should increase the dose. The doc said I could go up to 2 grains. Here are my questions:

1-What blood tests should I do to find the underlying cause of the problem. CRP, antibodies, iodine level? (My doctor may not be of much help in this regard.)

2-My estrogen level is quite hight due to being on TRT. My estradiol sensitive was 27.9 in a 8-35 range as the same time the thyroid hormones. It should have decreased a bit now but I've read high estrogen causes hypothyroidism. So I'm suspecting this may be the cause of my problem? Although I've had a severe problem with fatigue long before going on TRT and it seems TRT has improved it a bit. The underlying question is: can my thyroid problem be reversed without taking (more) exogenous hormones?  
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Avatar universal
First thing to understand is that hypothyroidism is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of or response to, thyroid hormone".   So it is not only the supply of thyroid hormone but also the response to it as affected by a number of variables I'll discuss later.   Also, there is no biochemical test that is adequate for a pass/fail decision about a person's thyroid status.  Tissue T3 Effect and associated thyroid status is best assessed by an evaluation for symptoms that occur more frequently with hypothyroidism than otherwise.  Then that evaluation must be supplemented by  extended biochemical testing.   Those tests should include Free T4, Free T3, TSH (mainly to distinguish between primary and central hypothyroidism), arguably Reverse T3, cortisol, Vitamin D, B12 and ferritin.   So there are additional tests that should be done.

As for symptoms you have mentioned several that are frequently related to hypothyroidism.  

Looking at your test results, it is important to understand that TSH  is useful as an indicator of thyroid status only when it is at extreme levels.  So looking beyond TSH, note the following quote from an excellent thyroid doctor.   "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."   Your Free T4 is only at 18% of its range and your Free T3 is at 54% of its range which seems to fit this scenario.  

As to the  question of why this seems to be happening,  You mentioned high estrogen, but it was within range.  I think it would be more valuable to also test for progesterone along with the estrogen to determine the ratio.  If the ratio is too low, then more thyroid binding globulin is produced, which ties up thyroid hormone and reduces free thyroid hormone.  "When progesterone dips, estrogen increases, creating an uncomfortable state of affairs in your body. But for your thyroid specifically, when estrogen is out of control, the liver starts producing high levels of “thyroid binding globulin” (or TBG): a protein that binds (just like its name!) the thyroid hormone, thereby decreasing the amount of thyroid hormone that can be properly utilized by cells."

If this is the case, then your body is converting extra T4 to T3 trying to maintain body functions.  The doctor might be able to shed light on this possibility by also testing for TBG to see if it is high.  If this is not the case then central hypothyroidism might be in play.   With central there is a dysfunction in the hypothalamus/pituitary system resulting in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.  

In addition to inadequate supply of thyroid hormone, the response to thyroid hormone I mentioned must also be considered as an additional factor.   This is the reason for the additional tests I mentioned.  

Also, be aware that a small starting dose of thyroid med is not additive to your prior levels.  The med causes TSH to drop, resulting in less stimulation of the thyroid gland and less output of natural thyroid hormone.  Serum thyroid levels are the sum of both natural thyroid and thyroid med, so only when the dosage is high enough to essentially suppress TSH, will further increases start to raise your Free T4 and free t# levels.   It is not unusual for symptoms to not improve, or even get worse, with small starting doses of thyroid med.   A recent, excellent scientific study concluded that:  "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range. "

So you need for a doctor to do the additional tests and then supplement as needed to optimize variables that affect response to thyroid hormone such as Vitamin D, B12 and ferritin.  D should be at least 50 ng/mL, B12 in the upper end of its range and ferritin should be at least 100.  Along with that cortisol should be neither too high or too low.  Excess Reverse T3 is an antagonist of Free T3.   You do need higher levels of Free T4 and Free T3, but it might be wise to get these tests done and supplement as needed before increasing your thyroid med dosage.  
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Thank for your detailed response. My E2 was 12 before TRT. Rather low at the time but how much it has increased! I think my progestron is low as my libido is low. I had my B12 checked and it was 632 in 193-986 (while folic acid at 18.3 in 8.6-58.9). I'll have the others you mentioned checked too. It's easy with my TRT clinic to have blood works prescribed although I don't know why they've not checked my progestron already.

Now a somewhat unrelated question: can ATP be measured by a blood test?
Avatar universal
Not sure what you men by ATP.
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Adenosine triphosphate
Avatar universal
All I know about it is what I read in articles like this one.  

https://academic.oup.com/europace/article/16/12/1703/489394
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Avatar universal
So, from your answer I don't quite understand if you suggest taking dessicated thyroid is good for me or not. I'm doing a comprehensive bloodwork next week and will consult with my doctor in August.
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Avatar universal
To avoid any effect from the thyroid med on test results, I think that it would be a good idea to delay starting on the thyroid med until after getting the additional tests done so that you have a better picture of what is happening.   When you have the additional test results please post them along with reference ranges and we will be happy to help interpret and advise further.  
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I did the tests last week and am waiting for their results. I immediately started taking the medicine and here is what I've noticed:

1-I'm more tired and my breath is short. I can hardly do my lifting workouts.

2-My appetite has gone through the roof.
Avatar universal
How much of the desiccated thyroid med are you taking?  When did you start?  
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Just half a grain and I started last Thursday. Today I took one grain.
Avatar universal
Recall what I mentioned previously that it is not unusual for symptoms to not improve, or even get worse, with small starting doses of thyroid med.   A recent, excellent scientific study concluded that:  "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range. "   In addition you need to get the results from the additional tests to see what else may be needed.  
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Avatar universal
Here they are.

CoQ10 total: 0.65 in 0.37-2.20
B12: 600 in 193-986
Ferritin: 244 in 5-244
Vit D-25 HIDROX:  25.8 in 30.0-100

BILI total: 1.3 in 0-1.2
Magnesium: 2.3 in 1.8-2.4

HDL: 67 in 40-60
Cholesterol:  138 in 120-200
fT3: 3.8 in  2-4.4
fT4: 0.86 in 0.76-1.46
rT3:  18.9 in 9.2-24.1
TSH: 0.985 in 0.385-3.74

Carnitine:  47 in 27-73
Carnitine esterified/free:  0.3 in 0-0.9

Estradiol: 33.7 in 8-35
Progesterone: 0.2 in 0-0.5
Total T: 867 in 264-916
Free T: 29.4 in 8.7-25.1

Zinc, plasma: 86 in 56-134
Prolactin: 7 in 4-15.2
DHEA-S: 341 in 102.6-416.3

Negative in Anti-nuclear antibodies

How come my Vitamin D is so low? I I take walks outside everyday and I take a tbs of cod liver oil everyday which is supposed to have 200% RDV of Vit D. TSH is low too.
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My iodine is 45.8 in 40-92. Can it be that I'm just deficient in iodine?
Avatar universal
It is hard to attain adequate Vitamin D just from sunshine and I don't know how much D you are getting in the cod liver oil, but you do need to consider supplementing with about 2000 IU daily of D3.  

Another potential issue is your ferritin level.  Unless you are taking supplements to raise your iron level. your ferritin of 244, right at the top of the range, indicates that you need to do a full iron test panel of serum iron, TIBC, % saturation and ferritin from the same blood draw.  

As for iodine I have not run into anyone with an iodine deficiency before so I am not sure about your result, but it does make me think you need to discuss with your doctor.  Note the following info I found.  

"It seems like the safest approach with iodine is to start low, 150 mcg in the form of potassium iodide/iodine, along with 200 mcg of selenium, and then gradually increase iodine until you can feel your body temperature increasing and hypo symptoms going away. I'm starting to feel the warmth again slowly, although I'm still fluctuating. Selenium should be 200-400 mcg, but not above 400 mcg. Iodine is more variable but it looks like 1000 mcg should be as high as one should go.

Also it is recommended to do the 24 hour loading test. You take a 50 mg (that is 50,000 mcg) pill of roughly half iodine and half iodide and then collect your urine for 24 hours. Then they measure how much iodine you peed out. If you are deficient then you won't pee out much but if your body is "full" then you should pee out 50 mg. "
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No iron supplementation but I eat quite a lot of meat. It may be my thalassemia.

So the question still remains if I'm really hypothyroid. I think it may be the combination of iodine deficiency and high estradiol. People who go on TRT usually take an aromatase inhibitor to lower their E2 and that's something I've been resisting. Folks on TRT forums tell me an E2 level  near 22 would be ideal, which is far from what I have now.
Avatar universal
Hello. Here is my last lab:

fT3: 2.9 in 2-4.4
THS: 1.18 in 0.27-4.2

I take iodine (one drop of 2% Luggol's on skin 3 times a week). I've heard contradictory things about the effect of iodine supplementation on thyroid (e.g. WebMD says it can cause hypothyroidism). Have not been taking desiccated thyroid for a while. Even though it gives me energy, it makes me anxious and irritable.  Doctor suggested I take synthroid which is milder than desiccated thyroid but I've not started it yet because I'm not sure.
I have multiple health issues and am not sure which causes which. I have low hemoglobin (genetic but has got worse recently),  terminal insomnia which may be caused by hypothyroidism and my estrogen level is near the top of the normal range. The latter is caused by TRT and my E2 level is about 3 times what it was before TRT.  
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Avatar universal
@gimel My high iron and ferritin levels are caused by my thalassemia. It's hard to find a doctor familiar with this disorder here as it is rare. I may even need chellation therapy. High iron and low hemoglobin, not a good thing.
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Avatar universal
Forgot to mention I have shortness of breath and orthostatic hypotention as well.
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