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Hypo or hepa?
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Hypo or hepa?

Greetings. In the quest chasing for good health, I bumped into some new unsuspected details…
First I noticed problems a while ago, like 5 years, though they were mild and I didn’t pay much attention. That was time of stupid pharmaceutical experiments with oral AAS, a/b-antagonists, nootropics, other ‘notsoharmless’ substances together with some crazy diets, like being completely fatless and consuming enormous amounts of protein. Dunno what really broke me back then.
Right now I am 25, male, 178 cm (5” 10’), 68 kg (150 pounds). My current health concerns are.
Physiological: low body temp 35.6 to 36.3 Celsius (95.54 to 97.25 Fahrenheit), taken underarm; low resting heart rate 45-50 bpm(down to 33 during night); low body pressure; cold hands and feet; very dry skin; overall yellowish tone of skin; constipation; poor sleep, waking up in the middle of a night; swelling at evening; poor exercise performance; fatigued most of time; facial acne.
Mental: hard to concentrate, easly distracted; apathy; “don't-care / couldn't-care-less” attitude.
All these clearly points at compromised thyroid function. Well, I damn wanted it to be thyroid, because I now know so much about it, possible treatment methods. But not so fast, let’s look at the labs.
It goes like this – “current [reference range] (my comments if any)”. * marked stuff is somewhat out of reference range. rT3 test in not available in my country. If you are not familiar with units I provided, there is a good conversion service:
###Thyroid stuff and other hormones###
T3 free 3.2 pmol/L [2.6 - 5.7]
Т4 free 12.2 pmol/L 9.0 - 22.0
TSH 1.58 mIU/L [0.4 - 4.0]
TGaB 0.5 UI/mL [<18.0]
Anti-TPO 0.3 UI/mL [< 5.6]
ACTH 21 pg/mL [<46]
Renin 6.3 ng/L [2,8-39,9]
Cortisol 632 nmol/L [138 – 635] (taken at ~8:00 am)
Estradiol 42 pmol/L [40 – 161] (highlighted by the lab as CHECKED TWICE)
Testosteron total 11.24 nmol/L [5.76 - 30.43]
SHBG 30 nmol/L [13 – 71]
Free testosterone 38.1 % [14.8 - 95.0] (sucky for an athlete )
Prolactin 411 * mIU/L [73 – 407] (still elevated as appeared on the test month ago)

###Liver and lipid stuff###
ALT 21 IU/L [< 41]
ASAT 24 IU/L [< 37]
Albumin 52 * g/L [40.2 - 47.6]
Bilirubin total 21.9 * μmol/L [3.4 - 20.5] (probably explains my yellowish skin?)
Bilirubin direct 7.8 μmol/L [< 7.9]
GGT 13 UI/L [< 49]
Protein total 75 g/L [64 – 83]
Alpha-1-globulins 2.0 * g/L [2.10 - 3.50]
Alpha-2-globulins 6.1 g/L [5.1 - 8.5]
Beta-globulins 5.9 * g/L [6.0 - 9.4]
Gamma-globulins 9.5 g/L [8.0 - 13.5]
Triglycerides 0.60 mmol/L [0.52 - 2.81]
Total cholesterol 5.19 mmol/L [3.44 - 6.32]
LDL cholesterol 1.91 * mmol/L [0.80 - 1.63]
HDL cholesterol 3.01 mmol/L  [1.81 - 4.27]
Cholinesterase 6362 UI/L [5100 – 11700]
ALP 93 UI/L [40 – 150]
Homocysteine 7.18 μmol/L [6.26 - 15.01]
Alpha-Amylase 84 UI/L [25 – 125]
Glucose 4.1 mmol/L [4.1 - 5.9]
Creatinine 83 mmol/L  [80 – 115]
Urea 6.6 * mmol/L  [2.5 - 6.4] (due to high protein intake?)
Uric acid 195 * μmol/L [210 – 420]

###Iron, vitamins and minerals stuff###
Iron serum 13.67 μmol/L [10.70 - 28.60]
TIBC 41 μmol/L [20 – 62]
Transferritin 2.50 g/L [2.15 - 3.66]
Transferritin saturation 21.8 % [15 – 50]
Ferritin 199 μg/L [20 – 250]
В12 vitamin 1184 * pg/mL [208 - 963.5] (I eat decent amount of animal stuff, plus liver once a week)
Folic acid 13.0 ng/mL [3.7 - 14.4]
Potassum 3.8 mmol/L [3.5 - 5.1]
Sodium 141 mmol/L [136 – 145]
Chloride 104 mmol/L [98 – 107]
Magnesium 0.92 mmol/L [0.85 - 1.15]

###Other stuff out of reference range###
Neutrophils total 33 * % [48.0 - 78.0]
Lymphocytes 54 * % [19.0 - 37.0]

So I feel I should drop my thyroid accusations and start digging towards the liver…

My diet is very clean, paleoish. Though I was relying heavily on dairy products (cottage cheese, yogurt, kefir, plain whey powder). I cut them completely last week to see what happens. I do avoid gluten, but not carbs as I eat plenty of starch and fruits. I don’t smoke nor drink alcohol, except very pricey red wine in homeopathic doses once in a while.
I don’t take any prescribed meds, only multivitamin and 10.000-20.000UI of vitD per week.
Exercises 2-4 times a week, mostly HIIT (sprints, bike or kettlebells).

Any tips would be welcome. As I don’t know a lot of liver physiology.
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T3 free 3.2 pmol/L [2.6 - 5.7]
Т4 free 12.2 pmol/L 9.0 - 22.0
TSH 1.58 mIU/L [0.4 - 4.0]

I just copied those down for easy reference.  I agree with you.  The liver function tests would seem to push you in that direction.

Would I drop the thyroid accusations?  Perhaps not entirely.

Your FT4 is only at 25% of range.  Midrange is the target for FT4.  Reference ranges for thyroid labs are severely flawed for a number of reasons, so we consider the whole lower half of the range questionable.  

Your FT3 is at 19% of range, which is very low.  Target for FT3 is upper half to upper third of range.  Also, ideally, FT3 should be higher as a percentage of its range than FT4 is.  So, relative to FT4, FT3 is really lagging.

Forgive me if I tell you what you already know.  T4 is a kind of "storage" form of the thyroid hormones.  Before it can be used by cells, it must be converted to T3 by stripping an iodine molecule.  Although conversion sites are ubiquitous throughout the body, most conversion happens in the liver.  So, you may be experiencing hypo symptoms secondary to liver dysfunction.  Just a thought...

I mentioned that midrange FT4 is the target rule of thumb.  Yours is quite a bit below that.  However, midrange is the target ONCE ON MEDS, and I think (personal opinion) that once we no longer have "hormones on demand", we tend to have to run them a little higher to compensate during high demand periods.  So, although your FT4 is on the low side, since you're not on meds, I wouldn't be as concerned as I would be if you were on meds.  I think if I were you, I'd tend to pursue the conversion and liver dysfunction issues and see just what that does for your symptoms and your FT3.

Iron is also a little on the low side.  
Both your FT3 and FT4 are relatively low in their ranges, so I wouldn't completely rule out thyroid, but I'd say it's pretty slim, right now.

I did notice that your morning cortisol was right at the top of its range.  Are you under a lot of stress, that would cause possibly adrenal issues?

Also notice that LDL cholesterol is high; that can be a thyroid symptom.

I don't see a vitamin D test; with the amount of vitamin D you take weekly, I'd be interested to see what your levels are.  Vitamin D is a fat soluble hormone, so doesn't just go out of your body in urine; it's stored and can be toxic in very high amounts.

Vitamin B12 is water soluble and isn't stored.  No toxicity level has been found.

Since this is the thyroid forum, I don't think we have anyone well versed on liver issues either; maybe you should ask your questions on that forum. You get there via the following link:

Can I post the same question on liver forum? Rules aren't very clear on this.

I really have no knowledge on how to treat liver, it should be pretty regenerative self sufficent organ for itself. Right now I am started to take milk thistle and drink warm water with lemon juice every morning before I see a doctor.
You can just copy and paste your question into the liver forum.  I know the rules state no repetitive posts, but I don't think that applies to questions that are appropriate to more than one forum.  

The liver is very regenerative, but I guess you have to figure out what is causing the dysfunction and address that.  With your liver function tests and neutrophil and lymphocyte counts, I'd suspect hepatitis, but I'm no expert on liver ailments.  See your doctor for treatment.  Once that's resolved, you might want to test FT3, FT4 and TSH again just to be sure.
Yes, as goolarra already said - you can simply copy your entire post above and paste it into a new thread on the liver forum.. I know a couple of people on that forum; I'm sure you'll benefit from their knowledge.
So just did! If you interested to follow there it is:

As for vitD test, I haven't done it because I couldn't justify the price local labs were asking for it. It is somewhere near the most complicated stuff like genetic\legacy testing. Probably fad at the time. Anyways summer came, so I guess I will ditch entirely it for now.
The yellow skin tends to lean towards liver issue.

But as previously stated your FT4 and FT3 levels are low.  Combined with a high cortisol level may be and issue with reverse T3 which you've stated you can not get tested in your country.  That is too bad it may tell the tail that you could be hypo at the cellular level even though you have FT3 available. But since you are also low on FT3 that can compound the issue.

Selenium can help with conversion of T4 to T3.  Be careful as too much selenium can be toxic but it may be worth considering.  But again with your low FT4 levels there is not a whole lot of T4 to be converted anyhow.

Vit D is low and that is also related to fatigue.  Most of the other symptoms you list are consistent with low thyroid.

you may want to talk to your Dr to see if they are willing to give a trial small dosage of T4 medication to see how that responds to your labs and also symptoms.

10,000 to 20,000 of vitamin D is good but not outrageously high. Some people take up to 5,000 IU's a day = 35,000 per week.

Just some things to think about.
I think I consume plenty of seleneium (up to 400 mcg) with multi and a religious couple of brazil nuts per day.
As far I know, synth T4 can put some strain on the liver and that is the latest thing I want now. I always wanted to try out some NDT. I think I will get myself some, while figuring out whats going on with my liver. I'd rather be on hyperthyroid side.
Nature-throid by RLC Labs any good? I can get Armour as well, but I see a lot of controversy around this brand.
You might want to watch your selenium intake.  I've read that brazil nuts have so much selenium in them that it's not recommended to eat them regularly to supplement.  Between 400 mcg in your vitamin and the nuts, you might be over the top.  70 mcg is the recommended daily value, and you're way over that.

I should also have added that hypothyroidism can be your body's natural defense in times of stress, acute or chronic disease, malnutrition, starvation, trauma, etc.  If hypo isn't caused by some failure in the thyroid/hypothalamus/pituitary axis, but by the body's response to another current dysfunction, you might not want to be hyper.  I'd shy away from trying to treat this on my own until other issues have been reconciled.
There is a research regarding its toxicity among local brazilian folks who consume loads of them daily. No adverse effects.

RDA for vitD is what? 400UI?
I've done brain\hypothalamus MRI recently - nothing is there, thankfully. Nothing bad (adenomas, pathologies and such), I mean. :)

> I'd shy away from trying to treat this on my own until other issues have been reconciled.

It is wise. I've done enough damage with my experiments of the past. Though some gurus like Ray Peat, suggest to take thyroid even for healthy persons just to optimize body performance.
Synthetic T4 is identical to what your body produces.  I can't see where it would be any harder on your liver than anything else.

Recommended daily intake of selenium is about 70 mcg/day for adult males; however, the upper tolerable limit has been determined to be 400 mcg/day.    
I take a selenium capsule, daily, that contains 200 mcg.

High amounts of selenium can cause a condition called selenosis, which can adversely affect the gastrointestinal tract, the heart and the liver.
You might want to go back and take a longer look at the following hormones.

Testosteron (sic) total 11.24 nmol/L [5.76 - 30.43]
Free testosterone 38.1 % [14.8 - 95.0] (sucky for an athlete )
Prolactin 411 * mIU/L [73 – 407] (still elevated as appeared on the test month ago)

There is no normal function of prolactin in men, which makes me wonder why yours is high.  High levels of prolactin will lower levels of testosterone, and while your levels of testosterone are "in range", they are very low in the ranges.

High levels of prolactin are found in the following conditions:      
    Chest wall trauma or irritation
    Hypothalamic disease
    Kidney disease
    Pituitary tumor that makes prolactin (prolactinoma)
    Other pituitary tumors and diseases
High prolactin can also be caused by high protein meals.

Because prolactin is a hormone produced by the pituitary, you might want to look further into that.  You levels are not alarmingly elevated, however, if they continue to be elevated, that could indicate a problem.
I don't know how much thyroid Peat suggests healthy people take.  In the absence of hypo symptoms and with adequate FT3 and FT4 levels (not just "in range"), low doses of exogenous hormones don't do a lot since they work in combination with endogenous hormones.  You take a little, your body produces less to compensate (down regulated by the pituitary) effect zero.  If you took enough to actually increase levels, you'd be flirting with hyper.  
Damn all those positive\negative feedbacks. Why everything has to be so complicated? :P

> Prolactin 411 * mIU/L [73 – 407] (still elevated as appeared on the test month ago)
Twas 517 mIU/L month ago. Hyperprolactinomia starts somewhere 800+ as my doctor says and need to be treated by the meds. Lower than that just indicates that something somewhere isn't right.

I forgot to mention, that I've done ultrasonic diagnostics of like every organ. No pathologies. Even liver\gallbladder sizes are intact.
Also I have sinus bradycardia due to sinoatrial node is not always working in full strength. So if we rule out thryroid it has to be faulty liver or heart doesn't provide enough bloodfloow, which causes malfunction of other tissues. The question is that heart damaged by itself (sick sinus syndrome?) or acting like that due to insufficient stimulus from somewhere else.

I will see a hepathologist on the morrow.

Thanks for your suggestions so far. Nice to have some support here.
According to Wikipedia, normal prolactin levels are < 500 for women and
< 450 for men; anything over that is considered  hyperprolactinemia.  It can be caused by a variety of drugs, which makes me wonder if your symptoms have to do with your past "pharmaceutical experiments".

You have a lot of symptoms of hypothyroidism, so you might want to keep monitoring your TSH, FT3, FT4 and antibodies to see if/how they might change over a period of time.  It's sometimes common for labs to lag behind symptoms, and it's also possible for antibodies not to show right away.  If your thyroid function is declining, your lab values for FT3 and FT4, should start declining, as well.

I don't know your doctors, but you could try to get a trial dose of thyroid medication and see if it helps.
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