Hashimotos? Low Testosterone? Pituitary Issue? Please help LABS enclosed

[buckeye2004]

I am a 29 year old male (5'9" 208lbs). A couple of months ago I started feeling lethargic/fatigued and what I could describe as brain fog. I also started having difficulty sleeping. I don't have a problem falling asleep but wake up around 3-4am for no reason and no matter what I can't fall back asleep. On my quest to find out what's wrong I went to my GP and had him test my testosterone levels. They came back really low (see results below). He offered to put me on Androgel but I declined. I then had him test Thyroid and he only ran the TSH test which came back elevated (see results below). After getting the TSH results I went online and read everything I could about hypothyroidism because that's what I thought I had. After reading for a couple of weeks I went back to my GP again and had him run a battery of other tests (TPO ab, Tgab, T4 Free, TSI, Vitamin D, Calcium serum and ionized, RBC Magnesium...). I asked him to also run a T3 Free but for some reason they didn't run it. At the time of this visit he also put me on .25 mcg LevoThyroxine. From reading everything I already know this is not enough and w/out knowing my T3 free levels I will never know the clear picture. I didn't ask him to run the T3 Free again because today I received the results (see below) and I have really elevated TPO Abs and they are referring me to an Endo.

I am really confused and hope someone here can shed some light on what's going on with my body. I also had them run a CBC which all came back normal but I didn't include those results below but I can if you think it will help. I also had them test me for diabetes, kidney and liver functions which are all normal according to my GP (see below). I have some symptoms of hypothyroid (cold extremities), average body temperature ~ 78.6 F (I charted my temperatures 3 times a day for a week). But then I also have some symptoms of hyper such as insomnia, low appetite, I lost 12 lbs in last 2 months w/out changing my habits or exercising more. I did the home adrenal tests (taking blood pressure lying down and then standing up, flashlight test for eyes) and they were normal. I am still going to have the cortisol, DHEA saliva tests soon. I can't figure out if I have Hashimoto's or Grave's. I would like to add I do have some history of thyroid disease (never cancer) in my extended family and my parents had me tested for TSH (I assume) when I was 18 and it was normal then. I have always felt I had a slow metabolism.

Some of the things on my results below that stand out are low Vitamin D (GP prescribed 50,000 IU D 1xWeek for 6 weeks and I have been taking 5000IU for one week already), Elevated B12 ( I had been taking sub-lingual B12 for 2 weeks prior to testing), Ferritin seems low. Should I do something to raise it? Do the elevated TPO Abs correlate with my symptoms? I had them test other pituitary hormones like PTH, FSH, LH because I suspected low thyroid and low testosterone indicated a pituitary issue, but from what I can tell my pituitary is functioning fine and sending the signals for more thyroid and testosterone. What do you think, should I have them do a MRI brain scan?

I am being referred to an Endo but that probably won't happen for 1-2 months. What can I take/do in the mean time? Below is the list of supplements I have and whether I currently take them or not. I drink water and maybe 1 can of pop a week. I don't drink tea, coffee and try to eat healthy.

GNC Mega Men Multi-Vitamin (Has assortment of things and this is the multi-vitamin that doesn't upset my stomach)
Pro-biotics (10 Billion CFU Dailty)
B12 5,000 IU Sub-lingual (Have been taking since 2 weeks)
Calcium, Magnesium, Zinc from Whole Foods (Not sure of IU's but have been taking since 2 weeks)
Vitamin E (400 IU's. Have been taking for 2 weeks)
Vitamin D-3(5000 IU. Had been taking for 2 weeks until I got a prescription for 50,000 IU 1xweek for 6 weeks. I took the first 50,000 IU today)
Selenium from Whole Foods (Not sure of units but multi-vitamin that I take also contains it)
Vitamin C 1000mg w/out ascorbic acid.
L-Tyrosine (1000mgs from GNC. I got this today but haven't taking this yet)
Iodoral (Iodine supplement. I have this already but haven't taken this yet. I read it might not be good if you have anti bodies)

TSH 5.350 High uIU/mL (0.450-4.500)
THYROXINE (T4) FREE 1.17 ng/dL (0.82-1.77)
TRIIODOTHYRONINE (T3) 90 NG/Dl (71-180) *Didn't do T3 Free

THYROID PEROXIDASE (TPO) Ab 273 High IU/mL (0-34)

ANTITHYROGLOBULIN Ab 1999 High pg/mL (211-946)
Folate (Folic Acid), Serum 8.4 ng/mL (>3.0)

POTASSIUM, SERUM 4.2 mmol/L (3.5-5.2)

CALCIUM, SERUM 9.8 mg/dL (8.7-10.2)

MAGNESIUM, SERUM 1.9 mg/dL (1.6-2.6)

FERRITIN, SERUM 158 ng/dL (30-400) *Doesn't this look low?

CALCIUM, IONIZED, SERUM 5.6 mg/dL (4.5-5.6)

VITAMIN D, 25-hYDROXY 13.0 Low ng/mL (32.0-100.0)

BASIC METABOLIC PANEL (8)
Glucose, Serum 94 mg/dL (65-99)
BUN 8 mg/dL (5-26)
Creatinine, Serum 0.90 mg/dL (0.76-1.27)
eGFR >59 mL/min/1.73 (>59)
BUN/Creatinine Ratio 9 (8-27)
Sodium/Serum 139 mmol/L (135-145)
Potassium, Serum 3.7 mmol/L (3.5-5.2)
Chloride, Serum 103 mmol/L (97-108)
Carbon Dioxide, Total 23 mmol/L (20-32)
Calcium, Serum 9.6 mg/dL (8.7-10.2)

TESTOSTERONE, FREE AND TOTAL
Testosterone, Serum 274 Low ng/dL (280-1000)
Free TEstosterone (Direct) 8.4 Low pg/mL (9.3-26.5)

FSH and LH
LH 5.4 mIU/mL (1.7-8.6)
FSH 5.1 mIU/mL (1.5-12.4)

PROLACTIN 7.3 ng/mL (4.0-15.2)


PROSTATE-SPECIFIC AG, SERUM 1.6 ng/mL (0.0-4.0)

GLUCOSE, SERUM 93 mg/dL (65-99)

HEPATIC FUNCTION PANEL (7)
Protein, Total, Serum 7.2 g/dL (6.0-8.5)
Albumin, Serum 4.5 g/dL (3.5-5.5)
Bilirubin, Total 0.4 mg/dL (0.0-1.2)
Bilirubin, Direct 0.13 mg/dL (0.00-0.40)
Alkaline Phosphatase, S 49 IU/L (25-150)
AST (SGOT) 28 IU/L (0-40)
ALT (SGPT) 39 IU/L (0-55)

I know this is a really lengthy post and I am a new member. I want to thank you in advance for taking your valuable time to look this over. I know there are others out there who have gone through the journey I am just beginning and I could really use some help right now.

[Barb135]

You've accessed a very old thread and buckeye has not been active on the forum since posting on this thread in 2010.  

[sben3726]

Man, you sound exactly like me.

I'm 22 and have Hashimoto's and low-T for my age (albeit I'm worse in the TSH category than you, but thankfully luckier in the Testosterone category). I had to be about as proactive and aggressive as you to finally get a diagnosis and start putting things under control.

- You def have Hashimoto's because of your elevated TPOab levels
- Stay off the iodine - there's a lot of controversy around the issue, but the truth is that there's a very sensitive optimal range of iodine that promotes thyroid health. Most people get too much with an american diet so I wouldn't recommend it.
- ZMA is great for improving testosterone. It does so naturally and helps you sleep
- Test will improve as you supplement thyroid I have heard, but there are plenty of ways of improving testosterone naturally. Read a bunch of body building forums and you'll find hundreds of natural things you can do to boost them. I'm in the process of doing that stuff myself because I only recently found out that my test levels were low for my age (i'm at 500, which is 60 year old man status)
- Take a TON of vitamin D. Doctors think optimal is 30+ but keep in mind that reference ranges are based on the general population aka a bunch of people who don't get sunlight. The entire population is vitamin D deficient, so this is a skewed way of coming up with a reference range.

****'s scary and I'm working on this too. Let me know if you want to chat offline about this as I think it could help both of us.

[redheadaussie]

Aha! Now it makes sense.
Good then you don't have a problem with the TgAb then. Just the TPOAb. Which are raised. Which is Hashimoto's.

[buckeye2004]

Dear Redheadassie

The 'ANTITHYROGLOBULIN Ab 1999 High pg/mL (211-946) was a typo.  Those were actually my Vitamin B12 numbers but when I copy/pasted them it screwed things up.  My real TgAb is <20.  Sorry about the misconfusion.  

[redheadaussie]

Usually the antithyroglobulin antibodies are requested as TgAb.  Some people have both TgAb and TPO Ab.. Your post of 'ANTITHYROGLOBULIN Ab 1999 High pg/mL (211-946)' shows you have them, the next post you put of   'ANTITHYROGLOBULIN Ab <20 IU/mL (0-40) Siemens (DPC) ICMA Methodology' shows that they are less than noticeable and acceptable as not being a big deal.

Now I am confused...coz the same test and you have two different results? I think you put the pg/ml before the ref range which is normally written after the brackets and numbers in the ref range. Is so the 1999 is high and VERY positive for them.

I'd like to see the actual numbers you got in your TSI test.

Having been on the thryoid medication for one week is not of any symptomatic value. It will take another week to even start to affect your levels. Thyroid medication takes up to 6 weeks to be at full strength so to speak.

Hashi's can wax and wan over years, months. It can get very severe or can stay a certain way for many years. It is a highly individual thing and no one can predict the outcome for anyone.

I wouldn't be worrying about an MRI as it is an autoimmune issue not a pituitary gland one in your case. Your testosterone may well come up once you have been on thyroid medication for a while.  

[buckeye2004]

Ok there must be something going on when I copy/paste that.  Let me try again...

ANTITHYROGLOBULIN Ab <20 IU/mL (0-40) Siemens (DPC) ICMA Methodology

[buckeye2004]

I am so sorry you aren't going blind.  I copied that wrong.  It should have been like this (see below).  Does this mean I don't have the TgAb anti-bodies?

ANTITHYROGLOBULIN Ab 1999 High pg/mL (211-946)

[LazyMoose]

"  THYROID PEROXIDASE (TPO) Ab 273 High IU/mL (0-34)

ANTITHYROGLOBULIN Ab 1999 High pg/mL (211-946)   " -  check this over, its usually just called thyroglobulin antibodies, the range is weird. 1999? Whats this? Was this copied wrong, or am I going blind?

You should get blood work a minimum of 2 X per year. Lazy docs like once per year, that's not good management, your always under-medicated on that plan.

With Hashi you increase meds over time until......well...........your thyroid dies.

30 years or 15 years, no one can tell you when that will be.

Its not that bad, your just dependent on replacement hormone from that point on and wont need much more adjustments.

[buckeye2004]

HI LazyMoose thanks for your reply.  I think my doc just forgot to order FT3 because I was asking him to order a lot of stuff.  I know my TPOab was hight but I thought my Tgab was withing range.  Did I miss something?  My Antithyroglobulin Ab was <20 IU/mL with the range of 0-40.  I thought asking for MRI in case it was a pituitary problem.  I hope I can get to see the Endo within a month because by then I would have been on T4 med for 5 weeks and go from there.  I will keep you posted.

[buckeye2004]

Thanks for your reply to my post.  I will start working on the potassium, magnesium, and ferritin levels.  I am currently on .25 levothyroxine and I have been taking it for a week now.  I don't really notice a difference.  Hopefully by the time I get to see an Endo my dose could be adjusted.  Do Hashi patients continuously have to adjust their meds for the rest of their lives?  How often do you get tested and adjust?  I will also ask the Endo for the corrected calcium test.  

I thought I asked for the TSI test.  On my results it says Thyroid Stim Immunoglobulin.  Is this the same thing as TSI?  The results are 76 % and range is 0-139.

Thanks!

[redheadaussie]

Welcome to our forum!

From the get-go it is obvious you have Hashimotos, which is what is making you feel so cruddy. For most of us with that disease things will be out of whack too.

Your Potassium, Magnesium, and Ferritin are on the low side. You could try to get them up a bit and you will find the magnesium especially will help with your thyroid medication and any calcium issues. Men need iron too, and yours is on the low side. Ferrous sulphate works the best, tastes like swamp water but is effective in getting those levels up quickly.

If you make sure you take your thyroid meds at least 4 hours away from iron, and never eat anything with your thyroid tablet at least up to an hour after taking it, you should find that your levels should all start to come good with time.

Hashi's never goes away, and you need to get your body at optimal fighting zone to help deal and live with it.

I didn't see any TSI results which would show Graves. Some people can have both at the same time, Graves and Hashi's. For some people it swings from one to the other over time.

You should ask for a corrected calcium test to make sure your calcium levels are ok. Serum just tests for what is in your blood, the corrected means what is being utilised.

Cheers

[LazyMoose]

Looks like you did your homework! Seem to remember you a while back. I cant say I ever seen someone get all that tested at once - and the doc still refuse Free T3.

With TPOab and TGab both testing positive, you have Hashimoto, welcome to the club!

Testosterone will most likely improve when your thyroid does - has happened to others.

You need vit D for sure.

Adding magnesium (anything but Mag oxide) would be good for aches if you have them and helps sleep.

Never used ferritan- but yes looks like you might benefit from some.

Why do you think you need an MRI?

Some Hashis people react bad to iodine, some cant eat sea food - I know someone like that.

Good homework you did.

Now you will have to play the waiting game on your Levothyroxin and get tested in 6 weeks, then they might up it more - usually the case for fine tuning - and then you will want to see FT3 - demand it!

Hopefully an endo will test FT3, that is very important as some are low there - more often than what docs think.