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Avatar universal

My TSH is 11 with normal T3, T4, FT3, FT4 levels. High ATG.

My TSH is 11 with normal T3, T4, FT3, FT4 levels. Also normal Anti Microsomal Antibody. Only my Anti Thyroglobulin Antibodies are high. I am assuming I have Hashimoto's.
SyntheticT4 isn't  helping anymore and I can't go higher because I get severe acne cysts on my face when I do. Should I shift to Nature/Armour? I am beyond desperate! My life is in tatters at the moment.  
23 Responses
Avatar universal
The DHEAS was the one I was looking for.  When you look around for optimal range for DHEAS, I found the following link and info.

http://www.lifeextension.com/magazine/2006/5/report_blood/Page-02

               OPTIMAL RANGE OF DHEA IN WOMEN*

               Standard Reference Range        Optimal Range

                      65-380 µg/dL                        350-430 µg/dL



                *Measured as DHEA Sulfate

So that info suggests that your DHEAS is lower than optimal.  Also, please note that "cells throughout the body take in DHEA and DHEAS and convert them into estradiol and testosterone. It is estimated that this
"intracrine" process provides 70% of a young woman's total androgen effect."  So, perhaps this is a contributor to the low testosterone level.

Also, your Vitamin D is too low.   Optimal is about 55-60. I also recommend that you test for Vitamin A, Vitamin B12 and ferritin.  Vitamin A because of its potential effect on the acne.  B12 has a significant effect on energy levels.  B should be in the very upper end of its range.  Ferritin should be about 70 minimum.  Low ferritin can adversely affect metabolism of thyroid hormone.


Following is a link to good info on PCOS, in which you will notice the possible effect on acne.  Is your doctor doing anything to help with that?


http://www.webmd.com/women/tc/polycystic-ovary-syndrome-pcos-topic-overview

Finally for now, please give me the measurement units for the progesterone test result.  I'd like to calculate the ratio of progesterone to estradiol.  
Avatar universal
Please post the reference ranges shown on the lab report for those test results.  What other symptoms do you have/  What is your daily dose of T4?
Avatar universal
TSH - 11 (HIGH)
T3 - 89
T4 - 10.2
FT3 - 3.03
FT4 - 1.53
Anti Microsomal Antibodies - 6
Anti Thyroglobulin Antibodies - 190 (HIGH)


I have no weight issues, but constantly tired. Have been feeling "lost" almost all my life. Unable to make life decisions due to this.
Avatar universal
Test results and associated reference ranges vary from lab to lab, so it is important to always compare results against reference ranges from the same lab.  Please post the ranges for above tests.  Also daily dose of T4 med?
1 Comments
Thank you so much for responding.

TSH - 11 (HIGH): 0.3 - 5.5
T3 - 89   : 60-200    
T4 - 10.2 : 4.5 - 12
FT3 - 3.03 : 1.7- 4.2
FT4 - 1.53 : 0.7 - 1.80

Anti Microsomal Antibodies - 6 : 115 positive
Avatar universal
My daily dose of T4 is 50mcg.
3 Comments
EDIT: Anti Microsomal Antibodies - 6 : 115 Positive
Anti Thyroglobulin Antibodies: 190 : >135 Positive.
I am unable to type here. All in all, AMA is 6 and negative. ATG is 190 and positive.
Avatar universal
Does changing to Armour  Thyroid help in my case?
Avatar universal
The acne that seems to be your biggest concern can be due to a number of things, including hypothyroidism as well as hyperthyroidism.  With you having Hashi's I'd be more inclined to think hypo; however, with your FT4 at 75% of the range, and your FT3 at 53% of its range, those levels don't scream hypo.  Athough there are other things that can affect tissue thyroid effects, like cortisol level, Vitamin D, and ferritin.  Have you been tested for those?   Also, I did some reading and found this info.

"Thyroid and vitamin A are the basic things that help with acne," he says. This is because when thyroid hormone is deficient, the body cannot convert cholesterol to the steroids pregnenolone, progesterone and DHEA. Of these, progesterone is the most important in the prevention and cure of acne—and thyroid hormone plus natural vitamin A work to ensure its formation."  We'll get back to the possible need to test for those later.  

This made me wonder about a couple of things.  First, what were your Thyroid test results right before you started on thyroid med?  Why did you say that synthetic T4 wasn't helping anymore?  What made you decide to try a higher dose?  What was the new dose?   How quickly did the acne become a problem, when you increased your dose?  

Sorry for all the questions, but your status is a bit unusual.
Avatar universal
Thanks for the reply again, Gimel.

My face is clear now, it goes out of whack only when T4 dose is raised and they appear in painful cysts. My doctor raised my T4 when my TSH was high. I started with 25mcg, graduated to 50mcg(at which I don't get acne), but anything more 50mcg, I get acne immediately, I didn't connect it at the start, but within a month my face was full of cystic acne.

I've got myself tested with all of the tests -
My cortisol levels are 12 at 8 AM. (ref range: 08.00 AM : 5 - 23 μg/dL)
My Progesterone levels are 0.82(ref range says follicular phase: less than 2.7). Do you think this is less? It does feel a little on the lower range.


My DHEA levels are normal as well. 5.93( ref range: <= 8 ng/mL)
Estradiol:85.36 (ref range:Follicular Phase: 39-375 pg/mL)

My D levels are slightly (only 0.1level)deficient and I supplement with vitamin A and zinc. I haven't tested my ferritin levels though.


To add to my problems, my testosterone levels are 11.8(ref range: 15-70), which confuses me about the higher T4 resulting in acne.  

When I was first diagnosed my TSH was only 7. My TSH isn't in range anymore, which is why I feel it doesn't help anymore, and my doctor says that I have to be on the higher dosage, which I wouldn't mind if it weren't for my acne acting out. I couldn't even keep taking the higher dose until my next blood test. It was that bad. My doc says skin is not a priority, but I go from looking like a normal person to someone who would hate the sight of a mirror, and the acne comes even on my tummy- and I have never in my life had a single acne on my body.

So  I was wondering if Armour helps in anyway.
I have all the symptoms of Hypo except I don't have any weight issues. Severe brain fog is the worst of all the problems and even the higher dose wasn't helping me much. Is hyperthyroidism possible at my levels?
I am planning on freezing my eggs soon, and I think it'd be unwise to freeze with this level of TSH.

Avatar universal
Also, I have an oily skin which is confusing me again.
Avatar universal
And I have Polycystic ovaries. Does it change anything?
Avatar universal
That DHEA range looked unusual to me, so I looked and found these.  Please check that result and reference range and also list the measurement units.

"Typical normal ranges for females are: Ages 18 - 19: 145 - 395 micrograms per deciliter (ug/dL) Ages 20 - 29: 65 - 380 ug/dL"

When your say your D was only .1 low, what was the actual result?  
Avatar universal
It says it's well within the lab range though.

DHEA - SULPHATE (DHEAS) : 149.57 μg/dL

DEHYDROEPIANDROSTERONE  5.93 ng/mL

VITAMIN D TOTAL LC-MS/MS 29.03 ng/mL  sufficiency 30-100
My D3 is higher than my D2.


The ref range of DHEA from Mayo is as follows:
Premature: <40 ng/mL*
0-1 day: <11 ng/mL*
2-6 days: <8.7 ng/mL*
7 days-1 month: 1-23 months: <2.9 ng/mL*
2-5 years: <2.3 ng/mL
6-10 years: <3.4 ng/mL
11-14 years: <5.0 ng/mL
15-18 years: <6.6 ng/mL
19-30 years: <13 ng/mL
31-40 years: <10 ng/mL
41-50 years: <8.0 ng/mL
51-60 years:  or =61 years: <5.0 ng/mL
Avatar universal
1. PROGESTERONE - 0.82 ng/mL

Females :

5 – 9 Years <= 0.6

10 - 13 Years <= 10.2

14 - 17 Years <= 11.9

Follicular Phase <= 2.7

Luteal Phase <= 31.4

Postmenopausal <= 0.2


2. ESTRADIOL - 85.36 pg/mL

Females:

6-12 Yrs: <= 60 pg/mL

12-13 Yrs: 15-85 pg/mL

Follicular Phase: 39-375 pg/mL

Mid cycle : 94-762 pg/mL

Luteal Phase : 48-440 pg/mL

Postmenopausal Phase : <= 10 pg/mL
Avatar universal
Thank you so much for your time. No, my doctor's not been worried about PCOS - for "it's so common" according to her. I've been running around doctors for the past 7 years for my PCOS and I was diagnosed only 3 years ago. I wish she'd ask about 10% of the questions that you have.

I've been looking for optimal ranges for tests online, but I only find the lab ranges everywhere which I cannot use to supplement myself with anything. So thanks so much for giving me those optimal ranges.

I also found a great video on YouTube: You Can Beat Thyroid Disorders...Naturally! By Dr Michael Johnson, which is great!


B6 and B12 are also considered the worst for acne, and it does affect me when I try to supplement. But maybe I should be looking into a supplement which has a balanced formula after my tests.

The main reason T4 gives me acne is because it increases the testosterone levels. Maybe the ratio of Testosterone to Estradiol increases, and causes acne? So maybe supplementing with DHEA may help with keeping the ratios balanced, and in turn help with my Thyroid function? Just a thought.

And thanks once again for being so helpful.
Avatar universal
Am I reading your progesterone result correctly, at only .82 ng/ml?  Do you know what phase you were in when test done?  The reason I ask is I was trying to calculate the ratio of P to E, as follows in this link.

http://blog.zrtlab.com/progesterone-estradiol-pg-e2-ratio

How is the ratio calculated?

We report an “optimal” ratio of 100-500, however this is only valid when E2 is within a normal luteal phase range; i.e., when E2 is 1.3-3.3 pg/mL in saliva, and 43-180 pg/mL in blood spot.  The ratio is calculated from the Pg value in pg/mL divided by the E2 value in pg/mL.

Saliva test example: a patient has E2 = 1.5 pg/mL and Pg = 300 pg/mL.  The units are the same (pg/mL), so the ratio is 300 divided by 1.5:

Pgratio1

Blood spot or serum example: a patient has E2 = 100 pg/mL and Pg = 20 ng/mL. The Pg units are first converted to pg/mL before calculating the ratio: 1 ng/mL is equivalent to 1000 pg/mL. Therefore, the ratio is 20 ng/mL x 1000 = 20,000 pg/mL Pg, divided by 100 pg/mL E2:

Pgratio2

Both of these examples represent normal endogenous luteal phase levels of E2 and Pg.
__________________________


Then I realized that if the .82 ng/ml is correct , then your progesterone level was so low that it was even below the range.  If so, that is called estrogen dominance.  You can read this about that condition,  

"We get acne when androgens (male sex hormones) such as testosterone get turned into its more potent form called Dihydrotestosterone or DHT, via the action of an enzyme called 5 Alpha Retuctase. DHT then causes sebum production to increase, leading to more oily skin, clogged pores and acne.

Balanced progesterone helps to prevent this by regulating the production of DHT in the body. It inhibits the activity of 5 Alpha Reductase and prevents it from turning Testosterone into DHT. When your Progesterone levels are normal, this will help to keep your DHT levels down. But when estrogen gets high and progesterone is low, all hell breaks lose! :-)

This is how estrogen dominance and low progesterone can cause acne."
Avatar universal
I was on the 5th day of the cycle.

I am not sure about supplementing with progesterone though.
I was wondering if Anti-DHT supplements help with increasing progesterones naturally?
Avatar universal
What can I say! I think I've been amazingly lucky that you answered to my question in the first place!
Avatar universal
I think this link written by a good thyroid doctor might alleviate your concerns about progesterone supplementation.

.  
http://www.hormonerestoration.com/Menopause.html
Avatar universal
Alright. SO I picked up a few supplements - DHEA, Vit D3 and Progesterone cream. Also got a prescription for Armour. I  guess I will get a blood test again in another 2 months.
Will come back with the update soon. Thanks so much for all the info. You were really helpful.
Avatar universal
If the progesterone is over-the-counter, then you do need to know this.

"How to tell if it has real progesterone in it
We can hope that the cream we buy is powerful due to containing a hormone. Many so-called progesterone creams do not contain effective ingredients. In particular, creams that contain "wild yam extracts" or "Mexican yam" or "diosgenin" as their only active ingredient are not going to provide progesterone. While it is true that progesterone is produced in the lab from this plant source or partially-refined source, these sources cannot be converted to progesterone in the body. Creams containing these ingredients may cause produce some degree of effect when used, but that effect is not due to progesterone.

We have to be careful to read the ingredients, not just the label and advertising, though: some things that are called "Wild yam" actually contain real progesterone and some things called progesterone only contain wild yam. What a cream must contain to be effective is "USP Progesterone," and unless the label specifies this as an ingredient, we're not getting it.

We'll find OTC creams available in various strengths, but in practical terms, the ones that contain about 450 mg/oz are the only ones worth purchasing. Others that contain lesser amounts require such a large volume of cream to deliver an effective dose that they are ridiculously expensive. As a rule, a high-quality OTC cream costs around $20-$40 a tube, about twice as much on a per-volume basis as an equivalent-strength Rx cream."
Avatar universal
I ended up with Emerita Pro-Gest Cream Paraben Free, I was sold on the paraben-free. :) Thankfully, it also says USP progesterone on the ingredient list.

I hope I am doing the right thing taking all the new supplements together. My only worry is if I can tell which is helping me and which isn't. I guess I will have to closely monitor how I feel and react. I am also planning on adding a few anti-dht supplements while being on DHEA.

Do you think 7-keto DHEA is better than DHEA, since they do not convert to steroid hormones? Do I need the conversion? Anyway, I have the normal DHEA now, will try the 7-keto if this doesn't work for me.




Avatar universal
I found this info on the 7-keto DHEA.  Sounds like the regular DHEA might be the better choice.  

7-keto-DHEA is a by-product of dehydroepiandrosterone (DHEA), a chemical that is formed in the body. DHEA is a "parent hormone" produced by glands near the kidneys. But unlike DHEA, 7-keto-DHEA is not converted to steroid hormones such as androgen and estrogen. Taking 7-keto-DHEA by mouth or applying it to the skin does not increase the level of steroid hormones in the blood.

People take 7-keto-DHEA to speed up the metabolism and heat production to promote weight loss. 7-keto-DHEA is also used to improve lean body mass and build muscle, increase the activity of the thyroid gland, boost the immune system, enhance memory, and slow aging.
Avatar universal
7-keto sounds better when I read more. Do I really need more of those steroid hormones in my body with the regular DHEA?
Aaah! My body will be the site of experiments for the next few months. :)
Can't wait.
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