Avatar universal

Thyroid or Hypogonadism?

Hi!  I am simply posting this to determine whether the following tests indicate hypothyroidism, and through what diagnosis do they.  If anyone is familiar, I am also looking to see if the tests indicate hypogonadism.  Is it primary or secondary?  And to what diagnosis may this be caused?  Here are the tests!  Thank you: I look forward to all of your input.

Testosterone, Serum: 265 (348-1197)

This was concerning, so another more extensive test followed.

TSH: 2.360 (0.450-4.500)
LH: 4.2 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
Testosterone, Serum: 330 (348-1197)
Prolactin: 8.5 (4.0-15.2)

The next test was issued by an endocrinologist.

Free Testosterone(Direct): 9.4 (9.3-26.5)
Testosterone, Total, Lc/Ms: 253.9 (348-1197)
Lh: 4.1 (1.7-8.6)
FSH: 1.1 (1.5-12.4)

The next test my current endocrinologist ordered because I had been off Prozac for one week and figured why not.

Cortisol: 20.8 (2.3-19.4)
TSH: 4.2: (0.450-4.500)

The first two tests were taken at 11:30 AM and 10:30 AM respectively, and the last two were taken at 8:00 AM.

I had an MRI done, and the results came back clear.


Thyroid Panel With TSH
TSH: 1.930 (0.450-4.500)
Thyroxine (T4): 9.6 (4.5-12.0)
T3 Uptake: 34 (24-39)
Free Thyroxine Index: 3.3 (1.2-4.9)
Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab: 8 (0-34)
Antithyroglobulin Ab: <20 (0-40)
Luteinizing Hormone (LH): 7.3 (1.7-8.6(
FSH, Serum: 1.3 (1.5-12.4)
Calcitonin, Serum: <2.0 (0.0-8.4)
Reverse T3, Serum: 21.5 (9.2-24.1)
Vitamin D, 25-Hydroxy: 32.6 (30.0-100.0)
Triiodothyronine (T3): 115 (71-180)
Estrogens, Total: 83 (40-115)
Ferritin, Serum: 70 (30-400)
Triiodothyronine, Free, Serum: 3.7 (2.0-4.4)

I do not know if this is important, however, these tests were taken at 8 AM. This could cause for the imbalance in some tests, as I had not eaten. I wonder if these are impacted: Calcitonin, Serum; Ferritin, Serum; and/or Vitamin D, 25-Hydoxy.

It is also important to note, I am currently taking: 50mcgs of Synthroid in the morning, 20mg of Adderall in the morning, and 10mg of Prozac at night. I started taking Synthroid before the last blood work.
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1756321 tn?1547095325
You do not have to fast unless your doctor orders a fasting glucose, fasting lipid panel, fasting metobolic panel, fasting cholesterol, HDL or triglycerides.  

The TSH test is higher in the morning (one study showing 73% higher) than in the afternoon so the time of day does affect TSH results. Serum T4 concentrations peak 2 to 4 hours after taking T4 medication and remain above normal for approx 6 hours. Therefore, it is recommended to test thyroid labs in the morning before taking any thyroid medication.

Of the total circulating testosterone, 60% is bound to sex hormone binding globulin (SHBG), 38% is bound to albumin, and 2% is free.  Free testosterone is the biologically active form and is considered to be a better representation of the true testosterone status.

There are situations in which the total testosterone level is low but free testosterone levels are normal (your lab work shows low total serum and in range (albeit at the bottom of the range) free testosterone.

Total testosterone is affected by alterations in the levels of SHBG and albumin.  A reduction in the level of SHBG can result in low total serum testosterone levels in patients with obesity, type 2 diabetes (states of insulin resistance), cachexia, malnutrition, advanced cirrhosis, acromegaly, hypothyroidism, nephrotic syndrome, glucocorticoids, progestins, androgenic steroids.

The end of the world is happening as i type...arg lol.
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Avatar universal
Fortunately, I took it at 8AM without taking my thyroid medicine, suspecting it might be the case.

I understand that free levels are a more accurate representation, but I am confused as to why my TSH is in the normal range and my free T4 is so high.  

My testosterone is considered in the "normal range", but I have laughed that off as a flaw in medicine.  Obviously the tests are subjective.  There is no range that can be decided in consistence with all people.  I have experienced a low quality of life and a wide-variety of harsh symptoms since the age of 12.  I am 20 years old now.

That is interesting.  I do not know anything about SHBG or albumin.  No doctor has ever had me tested on these.
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1756321 tn?1547095325
"SHBG levels are commonly measured as a supplement to total testosterone determinations." In the real world, that may be another matter. :)  I had to request my SHBG test. Albumin is part of a liver functions test.

Your labs work lists Thyroxine (T4) (Total T4), Free Thyroxine Index (FTI or T7) and T3 uptake.  FTI and T3 uptake are both outdated labs tests that both estimate free T4 in serum.  Total T4 is a measurement of both bound and unbound T4.

Free T4 and free T3 measure what is unbound (free) and available to use. These two tests are not listed on your lab work but are recommended. There should be 20 times more free T3 than reverse T3.  There are RT3 ratio calculators online that check the RT3 and FT3 ratio.

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Avatar universal
Testosterone, Serum: 330 (348-1197)
Free Testosterone(Direct): 9.4 (9.3-26.5)

I have low testosterone going on 10 years  I know these ranges well. You have the testosterone levels of an 80 year old man. However you are twenty.  

Fire your doctor.
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Queensland, Australia
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