Your numbers may look real good indeed, but good health is not just good lab numbers.
We try to treat so many imbalances and conditions just by using these results.
But that's only a small part of the big picture.
Vitamin D must be taken with K2, your magnesium levels should be high enough and the same for vit A
They all work in synergy in the body to avoid Vit. D toxicity,calcification of soft tissues, arterial calcification,
low blood coagulation and to facilitate bone formation
among many other important functions.
To take things a step further, have you had your thyroid function properly tested?
For thyroid function, not just circulating thyroid hormones in serum, you need more than the conventional testing of TSH and T4.
You need Free T3 (FT3), Free T4 (FT4) AND Reverse T3(RT3).
In your case TBG* might be valuable to verify the source.
Your symptoms are typical hypothyroid and it would be consistent with TRT side-effects, which may have to do with causing lower *thyroid binding globulin, which affects Free T3 levels by increasing Reverse T3 (it's a reversing or reducing thyroid hormone, as the name implies).
Very few doctors know about this, so you may have to insist for these tests. That's the only way to rule hypothyroidism out, otherwise you might be in medical
limbo, should you actually have ( undiagnosed ) hypothyroidism.
You should also know your iron status, so consider having a complete iron panel and also an MMA test for methylocobalmin B12 and methylfolate levels
(repeat MMA test within a few weeks).
Niko, thank you so much for the response. Quite a few very knowledgable people have suggested for me to have the full thyroid panel done. Yes, all they've run is TSH and T4. My T4 is only .7 which is bottom range. Looking back over the last 5 years it's been even out of range low. Dr didnt' think that was a problem.
I used your post to me and sent it to my dr requesting to look into this. you and others think i'm hypothyroid. Yes, I am on trt for 7 years. The first 6 went great but not this 7th one. This could very well be it.
thank you again and for explaining it out so I could communicate with my dr and check this full panel.
Is it an easy fix?
I had mentioned testing thyroxin-binding globulin (TGB)
which can be confused with thyroglobulin AB which you had tested.
The purpose of the TGB test is to determine the cause of your below range FT4 and low range FT3.
At any rate, I suspect this is an effect of your TRT
Your normal TSH and both FT3 and FT4 being low, point to secondary hypothyroidism.
Reverse T3 -which was not tested- would be high, I suspect, and it would explain where Free T4 goes and why FT3 is low.
So to recap: You have a conversion problem.
Your T4 is converting to Reverse T3, instead of Free T3, reducing further your Free T3.
You likely have developed secondary hypothyroidism, possibly due to your other hormonal imbalance and treatment.
What to do for the time being?
I'm afraid that a conventional Endo may not be your best choice, if s/he sticks with the established conventional protocol
.Reverse T3 &Thyroid resistance (type 2) may not be considered for dx or tx
There's a definite clash between Conventional and Functional Medicine.
My views and comments are derived from Functional Medicine principals.
I would suggest you ask your PCP for a trial of T3 only, like Cytomel (liothyronine) and with the smallest dose, to start. T3 only cannot convert to RT3.
The second suggestion is to take some zinc (50 mg?) and some selenium (400 mcg?), which help optimize T4 to T3 conversion.
The third suggestion is to get the 2 tests that were missed, thyroxin-binding globulin (TGB) and Reverse T3 (RT3) as I mentioned earlier, just to confirm you're on the right track.
No worries, it will eventually get resolved.
You can do a trial of zinc and selenium immediately, if you choose to do so.
And BTW, if you're still doing Vitamin D3, make sure you follow up with K2 and Mg supplementation, for the reasons I explained in my 1st post.
There is a thread on recovery time after correcting vitamin D deficiency. It could take a year..ayayaya!
Oh yeah your thyroid labs aren't looking too good. I have Hashimoto's thyroiditis but there are many other causes of low thyroid function such as iodine insufficiency, over consumption of goitrogenic foods, whiplash or neck trauma.
I forgot to mention hypothyroidism lowers testosterone.
80 to 90% of people with Hashimoto's thyroiditis will have TPO antibodies, TG antibodies or both. In your case both your antibodies are negative.
That does not rule out Hashimoto's thyroiditis however since some people will never test positive for thyroid antibodies - this is called seronegative Hashimoto's thyroiditis. A thyroid ultrasound will show a hypoechoic pattern that is seen with Hashimoto's thyroiditis.
Seronegative autoimmune thyroiditis is a less aggressive form of Hashimoto's thyroiditis but you may still develop hypothyroidism. Hashimoto's thyroiditis is often silent in the early stages with no symptoms.
Excerpt from Hypothyroid Mom - Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism...
"Thyroid Tests "Normal" But You Don't Feel Well?
If you're undiagnosed, or a thyroid patient taking thyroid hormone replacement medications, being in the "normal" range does not mean you feel well, or that your treatment is optimized. What levels are considered "optimal*" by many integrative physicians?
~ TSH - Typically less than 2.0
~ Free T4 - Top half of the reference range
~ Free T3 - Top half - top 25th percentile of reference range
~ Reverse T3 - Lower end of normal range
~ Thyroid Peroxidase Antibodies (TPO) - Within reference range
~ Vitamin D - Above 50
~ Ferritin - Above 60 (Above 80 if experiencing hair loss)
* we are all different, one size doesn't fit all, so these are guidelines. Your optimal levels may vary."
Just to add, for those who don't live in the US, Vitamin D - above 125 nmol/L. I had vitamin D deficiency (and most people with Hashimoto's thyroiditis do) and it was down to 30 nmol/L (12 ng/mL).
I really appreciate you’re help everyone. None of this obviously makes sense so far and as time goes on to almost a year now I’m really down and hopeless.
I have absolute pain, weakness, no erectile function or libido, so depressed(I’m sure mostly from life falling apart), hardly have dreams, dry skin, gained 10 lbs, vision declined, can’t focus or concentrate,so fatigued and etc...
1 year ago I went from being the opposite and probably the best shape mentally and physically in my life at age 50.
It’s all been yanked and I have no idea why. That’s the worst part, not knowing.
An interesting symptom of hypothyroidism is myxedema. A video on how to do the simple skin test is on youtube if you want to watch it - search: "Hypothyroidism Type 2: Myxedema Symptoms." I am covered from head to toe in myxedema (have had cellular hypothyroidism for decades and Hashimoto's thyroiditis for maybe 8 years now). Even after a couple of years of taking thyroxine it has improved only mildly in some areas. It's stubborn stuff to get rid off!
When I corrected my vitamin D deficiency, symptoms cleared up not that long afterwards. I have never reached optimal vitamin D levels due to various reasons from magnesium deficiency to stress..it's a work in progress! Due to stress my vitamin D levels have dropped again and I knew it due to various symptoms showing back up. I was surprised some people did take quite a long time to recover from vitamin D deficiency symptoms. I clearly am not one of those people.
OK, 27% of all people have a Vitamin D Receptor Gene Mutation called VDR taq and another 26% have the other
Vitamin D Receptor Gene Mutation called VDR Bsm.
The degree of Vitamin D resistance depends on whether these genes are inherited from one parent (homozygous)
or from both parents (heterozygous), among some other lesser factors.
Other causes of Vit. D resistance are the ones I mentioned
before,like High/Low Cortisol,Obesity,possibly Hashimotos (I have not reviewed any articles or studies on the last one)
You would need your D levels to reach 100 ng/ml or 250 nmol/L before symptoms related to a functional Vit. D deficiency improve.
Upping the intake to 10000 IU of oil based Vit. D3 per day along with 100 mcg of K2(MK7) and 400-600 mg of Mg oral ( transdermal Magnesium Oil, as an adjunct), is a recommended protocol by many experienced practitioners.
Vit D3 must be taken with a meal containing some good quality fat.