Elevated TSH on TRT/HCG

[Dr Justin Saya MD]

I have a pituitary microadenoma that is (supposedly) nonfunctioning. I did try clomiphene, I believe up to 50mg, which pushed my total T near 600 or so, but without significant symptomatic relief.

By golly, "idiopathic" hypogonadotropic hypogonadism, "non-functioning" pituitary adenoma...sounds like they were quick to diagnose you with the catch-all diagnoses of exclusion. At least they didn't just chalk it ALL up to depression, give you and anti-depressant and viagra, and send you on your way, lol.

You've uncovered a major (but correctable) problem, if not then certainly now. The past is water under the bridge I suppose. Look forward to our chat soon and an update from you.

 

[bluezebra5]

By golly, "idiopathic" hypogonadotropic hypogonadism, "non-functioning" pituitary adenoma...sounds like they were quick to diagnose you with the catch-all diagnoses of exclusion. At least they didn't just chalk it ALL up to depression, give you and anti-depressant and viagra, and send you on your way, lol.

You've uncovered a major (but correctable) problem, if not then certainly now. The past is water under the bridge I suppose. Look forward to our chat soon and an update from you.

Well first it was, "so when did you stop using anabolic steroids"? But depression certainly came up.


Talk soon, Dr. Saya. Thank you.

 

[bluezebra5]

Yeah, you need to talk to your physician about Hashi's. Your enzyme related antibodies are concerning.

In the future dump those "Uptake" labs, and anything that says "index" on it! They're worthless and outdated about 30 years! Next time round, see if you can also get a Free T3 Serum and a Reverse T3 Serum lab(s).

As we already spoke about Selenium, it can work quite effectively on its own with Hashi's. 300 to 400mcg of selenium is usually a decent range with people having elevated TPO, plus a regular regiment of kelp/iodine as also mentioned. Additionally, NDT treatment can be administered effectively, and can make a HUGE dent on reducing and stopping the autoimmune attacks. The trick is titrating to a correct dosage; usually upwards of 3 grains or more.

With that said, just keep this and other information in the back pocket, do some additional research and cross check anything you read, and don't make any moves without the guidance of a trained physician. I'd run all this by your current guy, see what he says, then look at going to get a second opinion from Dr. Saya, or someone who is also specialized in the endocrine side of things.

Chris, so I can prepare myself for Monday, if I'm being offered synthetic T4, would you recommend I push for something like Armour instead?

 

[CoastWatcher]

Chris, so I can prepare myself for Monday, if I'm being offered synthetic T4, would you recommend I push for something like Armour instead?

Dr. Saya indicated he looks forward to speaking with you. If he is going to help you manage your care, I wouldn't involve so many other people and possible options. You may find yourself chasing shadows and creating anxiety that you don't need.

 

[bluezebra5]

Dr. Saya indicated he looks forward to speaking with you. If he is going to help you manage your care, I wouldn't involve so many other people and possible options. You may find yourself chasing shadows and creating anxiety that you don't need.

I understand, and I appreciate the concern CoastWatcher. There's a bit of a waitlist to see Dr. Saya, a testament to his prowess as a physician. He's in the loop.

 

[CoastWatcher]

I understand, and I appreciate the concern CoastWatcher. There's a bit of a waitlist to see Dr. Saya, a testament to his prowess as a physician. He's in the loop.

I know, from personal experience, how too many doctors can lead you into confusion. All the best.

 

[bluezebra5]

I know, from personal experience, how too many doctors can lead you into confusion. All the best.

I'm with you. I've had 8 cardiologists weigh in on these arrhythmias. That's about 6 too many cooks in the kitchen. Wish you the best as well.

 

[FrankUnderwood]

Wondering if your HCG usage is stimulating/overstimulating your thyroid.

See :
http://www.ncbi.nlm.nih.gov/pubmed/8045981

http://www.ncbi.nlm.nih.gov/pubmed/1648698

Hoping Dr Saya / Dr Crisler can chime in on if they see similar results with patients on either HCG monotherapy or TRT+HCG. Is it typical to see increased TSH output in males?

 

[bluezebra5]

Wondering if your HCG usage is stimulating/overstimulating your thyroid.

See :
http://www.ncbi.nlm.nih.gov/pubmed/8045981

http://www.ncbi.nlm.nih.gov/pubmed/1648698

Hoping Dr Saya / Dr Crisler can chime in on if they see similar results with patients on either HCG monotherapy or TRT+HCG. Is it typical to see increased TSH output in males?

A) That's quite an interesting theory. Thank you for providing the literature to back it up as well.


B) I started season 4 of House of Cards right before I read your post. Kind of spooky.

 

[Dr Justin Saya MD]

Wondering if your HCG usage is stimulating/overstimulating your thyroid.

See :
http://www.ncbi.nlm.nih.gov/pubmed/8045981

http://www.ncbi.nlm.nih.gov/pubmed/1648698

Hoping Dr Saya / Dr Crisler can chime in on if they see similar results with patients on either HCG monotherapy or TRT+HCG. Is it typical to see increased TSH output in males?

Good stuff, FrankUnderwood, and indeed hCG shares a close structural similarity to endogenous TSH. A few points however:

- hCG can have a modest stimulatory effect on the thyroid (via its structural similarity to TSH), but this is typically at HIGHER serum hCG levels often achieved with VERY HIGH dosing (female fertility treatment for example) or more commonly during pregnancy (where serum hCG concentrations can reach into the tens of thousands mIU/mL ---for comparison, with my recent case studies of serum hCG levels after hCG injections, we found that maximal serum hCG concentration after even a 500iu injection was only ~3mIU/mL).

- stimulation of the thyroid (via pseudo-"mimicking" TSH) would actually LOWER endogenous TSH levels (as seen during pregnancy). OP's TSH was ELEVATED.

Good questions nonetheless and certainly an interesting case!

 

[Vettester Chris]

Chris, so I can prepare myself for Monday, if I'm being offered synthetic T4, would you recommend I push for something like Armour instead?

I'm sure much has happened since you posted this. Sorry, I didn't catch it at the time you posted. Curious how this part of it sorted out. Keep in mind, a key factor you need to keep in mind is the autoimmune enzyme issues with your TPO results.

Not treating your condition "properly" can be even worse than not treating at all, essentially fueling the fire when the autoimmune attacks happen. I firmly believe you can medicate with NDT's, but honing in the adequate dosage will be the trick, along with supporting a protocol with selenium and kelp as already noted.

I personally don't think the HCG hypothesis is in play (I could be wrong), again just simply due to the antibodies presented in your labs. The autoimmune attacks would present erratic variances in thyroid hormone levels, causing TSH readings to be all over the place. The TPO looks more than likely to be the culprit, but by all means review every possibility.

 

[bluezebra5]

I've been far too slow to update and I apologize. My sincere thanks, again for all of your contributions. Here's the latest:

After meeting with my endocrinologist, and soon after, Dr. Saya, I began levothyroxine therapy at 75mcg/day. I was apprehensive at first, given all that I'd read about NDT, but was assured that this was a cautious first step to gauge the TSH response, as well as to assess my natural ability to convert the T4 into T3.

After one month, I felt no different (doc was clear that this was unlikely to be a sufficient replacement dose). Labs were as follows:

FT4: .89 (.76-1.46)
FT3: 3.00 (2.18-3.98)
TSH: 4.44 (.36-3.74)


So it appears I am doing a decent job making T3, and good to see that the TSH is coming down from the stratosphere. We raised the dose to 100mcg T4/day. Labs after 1 month:

FT4: 1.19 (.82-1.77)
FT3: 2.8 (2-4.4)

I'm unsure what to make of this. Unfortunately the reference ranges do not match, as the first set were drawn in-office, and the second set through Discounted Labs at Labcorp. I made a mistake and did not purchase a TSH test, for which I'm now kicking myself.

It's hard to tell, as so much time has passed, but I think I'm feeling a little better, certainly a little brighter and more energetic. More importantly, I have not had any cardiac symptoms since beginning thyroid replacement. This wouldn't be the longest asymptomatic period I've had, but it is encouraging nonetheless.

Additional info: I began Kelp and Selenium supplementation quickly after the recommendations from Chris and Dr. Saya. I have since transitioned to a multivitamin which provides iodine in the form of kelp, and also a small amount of selenium. I also eat Brazil nuts regularly. For some reason, taking the standalone selenium made me intensely nauseous. I may try it again soon depending on what the Anti-TPO labs reveal. I will obtain a more comprehensive panel after my upcoming talk with Dr. Saya- it's just tough when everything is out-of-pocket.

Again, this is all just to say thanks and give an update for anyone who may be experiencing something similar. I feel very confident in the hands of the Defy team and hope to bring good news soon.

 

[J.James.A]

Good stuff, FrankUnderwood, and indeed hCG shares a close structural similarity to endogenous TSH. A few points however:

- hCG can have a modest stimulatory effect on the thyroid (via its structural similarity to TSH), but this is typically at HIGHER serum hCG levels often achieved with VERY HIGH dosing (female fertility treatment for example) or more commonly during pregnancy (where serum hCG concentrations can reach into the tens of thousands mIU/mL ---for comparison, with my recent case studies of serum hCG levels after hCG injections, we found that maximal serum hCG concentration after even a 500iu injection was only ~3mIU/mL).

- stimulation of the thyroid (via pseudo-"mimicking" TSH) would actually LOWER endogenous TSH levels (as seen during pregnancy). OP's TSH was ELEVATED.

Good questions nonetheless and certainly an interesting case!

I'm going through something similar. Been on 300mg cypionate (split into 2 injections, so 150 wed 150 sun) 500units hgc+b12 also wed and sun and arimidex 2x week for over a month now. Well a couple weeks ago I started to feel a little off, anxiety, skipped heart beats, night sweats. I suffer from Hashimotis so I went to my thyroid Dr. a couple weeks ago and had blood work done. My labs went as followed
TSH 1.08 (0.27-4.20)
Total T4 10.60 (4.00-11.00)
Free T3 4.6 (2.0-4.4) marked as "above normal high"
Antibodies 322 (0-34)
Testosterone >1500 (348-1197)
Estradiol 21.7 (7.6-42.6)

My thyroid symptoms (skipped beats, night sweats) tend to subside when my Free T3 is in the 3 area. I've had it up in those areas before and felt awful. My Dr. thinks since I have had such a boost in my T that it's kinda helping my Thyroid function in the same way a balanced thyroid helps Testosterone.
We are going to cut back from 112 Levo to 100 and see if it will lower my T4 & T3 and up a TSH. I think my labs show borderline Hyperthyroid definition.

I'm also thinking about talking to my T Dr. about lowering my T dose, I'm sure that's not helping with the palps.

 

[J.James.A]

I've been far too slow to update and I apologize. My sincere thanks, again for all of your contributions. Here's the latest:

After meeting with my endocrinologist, and soon after, Dr. Saya, I began levothyroxine therapy at 75mcg/day. I was apprehensive at first, given all that I'd read about NDT, but was assured that this was a cautious first step to gauge the TSH response, as well as to assess my natural ability to convert the T4 into T3.

After one month, I felt no different (doc was clear that this was unlikely to be a sufficient replacement dose). Labs were as follows:

FT4: .89 (.76-1.46)
FT3: 3.00 (2.18-3.98)
TSH: 4.44 (.36-3.74)


So it appears I am doing a decent job making T3, and good to see that the TSH is coming down from the stratosphere. We raised the dose to 100mcg T4/day. Labs after 1 month:

FT4: 1.19 (.82-1.77)
FT3: 2.8 (2-4.4)

I'm unsure what to make of this. Unfortunately the reference ranges do not match, as the first set were drawn in-office, and the second set through Discounted Labs at Labcorp. I made a mistake and did not purchase a TSH test, for which I'm now kicking myself.

It's hard to tell, as so much time has passed, but I think I'm feeling a little better, certainly a little brighter and more energetic. More importantly, I have not had any cardiac symptoms since beginning thyroid replacement. This wouldn't be the longest asymptomatic period I've had, but it is encouraging nonetheless.

Additional info: I began Kelp and Selenium supplementation quickly after the recommendations from Chris and Dr. Saya. I have since transitioned to a multivitamin which provides iodine in the form of kelp, and also a small amount of selenium. I also eat Brazil nuts regularly. For some reason, taking the standalone selenium made me intensely nauseous. I may try it again soon depending on what the Anti-TPO labs reveal. I will obtain a more comprehensive panel after my upcoming talk with Dr. Saya- it's just tough when everything is out-of-pocket.

Again, this is all just to say thanks and give an update for anyone who may be experiencing something similar. I feel very confident in the hands of the Defy team and hope to bring good news soon.

Don't mind me asking, what are you taking? I want to try it for my high TPO.

 

[bluezebra5]

Don't mind me asking, what are you taking? I want to try it for my high TPO.

I was doing Optimen from ON with additional Kelp (NOW brand I think). I'm experimenting with Legion Triumph as of a couple of weeks ago.

I'm planning on doing a full panel (esp TPO) once I get home from a trip this weekend. I'll be sure to post the results. Thank you for your input, I appreciate hearing from someone with a similar presentation.

 

[bluezebra5]

I'm going through something similar. Been on 300mg cypionate (split into 2 injections, so 150 wed 150 sun) 500units hgc+b12 also wed and sun and arimidex 2x week for over a month now. Well a couple weeks ago I started to feel a little off, anxiety, skipped heart beats, night sweats. I suffer from Hashimotis so I went to my thyroid Dr. a couple weeks ago and had blood work done. My labs went as followed
TSH 1.08 (0.27-4.20)
Total T4 10.60 (4.00-11.00)
Free T3 4.6 (2.0-4.4) marked as "above normal high"
Antibodies 322 (0-34)
Testosterone >1500 (348-1197)
Estradiol 21.7 (7.6-42.6)

My thyroid symptoms (skipped beats, night sweats) tend to subside when my Free T3 is in the 3 area. I've had it up in those areas before and felt awful. My Dr. thinks since I have had such a boost in my T that it's kinda helping my Thyroid function in the same way a balanced thyroid helps Testosterone.
We are going to cut back from 112 Levo to 100 and see if it will lower my T4 & T3 and up a TSH. I think my labs show borderline Hyperthyroid definition.

I'm also thinking about talking to my T Dr. about lowering my T dose, I'm sure that's not helping with the palps.

You are on a rather high dose of testosterone. One of our experts should chime in on this, but if you would feel comfortable reigning it back a bit, your lipids may thank you.

Have you had a full CBC/CMP + lipid panel on this regimen?

 

[CoastWatcher]

I'm going through something similar. Been on 300mg cypionate (split into 2 injections, so 150 wed 150 sun) 500units hgc+b12 also wed and sun and arimidex 2x week for over a month now. Well a couple weeks ago I started to feel a little off, anxiety, skipped heart beats, night sweats. I suffer from Hashimotis so I went to my thyroid Dr. a couple weeks ago and had blood work done. My labs went as followed
TSH 1.08 (0.27-4.20)
Total T4 10.60 (4.00-11.00)
Free T3 4.6 (2.0-4.4) marked as "above normal high"
Antibodies 322 (0-34)
Testosterone >1500 (348-1197)
Estradiol 21.7 (7.6-42.6)

My thyroid symptoms (skipped beats, night sweats) tend to subside when my Free T3 is in the 3 area. I've had it up in those areas before and felt awful. My Dr. thinks since I have had such a boost in my T that it's kinda helping my Thyroid function in the same way a balanced thyroid helps Testosterone.
We are going to cut back from 112 Levo to 100 and see if it will lower my T4 & T3 and up a TSH. I think my labs show borderline Hyperthyroid definition.

I'm also thinking about talking to my T Dr. about lowering my T dose, I'm sure that's not helping with the palps.

Your total testosterone is at supraphysiological levels - undoubtedly due to your total dose of 300mg per week. That could well be contributing to your anxiety. What is your hemoglobin and hematocrit? Can you post a recent CBC? And, for future reference, ask your doctor to run the sensitive LC, MS/MS estradiol test. You were tested via the standard assay and it is of little value for men.

 

[J.James.A]

Your total testosterone is at supraphysiological levels - undoubtedly due to your total dose of 300mg per week. That could well be contributing to your anxiety. What is your hemoglobin and hematocrit? Can you post a recent CBC? And, for future reference, ask your doctor to run the sensitive LC, MS/MS estradiol test. You were tested via the standard assay and it is of little value for men.

Hemoglobin 17.0 (14.0-18.0)
Hematocrit. 51. (40-54)
Platelets 253 (150-375)
RBC. 5.7 (4.2-5.4) this one showed a bit high but she said she wasn't worried about it too much.

I also just sent my T Dr. A text letting him know what's been going on and that I would like to lower my T dosing. I've read that a good dose is
100mg T
250ui hcg
1 arimidex
See what he says

 

[CoastWatcher]

Hemoglobin 17.0 (14.0-18.0)
Hematocrit. 51. (40-54)
Platelets 253 (150-375)
RBC. 5.7 (4.2-5.4) this one showed a bit high but she said she wasn't worried about it too much.

I also just sent my T Dr. A text letting him know what's been going on and that I would like to lower my T dosing. I've read that a good dose is
100mg T
250ui hcg
1 arimidex
See what he says

NEVER take Anastrozole in the absence of confirmed elevated levels on the sensitive, LC, MS/MS lab test. You can crush your E2 levels in the blink of an eye and open up a period of misery. You aren't taking it now, on 300mg of testosterone a week, are you? What makes you believe you'd need it at a third of that dose?

 

[J.James.A]

NEVER take Anastrozole in the absence of confirmed elevated levels on the sensitive, LC, MS/MS lab test. You can crush your E2 levels in the blink of an eye and open up a period of misery. You aren't taking it now, on 300mg of testosterone a week, are you? What makes you believe you'd need it at a third of that dose?

Both my GP, who has her own pellet clinic and also does injections said my E was on the elevated side compared to where my T was when we found I had low T. The Dr. That put me on this regimen also said that to be true.

I haven't felt bad, I actually have energy, maybe too much energy at the moment though. My higher FT3 and High T are putting me on edge. Like I said, my FT3 has been at the 4.6 level and I felt bad then, that was so to being out on Armour which has T4 and T3. My Dr. says my body converts just fine, have had multiple blood labs that shows this