Hey Anabolic Minds,
I'm hoping that I might be able to crowd-source some advice.
I've been dealing with fatigue for the better part of 10 years now and in the last year it's become significantly worse.
After doing a lot of reading here at Anabolic Minds (and some similar forums) and I've started approaching this problem with hard data (getting labs, measuring everything, etc).
I've also been working with a doctor (an endocrinologist who is discussed here and on similar forums) for the last 8 months and have lots of lab work at this point.
Last 10 years:
- Extreme fatigue
- Cold hands and feet
- "Brain fog"/difficulty concentrating
- Low libido
- Low motivation
- Memory loss (can't remember names, words, etc)
The endocrinologist I'm working with diagnosed me with hypothyroidism (specifically, low free T3 and low Ft4)
Went on 100 mcg T4. 2 months later had symptoms of hyperthyroid (very low TSH, insomnia, etc). We ran labs and found that I also had extremely high reverse T3 (RT3), though FT3 hadn't moved much.
Endocrinologist diagnosed me with T4 to T3 conversion problem, and switched me to 25mcg of Cytomel (T3 medication).
Since then, my fatigue has not improved. Did a sleep study and was prescribed Nuvigil (not by my endocrinologist; a separate sleep doctor prescribed the Nuvigil).
Just ran new labs and several things are abnormal (very high Test, SHBG).
Iodine (lugols) 12 mg
Selenium 200 mcg
Vitamin C 1000 mg
Krill Oil 600 mg
B-complex 100 mg
Zinc 50 mg
Copper 2 mg
Creatine 5 g
Melatonin 3 mg
Cytomel 25 mcg
Nuvigil 100 mg (I just cut the pill down because I was getting jittery at 150 mg)
LABS (these are the most recent labs, drawn Oct 24-Oct26)
Glucose, Serum 99 mg/dL 65-99
Uric Acid, Serum 6.0 mg/dL 3.7-8.6
BUN 19 mg/dL 6-20
Creatinine, Serum 0.96 mg/dL 0.76-1.27
eGFR If NonAfricn Am 104 mL/min/ 1.73 >59
eGFR If Africn Am 120 mL/min/ 1.73 >59
BUN/Creatinine Ratio 20 8-19 HIGH
Sodium, Serum 140 mmol/L 134-144
Potassium, Serum 5.0 mmol/L 3.5-5.2
Chloride, Serum 103 mmol/L 97-108
Carbon Dioxide, Total 27 mmol/L 20-32
Calcium, Serum 9.4 mg/dL 8.7-10.2
Phosphorus, Serum 3.7 mg/dL 2.5-4.5
Protein, Total, Serum 6.4 g/dL 6.0-8.5
Albumin, Serum 4.2 g/dL 3.5-5.5
Globulin, Total 2.2 g/dL 1.5-4.5
A/G Ratio 1.9 1.1-2.5
Bilirubin, Total 0.3 mg/dL 0.0-1.2
Alkaline Phosphatase, 57 IU/L 25-150
LDH 140 IU/L 0-225
AST (SGOT) 18 IU/L 0-40
ALT (SGPT) 19 IU/L 0-55
GGT 24 IU/L 0-65
Hemoglobin A1c 5.1 % 4.8-5.6
Insulin 7.6 uIU/mL 2.6-24.9
Cholesterol, Total 142 mg/dL 100-199
Triglycerides 82 mg/dL 0-149
HDL Cholesterol 53 mg/dL >39
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
LDL Cholesterol Calc 73 mg/dL 0-99
T. Chol/HDL Ratio 2.7 0.0-5.0
TSH 0.006 uIU/mL 0.450-4.500 LOW
Thyroxine (T4) 9.0 ug/dL 4.5-12.0
Triiodothyronine (T3) 145 ng/dL 71-180
T3 Uptake 39 % 24-39
T4,Free(Direct) 1.79 ng/dL 0.82-1.77 HIGH
T3,Free,Serum 4.9 pg/mL 2.0-4.4 HIGH
Reverse T3, Serum 36.5 ng/dL 9.2 - 24.1 HIGH
Thyroid Peroxidase (TPO) Ab 8 IU/mL 0-34
Antithyroglobulin Ab <20 IU/mL 0-40
PTH, Intact 21 pg/mL 15-65
Ferritin, Serum 296 ng/mL 30-400
Iron, Serum 104 ug/dL 40-155
Iron Bind.Cap.(TIBC) 238 ug/dL 250-450 LOW
UIBC 134 ug/dL 150-375 LOW
Iron Saturation 44 % 15-55
steroid hormones and related
Testosterone, Serum 1103 ng/dL 348-1197
Free Test(Direct) 16.7 pg/mL 8.7-25.1
Dihydrotestosterone 85 ng/dL 30 - 85
SHBG, Serum 74.7 nmol/L 16.5-55.9 HIGH
IGF-I 234 ng/mL 71-241
DHEA-Sulfate 288.6 ug/dL 160.0-449.0
Progesterone 0.9 ng/mL 0.2-1.4
Estradiol 27.7 pg/mL 7.6-42.6
(Roche ECLIA methodology)
LH 7.2 mIU/mL 1.7-8.6
FSH 2.5 mIU/mL 1.5-12.4
Prolactin 13.9 ng/mL 4.0-15.2
cortisol and related
Pregnenolone, MS 196 ng/dL Adults: <151
Cortisol - AM 23.9 ug/dL 6.2-19.4 HIGH
ACTH, Plasma 96.7 pg/mL 7.2-63.3 HIGH
C-Reactive Protein, 0.35 mg/L 0.00-3.00
Relative Risk for Future Cardiovascular Event
Average 1.00 - 3.00
Vitamin A, Serum 69 ug/dL 18-77
Vitamin B12 782 pg/mL 211-946
Folate (Folic Acid), Serum 15.6 ng/mL >3.0
Vitamin D, 25-Hydroxy 66.3 ng/mL 30.0-100.0
- Why do I still have high Ft4? Wouldn't the cytomel (and subsequent low TSH) suppress the formation of T4?
- Why do I still have high reverse T3?
- Why are my androgens so high? (back in the July, my TT was about 714)
- How can I drive down SHBG (I'm guessing that the cytomel increased it.)
- Why is my ACTH so high? Could the Cytomel do this?
- What's causing my fatigue? My thyroid hormones are in range now ( they were not when I started) but I still feel worn out. Is this a RT3 issue?