T3/T4 intake question for those with experience

[MYP9864]

46 y/o male, 6.2" 175lbs, 11% bf.
Currently on TRT (16 years) at 100mg Test C weekly, ED injections and 4iu HGH daily.

SHBG 23.2
TOTAL TEST 1260
FREE TEST 29.6 (6.8-21.5)
ESTRADIOL SENSITIVE 35.5

Thyroid Labs from 12/12/24

TSH 1.050 (0.450-4.500)
T3 78 (71-180) low normal
T3 Free 2.4 (2.0-4.4) low normal
T4 6.1 (4.5-12.0)
T4 Free 1.05 (0.82-1.77)

Thyroid Labs from 12/31/24 after one week on 25mcg Levothyroxine

TSH 0.670 (0.45-4.5) low normal
T4free 1.12 (0.82-1.77)
T3 72 (71-180) very low normal
Reverse T3 20.9 (9.2-24.1) high normal (FIRST TIME HAVING REVERSE T3 TEST DONE)
3.44:1 ratio T3 to rT3 (normal ratio should be 10:1)

After struggling with typical Hypothyroid symptoms such as daytime fatigue/lethargy, brain fog, cold feet, bad sleep for a long time, I have decided to try a thyroid medication. Took 25mcg of T4/Levothyroxine for one week and did labs. See results above from 12/31/24.

Saw improvement in all symptoms since day 1 of T4 supplementation. Currently on 50mcg of T4 for one week and will do bloodwork in three weeks.

My observations:
-TSH decreased upon starting T4, although still within normal range
-minor bump in T4 free
-T3 decreased from 78 to 72 (very low normal)
-Reverse T3 is high and T3 to rT3 ratio is very low

Upon doing an extensive research, it appears that my body doesn’t convert T4 into T3 very well, resulting in high Reverse T3 numbers.

Some online doctors recommend a T3 mono therapy in place of T4. Logic is that T4 in this case is useless as it doesn’t convert to T3 and that T3 should directly increase T3 numbers and alleviate Hypothyroid symptoms. Many patients with high Reverse T3 claim their symptoms have greatly improved after switching to T3 only.

If my assumption is right, my Reverse T3 numbers will be even higher when I do labs in three weeks while on 50mcg of T4 and T3 numbers will not improve.

My plan is to either add low amounts of T3 in combination with T4 or switch to T3 only. Which option would you guys recommend?

T3 Mono therapy plan:
-T3 5mcg three times daily (due to short half life)

OR

-T3 5mcg three times daily with 25-50mcg T4

I still feel minor lethargy midday while on 50mcg T4 but other symptoms are much better.

I am confused though, as to why I am feeling better overall since starting T4, despite having high Reverse T3 numbers and no improvement in T3.

I am also concerned that taking T3 might lower my TSH even more causing Hyperthyroidism.

 

[MrCloud]

Your FT4 isnt bad. My last thyroid bloodwork showed a TSH of 0.60 and FT4 of 1.88. Higher T4 isnt necessarily better, it should lower TSH at that point, but that means the body isnt using or converting to T3. For a more definitive answer on it, you'll want a FT3 and RT3 results. However, your numbers look well within the normal range, it's unlikely any doc would see those numbers as bad or worrisome, quite especially if they're consistent. The ranges are wide to indicate individual variability.

BTW: As hypothyroid, that last bloodwork concerned my endo and wanted me to lower my T4 dose.

Yep, nothing to worry about but maybe it has to do something with my lower natty testosteron levels. 420 units at 21 .If I remember correctly hyperthyroid people have more igf1 or testosteron then hypo...

I was not born to be huge unfortunately.


Also anyone notice the shitty range my lab gives on testosterone ? 197-670 should be malpractice. Another Romanian lab I had same results so they used the same machine or reagent but the range for 20-50 years old was 250-836

 

[wldb33rz]

Yep, nothing to worry about but maybe it has to do something with my lower natty testosteron levels. 420 units at 21 .If I remember correctly hyperthyroid people have more igf1 or testosteron then hypo...

I was not born to be huge unfortunately.


Also anyone notice the shitty range my lab gives on testosterone ? 197-670 should be malpractice. Another Romanian lab I had same results so they used the same machine or reagent but the range for 20-50 years old was 250-836

There's a lot of hormonal issues that are intertwined. Thyroid issues can produce low t issues and symptoms (there's a lot of overlap with hypogonadism and hypothyroidism) Test production can affect thyroid function as well...there's a few other AAS that specifically mess with thyroid and why it's a common marker to check in a lot of the AAS/PED health panels that are available.

I just recently checked because when I was a kid I didnt really have the money to be checking bloodwork just because so I have no clue; but as a kid I was very active, walking a minimum of 10 miles per day, when I had a bike, it was often 3-4x that distance....seemingly didnt have much of an appetite, but gained weight and hovered around 200 my entire life. When working out was slow and not noticable even going consistently over the course of a year. And recently the past year or so I've been able to pack on muscle, it's still slow but it's remarkably different and what I guess normal people experience when they try to work out. But, right now my thryoid is optimized, and test levels are pretty normal maybe even high for age, since I'm in my late 40's (582 @afternoon testing) So thyroid could be linked there but no clue how it's actually affected me throughout my life.