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[Katymac]

I made a previous thread but Hurdity suggested making a new one and expanding it

Ive been on evoral conti since early 2019 and in the summer i saw a private specialist who prescribed 75 evoral and 5mg Norisethone (but I only take half) & she also prescribed vagifem equivilent and testosterone and was concerned about my thyroid because of previous blood test results

I had the blood tests and have these results
I guess i need to know if I should stop testosterone or reduce it?


Started testosterone and just got 3 month blood test results
« on: November 16, 2023, 12:53:14 PM »
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I have got to "speak to the doctor"

Which is fine but I need to know what to say

I have a free androgen result of


Free androgen index 6.74 [0.187 - 3.63]; Female Free Androgen Index Ref Range
20-49 years: 0.297-5.62%
>= 50 years: 0.187-3.63%; Above high reference limit

Serum sex hormone binding globulin level 24.2 nmol/L [27.1 - 128.0]; SHBG ref range (nmol/L):
20-49 yrs: 32.4-128
>50 yrs: 27.1-128
SHBG female reference range is for non-pregnant
patients.; Below low reference limit

Serum testosterone level 1.63 nmol/L [0.101 - 1.42]; Female Testosterone Reference Range
20-49 years: 0.290-1.67 nmol/L
>= 50 years: 0.101-1.42 nmol/L; Above high reference limit

Serum TSH level 5.61 mIU/L [0.27 - 4.2]; Above high reference limit
Serum free T4 level 14.5 pmol/L [12.0 - 22.0]

So where do I go from here

Id rather have 1 and a half evoral conti than the 75 & a tablet as my brain fog and tablets dont agree

I dont want to give up my testosterone as I like it!!

& I dont want to wait 3 months to retest my thyroid as I have had previous odd results - but apparently they are too long ago

can anyone help?

[Hurdity]

Hi Katymac - you didnt get any answers - oh dear! I wasn't really clear enough - sorry. What I meant was to focus mainly on the thyroid rather than the testosterone as that is being covered in your other post because even though there is an overlap (in reproductive hormones and thyroid function), the thyroid reading alone would to me indicate a potential need for treatment.

I mentioned Wrensong as the knowledgeable member about this, and hopefully she may be along to give her input.

I don't know enough about the relationship between T4 (which for you is at the low end of normal) and TSH - which for you in above the ref range, and it should be ppinted out that some authorities like to see TSH to be much lower than the upper limit of 4.2 before suggesting treatment. In your case your thyroid function may well be sub-optimal.

Do you have any symptoms of underactive thyroid, chief of which would be, fatigue, weight gain (with no obvious reason) and feeling cold?

Hopefully someone will be along....

Hurdity x

[Wrensong]

Hi Katymac, your thyroid function test with the raised TSH & lowish but within range T4 suggests what's referred to as subclinical hypothyroidism.  I would definitely follow this up with your doctor, especially if you've had out of range thyroid results before.  There is a link & extract here from the British Thyroid Foundation:-

https://www.btf-thyroid.org/hypothyroidism-leaflet#hypo5

“A blood test result showing a slightly raised TSH level with a normal FT4 level indicates that you may have mild thyroid failure, also known as subclinical hypothyroidism and that you may have an increased risk of eventually developing hypothyroidism. You should have a regular thyroid function test and consult your doctor if you notice any symptoms, as you may benefit from treatment.”

The following are some of the symptoms that can occur with an underactive thyroid: abnormal fatigue, weight gain, fluid retention, puffy eyelids, difficulty getting/staying warm, constipation, hair loss, inc outer third of eyebrows, muscle & joint pain, low mood, poor memory.  Some of these are not very specific i.e. can be caused by other conditions too, of course, but if you have some of them it would add to the likelihood of your thyroid needing treatment sooner rather than later.

I've had a quick look at your other thread & I see the testosterone question has been helpfully discussed there & you've had good advice.  I can't add much but would just mention that low SHBG can be associated with hypothyroidism but also I think caused by too much testosterone replacement & as your T is quite high I think you're wise to reduce the dose a little.

Btw I am very long term hypothyroid, both ovaries removed & later hysterectomy, on HRT with testosterone.  Sorry this is a bit abrupt today.
Wx

[Katymac]

Sorry Hurdity, I'm sure you were clear but I'm a nightmare

My last thyroid were last year Sept and Sept 21 - I think its long, long term but my newsletter symptom is cold, sort of cold flushes; but the crossover my chronic fatigue and fibromyalgia symptoms cast doubt on tiredness, muscle pain, joint pain, eye issues

There so many symptoms that could be so many things - I guess I'm feeling more in control and pragmatic about it

[Katymac]

Sorry @wrensong the gp says test in 3 months no discussion

So I've booked it already! I'm not being forgotten again both times I should have had a second test 3 months later

[Wrensong]

Hi Katymac, 3 months is considered a sensible gap between tests when it's possible your last TFT was a bit odd for reasons other than thyroid disease, to give your body time to reset, if that were the case.  But I understand your wanting some certainty when you are not feeling well, especially if you have previously had out of range TFTs.  Sorry my post yesterday was a bit blunt - didn't have enough time to word it as I'd have liked.  Please don't worry - if it turns out your thyroid is failing you should feel better for treatment.

I see on your other thread you mention having gained bulk in the tummy area despite v thin limbs & that makes me wonder whether suboptimal thyroid function could be causing you to retain fluid or slowing down digestive throughput, as either could result in bloating.  There is also said to be an association with weight gain around the tummy & high testosterone in women (as happens in PCOS).  I do find too, that higher doses of oestrogen cause me to retain fluid & also slow digestive transit.  I don't know whether any of this feels likely?  Can I ask has your oestradiol been tested on the 75mcg patch?  If you have past TFT results with dates & ref ranges you don't mind posting, that might also enable us to get a better idea of what's going on.  Sorry for so many questions.
Wx

[Katymac]

You werent blunt at all, honestly - and tbh my learning style needs blunt

Ive been diagnosed with IBS since 1995 so I expect tummy issues but when they took my ovaries in 2018 they found extensive scarring and adhesions around the site of my ectopic pregnancy in 2000 bowel, ovary, fallopian tube (what was left of it) and uterus (my 26 yo has just been diagnosed with endometriosis and chocolate cysts so I wonder if that had some input into the scarring etc) so part of my bowel didnt do peristalsis

It was all cleared off but had obviously regrown as my problems went away afterwards but have slowly come back

I also have several diagnosed vitamin deficiencies I take Magnesium, Zinc, Methyl Folate, B12 (alongside Vit K, Iron, ubiquinol & potassium) Rose hip for knee/joint pain & I am considering tumeric & I have a very restricted diet because of my bowel issues - going 15 times a day isnt good for a girl and cutting out stuff reduces it

I started testosterone 18th August & the higher patch a few weeks before I think I have never had my oestrogen tested

They arent all bad - they are just a bit all over the place

Sept 22
Serum TSH level 4.10 mIU/L [0.27 - 4.2]
Serum free T4 level 12.3 pmol/L [12.0 - 22.0]

Nov 21
Serum TSH level 7.00 mIU/L [0.27 - 4.2]; Above high reference limit
Serum free T4 level 14.6 pmol/L [12.0 - 22.0]

Jun 21
Serum TSH level 2.20 miu/L [0.27 - 4.2]
Serum free T4 level 12.1 pmol/L [12.0 - 22.0]

Nov 18 (after surgery to remove my ovaries)
Serum TSH level 2.87 miu/L [0.27 - 4.2]
Serum free T4 level 15.0 pmol/L [12.0 - 22.0]

Feb 18
Serum TSH level 3.18 miu/L [0.27 - 4.2]
Serum free T4 level 14.9 pmol/L [12.0 - 22.0


I have a phone call from the GP this morning, Thyroid, POTS and Elhers danlos  under discussion along with maybe MAST cell activation?

[Wrensong]

Oh Katymac, what a lot you've had to deal with.  I am sorry.

I also have several diagnosed vitamin deficiencies I take Magnesium, Zinc, Methyl Folate, B12 (alongside Vit K, Iron, ubiquinol & potassium) Rose hip for knee/joint pain & I am considering tumeric & I have a very restricted diet because of my bowel issues - going 15 times a day isnt good for a girl and cutting out stuff reduces it

Are the nutrient deficiencies a result of the restricted diet & have you seen a dietitian/nutritionist for help with this?  I wonder whether the deficiencies are adversely affecting your thyroid status, rather than thyroid disease being present.  Do you know whether they have tested for thyroid antibodies?  If raised, it would suggest an autoimmune process going on.  Either way, your last 2 years' TSH results do seem to suggest your thyroid is struggling a bit & your FT4 has been in the bottom half of the range for some time, which would tie up with the raised TSH.

It was all cleared off but had obviously regrown as my problems went away afterwards but have slowly come back

Has a gynae looked into this for you again since the surgery?  When you mention your daughter's endometriosis in relation to your own BSO, I'm not clear whether you mean the adhesions found at the time of your BSO were/were not explained as due to endometriosis?

I take it the conditions you list for discussion this morning are possibilities being considered rather than confirmed diagnoses?

It all sounds like a lot for you & your GP to unravel & I think he/she is best placed to take an overview for you, with access to your complete medical history.  Sorry to have come back with more questions & please don't feel obliged to answer anything you don't feel will be helpful.
Wx

[Katymac]

 I havent been checked for antibodies at least since 2010 but records are patchy before that

I saw someone at the surgery who did fodmap with me but abandoned it after about 8 months because adding anything in caused problems so she couldn't help - this was in 2013

I had 2 colonoscopies one in the early 00 and the second in 2012 I think so no coeliac

They didn't say endometriosis but considering the scar tissue and adhesions were "extensive" I was wondering if there might have been a predisposion for it

Yes every few years I have a strop and ask for tests as the way I feel can't be normal thise are possibilities that haven't been considered seriously

I dont mind questions I have pretty good records but I donget lost in it all sometimes

[Katymac]

@hurdity @wrensong

OMG they arr going to trial 3 months of thyroxine!

I am in total shock

I pick it up from the pharmacy this afternoon

This is what they write after my last appt "History: vomplex. in pain since 96, never been listen to. her bloods test esp TFT, asking why no to start on levothyroxine if she has clinical signs. said aged 55 but feels like 70 and always in pain. felt dismissed by her previous GP and now with BL as well. She wants to start treatment despite trying to explain why only on borderline raised TSH in her previous bloods was not started on and said another raised result in TSH should be enough to start treatment and not to repeat in 8-12 weeks. She is very distress on this issue. will discuss with SD"

[Wrensong]

Hi Katymac, are you sure they haven't checked for thyroid antibodies recently?  That could throw some light on what may be going on with your thyroid & it seems odd that they would start you on Thyroxine without doing this first.  I'm also a bit concerned about what you say about your diet being so restricted if you have no one helping you with this & you have multiple nutrient deficiencies.
Wx

[Katymac]

I have contact skin allergies to coconut and almond oils - they upset my tummy when I eat almond or coconut...so I don't (by 'upset' I mean I bleed.....but don't worry the gp tells me just because I get blisters/open sores when I use them in my skin doesn't mean they do the same internally, apparently food intolwrancea don't work like that)

Raw/lightly cooked veg & some fruits come through undigested as do antibiotic capsules and some painkillers

I've been milk and egg free for decades

Ita a bit trial and error but the B12 & D improved things dramatically from around 15 times a day on the loo to about 4/5 (around 2015)

I've had input but I don't fit the box so...

No thyroid antibody test during the dates I list before unless it has a very odd name

I'm saving up for a private test

[Wrensong]

4 or 5 times a day is a lot Katymac, no wonder you're not retaining/absorbing nutrients well.  Surely gastroenterology or a dietitian should be helping you with this or are you happy managing it alone?  Have you had a DEXA scan to check your bone density?  What dose of Thyroxine are they starting you on?  Sorry  - more questions.
Wx

[Katymac]

Neither happy nor unhappy is it worth another strop at the doctors? I have diet advise, 2 colonoscopies and ibs was the diagnosis

Something like mast cell activation might be a possibility but I cam only attack one at a time as the mental energy is so draining

I have my sheets from my dexa scan no idea how to send them to you  - I had a previous ankle one that said I had oestopenia (sp)

25 hopefully I can save up and pay private tests at about 6-8 weeks

[Katymac]

Spine z score 3.3
Left femur 1.9
Right femur 2.2

I understand the z scores are quite high for someone of my age (this was 2018)