Hello. Thank you Barbell Medicine team for all of the information that you guys put out; it has really helped me out. I am looking for some guidance about what to do about the issues that I have been having.
Some background on me: I’m 19 years old, 6ft 1.5in tall, about 177lbs, and have a waist circumference of about 32in, at about 12% body fat. Over the past couple of years, I have been focusing on diet and training to lose body fat and gain muscle and strength. Once I am satisfied with my body fat percentage (probably around 10%), I plan on maintaining for a bit and then slowly gaining weight back. Around three years ago, I was about 195lbs and probably around 25% body fat. I am also a college baseball player. I am currently eating about 2100 calories a day with 170 grams of protein, generally lower fat (15-20% of calories), and plenty of fruit and vegetables. I sleep about 8 hours a night. I squat 315 for 5, deadlift 365 for 5, and bench 160 for 5. I am also a very strong student and a high achiever in school, going to a very demanding college.
For the past few years, I’ve been experiencing constant daily fatigue, brain fog, mild headaches, and trouble concentrating. I have also been depressed for most of this time. On June 8th of this year, I started being treated for depression, starting on Prozac at 25mg/day, then 50mg/day after two weeks at 25mg/day; I have been taking that for about 9-10 weeks now, but have not noticed any improvement. About two weeks after changing to 50mg/day, I had a range of labs done to check for physical causes of my symptoms. Results of note from the labs are below:
Total cholesterol - 203 mg/dL
LDL cholesterol - 124 mg/dL
Non-HDL cholesterol - 137 mg/dL
TSH - 1.90 mIU/L
Total T4 - 4.5 mcg/dL
Total T3 - 51 ng/dL
Everything else was essentially normal. Also, the labs unfortunately did not include free T4 or T3, and I also took a vitamin containing Biotin the night prior, which I know can affect the thyroid tests in particular.
Based on the T4 and T3, combined with my symptoms, my primary care doctor started me on Levothyroxine 50mcg/day on July 31st. My father was diagnosed with hypothyroidism about 10 years ago, and I also had some other symptoms that pointed towards it for myself, such as feeling cold often, having trouble losing weight, dry scalp, and high cholesterol despite a healthy lifestyle.
I then saw an endocrinologist, who ordered more labs and stopped me taking the Levothyroxine exactly two weeks after I had started it; he said this was because the TSH was normal, and so he did not believe I should be on the medicine. I got the new labs exactly two weeks after stopping the Levothyroxine, and I did not take any vitamins in that period. Results of note from the second round of labs are below:
Total cholesterol - 198 mg/dL
LDL cholesterol - 118 mg/dL
Non-HDL cholesterol - 133 mg/dL
TSH - 3.15 mIU/L
Total T4 - 4.4 mcg/dL
Total T3 - 67 ng/dL
Free T4 - 0.9 ng/dL (range 0.8-1.4, so barely normal)
Free T3 - 2.1 pg/mL
Antithyroid peroxidase antibodies - 5 IU/mL (range <9 IU/mL)
Anti thyroglobulin antibodies - <1 mIU/mL
Everything else was again essentially normal.
I then saw another endocrinologist, who said that they don’t believe that my problem is from the thyroid or a pituitary issue based on the TSH and free T4 being normal, despite the low values of total T4, total T3, free T3, and barely in range free T4. I am checking the TSH, free T4, and free T3 again using a new lab, as well as with a cortisol test to check for a possible adrenal condition, but the endocrinologist seemed doubtful that these would turn up anything different. They did not recommend any treatment at this time.
Sorry for the long background, but I wanted to be thorough. So, my questions are about what to make of the situation now.
- Is it common to have low levels of thyroid hormone but not have a problem in the thyroid or the system controlling it, and why would this be happening?
- Given that the issue is not with the thyroid, what other causes should I look into for my symptoms? Our current approach is to try treating the depression differently.
- Should I look to try a different type of antidepressant than Prozac, which has not seemed to have any positive effect, such as Wellbutrin?
- Could it be that treating the depression alone will relieve the hypothyroid symptoms, or even raise the thyroid hormone levels?
- Would there be any reason to try taking both T3 and T4 replacement to see if they help me to feel better? The endocrinologists I have seen have pushed back against this, but I know that some people have seen results.
- Is there any reason why my cholesterol would be high despite living a healthy lifestyle with good diet, exercise, and sleep? Most of the doctors have not been too concerned with this, but I’m curious as to why I may be seeing this result.
Thank you for taking the time to read about my situation, and I truly appreciate any help that you can offer me.