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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64330
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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I had a previous conversation with Dr Chip I am 65, diabetic

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I had a previous conversation with Dr Chip I am 65, diabetic since age 40 and encountering rapidly decling health since discovery of a PSA at 13+ in Sept ;13 following routine testing. A biopsy indicated no malignancy, however in the months following the
biopsy, my energy levels plummeted to the extent that my evening 90 walk turned into being almost exhausted after 15 minutes. Serious erection difficulties and despite using either Viagra or Cialis, I cannot sustain an erection for more than 5 minutes. Prior
to the biopsy, I had no problems. My total is high, very high, today 35nmol/L and a Free of 0.465. I started Thyroxine 8 weeks back and no change I have attempted DHEA and got nowhere. I did a routine check on Estrogen and Progesterone (as I thought it might
be low). The results were surprising with P at 10.9nmol/L (Range 0.6 - 4.5). E was 146 (range 28 - 156) My Question. What does this Progesterone reading mean? How do I deal with this?
Submitted: 1 year ago.
Category: Medical
Customer: replied 1 year ago.
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Expert:  DrRussMD replied 1 year ago.
HelloI looked at your last question, and I believe I even answered it after the fact. If I am remembering the question correctly, I requested at that time that you request me. Your TSH is too high. 2.25?, correct?] what is your most recent value?You are going to be fatigued as your thyroid replacement is not adequate at this time.Your progesterone reading, as a spot test, is not meaningful.It can fluctuate and you would need several readings to assess this.What type of doctor are you working with exactly? OK, so that is an initial answer….Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 1 year ago.
Dr. Thank you. There are indeed 2 questions but the subject is the same. Dr Chip seems to have disappeared. Ok. TSH was 4+ when taken am fasting about 2 months back. Now. I'm in Kuwait and we don't have hormone specialists here. I deal with a Urologist and a GP. That's it. I did persuade the GP to start me on T4. I started on 25ug for 6 weeks and raised it to 50ug 2 weeks back. Nothing has changed. Now I'm just leaving Kuwait this minute on a business trip and won't be back for 7 days. What I was also looking at was SHBG. I had a reading of 65 in 2011. On my return on 7th I want to do a full hormone analysis, so I am attempting to determine what tests to get that may be productive.
Expert:  DrRussMD replied 1 year ago.
That is a very low dose.You should increase the dose every 6 weeks until you are at .8 on TSH, thereabouts. Thyroid should be adjusted and stable before making any other assumptions.Please click a positive rating.Come back then as needed.
Customer: replied 1 year ago.
Dr. I am travelling and only getting this now. Ok. You are interested only in TSH and not in T4 or T3. Is that correct? The earlier TSHs have not been consistent, whereas the T4 have been. In 1 week I will increase to 75ug and as you say, take from there, but please clarify T4 and T3?
Expert:  DrRussMD replied 1 year ago.
TSH is the sensitive indicator.
Not T4 and T3.
I see no positive rating on any of my answers at this point, and we are only paid per rating.
Please rate at this point.
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64330
Experience: Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
DrRussMD and 3 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
Dr. I did rate this 3 stars. If a reduction in TSH does indeed resolve the problems, a 5 is z certainty. Thank you
Expert:  DrRussMD replied 1 year ago.
anytime
Expert:  Dr. Phil, MD replied 1 year ago.
any other medical issues?
Customer: replied 1 year ago.
Dr Phil - My 3rd Specialist. I left Dr Thomas seeking an improvement inTSH. After 3 months on levothyroxine building up to 100mcg, results came back today at TSH = 1.07 (previous 4.27), Free T4 = 19.06 (previously 15.42) and Free T3 = 3.52. Now the last time T3 was taken was 2.5 years back at 3.8.I feel no different. Appears to me that conversion to T3 is not taking place.What would you suggest?
Expert:  Dr. Phil, MD replied 1 year ago.
what is your testosterone level? maybe I missed that?
Customer: replied 1 year ago.
Measuered yesterday also Free = 0.427 nmol/LDr Thomas suggested that I should not consider Test until the Thyroid was normailsed. The over riding condition is High Total T (35.4nmol/L) and low Free T. I am aged 65
Expert:  Dr. Phil, MD replied 1 year ago.
Interesting. are you obese?
Customer: replied 1 year ago.
Not at all 183 tall and 75kg. The brief background here is that I am diabetic, type 1 from age 40. Firing on all cylinders till Oct 2013 when a routine blood test (medical insurance) noted PSA at 13. A prostrate biopsy followed, clear of cancer but I started to go downhill thereafter. Libido, sexual function, energy all faded. I put on weight, (about 5kg). Saw a number of doctors all of whom put it down to old age / diabetes etc etc. So self diagnosis started about 6 months back. How can a man of 65 have record levels of T, low free T and be dead on my feet. There has to be a reason. My SHBG was checked 4 weeks back at 75, todays its 44 following 67mg dianozl daily. My Prolactin was 14.5 and its now 11.8 following just 0.25mg dostinex once weekly.Today, the only items outside the better portion of normal range are T3 and Free T, as far as I can see, and I feel do better than I did 2 years back and a hell of a lot worse than I did 2 and a half years back.As you say - Interesting. Im Irish by the way, living in Kuwait
Expert:  Dr. Phil, MD replied 1 year ago.
Well as you know type 1 DM is autoimmuneCeliac is very common in you folks. Also northern european decent.I have seen NO GI symptoms at all with celiac and just fatigue.Get tested for that.Also, get a sleep study. Skinny people get it too
Customer: replied 1 year ago.
Tried that about 18 months back. 6 months on a gluten free diet. Made or felt absolutely no different.So why the low T3? Why did T4 not convert to T3? Why did T3 drop?To me, those are the pertinent questions
Expert:  Dr. Phil, MD replied 1 year ago.
That is a great question.For some reason your body is not converted to T3.You could try cytomel. I have given this before
Customer: replied 1 year ago.
I have armour thyroid in my possession, but I am more concerned as to why the conversion is not taking placeAre there other issues that impact conversion?
Expert:  Dr. Phil, MD replied 1 year ago.
It could be some type of autoimmune phenomenon
Customer: replied 1 year ago.
Dr Phil - With all due respect, is there any possibility that I could continue this conversation with Dr Thomas?
Expert:  Dr. Phil, MD replied 1 year ago.
I can opt out and see if he picks it up. No problem
Customer: replied 1 year ago.
Thank you. He did seem to have a much better understanding if the workings of the Thyroid, hence his focus on that, which seems to have been correctThank you for the discussion
Expert:  DrRussMD replied 1 year ago.
Hello
The problem is that your TSH is still on the high end.
Make sure you are working with an endocrinologist.
Most people have to get down to .8 to feel better.
Some people require higher T4
Armour has a higher than normal T3 and some patients tolerate that better.
Some need a combination of synthroid and cytomel.
Some need a compounded formula.
The reason currently that you don't have enough thyroid of any type is the dose again needs to be slightly increased.
Please find me in medical by request for future questions.
This will make sure you get me.
Use "for Dr. Thomas only" in the title.
And use a long request lock.
I would not have seen this question as it happened. I came across it by accident.
Customer: replied 1 year ago.
Thank you DrOn the TSH. One piece of infor I witheld. One month back I did the TSH test only and the result came back at 0.85. The test was taken at 8am and I HAD taken the T4 the night before. I was on only 50mcg at the time. Thereafter I increased to 75 and just a few days back 100mcg. When i took the test on Friday, again at 8am (for consistency) I had NOT taken the T4 the night before.Does that change your recommendation in any way?I still would like to know why the T4 is not converting to T3
Expert:  DrRussMD replied 1 year ago.
The T4 is converting to T3, you have plenty of T3.TSH can go down to .3 in some people.No , my answer has not changed.The tSH should be measured at 8 weeks after a dose increase. This assures stead state accuracy.You still have not mentioned that you are working with an endocrinologist, which is what should happen next. Please find me in medical by request for future questions, or, see my additional services offer. We are only paid by just answer per positive rating, for bonuses and for accepted additional services offere.
Customer: replied 1 year ago.
Dr. The units of T3 are pmol/L (not pg/mL). Do you still believe that T3 is high enough?
Expert:  DrRussMD replied 1 year ago.
Yes.The T3 measurement is not accurate, which is why we go by T4 and TSH together in terms of treatment.To get into forefront comments and analysis of this, see my additional services offer.
Customer: replied 1 year ago.
Noted Dr. I think we'll leave it at that. I dont have an answer to my initial question as yet. As TSH is almost there and T3/T4 are now all "normal", nothing has actually changed. The initial condition of fatigue ect is unchangedSo where do I go from here?
Expert:  DrRussMD replied 1 year ago.
see my add services offer

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