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Low energy, brain fog, taken Eltroxine, done blood test. Concerned about missing something in tests

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General & Family Physician
Practicing since : 1980
Answered : 1 Question
Endocrinologist Required! Hi, I am a 46yr old male 1.82m 100kg retired police officer and I have been on several different anti depressants for 7 years now and I am currently taking 50mg Setraline daily. I have always ahd low cholesterol and have it checked each year. Blood pressure average last week 114/70 with a resting heart rate of 71.

There is a history of Addisons disease in the family (my mother) and I recenty undertook some blood tests as I have had a serious lack of energy and libido for some time now (over 12 months). I am living in Egypt and miles away from a specialist! I have been trying to figure this out by myself, so I hope that you can help. I will give you my blood test results from the last 2 months.
Testosterone 2.02 ng/ml
Free T3 2.88 pg/ml
T3 114 ng/dl
Free T4 1.18 ng/dl
T4 8.41 ug/dl
TSH (4th Gen) 1.68 ulU/ml
Anti Microsomal Antibodies - Negative
Antithyroglobulin - Positive
Antimicrosomal - Negative

After 4 weeks of taking 50mg of Proviron (recommended by a doctor here) I had some other tests done, thinking that there must be something else amiss. Bloods were as follows.
28th July
Testosterone 1.08 ng/ml
Free Testosterone 4.3 pg/ml
Luteinizing Hormone 2.07 mlU/ml
FSH 2.7 mlU/ml
Total PSA 0.64 ng/ml
Free PSA 0.29 ng/ml
Ratio 0.45 - over 0.2 benign lesion
Cholesterol LDL/HDL 5.2
Serum Cholesterol 259 mg/dl
HDL Cholesterol 34 mg/dl
LDL Cholesterol 178 mg/dl
Serum Tryglicerides 231 mg/dl
Risk Ratio - T/Cholesterol/HDL 7.6

As a result of these tests I stopped the Proviron and started a course of Eltroxine (Thyroxine) starting at 50mcg, increasing to 100mcg before having further bloods done 4 weeks later. Here are the results.

28th August
Testosterone 1.96 ng/ml
Luteinizing Hormone 2.80 mlU/ml
FSH 2.34 mlU/ml
Free T3 4.16 pg/ml
T3 137 ng/dl
Free T4 1.30 ng/dl
T4 9.41 ug/dl
TSH (4th Gen) 0.53 ulU/ml
Fasting blood glucose 98 mg/dl
Serum Cortison 9am - 20.38 ug/dl
Cholesterol LDL/HDL 4.32
Serum Cholesterol 207 mg/dl
HDL Cholesterol 31 mg/dl
LDL Cholesterol 134 mg/dl
Serum Tryglicerides 212 mg/dl
Risk Ratio - T/Cholesterol/HDL 6.67
Total Leucocytic count - 8,300 /cmm
Hemoglobin 16.3 gm/dl
Hematocrit 51.2%

I do have more energy than before and less brain fog but I am concerned that I am missing something in my bloods or not on the right track at all. I would welcome any thoughts that you have concerning my aparent condition. I know it has only been 4 weeks since I started taking Thyoxine and my cholesterol seems to be moving in the right direction, but my Testosterone is still woefully low. I am now taking Selenium and omega 3 supplements. My 9am cortisol levels are also right at the top of the scale.

I have gone just about as far as I can with reference material and it is starting to get too compicated for me, I am considering testosterone injections (I tried them once and it had an amazing effect on my feeling of wellbeing in general as well as my libido) but I don't want to treat what may be a symptom of something else without understanding what is causing it.

Ok over to you, take your time, there is a lot here, I know! Thanks in advance, AAAA
Posted Tue, 25 Sep 2012 in Thyroid Problem and Hormonal Problems
Answered by Dr. Rahul Tawde 14 hours later
Dear AAAA,

1.Your thyroid tests are perfectly normal. There is no reason why you need to take eltroxin. Even if you have noted some improvement in energy using it, it is only transient and would lead to side effects on long run. My advice is to discontinue it.
2.Testosterone levels are quite low. Low testosteron in the presence of normal LH, FSh points towards a problem in pituitary and/or hypothalamus. Psychological causes and depression are documented causes of this central functional hypogonadism. Low testosterone can very well be associated with the kind of symptoms you have had for last 12 months. You can definitely consider testosterone for a short period like 3-6 months as a therapeutic trial. You need to monitor your lipid profile, PSA and testosterone levels while you are on it.
3. There are few mor ethings which you need to do. Take vitamin D, calcium and multivitamin supplementation. Practise Yoga or other relaxation methods to rejuvinate your energy and reduce stress levels. They can do wonders at times.Be optimistic - feed positive thoughts to your mind.
4. When we have one obvious cause for low energy levels there is no point in thinking about other causes for the same. So first we should try to address that problem than look at other causes.
5. Your good cholesterol (HDL) levels are low. omega 3 supplements, aerobic exercise, eating a lot of fresh greenies all help to increase it.
If you have any other doubts get back to me.
Above answer was peer-reviewed by
Follow-up: Low energy, brain fog, taken Eltroxine, done blood test. Concerned about missing something in tests 7 hours later
Hi, Thanks for your reply,
Should I be concerned about my pituitary and get my prolactin levels checked with an MRI scan if they should prove to be high? Will increasing my testorsterone to "normal levels" have a beneficial effect on my cholesterol? AAAA
Answered by Dr. Rahul Tawde 5 hours later
Problem in your case is more of a functional defect due to hypothalamic dysfunction due to stress/depression/effect of antidepressants. However there is nothing wrong in getting Prolactin levels and MRI Sella irrespective of prolactin levels. Testosterone replacement can be expected to lower total cholesterol and LDL(bad) cholesterol. However not much benefit can be expected in HDL(good) cholesterol. Some studies have shown that HDl cholesterol decreases with testosterone replacement. This however should not be assumed as detrimental because benefits outweight the risks- you need to monitor at regular intervals and if HDl levels do fal treatment can be initiated for the same.
Above answer was peer-reviewed by
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