QUESTION- Question regarding pateient's thyroid function. Patient on HGH

28 year old male Patient with euthyroid. 160 lbs. 5 ft 11. Patient has been taking rHGH for sports and atheltic purposes at 2iu per day for the last 3 weeks. His energy levels have fallen and lots of fatigue kicked in. Got thryoid tested and following were the results: Normal TSH and Normal (towards the lower end of the range) FreeT3 and FreeT4,LOW t3 and LOW t4.

LOW T3 (Tri-iodothyronine) 58.38 *  RANGE (80 - 200 ng/dl)
Free T3 1.85 pg/ml   RANGE: Euthyroid : 1.4 - 4.4    PREGNANCY 1st Trimester : 2.1 - 4.
LOW T4 4.31 * RANGE (4.5 - 12.5ug/dl)
FREE T4 1.17 ng/dl RANGE :Euthyroid : 0.8 - 2.0     Pregnancy 1st Tri:0.9 - 2.2
NORMAL TSH 2.03 RANGE (0.2 - 5.0)

Started supplementing with Synthroid which completely made the symptoms of hypothyroid dissapear and patient was able to continue HGH use. However patient started experiencing hair loss / thinning and discontinued use.

Should I get patient to try a natural formula(such as thyro balance) to increase t4 production, or continue use of HGH without addition of any thyroid supplement and allow the body to naturally adjust its T3,t4 production ? . Arjun Whabi, MD. Dubai , Mumbai
RESPONSE-- There are few data available about the possible hormonal derangements observed in the use of rHGH for athletic purposes. However, there are some data in patients with GH deficiency on GH replacement who develop certain hormonal derangements, particularly involving the thyroid axis.

Data from a placebo-controlled crossover study of 4-months of GH therapy in GH-deficient adults, some of whom were on ongoing T4 substitution, revealed that the most prominent effect on thyroid function was increased peripheral T4 to T3 conversion without significantly affecting TSH levels or secretion from the thyroid gland. However, this is not the thyroid profile seen in your patient.

The fact that both total T4 and T3 are low, with normal free fractions, indicates that his thyroid binding globulin (TBG) might be low. Low TBG is well recognized to occur with the use of anabolic steroid abuse. Many studies have shown that almost all persons using HGH for athletic purposes in fact use anabolic steroids simultaneously for the same purpose. I feel it is worthwhile in your patient to explore the possibility of use of anabolic steroids. If this is the case, he needs further evaluation to assess the gonadotrophin and cortisol axes. GH itself may also lower TBG, as it does for SHBG.

With this background, I feel it is worthwhile testing the TBG, albumin, the cortisol axis and IGF1 level in your patient. In my opinion, I would not recommend the use of rHGH and possible anabolic steroids for athletic purposes should be withheld (with caution regarding cortisol axis suppression). In the meanwhile, he is currently off thyroxine, and I would not see any endocrine indication to replace it, either with T4 or any other combination of thyroid hormones. (The hair loss he is experiencing currently could be due to his hypothyroid status few months back, due to telogen effluvium.) Dr Kavinga Gunawardane