Weight Gain - Please help!

[Pepperpotts73]

Hi, I had a total thyroidectomy 4 months ago, and I'm on 125mg of Levothyroxine. I've felt fine, but I'm putting on lots of weight - over a stone since I had the op. I had a blood test after the op and the consultant said all was 'normal', and I had another blood test last Friday and the GP says the results are 'normal' too. I don't know the numbers, but I can't carry on piling on the weight. I'm quite active and have been running every day in an attempt to keep the weight off, but I feel quite depressed and tired as the weight isn't shifting. I've asked for a phone conversation with the GP, which I have tomorrow. Does anyone have any advice of the best things to ask the GP, or how to lose the weight please? Thanks so much.

[Nanaedake]

What was the reason you had a thyroidectomy if you don't mind my asking? The reason I ask is that your target TSH level may vary depending on the reason for the TT. It sounds like you may not be optimally dosed. In your last post you said you were feeling a little low which could also be a sign of being undermedicated.

[Pepperpotts73 in reply to Nanaedake]

Not at all. I had Graves disease for 10 years. It was controlled really well but it was suggested the for a long term solution I needed a TT. I'm beginning to wish I hadn't had one now! Thanks for your reply. I'll mention perhaps being under medicated to the GP.

[Nanaedake in reply to Pepperpotts73]

Ask your GP to give you a copy of your results. Most people don't feel well until their TSH is 1 or a little lower so that should give you some idea of where yours is in relation to other people. Doctors will say all is fine if we fall anywhere within the NHS range but that doesn't always make us feel well. I find that my TSH needs to be very low to feel well and my FT4 is often slightly over range.

You probably didn't have much choice about the TT is you didn't go into remission so no point in regrets. However, if in the UK, the NHS is not giving us any choice about treatment because it only seems to offer levothyroxine and no T3. The best thing you can do for now is to make sure all your vitamin levels are good. Get GP to check, B12, folate, ferritin and vitamin D and then post the results here for good advice. Don't take GP's word for it that all is ok. If you're bumping along the bottom of the NHS ranges you won't feel well, ever. We need all our vitamins to be optimal for levothryoxine to work well.

[Pepperpotts73 in reply to Nanaedake]

That's great, thanks so much for your reply. I'll ask to get my vitamins checked and try to discuss the levels with the GP tomorrow. I'm quite surprised I was discharged from the endo clinic so soon after the op, as I'm sure my GP isn't that clued up on the finer details of thyroid function! Thanks

[Nanaedake in reply to Pepperpotts73]

You may get lucky but most GP's seem to have little idea of how to manage thyroid conditions and really cannot give advice. Mainly because they don't seem to understand what the various symptoms caused by being under or overmedicated are and what they indicate. They just look at blood results.

The 'normal' ranges they use are based on healthy people without thyroid conditions and with a whole thyroid. The 'normal' range might not be right for us without a whole thyroid. You might need more medication than your doctor thinks you do in order to feel well. Your TSH might need to be lower than your doctor thinks it should be to achieve a high enough T3 level to feel well and function properly.

It's the amount of T3 we have that our body can utilise that makes the difference to how we feel. The aim of being on levothryoxine is to be symptom free so don't give up until you are symptom free.

As for being discharged into care of GP - I think that perhaps as soon as you are no longer hyperthyroid you are not considered a risk so therefore can be dismissed to care of generalist. Being cynical, it's probably cheaper to manage patient as hypo than hyper but it's just a guess.

[Pepperpotts73 in reply to Nanaedake]

Well I spoke to the doctor today and they said my TSH is 1.2, so within the normal range of 0.5 to 4.4. That was all they gave me as they don't test anything else if your TSH is normal apparently. She's going to do a further blood test for anaemia, diabetes, liver and kidney function, body salts! and then have a face to face with a doctor when those results are back. I don't think I'm any further forward but think I need to just do some effective diet and exercising and pull myself out of this slump!

[Nanaedake in reply to Pepperpotts73]

Well, good for you for asking your doctor for tests and it's the start of your journey to being symptom free. These days we have to just keep going back to the doctor as they will only check one thing at a time so it's a case of persistence on our part. Set in your mind that your aim is to be symptom free and back in work or whatever your aim is.

At least your doctor is going to do some tests but she should also test vitamin D as many people on this forum with thyroid conditions have found they have vitamin D deficiency and when corrected it has helped. Do you work from 9-5 in a room without much natural light or not get out into the sunshine much? The NHS needs a reason to test vitamin D and having no thyroid does'nt seem to be enough reason it seems.

With B12, I believe a person can have vitamin B12 deficiency without anaemia so unless B12 is tested you won't know what your level is and whether it's worth supplementing. NHS won't offer supplements unless below ;ab range but being in range does not exclude deficiency and if you're low in the lab range you might still want to supplement.

As far as TSH goes, were you able to ask your doctor to trial you on a higher dose? Being in the normal range is not always right for those of us who have had thyroidectomy. My TSH is always suppressed and I don't feel well if it rises above 0.5 and I know people differ but it's worth trying a dose increase.

The problem is that when you've had a thyroidectomy you don't have any experience of being hypothyroid so it's hard to know what symptoms relate to hypothyroidism so you just have to experiment with your dose to find out what suits you. Increasing your dose is unlikely to help you lose weight but it may relieve symptoms of tiredness and depression which are hypothyroid symptoms. Once those symptoms are relieved you may feel more able to address your nutrition.

You could give your doctor this document from Professor Toft who I believe is the Queens physician when in Scotland and former president of the Royal College of Physicians.

Professor Toft - Counterblast to Thyroid Guidelines

rcpe.ac.uk/sites/default/fi...

I don't think you should blame yourself for gaining weight. Don't over-exercise, gentle exercise is good but for those of us who are hypothyroid too much exercise doesn't help as it uses up T3 and if we don't have quite enough anyway then it's not helping. Changing your diet to low carb high (good) fats can help energy levels and general health.

If you want to have your full thyroid panel tested you can get tests done through various online labs, fingerprick tests which include FT3, FT4 and TSH. Thyroid UK list reliable labs on their website. If you want to know more about how reliable their labs are, do a search on this forum or ask another question to get feedback.

[trelemorele]

If I was you, I would be looking at your blood results pre op time when you were well managed on carbimazole and felt well and aimed at the same blood stats now on Levo.

Yes, if it was my choice I'd personally stay on carbimazole for life over having the op as hypo is very badly managed in the UK of which you will learn soon.

Good luck.