Too fat for Surgey: Good afternoon folks. Just... - Thyroid UK

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Too fat for Surgey

Tldg45 profile image
50 Replies

Good afternoon folks. Just back from my appointment with MSK and feeling very disheartened. Due to having a BMI of 31 I have been told I would not be referred onto a surgeon until I have lost at least 6lbs. With recent bloods T4 4 (11-22) T3 4.1 (3.1-6.8 currently taking 150 Levo and 30 liothyronine (Levo was 100 but since bloods increased to 160) I'm finding loosing weight impossible 😔😔 any advice

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Tldg45 profile image
Tldg45
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greygoose profile image
greygoose

It's not your levo you need increased, it's your T3. I take it the reason you're on T3 is that you're a poor converter, so what's the point of increasing the levo?

You also need to look to your nutrients to lose weight. Have you had your vit D, vit B12, folate and ferritin tested?

My opinion is that they should not be using the BMI, it's very misleading. It neglects to take into account so many factors. But, if that's what you have to deal with, you need pull out all the stops to lose those 6 pounds. And to my mind, step number one should be to increase your FT3 level. Do you buy your own T3?

Tldg45 profile image
Tldg45 in reply to greygoose

I haven’t had b12, folate or vit D tested since last year. I get my T3 from the doctor but it was the endocrinologist that increased they thyroxine and he said t3 levels were fine. I’ve managed to lose a stone in a year but seem to have come to a standstill

greygoose profile image
greygoose in reply to Tldg45

Do you have the results for the tests last year?

I disagree with your endo. Your FT4 is low, but that's to be expected when taking T3. Have you had a test since you increase the levo?

Tldg45 profile image
Tldg45 in reply to greygoose

Only increased thyroxine 2 weeks ago. My t4 has never been this low since taking t3. When I bought my own cytomegalovirus my t3 and t4 were much higher but unfortunately I can’t get hold of it anymore

greygoose profile image
greygoose in reply to Tldg45

But, that's irrelevant. It's the FT3 the important number. Your FT4 is low because you are taking T3, the body only hangs on to what it needs, and it doesn't need as much.

Tldg45 profile image
Tldg45 in reply to greygoose

I will increase my t3 and see how I go, thanks

greygoose profile image
greygoose in reply to Tldg45

Just by a 1/4 tablet! :)

Jazzw profile image
Jazzw in reply to greygoose

I know what you’re saying GG, and being someone who takes NDT my FT4 is often a little below the reference range - but 4?? That’s a long way below. It’s like none of it’s being absorbed at all, which given the FT3 level isn’t high in range makes that all the weirder. Like the levo has no active ingredients...

Which brand of levo are you taking, Tldg45 ?

Tldg45 profile image
Tldg45 in reply to Jazzw

It's Almus levothyroxine

greygoose profile image
greygoose in reply to Tldg45

Do you take it on an empty stomach and wait an hour before eating or drinking? Are you taking any other medication at the same time?

Jazzw profile image
Jazzw in reply to Tldg45

Right, so from Boots then. Hmm.

I’m thinking your body just isn’t recognising the levo you’re taking at all and is relying solely on the T3 you’re taking. Which as others have already said, means you need an increase in T3.

Can’t believe the doctor is saying 31 is too high for your op. That’s hardly enormous. :( I suspect that’s not the full story - it’ll be more to do with fobbing you off because the waiting list is already too big.

Jazzw profile image
Jazzw in reply to Tldg45

Are you still taking omeprazole Tldg45 ? Even if you’re not taking it at the same time, that might be the reason...

Tldg45 profile image
Tldg45 in reply to Jazzw

I haven’t taken omeprazole in months

Jazzw profile image
Jazzw in reply to Tldg45

Right - good! Was just a thought... You’re a mystery. :) But proof that one size really doesn’t fit all. Wish doctors weren’t so obsessed with numbers. Human beings aren’t computers...

greygoose profile image
greygoose in reply to Jazzw

Yes, you're right. It is extremely low. That is weird.

Granny56 profile image
Granny56 in reply to greygoose

We don’t know what the FT3 and FT4 are, Tldg45 only gave us results for T4 and T3.

Tldg45 profile image
Tldg45 in reply to Granny56

Sorry, the results I've posted are free's free t 4 - 4(11-22) free t3 4.1(3.1-6.8) thank you

greygoose profile image
greygoose in reply to Granny56

You can tell the are FT3 and FT4 by the ranges. Besides, it's rare to have the TT3 and TT4 tested, these days.

jimh111 profile image
jimh111

Can you confirm these results T4 4 (11-22) T3 4.1 (3.1-6.8). What was your TSH?

Tldg45 profile image
Tldg45 in reply to jimh111

Tsh is 0.01 and yes I confirm the above results

jimh111 profile image
jimh111 in reply to Tldg45

These are very strange results. fT3 and fT4 contribute to lowering the TSH so your TSH should be higher. It's not unusual to see a TSH lower than it should be indicating a down-regulated axis. In this case there's no point in titrating by TSH, it is not reflecting hormone status.

Your very low fT4. Is it really 4.0 (11-22)? Sorry to ask again, so unusual. If so, it suggests you are not absorbing the levothyroxine and the little hormone you have is coming from your thyroid. You should take levothyroxine on an empty stomach away from other medicines and away from coffee. Your doctor should look into why you are not absorbing the levothyroxine. If they can't find a reason they should try liquid levothyroxine.

Tldg45 profile image
Tldg45 in reply to jimh111

Yes t4 is 4 range 11-22. Only concern my gp had was my low 0.01 tsh. My low t4 didn't cause my gp any conern

shaws profile image
shawsAdministrator

Did you have your blood test at the very earliest, fasting (you can drink water) and allow a 24 hour gap between last dose of levo/lio of 24 hours.

I wonder, due to you having such poor T4 results on 150mcg of levo plus T3, that you may be thyroid hormone resistant. If so it would mean that you need T3 only. I doubt any Endocrinologists are aware of Thyroid Hormone Resistant but I will give you a link which may be helpful:-

web.archive.org/web/2010103...

Your weight gain is not due to you eating too much but not being on an optimum of thyroid hormones that suit you. You haven't been given sufficient to raise your metabolism whch has has caused weight gain due to your T3 receptor cells not getting enough T3

If someone cannot convert T4 into T3, there is no point in them taking levothyroxine.

I will state I am not medically qualified at all but had, like many, a run-a-round before being diagnosed..

Tldg45 profile image
Tldg45 in reply to shaws

I had taken my liothyronine but not Levo. Thank you for the link

shaws profile image
shawsAdministrator in reply to Tldg45

You should not take any thyroid hormones before a blood test as it skews the results. A gap of 24 hours for levo and 12 for levo (if taking both together allow 24 hours gap).

jimh111 greygoose

greygoose profile image
greygoose in reply to shaws

Are you looking for a punch-up, shaws? lol You absolutely know that jim is going to disagree with that!

But, that makes things even stranger, because we now have a false high FT3 - although it's not at all high - to go with the very low FT4 and the suppressed TSH. None of this makes any sense.

Tldg45 do you have the result from the test before this one? Do you always take your T3 before the test? I think the endo ought to redo the tests because they are very weird.

shaws profile image
shawsAdministrator in reply to greygoose

:)

I much prefer Dr L's method of concentrating on relief of patients' symptoms and no blood tests after the initial diagnosis :)

greygoose profile image
greygoose in reply to shaws

Yes, but you have to be very experienced to do that. And very few doctors have that level of experience or knowledge. Nor do many patients, come to that. Symptoms can be confusing, and I do believe you need blood tests as a guide. We see so many people on here who believe they've 'gone hyper' due to symptoms, and when they're tested, they're actually very hypo. So many symptoms cross over. I think we need blood tests to keep our feet firmly on the ground. But I don't mean just the TSH! Obviously! lol

shaws profile image
shawsAdministrator in reply to greygoose

I only have a blood test yearly, thankfully. If I had symptoms return, then I would have a blood test.

Tldg45 profile image
Tldg45 in reply to greygoose

Previous test results

Free t3 2.6 (3.5-6.5)

Free t4 9 (9-23)

TSH 0.16 (0.55-4.78)

greygoose profile image
greygoose in reply to Tldg45

And did you take your T3 before that test, too? I'm guessing not. Your TSH there is also awfully low considering your Frees. You don't have Central hypo, by any chance, do you? What was your TSH when you were diagnosed?

But, in any case, that low FT3 is the reason you can't lose weight. And, surely, you have a whole heap of other symptoms, too. You must feel dreadful!

Tldg45 profile image
Tldg45 in reply to greygoose

I don't know what central hypo is. All I've been told is I've got hypothyroidism. I have days when I struggle to get out of bed, other days feel like I've got jet lag. I'm pushing myself to exercise and attending weight watchers. I just want to feel normal again

greygoose profile image
greygoose in reply to Tldg45

Yes, I understand you just want to feel normal, but you're not ever going to with such low FT3. It is T3 that causes symptoms when it is too high or too low. At the moment, it is too low.

You really should not push yourself to exercise with such low T3, it will just make you worse. And low-calorie diets are counter-productive because they negatively affect conversion, and make your FT3 even lower. Besides, they won't make you lose weight.

Central hypo is when the problem is with the pituitary or the hypothalamus rather than the thyroid itself. We can tell if you have that by looking at your blood test results from when you were diagnosed. Do you have them? Or can you get hold of them?

Tldg45 profile image
Tldg45 in reply to greygoose

TSH 4.9 (0.55-4.78)

Free t4 13 (9-23)

After my 2nd baby I lost a lot of weight very quickly. With both pregnancies I lost a lot of bloody - post partum haemorrhage with 1st and placenta previa losing a lot of blood. I know severe blood loss can damage the endocrine system but not sure about thyroid damage

greygoose profile image
greygoose in reply to Tldg45

So, your TSH wasn't very high. But your FT4 was a lot higher than it is now. That's very strange. I'm amazed you got diagnosed with those results, actually. Pity they didn't do your FT3.

I don't know about severe blood loss affecting the thyroid, I'm afraid. But, have you ever had your antibodies tested?

The point is that now, your TSH does not seem to be responding to your thyroid hormone levels, and you are very under-medicated. And you're going to have a lot of problems if your doctors only look at the TSH.

And, despite your low TSH, you don't seem to be absorbing the thyroid hormone you're taking. Because you're on quite a decent dose. So, going back to basics, how do you take your levo and T3? Do you take them on an empty stomach, and wait at least an hour before eating and drinking? Are you taking any other medication at the same time?

Tldg45 profile image
Tldg45 in reply to greygoose

I take both meds on an empty stomach and with water. I take my second dose of T3 around 2pm and my thyroxine at night before bed.

greygoose profile image
greygoose in reply to Tldg45

OK You didn't answer about the antibodies. Have you ever had them tested?

Tldg45 profile image
Tldg45 in reply to greygoose

Yes, I was tested back in 2013. Result was 30.5 - no range given

greygoose profile image
greygoose in reply to Tldg45

That's not very helpful, then! :) But, have you tried a gluten-free diet, anyway? You could have leaky gut, which would need healing. Have you ever had any exploration of your gut?

Tldg45 profile image
Tldg45 in reply to greygoose

No gut explorations.

greygoose profile image
greygoose in reply to Tldg45

Well, it might be an idea, to find out why you aren't absorbing your thyroid hormone. You should have a talk with your doctor about it.

Tldg45 profile image
Tldg45 in reply to greygoose

I've got an appointment in a couple of weeks and mention it then. Thanks guys, I don't know where I'd be without your guidance

greygoose profile image
greygoose in reply to Tldg45

Well, I'm just sorry we can't do anything more. But it really is a mystery. I've never come across results like those before.

Tldg45 profile image
Tldg45 in reply to greygoose

Trust me to be different.

greygoose profile image
greygoose in reply to Tldg45

lol I know the feeling! x

Jazzw profile image
Jazzw

You’ve got me pondering Tldg45 so I’ve been having a look through your previous posts and see you’ve had a few absorption issues, including low Vit B12.

I know you told me you don’t take omeprazole any more - but why was it prescribed in the first place? Do you still have tummy issues? Have you ever been tested for coeliac disease? Any inflammatory bowel disease in your family history?

Do you know if you have Hashimoto’s?

Tldg45 profile image
Tldg45 in reply to Jazzw

I don’t as prescribed omeprazole for acid reflux. After reading comments on here I stopped and eventually the symptoms lessened and are less frequent. My B12 was within range for the doctor but low to the guys advice on here. I have been feeling really ill recently, low energy, just want to sleep and mid afternoon feel like I have jet leg. I told this to the gp and they sought advice from consultants. NHS endo said I was over medicated and my private endo suggest I increase Levo from 100 to 150. All I want to do is feel like my old self. I hate the way I feel and look.

Jazzw profile image
Jazzw in reply to Tldg45

You have my every sympathy. You’re definitely not overmedicated - quite the opposite. And it’s horribly frustrating when nothing helps with losing weight.

It might be worth trying a gluten free diet - if you’re thinking of asking to be tested then get the test done first but if you’ve reached that point of going it alone as many of us do... worth a try.

Are you supplementing B12 and Vit D?

Tldg45 profile image
Tldg45 in reply to Jazzw

Yes supplementing both. It’s very frustrating, I have days where I don’t have the energy to get off the sofa. I’ve tried ordering t3 on line as the one I’d bought last year seemed to help. Unfortunately I can’t get it anymore

Jazzw profile image
Jazzw in reply to Tldg45

I don’t buy T3 - I’m on Nature-Throid - but if you start a new post asking where you might be able to source the brand you’d like (asking for replies by private message as the forum doesn’t allow us to name online pharmacies) you may get some replies.

It’s horrible feeling ill all the time, isn’t it? I have a feeling though that an increase in T3 might make all the difference.

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