Does weight loss affect amount of levothyroxine required?

[bluehaven201]

I’m getting a bit concerned with my thyroid blood tests. I have hypothyroidism and up until recently was taking 200mcg levothyroxine each day. I was still feeling unwell so thought it worth trying T3, so I started taking 25mcg a day along with 175mcg levo. Six weeks ago blood test showed I needed to reduce my levothyroxine so my doctor reduced me down to 100mcg. I have just had another blood test and my GP says my tsh is still suppressed so I need to reduce my thyroxine even more. My doctor feels this could be due to the 4 stone I have lost this past year. Is this possible? What concerns me now is that I haven’t lost a pound since levothyroxine being reduced. Any help greatfully received please.

[Karenk13]

First of all well done for loosing 4 Stone ! Thats amazing.

I have looked into this in the past trying to find the answer and it all seems very vague out there. the reason being I am Hypo myself but have also studied nutrition and am a qualified nutritionist. There was a study done on medication dosage in Hypothyroid patients who were classed as obese who then had weight loss surgery to help them loose weight to see if their doasges would need to be adjusted much but there wasn't a huge need to reduce the dose and in some with hasimotos the dose actually had to be increased even after weight loss as their disease progressed.

If and only if you are properly dosed the other thing to consider is that now that you have lost a huge amount of weight the amount of calories you need to loose further weight will need to be decreased too to continue loosing weight. Take this from someone who lost 10kg (22lbs) my before calories and my after calories are much less as I am physically a smaller person so need less.

I would suggest tracking very carefully your food in an app like Myfitnesspal or similar if your not already doing so so you can see what your maintenance level of calories currently are then you can adjust from there. When you are Hypo your body processes food differently to others so if 2 people are the exact same size the healthy person will be able to eat more and loose weight compared to the person who is Hypo. Hope that helps a bit sorry i don't have any more info for you on it.

[SeasideSusie Remembering]

bluehaven201

You seem to have a TSH obsessed doctor. Dosing by TSH is wrong. It's the FT4 and FT3 that matter, FT3 being the most important.

Does your doctor know you take T3? Taking T3 lowers, even suppressed TSH.

Also, to reduce your Levo from 175mcg to 100mcg in one go is madness. Dose changes should only be 25mcg at a time with Levo and 1/4 of a tablet of T3, these are hormones we are taking, too big a change is too much of a shock to the body, it must be done gradually.

Why not post your results, with reference ranges, so we can see what's going on.

[bluehaven201 in reply to SeasideSusie]

Thanks SeasideSusie. Yes my GP knows I am taking T3. My latest results are:

FT3 5.3 (3.5-5.8 range)

FT4 10.0 (7.0-20.0 range)

TSH 0.01 (0.3-5.0 range)

If you would like results from the previous blood test please let me know.

Thank you so much for your help

[bluehaven201 in reply to SeasideSusie]

I thought it may be a good idea to give you the last yearof blood tests so you have more information. I trust your opinion much more than my GP.

August 2018 (latest) Taking levothyroxine 100mcg & Liothyronine 25mcg

FT3 5.3 (3.5-5.8 range)

FT4 10.0 (7.0-20.0 range)

TSH 0.01 (0.3-5.0 range)

July 2018 Taking levothyroxine 125mcg & liothyronine 25mcg

FT3 6.1 (3.5-5.8 range)

FT4 13.8 (7.0-20.0 range)

TSH 0.01 (0.3-5.0 range)

March 2018 Taking levothyroxine 175mcg & liothyronine 25mcg

FT3 5.4 (3.5-5.8 range)

FT4 15.4 (7.0-20.0 range)

TSH 0.01 (0.3-5.0 range)

September 2017 Taking 200mcg levothyroxine

FT3 4.3 (3.5-5.8 range)

FT4 16.9 (7.0-20.0 range)

TSH 0.03 (0.3-5.0 range)

Thyroid peroxidase antibody level XaDvU 87ku/L (0.0-0.9 range)

May 2017 Taking levothyroxine 200mcg

Serum ferritin 17ug/L (11.0-307.0 range)

TSH 1.11 (0.38 -5.33 range)

January 2017 Taking levothyroxine 200mcg

FT4 15.1 (8.00-16.0 range)

TSH 1.77 (0.38-5.33 range)

Have I messed up by starting T3? I have never felt well on t4 alone so I thought it was worth trying. Also, was the antibody level okay taken in September2017? Was this a test or hashimotos? Any help you can offer would be greatfully received.

[SeasideSusie Remembering in reply to bluehaven201]

bluehaven

No, you haven't messed up by taking T3.

Thyroid peroxidase antibody level XaDvU 87ku/L (0.0-0.9 range)

Raised antibodies confirm Hashi's. This complicates things because antibody levels fluctuate and this in turn means thyroid hormone levels fluctuate, so it can be a big of a juggle balancing things at times I believe (I'm not Hashi's, and thankful for small mercies!).

Looking back at some of your results and assuming all tests were done under the same conditions ie early morning blood draw, overnight fast, Levo left of for 24 hours and T3 for 12 hours:

September 2017 Taking 200mcg levothyroxine

FT3 4.3 (3.5-5.8 range)

FT4 16.9 (7.0-20.0 range)

TSH 0.03 (0.3-5.0 range)

These results show good conversion with a FT4:FT3 ratio of 3.9 : 1 (good conversion takes place when ratio is between 3:1 and 4:1 however, your FT3 is low in range (35%)compared to FT4 (76%) so trialling T3 wasn't a bad idea.

March 2018 Taking levothyroxine 175mcg & liothyronine 25mcg

FT3 5.4 (3.5-5.8 range)

FT4 15.4 (7.0-20.0 range)

TSH 0.01 (0.3-5.0 range)

Those results look good, did you feel OK at the time?

There is nothing in those results that prompted a reduction in dose at that time. As I said, your GP is dosing purely by TSH.

July 2018 Taking levothyroxine 125mcg & liothyronine 25mcg

FT3 6.1 (3.5-5.8 range)

FT4 13.8 (7.0-20.0 range)

TSH 0.01 (0.3-5.0 range)

You can see how the reduction in Levo has affected your FT4 but for some reason your FT3 has increased. If anything, a touch less T3 and maybe a slight increase in Levo would be right here.

August 2018 (latest) Taking levothyroxine 100mcg & Liothyronine 25mcg

FT3 5.3 (3.5-5.8 range)

FT4 10.0 (7.0-20.0 range)

TSH 0.01 (0.3-5.0 range)

What we have here is an even lower FT4 and your FT3 has reduced as well due to the reduction in Levo, so you must still have some reasonable natural conversion for your FT3 to have reduced.

After a couple of years of Levo + T3, endless tweaking and testing, I now know my FT4 and FT3 need to be around 75% through range. I can't function with a low FT4. But everyone is different, you have to find out where you need your levels personally to feel best.

If your GP is happy for you to self treat with T3 then he either has to trust you or gen up on how it works. Your TSH will most likely be suppressed when taking T3, that's what happens, but as long as FT3 stays within range you aren't overmedicated. How you get that through to your GP I don't know, I haven't told mine that I take T3 and I don't intend to, they've ruined my life enough so I've taken control.

Some Hashi's information.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

[eeng]

If you are taking T3, or anything containing T3 then your TSH will be suppressed. Your doctor will make you very ill if he doesn't know this and continues to cut your dose because your TSh is suppressed.

[SlowDragon Administrator]

Taking T3 almost always causes suppressed TSH. This does not mean you are over medicated. Essential to test both FT4 and FT3

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

On T3 it's absolutely essential to test FT3

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, don't take in the 24 hours prior to test, and if on T3 don't take in 12 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

[Nannylynn]

I'm no expert but if you lost a lot of weight you have hyperthyroidism. Your body has too much thyroxine. I have the opposite problem and struggle to lose any weight on a restricted diet. I'm paying privately now and use natural nascent iodine 4 drops a day. I have more energy now and feel better. Im taking lots of other supplements to make sure I've got every vitamin and mineral known to man!!! I might need to use progesterone cream if I still can't lose weight. Our bodies are so complicated aren't they??!!

Let me know how you get on. Kind regards Lynn

[FancyPants54 in reply to Nannylynn]

I think she was loosing weight because she was on a diet. If that is the case then her thyroid levels were good because her body was able to loose the weight.

You can't diagnose hyperthyroidism from weight loss if the weight loss was being worked at.

[Loraine62]

Yes weight loss can affect your dosage and I have experienced the same. The result is it does affect further weight loss as the balance is reset if that makes sense. I constantly ask about this with my doctor, they don’t give us women much sympathy regards this, yet for women it’s important.

I haven’t found the answer I just constantly diet I’m afraid.

[Hidden]

I'm having the same problem. I had a 7/8ths of my thyroid gland removed and was 7st 9lbs but within 6 months my weight doubled to 15st. I'm now taking 100mcg of Levothyroxine for the 1/8th I have left, which is very under active, Since my operation ive had a problem losing weight, however,. I'm due to have two knee replacements but my surgeon was reluctant to do my first knee because I'm over weight & have bad asthma & he said the risk of the anaesthetic was too high. So I promptly joined Slimming World & the Gym11 months ago & only lost 3 stone (42lbs) but have now come to a standstill & for the last three weeks I have not been able to lose even1lb. I feel bloated & lethargic & getting about 3hrs sleep every night. My daughters neighbour told me she was not well on Levothyroxine & her GP has now put her on Armour instead & she feels really well on it. Has anyone else heard of Armour. Thank you

[eeng in reply to Hidden]

Armour is a brand of Natural Dessicated Thyroid (NDT), which contains T4 and T3. Other brands include Nature Throid, Thiroyd, Thyroid-S, Erfa, Metavive...... Lots of people on this forum self-medicate with NDT because T4-only meds like Levothyroxine (aka Synthroid, Eurythrox....) don't work for them.

[shaws Administrator]

Levothyroxine can cause weight gain in some people. The conversion to T3 may be insufficient. Levo is T4 and it is inactive hormone, It has to convert to T3 (liothyronine) and it is T3 which enables our metabolism to work effectively.

hormonerestoration.com/

hormonerestoration.com/Thyr...

hormonerestoration.com/Docs...

[Itsjakefromstatefarm]

Yes.. it's true.. I'm trying to lose weight so I can lessen my dose

[Hidden]

I'd say you were hyperactive now, especially with suppressed TSH and dramatic weightloss, I was hypo and then went hyper, get it checked out properly with a blood test. I went hyper due to Graves disease, so maybe a TRab blood test needed.

[Chromegirl32]

I lost five and a half stone and my blood test results stayed the same, I stopped smoking and my TSH rose so I ended up having my dose of Levothyroxine increased. That said I was only on a low dose 50m and it has just been upped to 75m so still on quite a low dose.

[SlowDragon Administrator in reply to Chromegirl32]

Quitting smoking can be a catalyst to thyroid change

verywellhealth.com/cigarett...

Thyroid tests should be done more regularly in 18months after stopping smoking