I'm hypothyroidism and have been on levothyroxine for about 3 years. In that time I've put on 2 stone in weight. Can I do intermittent fast?

[tonyjaynedaisy]

Hypothyroidism and intermittent fasting.

[shaws Administrator]

Welcome to our forum and I am sorry you have hypothyroidism.

Weight Gain is the commonest question when hypothyroid and it is due to our metabolism being so low that weight can be gained.

As ReallyFedUp advises, get a print-out of your blood test results.

If you didn't have your blood test at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between your last dose of levothyroxine and the test, your results could be skewed but follow that advice for all blood tests in future.

The reason an early a.m. is advised is because the TSH (thyroid stimulating hormone) is highest early a.m. and it drops throughout the day which can mean the doctors doesn't increase your dose.

We need sufficient hormone replacements (levothyroxine) to bring our TSH down to 1 or lower (many doctors make the mistake of thinking 'somewhere' in the range is fine but it isn't).

Blood tests are every six weeks with an increase of 25mcg until TSH is 1 or lower and a Free T4 and Free T3 should be in the upper part of the ranges.

Also request B12, Vit D, iron, ferritin and folate to be tested if you haven't already done so.

[tonyjaynedaisy in reply to shaws]

The last blood test i had revealed i was being 'undertreated'. I am in the UK and have been under the endocrinologist until my bloods were stable. Then for the next year under my doctor. My tsh was 5.5 six weeks ago so I've been told to increase the levothyroxine by 25mg, so am now on 100mg. I had a full blood count done and nothing else was flagged up. Does any of this make any sense to you?

[shaws Administrator in reply to tonyjaynedaisy]

It makes sense because for many people levothyroxine causes weight gain as it doesn't raise the person's metabolism. Besides you were on too low a dose and that is the reason for your weight gain.

Levothyroxine is an inactive hormone replacement. It has to convert to T3 but doesn't always do so effectively.

T3 (liothyronine) is the only Active Thyroid Hormone and every single cell needs T3 in order for our body to function.

The most important blood tests (rarely tested) is Free T4 and Free T3 and the aim is a TSH of 1 or lower. Both Frees should be in the upper part of the ranges.

stopthethyroidmadness.com/h...

[SlowDragon Administrator in reply to tonyjaynedaisy]

So you will need bloods retested in 6-8 weeks

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

Extremely important to test thyroid antibodies and vitamin D, folate, B12 and ferritin too

So doc full Thyroid evaluation in 6-8 weeks you need TSH, FT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

Ask GP to test vitamins and thyroid antibodies

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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

All thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24hours prior to test, delay and take immediately after blood draw. This gives highest TSH and lowest FT4. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

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

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

List of hypothyroid symptoms

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

Come back with new post once you have new results and ranges

You may need further increase

Always take Levo on empty stomach and then nothing apart from water for at least an hour after.

Many take early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.

verywell.com/should-i-take-...

Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

The most important results are FT4, should be towards top of range and FT3 at least half way in range.

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

[tonyjaynedaisy in reply to SlowDragon]

Thank you very much for your help.and information. My doc only tests tsh , I never get 53 or t4. I didn't know I could Get my bloods tested privately. Will look into it and Get back to you.

[SlowDragon Administrator in reply to tonyjaynedaisy]

Don't test until been on new increased dose at least six weeks, but eight weeks may be better

Including vitamins and thyroid antibodies is very important

Getting vitamins optimal is first step.

If antibodies are high, get coeliac blood test, before looking at trying strictly gluten free

TSH needs to be under one for many on Levothyroxine and FT4 towards top of range in order for FT3 to be high enough

A TSH of 5.5 shows you were extremely under medicated

[tonyjaynedaisy in reply to SlowDragon]

Could you just clarify something for me please. It was my pharmacist that now deals with my medication and blood test. He told me my tsh needs to be between 3 and 5. Why do they say that when I've read it should be around 1? I'm confused

[Nutripea1220 in reply to tonyjaynedaisy]

Your pharmacist is wrong!!!!

Other have given up excellent extended advice.

Your pharmacist doesn’t know what he’s talking about. He’s wrong. Plain and simple.

[SlowDragon Administrator in reply to tonyjaynedaisy]

He's only a pharmacist, not a doctor and not an endocrinologist who specialises in Thyroid disease

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

The most important results is FT3

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 (or pharmacist) please email Dionne at

[e-mail]

Also request list of recommended thyroid specialists

Professor Toft recent article saying, T3 may be necessary for many, otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

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

Professor Toft

President of British Thyroid Association 1996-2009

Past President of the Royal College of Physicians of Edinburgh

Physician to the Queen in Scotland

Consultant of Endocrinology, specialising in thyroid disease, at Royal Hospital Edinburgh

[Hidden in reply to tonyjaynedaisy]

If you had an increase 6 weeks ago you are due for anther test. It certainly sounds as if you are also due for another increase.

What other symptoms do you have besides weight gain?

[tonyjaynedaisy in reply to Hidden]

Yes I am booked to have another blood test this week. My hair is falling out and my skin very dry. Tiredness and no energy

[Hidden in reply to tonyjaynedaisy]

Post your results on a new thread on here when you get them. You do sound hypo

[MaisieGray]

I've read that the answer is that it depends on whether you are autoimmune or non-autoimmune hypothyroid; and if the former, whether your blood sugar is stable and your adrenal function is decent. If you are prone to low blood sugar and low blood sugar crashes and fatigue, the long gaps without eating required by intermittent fasting may trigger low blood sugar episodes and worsen adrenal fatigue. This triggers inflammation and may actually flare an autoimmune thyroid condition. If you have the opposite problem with high blood sugar, and are prone to binging after fasting, you may worsen your insulin resistance by overeating. This too is inflammatory. However, if your blood sugar and adrenal function are stable, intermittent fasting may be help you manage your Hashimoto’s. If non-autoimmune hypothyroid, nevertheless it's important to remember that calorie reduction leads to less circulating T3, so possibly self-defeating?

[elgranero5]

UAT for 22 years n I do intermittent fasting or 5:2

[Schenks]

Yes

[BadHare]

Before taking thyroid hormones (NDT & T3) I started intermittent fasting, I like eating too much to do the 5:2 type, but have stuck with the 16/8 daily type of fasting, where I only eat between 7-8 hours a day with a 16 hour fast.I also keep my carbohydrate intake as low as I can on a wholefood veggie diet, & make sure I have enough protein & good fats that I don't feel hungry. I have starchy Saturday off, so try to have a shorter eating window on Friday & Sunday. It's better for me fitting in supplements & meds too, & I feel out of sorts if I'm away & have to fit in with normal meal times.

It could be that your micro nutrient intake needs tweeking, to ensure you're converting your T4 ok, or that you might be better on an increased dose or trying NDT. As other folks have said, best look at your blood test results for clues as to the best approach, though changing what & how you eat could help.

[Tinkermt]

I have hypothyroidism and I was told that true intermittent fasting is bad for us. But allowing digestive rest is good. So instead of going 16 -24 hrs without eating just shorten your eating window to 10-11 hrs.

[Chocs09]

I am on lyothironineand I do the 5:2 intermittent fasting, it has been the only way I have been able to lose weight

[thyroidnodules]

i also put on a lot of weight with levo. i tried IF and lots of other diets. i also took the required amount of supplements. my tsh was supressed at 0.25 but i still gained weight and felt puffed up. i started taking NDT (THIROYD) and i have slowly lost a stone when dieting. its a slow process but it is now not going on rapidly. i tried every diet and read numerous articles but nothing positive happened at all when i was on levo.

[E_lizab8]

I have hashi and am celiac along with fructos intolerance and I take 75 thyroxine. I went lowish carb a while ago and feel much better for it, though as I have a tendency to low blood sugar I make sure that I eat enough good fats and plenty of veg and a normal amount of protein. The last six weeks I have been trying intermittent fasting by once or twice a week having only coffee with cream for breakfast, and skipping lunch, or eating lunch but skipping supper, and I have lost 3 kilos so far which Im very pleased about as had tried every other way without any success, also I feel so much better when I dont eat so much, I also sleep better.