Should I have the vertical sleeve bariatric surgery?

[Tammessa]

Considering Gastric sleeve surgery and I have Hashimoto's disease. Frankly I’m scared. I have read so many of your posts and it sounds like you all would have never done the surgery. I am 56 and weigh 293. Diagnosed with hypoThyroidism when I was 12. I hurt all the time and no diet seems to work. I’m currently trying a Keto plan. My hair is already very thin and I’m so afraid I’m going to lose it all. Should I have the surgery or not?

[Hillwoman]

Welcome to the forum Tammessa.

Before we can give any advice, can you share with us your most recent thyroid function test results, including the reference ranges?

Have you been tested for any nutrient deficiencies? Are you taking any supplements?

Any treatments/medications for other conditions?

[Tammessa in reply to Hillwoman]

As I said before I was diagnosed when I was 12 years old. I used to be in trouble all the time for sleeping too much and falling asleep in school until finally my mom had my blood tested and found my thyroid TSH was so high that I was hospitalized. I don’t know how high it was then. Now My TSH is and has been for years at between .74 - 1.00. The reference range is .45 - 4.5 in the US.

Of course as all of you know thyroid levels fluctuate throughout the years. There has been multiple times that my medications have had to be adjusted. Such as during pregnancy and afterwards. I have gone as high as 13.0 that I know of and low as .08.

I take 175mcg of Synthroid and 10mcg of Liothyronine (citoml) a day and have for a few years.

I take also take 2 - 2500mcg of B-12 quick resolve tablets daily and a D3 spray with K1 & K2 in it. And a multivitamin everyday and well as calcium and 50mg of iron. All chewable. Because I was worried about absorption.

It’s been a difficult struggle and the weight gain is constant.

I currently eat around 1100 - 1300 calories a day. No soda or breads. Very low sugar. And I use Monk Fruit as a sweetener. Even though I have tried multiple calorie restricting diet or sugar and carbohydrate restriction diets for years I just keep getting bigger. Due to a drastic knee injury, (and surgeries) exercise is very painful with this leg.

I still seem to gain.

The doctors are saying the sleeve surgery will change the hormones (along with a bunch more) in my body and that will help enough to lose weight.

I’m just so scared of having more complications and I’m scared if I don’t do something drastic I won’t be able to even get up my stairs. I’m 5’ 8” and 293 right now.

[Tammessa in reply to Tammessa]

I forgot to say I was diagnosed with Hashimoto’s thyroiditis about six years ago. And since then have tried to be as gluten-free as possible. I also stay away from soy foods.

[SeasideSusie Remembering in reply to Tammessa]

Tamessa

I take also take 2 - 2500mcg of B-12 quick resolve tablets daily and a D3 spray with K1 & K2 in it. And a multivitamin everyday and well as calcium and 50mg of iron.

Have all these vitamins been tested, do you know that you need to supplement, are you monitoring your levels regularly so that you don't over or under dose?

Have calcium and iron been tested? These two should never be supplemented unless you have tested and know that you are deficient.

A multivitamin is not a good idea. They tend to contain too little of anything to help, use the cheapest and least absorbable of active ingredients, and contain things we should test for first before supplementing, i.e. calcium, iodine, and iron. Also, if it contains iron then that affects the absorption of everything else because iron must be taken 2 hours away from any other supplements.

Also, the iron you are taking needs to be taken2 hours away from thyroid med and calcium should be taken 4 hours away from thyroid meds.

When we take D3, as well as Vit K being an important cofactor, we also need magnesium as that helps the body convert the D3 into it's usable form. Magnesium should be taken 4 hours away from thyroid meds.

[Tammessa in reply to SeasideSusie]

Thank you. Last blood test for iron in 11/2019 shows iron total at 50 shows that is normal, Iron binding capacity is at 348 and that shows normal, but the percent of saturation shows 14 and that is showing low as abnormal. I don’t really know what that all means.

[SeasideSusie Remembering in reply to Tammessa]

I'm afraid it doesn't mean anything without the reference ranges, and "normal" just means that the result is somewhere within the range.

[Tammessa in reply to SeasideSusie]

Iron total range is 45-160 mcg

Iron binding capacity is 250-450 mcg

% saturation is 16-45 % (calc)

[SeasideSusie Remembering in reply to Tammessa]

Tammessa

Iron panel optimal levels according to web.archive.org/web/2018083...

Serum iron: 55 to 70% of the range, higher end for men

Last blood test for iron in 11/2019 shows iron total at 50 shows that is normal,

Iron total range is 45-160 mcg

This is 4.35% through the range.

**

Saturation: optimal is 35 to 45%, higher end for men

but the percent of saturation shows 14 and that is showing low as abnormal.

% saturation is 16-45 % (calc)

Your saturation is very low, as you can see it is below the range.

**

TIBC: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron

UIBC: Low in range indicates that you may have too much iron in your blood which may be due to iron overload syndrome (hereditary haemochromatosis).

High in range signifies iron deficiency.

Which is yours - Total iron-binding capacity (TIBC) or Unsaturated iron-binding capacity (UIBC)

Iron binding capacity is at 348 and that shows normal,

Iron binding capacity is 250-450 mcg

Whichever it is, it's 54% through the range so doesn't indicate that you need to supplement or have iron deficiency, and it doesn't show that you have too much iron, it's sitting nicely mid-range.

**

I can't tell you what this means, you need to discuss this with a doctor.

Did someone prescribe iron tablets for you or did you just decide to self supplement?

You also need Ferritin testing to complete the iron panel.

[Tammessa in reply to SeasideSusie]

I am sure impressed by your knowledge on these things! Thank you for the time you have taken to answer all these things for me. That is very kind of you.

My Cardiologist said I should take 50mg every other day.

[Tammessa in reply to SeasideSusie]

I will be more careful to watch my vitamin and meds separation.

[SeasideSusie Remembering]

Tammessa

Nobody here can tell you if you should have the surgery, it has to be your decision alone, but before you make any decision you need to ensure that you are optimally treated for your hypothyroidism, undermedication will make weight loss very difficult.

Please test the following:

TSH

FT4

FT3

Vit D

B12

Folate

Ferritin

then post results on the forum, including reference ranges and units of measurement for Vit D and B12, and tell us what thyroid meds you take.

You may not get them all done with your GP, particularly the FT3 and they often wont test Vit D and need a good reason to test the other vitamins. If this is the case then if you are in the UK you might want to do what hundreds of us here do and that is a private test with one of our recommended labs, both of the following are good tests and very similar so either one would do, you can do them by fingerprick or venous blood draw which costs extra:

Medichecks Thyroid Check ULTRAVIT medichecks.com/thyroid-func...

You can use code THYROIDUK for a 10% discount on any test not on special offer

or Blue Horizon Thyroid PREMIUM GOLD bluehorizonbloodtests.co.uk... Both tests include the full thyroid and vitamin panel. They are basically the same test but with the following small differences: For the fingerprick test: Blue Horizon requires 1 x microtainer of blood (0.8ml), Medichecks requires 2 x microtainers (total 1.6ml) Blue Horizon includes Total T4 (can be useful but not essential). Medichecks doesn't include this test. B12 - Blue Horizon does Total B12 which measures bound and unbound (active) B12 but doesn't give a separate result for each. Medichecks does Active B12. Total B12 shows the total B12 in the blood. Active B12 shows what's available to be taken up by the cells. You can have a reasonable level of Total B12 but a poor level of Active B12. (Personally, I would go for the Active B12 test.)

Blue Horizon include magnesium but this is an unreliable test so don't let this sway your decision, it also tests cortisol but that's a random cortisol test and to make any sense of it you'd need to do it fasting before 9am I believe.

When doing thyroid tests, we advise:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Fast overnight - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Eating may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with doctors or phlebotomists.

[Tammessa in reply to SeasideSusie]

I’m in the US but you have given me great advise about when to take the meds and vitamins. Thank you! I didn’t know that part.

[SlowDragon Administrator]

Getting full thyroid and vitamin testing is frequently the key to finally making progress

Sounds like your thyroid condition has been extremely poorly managed

We need GOOD Vitamin levels for thyroid hormones to work well

Often, if been on levothyroxine a long time we eventually need the addition of small dose of T3 alongside levothyroxine if Ft3 remains low once vitamin levels are improved to optimal

If you have autoimmune thyroid disease frequently we also need to be on strictly gluten free diet

Come back with new post once you get results and members can advise on next steps

[humanbean]

My personal opinion :

Hypothyroidism frequently causes a substantial reduction in the production of stomach acid. The result is that food is poorly digested, nutrients are poorly extracted from food and poorly absorbed, and low nutrients are very common as a result. I'm sure that bariatric surgery could only make your situation worse in this respect.

A cautionary tale of the problems that may occur with bariatric surgery that you really should read :

facebook.com/notes/vanessa-...

Be prepared for possibly having to spend a lifetime taking every nutrient under the sun in supplement form because you will otherwise be at huge risk of suffering deficiencies.

[Wetsuiter in reply to humanbean]

that was my 1st thought

[FancyPants54]

Personally I wouldn't touch surgery with a barge pole. It will leave you nutrient deficient and struggling and often isn't the expected cure for weight loss long term.

Make sure your thyroid is properly treated and stick to your keto which should help reverse your insulin resistance.

[Nanaedake]

It is possible to have a qualified and registered hypnotherapist give you a hypnotic gastric band. This is reversible and therefore won't have a long term negative impact on nutrient levels. It could be an option if you have not yet tried it. Make sure you get a recommendation and check the hypnotherapist is properly registered with the relevant professional bodies if you go down that route.

[MrsBeasley]

I started on saxenda in December and have lost 21.8 lbs thus far. It’s a daily injection originally used in diabetics and is far less drastic than surgery. I would ask your doctor about it. It controls blood sugars and delays stomach emptying so you absorb more nutrients. I have no sweet cravings at all and I’m seldom hungry.