Hypo symptoms with low TSH (medicated)

[naryshkin]

Hi everyone,

I am a bit at a loss here and some insight would be welcomed. Since March I have been on 75mcg levothyroxine, which helps me to get out of bed in the mornings, which I take alongside a cocktail of supplements (folate, iron, magnesium, vitamin D). But my weight refuses to budge even if I cut down on eating (1200-1300kcal/daily ish) and up on the exercise without crashing my T3 levels. My weight remains the same 9.2st (59kg) since the spring (I'm 5ft and gained nearly 3 stone since last autumn's flare, diagnosis in spring), but given the lifestyle changes, I would have expected some of the weight to shift by now. Or am I impatient?

I understand that levo should ideally be raised, 1.6mcg per kg (1.6 x 59 = 94.4mcg)

But at 75mcg, my TSH hovers around 0.25-0.37 (0.27-4.2) in tests taken in July and August. T4 looks good, ranging 20-23 (12-22) and T3 was last at 5.8 (3-6.8). My iron profile is improving, even if having come out of a very bad flare, causing elevated ferritin, transferrin and P-iron levels (see history).

Most of my hypo symptoms have gone, but the bloats and weight refuses to move and my fingers are swollen (and a bit painful) more often than not. My face is puffy, but the puffiness even changes the size and shape of my nose, for instance. Values combined with TSH, raising levo might not be sensible? I cannot up on the iron tablets because of the risk of overdoing iron and ferritin. Still GF.

I'm anxious about this since we're going back to the office soon and I am struggling to find *anything* to wear that is adequate for my line of work. Sadly, I have a fantastic workwear closet but it's suitable if one were like 3st smaller...??

[SlowDragon Administrator]

What time of day are you taking levothyroxine

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[naryshkin in reply to SlowDragon]

Thank you for that, I forgot to add that I take my levo somewhere between 4am and 6am on an empty stomach every morning, then I go back to sleep for another 1-3 hours and then have tea with my brekkie. Iron taken about an hour before lunch (with folate and vit C), and magnesium with vit D with dinner.

Theoretically, this isn't wrong, right?

I'm wondering since a blood test is coming up later this month and I don't think I'll get a levo raise.

[naryshkin in reply to naryshkin]

I also quit omeprazole last November, before going on levo in February, after it turned out that I was unnecessarily medicated, it only worsened low stomach acid and IBS

[SeasideSusie Remembering in reply to naryshkin]

Iron taken about an hour before lunch (with folate and vit C)

You can take Vit C with the iron but the folate must be at least 2 hours away. Nothing except Vit C with iron (Vit C aids absorption of iron). Iron affects absorption of everything else hence the advice to leave a 2 hour gap between iron and most supplements/medication. Levo needs 4 hours.

[naryshkin in reply to SeasideSusie]

I read somewhere that folate helps with iron absorption so I’d take them together, thinking it’s ok. I’ll change this from now on, thank you so much!

[SlowDragon Administrator in reply to naryshkin]

TSH hovers around 0.25-0.37 (0.27-4.2) in tests taken in July and August.

T4 looks good, ranging 20-23 (12-22)

and T3 was last at 5.8 (3-6.8).

If you found you have benefit from gluten free diet then likely to need addition of T3 prescribed alongside levothyroxine

Ft3 is on low side

Suggest you retest full thyroid and vitamin levels see if vitamins are optimal and if Ft3 is improving

[naryshkin in reply to SlowDragon]

Thought TSH and T4 looked good and T3 has improved a lot since the spring (increasing from 3.8-4.2 to +5), but still struggle with the occasional tiredness as well. I’ll go in private to discuss T3 as am doubtful that NHS will prescribe it.

Retest is due in late September and I think I might come back for some advice before following up with my GP and maybe a new private endo.

Thank you for taking the time to answer 🌻🥰

[Anthea55]

As I understand it, weight gain due to being undermedicated is not the same as weight gain due to overeating. Cutting down on food is not going to help if gain is due to being undermedicated. You shouldn't reduce food too much. A friend of mine who has an underactive thyroid, went to those weight classes (can't remember which), stuck to the rules, lost no weight and was accused of cheating!

Bloating and swollen fingers etc can also be due to food intolerances. Several years ago I was getting problems with my joints and went to see if I had food intolerances, rather than getting medication for it. After 2 or 3 months on the revised diet my joints had improved, and as an unexpected bonus I wasn't getting my lifelong bloating and indigestion.

Hope that helps.

[jgelliss in reply to Anthea55]

VAnthea55 Thank you for sharing this great information.

[annnsandell]

Your thyroid levels appear good so it is doubtful that this is why you are not losing weight. Consider what else is doing it. Suggestions - food intolerances perhaps or water retention, do you have any stomach issues? I certainly wouldn't lose weight on 1200-1300 but that will depend on how old or active you are. Have you tried cutting down carbs? Most slimming schemes are based on food substitutions as well as cutting some calories. I am afraid that the loss of 3 stone is not going to happen overnight and if it did you would only put it back on so you will need some new clothes for now. Assuming that you have been working from home, you might find that getting back out to work helps with weight loss as well. Many people have put on weight during the pandemic and working at home so you won't be alone, enjoy the new clothes, perhaps a hair do and slowly does it.