I'm struggling with my health and I feel like I don't know where to start. I've been diagnosed with an underactive thyroid which I take 250mg or mcg levo and was told I had insulin resistance a few years ago. I had bariatric surgery 4 months ago (sleeve) I've lost around 50lb or 22 kg from a starting weight of 120kg. I found it almost impossible to lose weight prior to surgery and was always hungry. So now I'm full from less food, but and this is a huge but, I still feel something isn't right regarding my hunger. I'm getting hungry after a few hours and feel hungry even after eating when I don't have any room for food as my stomach is now very small. I'm very well hydrated and eating plenty of protein and it's not head hunger. So although I was told my insulin resistance which was supposed to be causing hunger would be solved by weight loss and surgery honestly I think it hasn't been. So no I'm wondering in my thyroid issues could be causing the hunger, or if hunger is linked to the thyroid issue. Its really not particularly normal or common after bariatric surgery to feel hunger like I am.
In addition my surgeon said I had very little fat around my liver stomach etc. This was observed from the surgery when he was in there. I know that fat around the organs is often blamed for insulin resistance and diabetes. So again this makes me wonder if there's something else going on..
I'm also really knackered a lot. But I am eating 1000 to 1200 calories a day due to surgery. So I think the tiredneas is just going to be dismissed as that,
I'm really in dispair as this surgery was supposed to fix this. So I've made an appointment with my GP as I really feel like something just isn't right. But honestly I don't know where to start. I feel the thyroid issue need addressing alongside potential insulin resistance, I've also heard of other issues like leptin resistance. So I wonder if I need to ask for a referral to an endocrinologist? I do have quite a good relationship with my GP and I've been letting this go as I was on the pathway to surgery which I thought would fix my issues. So I have no idea if this is a reasonable request or how I go about it. Sorry this is long. Thanks for reading. Any thoughts or advice would be much appreciated.
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Bearfam
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Bearfam calories are important for the conversion of t4 to t3. It could be that your restricted calorie intake is affecting the production of the and making you hypo.The only way to make sense of what is going on is to get TSH, ft4 ft3, vit d, folate ferritin and b12 blood tests and see what the results are
Do you always get same brand levothyroxine at each prescription
Levothyroxine dose may need reducing as weight reduces
When were your thyroid levels and vitamin levels last tested
After bariatric surgery vitamin levels need testing regularly
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
On levothyroxine Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.
In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Ord’s is autoimmune without goitre.
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s.
Thanks for this. It's a lot to get through so I'm sure I'll have more questions once I've looked at it. Once thought I had, you say nhs rarely tests for t3. So do people get private tests then go back to their doctor with them? Would this be a gp or endo? Just wondering if I get these tests and then what? I can use the info here to work our what I nerd but if my doctor disagrees then how do I get the meds I need?
I was always ravenous , I didn’t put weight on but the hunger was a big problem to me .Since being on T3 with better levels this symptom has largely disappeared.
Not sure if that fixed it but I think it did .
Previous to the addition of T3 my blood test showed that to be under the range .
Thanks for replying. Sounds daft, but when you say ignore your doctor and listen to the forum how does that work with your relationship with your doctor? How do you get the meds you need if they think differently? I'm starting to worry ill have to pay to see somone privately. Which I have the money for in savings but I need the savings for a house deposit! So it's absolutely a last resort.
Regarding your hunger your Leptin and Ghrelin levels may be out of balance ie Low Leptin, read the article, if it resonates to you, to bring your Leptin levels up increase your Fibre intake
Regarding your fatigue you might be iron deficient as Levothyroxine depletes iron stores, hence the returning fatigue after about a month feeling better on Levothyroxine the fatigue is often med induced iron deficiency.
There's some great advice in the other comments so won't ho into it again...
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
How to ask the GP for a referral letter
Appointment with Endo booked - need advice re GP and referral
Where should I start with my diet? 
Should I see another GP 
Should I ask my GP for thyroid medication with those results 
