Sense-check, Hashi Swings, and inability to lose weight

[CBDB]

I just wanted to sense check my plan for optimising my health, considering my latest blood tests have arrived.

So scroll down to blood tests, as first, I am providing all sorts of contexts for reference.

In short, I have Hashimotos and have been testing at least twice per year with Medichecks. Bio and Thyroid tracker is on my profile page, at the bottom after my running. I am recently post-menopausal, mid-50s of age.

Over the years, I think I’ve managed to make huge progress towards optimising my condition, from 2016 on only Levo/T4 feeling constantly depressed, to today on Levo/T4 and Lio/T3, physically very active and feeling as if on an constant runners high … so pretty happy.

However, the one thing ★ I was never able to do is to lose weight★. I am in the obese category, despite my levels of activity and my quite strict monitoring of carbs and calories. I keep a fitness and food diary and track it via the CarbManager app.

So over the last 2 years, I’ve been trying to optimise my nutrients, and over the last 6 months, I slowly increased my Levo/T4, with the objective of getting my FT3 levels into the top third of the range. (Apart from one exceptional test result due to a probable Hashi Swing, they have consistently remained in the bottom half).

Diet and lifestyle: My diet for more than 3 years is gluten-free (since 2019), dairy-free (since 2019), alcohol-free (since2003), carb low (since 2021), no soy, no chocolate for 2 years but since 6 months a couple of pieces of dark chocolate at times. Since 2020 I run ca 2-4 times per week consistently 40-60min at a time, and since 2021 I added indoor rowing 4-6 times per week. I also do daily 20-40 min of flexibility (Pilates, yoga, targeted Strength&Flexibility workouts, etc).

History of Medication and my Hashimotos-Swing:

My thyroid prescription is for 100microg Levo per day and 10microg Lio. But in reality, I now take 100microg Levo and 20 microg Lio. I take both AM and on waking, and I do not tend to split my Lio (apart from when I do blood tests). For info, the brands I get on prescription are Morningside Lio and Aristo or Tevo Levo (this seems to change every once in a while at my pharmacy).

In June 2021, I started increasing T4, as a result of blood tests at the time: healthunlocked.com/thyroidu... . My inability to lose weight made me think I might be undermedicated and just considering the usual formula of estimated requirements (Levo (microg) = 1.6 x weight); for my weight it results in an estimated 186microg. All this, and my FT3 in lower half of range, was pointing toward under-medication of Levothyroxine.

So by March’22 I had increased Levo to 150microg and I tested in April’22. (And yes, I should have done 6 monthly blood tests, but hadn't.) These April'22 results had, for the first time ever, well above range FT3 and FT4. I reduced my Levo back to 100microg, puzzled and for a few weeks was trying to figure out what happened with the help of looking into back posts in this forum. (Stupidly, I felt too guilty to post my results on the forum, thinking I had overmedicated myself.) I now know that it is likely that the spike was a Hashimotos Swing, a result of the destruction process of my thyroid, and it in turn releasing hormones, resulting in above-range FT4 and FT3. (No substantial symptoms around this time, apart from slightly swollen legs (mucin) and gaining weight, both of which I had associated with an attempt to eat cheese again.)

But until the next set of tests July'22, I was back on 100microg Levo and 20g Lio (and completely dairy free again), regrettably having lost a year of (presumed, as no blood tests) building up my FT3.

Nutrient Regime: I supplement with Vit D spray (with K), Magnesium, Berberine, Iron, Selenium, Omega 3, Vit C, NAC, Protolytic Enzymes, L-Glutamine Powder, Magnesium and Brewers Yeast. Timing of these nutrients is - since a year - carefully timed to minimise interactions (see healthunlocked.com/thyroidu... )

Blood Tests: I now do the blood tests at ca 9-10 am in the morning, following guidelines of last Levo 24h+ before, Lio taken in thirds the day before, last third 12hr before. Brewers Yeast stopped more than 2 weeks before.

Current Blood Results 26/07/2022 :

★Thyroid Hormones

TSH X 0.04 mU/L (Range: 0.27 - 4.2)

Free T3 4.56 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 14.4 pmol/L (Range: 12 - 22)

★Vitamins & Iron Status

Folate - Serum 6.56 ug/L (Range: > 3.89)

Vit B12 - Active 143.0 pmol/L (Range: 37.5 - 150)

Vit D 88 nmol/L (Range: 50 - 200)

Ferritin 77.2 ug/L (Range: 13 - 150)

★Autoimmunity

Tg-AB X 431 IU/mL (Range: < 115)

TPO-AB X 40 IU/mL (Range: < 34)

All blood tests I put in a spreadsheet and the attached image is of the stats from that spreadsheet, demonstrating the trajectory over the years.

Earlier Blood Results and Hashimotos-Swing 21/04/2022 :

I’m adding my blood results from 2 months earlier, as these had completely confused me. These depict, I believe now, my Hashi Swing.

★Thyroid Hormones

TSH X <0.005 mU/L (Range: 0.27 - 4.2)

Free T3 X 9.31 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine X 25.9 pmol/L (Range: 12 - 22)

★Vitamins & Iron Status

Folate - Serum X 3.49 ug/L (Range: > 3.89)

Vit B12 - Active 106.0 pmol/L (Range: 37.5 - 150)

Vit D 84 nmol/L (Range: 50 - 200)

Ferritin 85.4 ug/L (Range: 13 - 150)

★Autoimmunity

Tg-AB X 506 IU/mL (Range: < 115)

TPO-AB Antibodies X 46 IU/mL (Range: < 34)

My interpretation of my results and action plan:

Basically, I plan to start again with slowly increasing Levo/T4 until up to 150microg/day, and then test bloods again.

One strange thing in the blood tests is that during the Hashimotos Swing, my Folate dropped for the only time ever below range. So I wonder what the connection is between a Hashimotos Swing with above range FT3/FT4 and Folate.

Also interesting to consider is the consistently decreasing Tg-AB and TPO-AB counts. Either this means my gluten-free and dairy free and autoimmune diet is decreasing autoimmunity issues. Or my thyroid is getting progressively damaged, thus having less and less effect on these markers. Or a bit of both.

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So any thoughts and advice would be welcome, specifically considering the newest blood tests, that my plan to increase Levo/T4 slowly again is the best way forward to have a chance to lose weight in the future.

And warmest wishes and thanks to all on this forum!

[CBDB]

Image 1 up close

Stats

[CBDB in reply to CBDB]

Image 2 upclose. Grey and orange dots /lines are upper and lower range.

Stats2

[SlowDragon Administrator in reply to CBDB]

Suggest you try SMALL dose increase in levothyroxine

Initially perhaps 112.5mcg and retest 8-10 weeks later

You might do much better splitting T3 into 2 or 3 doses

And/or splitting levothyroxine into two doses

Only make one change at a time

So perhaps try splitting 100mcg levothyroxine initially as 50mcg waking and 50mcg at bedtime

Or

Try increasing levothyroxine to 112.5mcg

Retest 8 weeks later

[CBDB in reply to SlowDragon]

Brill, yes, I was thinking going up to 125mcg (as this can be done by quartering the tablets.)(no idea how you would split into 112.5 as I get 100mcg tablets)

I tried splitting the T3 tablets to morning and evening meals, but ended up forgetting the evening tablet altogether.

So I think it would be better to keep all Levo in the morning, and if I need to split Lio/T3, maybe that’s ok and not so bad if I forget to take the last Lio half in the evening, (that necessitates that I manage to convert well my t4 to t3).

But the risk of forgetting tablets in the evening is, I feel, higher than the tablet’s effectiveness. I feel quite well with taking all Levo and Lio just in the morning. (Although my hubby just suggested that my sometimes morning headaches might be due to depleted T3, but increasing Levo should ideally also help that, e.g. resulting in a higher FT3, I assume)

Something to ponder about, maybe.

Thank you!

[SlowDragon Administrator in reply to CBDB]

You absolutely must take exactly same dose T3 everyday without fail

Just set watch alarm

T3 needs to be on empty stomach and nothing for at least 40 minutes after

To take 112.5mcg Levothyroxine…. Take 100mcg and 125mcg alternate days

[CBDB in reply to SlowDragon]

(T3) : Ahhh, thank you. Got it. I might try again to split am/pm , but I think if it doesn’t work than I’ll revert to only take them in the morning. Risk is otherwise too high. (Complexities include work, family, workouts, and an already complex timing schedule of nutrients) 🤯

(T4) : And yes, doh! Of course. Alternate days, that’s how you get to 112.5. Brill! ✅

[SlowDragon Administrator in reply to CBDB]

Personally I find 3 doses easy to do

Waking - 6.30 alarm. Plenty of time before breakfast. Levothyroxine and T3

Afternoon only T3 - timing varies slightly depending on food and activities between 1.30pm and 3.30pm

Last dose - bedtime

Levothyroxine and T3

[CBDB in reply to SlowDragon]

Just wanted to say thanks again. I’ve re-read your profile, which was also helpful for me to make a decision on the split dose issue. It was on my mind, and discussed with hubby (who sometimes noticed patterns of my symptoms better than me), and I have decided to try the split tablet morning / evening routine, as you suggested.

Will have a look at my nutrient regime and might come back with some questions, but basically just wanted to say thanks.

If the split dosing helps just a little bit with weight loss, it will be worth it.

Thanks again!

[CBDB in reply to SlowDragon]

I finally figured out my new nutrient timing. So I will actually try splitting both T4/T3 as I’ve read that for some splitting both also makes a difference, and I’m more likely to remember. (Higher stakes! 😏). I am also stopping Berberine, as it has not made a difference and opinion here is not unanimous and it seems to not tried and tested. (I am also not willing to go up from the one capsule I’ve been taken for 2 months)

So I’ll try the below and have set my alarm, discovering that you could also ”label” the IOS alarm (pic).

I’ve tried to avoid any interactions between nutrients and hope I’ve caught them all, but it does get quite complicated.

NUTRIENT REGIME (from Aug 2022):(splitting my T4/T3, on waking and bedtime.)

☆ 06:30 (1): 0.5 T3 & T4

☆ 07:30 (2): W/ B’FAST: Omega3, NAC, VitB, L-Glutamine (in BFST Protein Smoothie)

☆ 11:00 (3): AWAY FROM FOOD: Systemic Proteolytic Enzymes

☆ 13:00 (4): W/ LUNCH: Selenium, VitC, Iron

☆ 15:00 (5): AWAY FROM FOOD: Systemic Proteolytic Enzymes

☆ 19:00 (6): W/ DINNER: Magnesium, VitD

☆ 23:00 (7): 0.5 T3 & T4

Nutrient timing

[SlowDragon Administrator in reply to CBDB]

Have you ever tested selenium

Perhaps move selenium to after breakfast, away from iron

I now only take selenium once a week

(test showed levels high after a year on selenium every 5 days)

[CBDB in reply to SlowDragon]

Right, will have a think where selenium goes. I’ve never tested selenium, as I only take a medicheck advanced thyroid panel, and it doesn’t do selenium. Is it possible to take too much?

[SlowDragon Administrator in reply to CBDB]

I never noticed any difference taking selenium

I initially started supplementing it on recommendation of gastroenterologist, when my endoscopy confirmed gluten intolerance

For a year I took it daily

Tested - level was high (not surprising);

Next year I took it 5 days week

Then tested again - level still high

Not tested since

[CBDB in reply to SlowDragon]

I’m considering this. So thank you so much for this! (I might just drop the one or other day of Selenium, but might opt for testing before I do)

Thanks ever so much!