Cytomel and Wegovy (Semaglutide)

[Kellykitty]

I’ve been on T3 only (Cytomel) for 15+ years for low thyroid /Hashimoto’s. My doctor put me on Wegovy (Semaglutide) which is a once a week injection. (In the UK I believe the Semaglutide brand used is Ozempic). The Wegovy dose increases each month (I’m currently up to 1.0 mg) until a maintenance dose of 2.4 mg is reached. One of the side effects of Wegovy for me has been fatigue for a day or two after the injection, but then it subsides. Now it’s getting to be a daily fatigue. Does anyone have experience with this? Do you think the Wegovy could be affecting the absorption of my Cytomel?

[Cassandrama]

T3 is not the normal treatment for hypothyroidism. That you need semaglutide suggests the weight gain aspect of hypothyroidism is uncontrolled. What are your TSH and FT4 and antibody numbers? Fatigue will be both hypo symptoms and the reduction of sugar in your system. Perhaps you have been needing more calories in the past because of hypo symptoms and now you are tackling weight the underlying issue is being revealed. Great news they gave you Wegovy to help you.

[Star13 in reply to Cassandrama]

I’m just a bit curious about your statement that T3 is not the normal treatment for hypothyroidism, can you explain?

[Cassandrama in reply to Star13]

The standard treatment, per NICE is T4, Levothyroxine. T3 is not approved and wily expensive. T4 is (supposedly) converted to T3. cks.nice.org.uk/topics/hypo...

[Star13 in reply to Cassandrama]

But as you no doubt know from reading MOST of the posts on this Forum people have issues with conversion and are therefore those that according also to the guidelines, after evaluation T3 IS APPROVED and can be prescribed. Combination therapy is an acceptable treatment under both NICE and RMOC Guidelines for those that need it.

[Kellykitty in reply to Cassandrama]

TSH 0.3 (0.4-4.0); Free T4 0.1 (0.8-1.7); Free T3 2.7 (2.0-4)

I cannot tolerate taking T4. Currently on 55mcg of Cytomel daily. I haven’t had my antibodies checked in a few years.

[tattybogle in reply to Kellykitty]

fT3 is under 50% .. how long a gap did you leave between last dose and testing ?

low T3 is likely to cause problems with weight ~ have you previously tried taking a higher dose of T3 ?

Wegovy seems to have significant risks ..... T3 doesn't .

"What is the most important information I should know about Wegovy®?

Wegovy® may cause serious side effects, including:

Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Wegovy® and medicines that work like Wegovy® caused thyroid tumors, including thyroid cancer. It is not known if Wegovy® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people

Do not use Wegovy® if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)" wegovy.com/

[Kellykitty in reply to tattybogle]

In the past I’ve been prescribed as high a dose as 100mcg of Cytomel (this was in response to a TSH spike of 57 due to ineffective Liothyronine medication made at a compounding pharmacy.) I lost weight and looked and felt great on that dose! For the latest test results, I’d taken my last dose of Cytomel 24 hours prior to the blood draw.

[Cassandrama in reply to tattybogle]

Unless they add a number in relation to tge risk it's not appropriate to talk about "significance". 60% chance is significant, 1% not so in comparison. Even so, the risk to health of weight- related illness is well known and proven. Everything has risks, just being alive is risky. What matters is relative risk.

[tattybogle in reply to Cassandrama]

'relative risk' is precisely the point i was attempting to make , although perhaps not very clearly ...

I mean that' relative to the risks of T3 use' , the risk of using semaglutide seem huge,

i appreciate that there are increased risks associated with being overweight . and there are also increased risks with undertreated hypothyroidism..

but in this case the hypothyroidism would appear to be undertreated.. (although we don't know for sure as the levels of fT3 were tested incorrectly at 24 hrs post dose ...it needs testing correctly at 8-12 hrs post dose to get a better picture of average fT3 levels)

but assuming fT3 is still looking lowish @ 8-12hrs , then it would seem relatively safer to increase the dose of T3 to treat the hypothyroidism properly rather than adding something with such a relatively high burden of additional risk.

As far as i know there are no reports of T3 causing increased thyroid tumors / cancers in anyone (or indeed in rats)

or any of these other side effects :

Wegovy® may harm your unborn baby. You should stop using Wegovy® 2 months before you plan to become pregnant

are breastfeeding or plan to breastfeed. It is not known if Wegovy® passes into your breast milk

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Wegovy® may affect the way some medicines work and some medicines may affect the way Wegovy® works. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin. Wegovy® slows stomach emptying and can affect medicines that need to pass through the stomach quickly.

What are the possible side effects of Wegovy®?

Wegovy® may cause serious side effects, including:

~ inflammation of your pancreas (pancreatitis). Stop using Wegovy® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back

~ gallbladder problems. Wegovy® may cause gallbladder problems, including gallstones. Some gallstones may need surgery. Call your healthcare provider if you have symptoms, such as pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay-colored stools

~ increased risk of low blood sugar (hypoglycemia) in patients with type 2 diabetes, especially those who also take medicines for type 2 diabetes such as sulfonylureas or insulin. This can be both a serious and common side effect. Talk to your healthcare provider about how to recognize and treat low blood sugar and check your blood sugar before you start and while you take Wegovy®. Signs and symptoms of low blood sugar may include dizziness or light-headedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, or feeling jittery

~ kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration

~ serious allergic reactions. Stop using Wegovy® and get medical help right away, if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat

~ change in vision in people with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with Wegovy®

~ depression or thoughts of suicide. You should pay attention to any mental changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you

The most common side effects of Wegovy® may include: nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, heartburn, and runny nose or sore throat.

[Star13]

Fatigue is a very common reported side effect of Semaglutide. It’s only just been approved in the UK so I’m not sure how many people who are also hypothyroid you will also find are taking it. Have you been prescribed it for Diabetes or for weight loss?

As with everyone who posts here it helps if you mention what dose of meds and vitamins you are on and what you last test results were with lab reference ranges. It’s possible there are other reasons for your fatigue that need to be addressed.

[Kellykitty in reply to Star13]

TSH 0.3 (0.4-4.0); Free T4 0.1 (0.8-1.7); Free T3 2.7 (2.0-4). Wegovy was prescribed for obesity with comorbidity of obstructive sleep apnea. Currently on 55mcg of Cytomel. My D3 is low at 25 (30-100) but no matter how much I take, it doesn’t ever budge. I took D3/K2 6000 IU and Magnesium for 2 straight years (ferritin, folate B12 all in range) and nothing helped the D levels. My endocrinologist thinks the low D it might be due to obesity, but I also know I have mutations of the VDR vitamin D receptor gene. 🤷🏻‍♀️🤷🏻‍♀️🤷🏻‍♀️Interestingly, taking Vit D gives me migraines.

[humanbean in reply to Kellykitty]

What kind of magnesium did you take and at what dose?

[Kellykitty in reply to humanbean]

oxide and aspertate

[Alanna012]

Ok I found this statement:

"Semaglutide injection may increase the risk that you will develop tumors of the thyroid gland, including medullary thyroid carcinoma (MTC; a type of thyroid cancer). Laboratory animals who were given semaglutide developed tumors, but it is not known if this medication increases the risk of tumors in humans."

I'm not sure about tumours but it seems it may have the capacity to affect the thyroid in some way. Possibly. This was a basic search.

When you have multiple illnesses you usually have to make the choice of which one to prioritise focus on treating - it depends on the impact on your life and well-being - sometimes to the detriment of the other. It's not a nice situation to be in and I have been in it.