I've gained a stone in weight all of a sudden, in just over a month with most of it while I've been on a calorie controlled diet the past two weeks and staying well below the calorie limit. Could any of this be down to my thyroid? My latest test results were tsh 2.11 ( 0.5 -4.4 ) and t4 12.1 ( 8.9 - 17.3) I'm still on 50 and 75 mg of levothyroxaine every other day. I was meant to speak to the consultant last month but due to the strikes will not get a review since my last my last appointment in Oct, for 6 months. My tsh came down from 3.5 in October but I noticed my t4 has not risen and was 12.1 back then. According to most medics I'm completely normal now thyroid wise. I've had dreadful joint pain recently and have been having night sweats and hot flushes in the mornings so it could be menopause related. My body just feels so out of control right now so just trying to grab some reins. I've been taking vitamins including magnesium, vit d, and multi vitamins and eating as balaced as I can.
Rapidly gaining weight. : I've gained a stone in... - Thyroid UK
Rapidly gaining weight.
Request next dose increase to 75mcg daily
Which brand levothyroxine are you using
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
When were vitamins last tested
Joint pain frequently low vitamin D
Night sweats low B12
Approximately how much do you weigh in kilo
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
I'm 89 kgs. I was 82.5kg in at beginning of Jan and was around 76kg when I was first put on thyroxine. I was initially on 25mg for months and then upped to 50mg and then finally 50 and 75 every other day. I had viral thyroiditis late in 2022 and became hypo once the initial viral hyper phase was over. I tested positive for tpo antibodies but they have been cautious with me as after de Quervain's you can spontaneously return back to normal thyroid function although for some it can become permanent ( I had normal thyroid function before the thyroiditis)
So guidelines suggest you are very under medicated
Likely to eventually be on around 142mcg per day if weigh 89kg
When you were 76kg = approximately 121mcg per day
Weight gain is most common hypothyroid symptom
I recognise that but it's trying to tell them that! I was told I was completely normal at my last appointment with my tsh being 3.5 ( and had risen since my last test) I'm taking 75mg daily now and am going to say that I left my meds while visiting my parents and get more but that won't last me till late April when I next speak to the consultant. I could just about cope before but the weight gain is really getting me down.
How many calories would you say you're getting daily?
Thing is, we need calories to convert T4 to T3, and if you don't get enough, or use them up on vigourous exercise or something, your conversion rate drops, you become more hypo and put on more weight. So, the usual advice in this case is: eat more!
As it is, you're under-medicated. Your FT4 is only 38.10% through the range and should be more like 75%. So if your FT4 is that low, your FT3 is going to be lower, so you really can't afford to mess up your conversion rate. It's low T3 that causes symptoms like weight-gain and difficulty losing it.
And it's probably not even fat if you're putting it on that quickly. More like water-retention. And no low-calories diet is going to get rid of that.
I don't normally like Westin Childs but he's got a few good points here:
healthunlocked.com/thyroidu...
I've been having around 1300 to1600 but mostly around the 1400 mark. I've not been doing any exercise. I found the weight gain more rapid once I started to watch what I eat. I was just over 12st this time last year and put on a stone since the beginning of Jan and now weigh over 14st and up from 13.8 just over a week ago. I'm 5'6". I have been urinating excessively in the mornings especially but that's been going on for a while. My consultant did say last time that the aim was to get my T4 to 15 ( that was only when I didn't except his idea of "normal ") but I have to now wait till April to speak to him due to the strikes.
* just want to add that I gained a stone over the course of last year. Although it's still overweight, I'm normally around 13st and that's what I was at the beginning of this year. I lost a stone when I was hyper during the thyroiditis illness
OK, so you have Hashi's? Weight will vary, then. But an FT4 of anything shouldn't be the goal, it's the FT3 that is important, and Hashi's people are usually bad converters, anyway. Not consuming enough calories will make that worse.
No it was viral thyroiditis ( de Quervains) I did test positive for tpo but before the illness my tsh was normal and was around 1.3 ( not sure of my other thyroid functions were.) They are not testing my T3 at all.
Well, that's what they told you it was. But, they're often wrong because they do not understand how Hashi's works. And if your TPOab were positive, you do have Hashi's, and Hashi's causes periods of false hyper. In between those periods, in the early days, TSH will be 'normal', but that doesn't last. Eventually you become hypo.
Although it's relatively rare, it was definitely de Quervains. I had classic symptoms and the most excruciating pain in my thyroid. A side effect of the illness is that due to the damage during the acute stage you can sometimes become permanently hypothyroid. It can also transiently raise your tpo. Mine was 38. I've not had it tested since but it's likely I'm probably one of the unlucky ones and will stay hypo although I'm pretty sure I've had replies on here from people in the same boat but then their thyroid function recovering in the end.
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