Over the last 2+ years Ive gained 50 pounds due to premature Ovarian Failure and Hypothyroidism. I was originally diagnosed with Graves Disease in 2014. My whole medical history is explained in my prior posts. I would retype but my history is super complicated due to rare illness. I have now been on Levothyroxine for several months and my dose is sitting at 50 mcg. In those several months I have put on another 15 pounds. I am sure it is from the Levothyroxine. My diet is very restrictive and has been for over 14 years. Never had a weight issue. I can't afford to gain more weight, it makes all my other illnesses much worse. I am now having so many issues I never had to deal with before. The main reason I opted to try Levothyroxine was due to high BP Bradycardia and weight gain. It has helped with the Bradycardia and high BP. I am pleased with that but if the weight gain continues I'm looking at possible sleep apnea and diabetes. My last bloodwork was the following, I guess Im wondering if staying on it is worth it? My Endo is really of no help and just suggested trying a semaglutide which I guess is always an option. I don't really want to take on more medications though. I feel so completely lost at this point.
December 28th on 25mcg Levothyroxine
TSH 2.89 (0.32-4.00) mIU/L
T4 11 (9-19) pmol/L
T3 4.1 (2.6-5.8) pmol/L
Written by
brethor9
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Hardly surprising you're still putting on weight. You are under-medicated. 50 mcg is only a starter dose and should have been increased to 75 mcg six weeks later. Your endo really is cluless! Levo is not going to help if you don't take enough of it.
Your TSH is much to high for someone on thyroid hormone replacement - it should come down to 1 or under.
T4 11 (9-19) pmol/L 20.00%
T3 4.1 (2.6-5.8) pmol/L 46.87%
Your FT4 is a mere 20% through the range! I should be more like 75%. You desperately need an increase in dose.
Hi I have also gained a lot of weight. Trying to diet is very hard . Please don't stop taking your medication. I've now cut my portion sizes to the minimum and have slowly started losing weight. Good luck.
Please stop dieting - it is not conducive when taking any form of thyroid hormone replacement -
Conversion of the pro-hormone T4 into the active hormone T3 that runs all your bodily functions needs a strong core strength and optimal levels of ferritin, folate, B12 and vitamin D and down regulation of T4 into T3 can also be caused by inflammation, antibodies, any physiological stress ( emotional or physical ) depression, dieting and ageing.
I understand that common dieting methods can cause the problems youve listed but healthy weight loss management supported by relevant, naturopathic specialists should not. I can provide links for such specialists, if anyone needs.
Levothyroxine doesn’t “top up” failing thyroid, it replaces it
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
You need bloods retested 6-8 weeks after each increase
Aiming for Ft4 (levothyroxine) at least 60-70% through range
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
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).
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
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Likely to need several further increases in dose levothyroxine over coming months
Come back with new post after you get next blood test
Can you see a different endocrinologist as it is painfully obvious that your need more thyroid hormone replacement as we generally feel best when our T4 is up in the top quadrant of it's range with your T3 tracking slightly behind at around 60% - 70% through its range.
I think this endo is ' hung up ' on the fact that you have Graves and not understanding that your thyroid has all but ' burnt itself out now ' leaving you hypothyroid and with very little natural thyroid function.
Low nutrients can make people fat. The one I know about personally is low iron and/or low ferritin (iron stores). And by low I don't mean necessarily that levels are below range. They can just be below optimal.
An example... Doctors seeing a ferritin level of 20 with a reference range of 13 - 150 think this is absolutely fine, but the hypothyroid person whose result this is might feel at their best with a level of about 90 or 100.
And this is worth watching - the presenter is better than most :
In the first link it mentions that vitamin D deficiency can cause weight gain, something I didn't know.
In the second link it mentions low vitamin A can cause people to gain weight, and vitamin A is also mentioned in this link in connection with hypothyroidism :
It is well known that too much vitamin A is dangerous and potentially toxic, particularly for women who want to become pregnant or who are pregnant. But I'm sure that too low a level of vitamin A is bad for everyone.
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Thinking of stopping levothyroxine
Weight Gain 
Weight gain with block/replacement treatment
Treatment for hypothyroidism to improve my quality of life
TSH Suppression
