What could be causing weight gain when bloods are optimum?

[Tiredofthis77]

Hi all,

I'd really like to get some advice re my results. I have been on a long journey (26 years) and never been able to tolerate thyroxine. After investigation it was discovered my reverse T3 was high and likely caused by me having the DIO2 variant.

About three years ago I went private and absolutely thrived on Erfa. The weight fell off without effort (about two stones) in a matter of months and everything was dandy.

Sadly though, about a year ago the weight started going back on, despite a healthy diet and daily exercise - I've never been so healthy in my life before) and I'm now two stones heavier again with the bulk of the weight on my tummy and top of thighs). Bloods look optimal and doc is puzzled. He tried me on metformin two weeks ago thinking it might be insulin resistance and the weight is continuing to go on and I feel very hypo. Can I please get your thoughts? I thought I had a breakthrough and now I feel worse than ever.

Thanks for listening.

Tired

[Tiredofthis77]

FT4 in range

FT4 results 19.2 (range 12-22)

[Tiredofthis77 in reply to Tiredofthis77]

FT3 in range

FT3 in range

[Tiredofthis77 in reply to Tiredofthis77]

Vitamin D

Vitamin D

[Tiredofthis77]

Glycated haemoglobin

Glycated haemoglobin

[Tiredofthis77]

B12

B12

[Tiredofthis77 in reply to Tiredofthis77]

Folate

Folate

[Hidden]

Hi-

I would look into leptin resistance and cortisol levels. Both can cause weight gain especially around the middle.

Many people with hypothyroidism who still struggle with excess weight despite being optimally medicated have leptin resistance as a root cause.

[Tiredofthis77 in reply to Hidden]

Thank you. Do you know where I can get tested for this?

[Hidden in reply to Tiredofthis77]

For cortisol do a 4 or 5 point diurnal salivary cortisol test - you can buy one from regenerus labs to do at home.

Re leptin I’m not sure how it can be measured- it’s not something I’ve personally had to go down the route of as weight gain and tell tale leptin resistance symptoms are not things that I’ve struggled with. I struggle to keep weight on! But I’ve been reading a lot about leptin resistance as cause of difficulty in losing weight amongst hypos. There’s a whole process for reversing it- avoiding pro inflammatory seed oils, processed food, refined sugar.. the usuals for optimum health. More protein eg 1 gram per pound of desired body weight per day.

Good luck

[Tiredofthis77 in reply to Hidden]

Thank you

[pennyannie]

Hello Tiredofallthis :

Do you have Free T3 and Free T4 readings and ranges please - what time lapse was there between last dose and the fasting blood draw and are you still taking Efra - how much - and do you split your dose or take it all at once ?

Did you manage to get tested 5 months ago as suggested for IGF-1 - insulin and cortisol ?

[Tiredofthis77 in reply to pennyannie]

Thank you for responding. I posted the Free T3 and Free T4 in replies as they wouldn't attach to my original message. I took the last dose of Erfa at noon the previous day and was tested at 9am the next day. Erfa dose is 2 grains at 7am and 1 and a half at noon.

Cortisol was 266. No range given

Insulin Like GF-1 was 122.2 (range 56.8-194.5)

Thanks for your help

results

[pennyannie in reply to Tiredofthis77]

This results show different and more realistic blood test results when taking NDT -

as when on NDT we track on the T3 and your T3 is around 72% and proportionately higher in its range than T4 which I've got coming in at around 22% -

were you feeling better whenever this blood test was run as I can't see a date ?

We generally recommend taking a blood draw around 12 hours after taking NDT so these other results show a false low -

which appear to be a T3 of 6.60 ( 3.10-6.80 ) and a T4 at 19.20 ( 12 - 22.00 )

I'm sorry but I've no knowledge of the cortisol reading nor the IGF - ( was hoping to learn something and why I asked the question ) and fully understand - being in a range - doesn't mean as much as optimal and feeling well.

[Tiredofthis77 in reply to pennyannie]

I was actually feeling unwell when the above results were taken. I always feel better when T4 is nearer the top of the range so my endo increased my Erfa following this.

[pennyannie in reply to Tiredofthis77]

So - maybe your T3 is now too high for you now you have the T4 higher :

Maybe the T3/T4 fixed ratio in NDT doesn't suit you and dosing T3 and T4 independently an option worth considering ?

[Tiredofthis77 in reply to pennyannie]

Thank you for your help! When I first started on Erfa it was great. I lost almost two stones and felt human again. When things started going wrong again, resulting in putting all the weight back on, I was tried on T4/T3 combo. I have never been able to tolerate T4 in the past and it was the case again at the tail end of last year.

[pennyannie in reply to Tiredofthis77]

If you feel you can't tolerate T4 - why do you feel you need it so high in the range ?

[Tiredofthis77 in reply to pennyannie]

I have never been able to tolerate thyroxine. On Erfa I have more hypo symptoms when I’m lower in the range

[pennyannie in reply to Tiredofthis77]

I'm not sure what else to suggest -

I been taking NDT for the past 6 years self sourced as refused on the NHS - and I'm with Graves and post RAI thyroid ablation 2005 -

NDT has relieved my crushed mental and cognitive functions which I experienced when around 10 years in on T4 monotherapy - and not aware it has had much impact on my overall energy levels -

Maybe an hour a day and 2 hours at the weekend playing tennis is a bit much for you - as some - if not all of us - need to pace ourselves.

[Regenallotment Ambassador]

How is your ferritin? I find my weight is linked to ferritin and absorption of the hormone circulating. 🌱

[Tiredofthis77 in reply to Regenallotment]

This is my latest result

Ferritin

[Regenallotment Ambassador in reply to Tiredofthis77]

Not that then…

Are you exercising a lot?

as in too much with hypothyroidism leaves you metabolically challenged…

[Tiredofthis77 in reply to Regenallotment]

I try to play an hour of tennis each day - sometimes 2 hours at the weekends. Is this too much?

[Regenallotment Ambassador in reply to Tiredofthis77]

This sounds wonderful to me, I wish I could! I think it’s very individual.

… I read this recently

medichecks.com/blogs/thyroi...

and I think I have seen articles in Harmony magazine from Thyroid UK that suggests a lot of cardio may cause challenges with metabolism.

I’m no expert I just know I get hungrier and hungrier and tireder and tireder and don’t lose any weight if I over do it.

I know one thing for sure, dieting doesn’t work. Ive tried all sorts, currently trying higher protein and focus on exercise that builds muscle and ditching the scales, I’ve just tested and my levels are in range and my trousers are a little looser so that’s something 🌱

[Tiredofthis77 in reply to Regenallotment]

That sounds really positive! Glad to hear something is working for you. I’ll take a look at the article. Thank you

[pennyannie]

With any physiological stress ( emotional or physical ) inflammation, depression, ageing or dieting T4 to T3 conversion is reduced and T4 will be preferentially converted to reverse T3 which acts as a competitor inhibitor of T3 - reduces metabolism - suppresses T4 to T3 conversion and blocks T4 and T3 uptake into the cell.

Stolen from text on nahypothyroidism.org

[Tiredofthis77 in reply to pennyannie]

I’m stressed up to the eyeballs all the time just now caused by work and the way I’m feeling/looking. I had high reverse T3 when I was on thyroxine alone. Erfa seemed to fix but now I feel like I’ve been here before. I keep reading that rt3 isn’t relevant but I do have a conversion problem. I’ve spoken to my doctor about this before but he said T3 on its own isn’t a good idea. I’ll take a read of the article and will book a test. Thank you

[pennyannie in reply to Tiredofthis77]

I have this highlighted in a section headed up -

How accurate is TSH testing -Diagnosis of Hypothyroidism - Are we getting what we want from the TSH testing.

The whole article is of interest and this extract found around 2/3rds through under the sub section - Current best methods to diagnosis :

[pennyannie in reply to Tiredofthis77]

Reverse T3 is a natural process and we all make some - it's excess, unconverted T4 which the body needs to loose to keep body function balanced and it ends up being broken down in the body and excreted.

I tested mine in 2016 and my reverse T3 was well over the accepted range -

I had been very unwell dealing with the consequences of RAI treatment ( Graves post RAI 2005 ) and 10 years on T4 monotherapy and refused both T3 and NDT through the hospital in 2017/18.

I have been self medicating NDT 6 years and my dose of T4 now 1/2 that which I was previously taking - and presume my reverse T3 has dropped / levelled off and now probably low in the range -

On NDT my Free T4 reading is around 25/30% with a T3 reading 90/110 % through ranges - which is the total opposite of my readings when on T4 monotherapy - as then my T3 was only ever at around 25% with my T4 at around 100/110%through its range.

I would imagine your high reverse T3 has also now reduced since you are taking NDT

It reads you are carrying a lot of stress, upset and exhausted, so these will negatively impact your health and well being -

Efra did work - and now it doesn't - what's changed ?

[Hidden in reply to pennyannie]

Erfa is still around 80 % which could mostly be converted to rT3.

[pennyannie in reply to Hidden]

I'm sorry - I don't understand what you have written :

[Hidden in reply to pennyannie]

RT3 can only be made from T4.

Levo is 100% T4 and NDT is 80% T4 so rT3 could still be high on Erfa.

[pennyannie in reply to Hidden]

Yes - I've written further down on this -

The fact that Efra worked very well and now does not - is - I think - the question :

I'm not aware of any potency issues with Efra -

I guess your theory could be ruled in or out by running another reverse T3 blood test :

[Tiredofthis77 in reply to pennyannie]

I’ll get an rT3 test ordered. It feels the same is it did in the past.

[Hidden in reply to pennyannie]

There have been many complaints about Erfa, starting about ten years ago when production was moved from Belgium to Spain. At the time, the STTM posted photos with pills looking different in colour, with some looking blotchy. The company denied reformulating it. The same complaints have since been made about most if not all brands of NDT, most recently Thyroid-S. But the OP must have taken the ’new’ Erfa so I don’t think that is an issue here.

[pennyannie in reply to Hidden]

Yes - I am aware as I take Thyroid S and have been unable to use around 4 bottles of prefixed 22 batches - and now on prefixed 23 batches - back to my ' normal ' again.

[Hidden in reply to pennyannie]

So it is working better now? I am glad to hear it. I have been hoping to go back on it one day.

[pennyannie in reply to Hidden]

Would appear so for me :

[Tiredofthis77 in reply to Hidden]

If rT3 is high I’m not sure where I go from here. Doc says T3 only is not a good approach but not sure what else I can do if T4 is causing the problem.

[Hidden in reply to Tiredofthis77]

Doctors in general do not know enough to be trusted with such a decision. There are quite a few members here who sell-treat with T3 only.

[Tiredofthis77 in reply to pennyannie]

The only thing that’s changed is my dose has increased over a period. I hit the sweet spot, lost a lot of weight without trying and boom, I started to feel hypo. The question is had too much T4 built up in my system, converted to rT3 and blocked cells or was I genuinely hypo? This was the same over years of trying T4. It worked initially then I couldn’t tolerate it, I felt toxic and when I stopped taking it I felt better and pretty good after a week had passed.

[pennyannie in reply to Tiredofthis77]

The symptoms of over and under medication can be very similar -

You found your unique set point once - hence feeling well and losing the excess weight - it took me around 18 months on NDT before I noticed my weight loss and I've stayed on the same dose and stable.

Maybe you are taking a little too much NDT now - maybe not - only you can know -

but carrying this amount of stress and working out every day with a double dollop on the weekends reads like a gruelling regime and when not optimally medicated likely compounding your health issues further.

[Hidden in reply to Tiredofthis77]

A few years ago, I read the book ’The Paleo Thyroid Solution’ by thyroid patient Elle Russ. She took NDT for years and felt great, only to end up back at square one. She had to switch to T3 only to regain her health.

My experience is simular to yours. Back in 2015, I lost over 4 stone/66 lb/30 kg on Thyroid-S and Berberine for insulin resistance. I did not diet or exercise more than usual. I kept my new weight until 2018 when I started feeling hyper and had to lower my dose. My free Ts dropped significantly but I could not take more thyroid hormone without feeling hyper. Over the next six months, I regained all the weight lost and some more. Doctors said it was physically impossible without overeating. Just shows how much they know.

I notice that I seem to need less T4 and more T3 as I have become more hypo due to loss of thyroid tissue (I have atrophic thyroiditis).

RT3 is a controversial subject. Some will say it is inactive and does not block T3 from entering cells, while others say that it does. But some people feel better on less or no T4. And some feel great on NDT and first and then end up symptomatic again. I often wonder what the point is of taking a lot of T4 the body cannot use…? The late Dr. Peatfield said the body can become toxic with unused T4.

[pennyannie in reply to Hidden]

As I understand things you can live without T4 but you can't live without T3 :

T4 - is inert, a pro-hormone - and stored in the body waiting to be converted into the active hormone - T3 - when and if needed - and if not needed it becomes reverse T3 and ultimately broken down in the body and excreted.

My T4 is now only around 25% through the range with my T3 at around 90/110% :

I'm post RAI thyroid ablation 2005 and without a fully functioning thyroid and with no natural thyroid hormone production of my own - on ' manual ' rather than automatic control -

and as I run a low T4 - there is no risk of my becoming hyper as I'm not carrying any excess thyroid hormones and converting well into T3 the 57 mcg T4 content in my daily NDT dose

[Hidden in reply to pennyannie]

So you only take 1,5 grains of NDT?

[pennyannie in reply to Hidden]

Yes:

However I'm likely at a very different stage in my life - 77 - retired, living alone and having no pressure put on myself apart from the rain dictating when I need to mow my lawns !!

i have read that without a thyroid it's likely you do not need so much thyroid hormone replacement.

Bed by 10 up at around 5/6 am and better for a 10 minute catnap after my main meal at around 1,00 pm - and my BB time of day is in the AM :

[Hidden in reply to pennyannie]

Wow, I would have thought it was the other way around…!

Glad you found something that is working for you😊. Given the price of NDT, that must be a relief. Dr. Peatfield says in his books that a common replacement dose of NDT is 1-2 grains. That always sounded low to me…but maybe he knew what he was talking about…!

[pennyannie in reply to Hidden]

Oh - I read the book but don't remember reading this but I was very unwell at the time ( RAI thyroid ablation consequences ) and my dyslexia the worst it had ever been in years -

I was writing everything out I thought relevant - several times over so to try and remember its relevance - just like you would do when in detention at school -

I've around 4 x A 4 lined school exercise books full of ' my light bulb moments ' which all came on together when I eventually started NDT and then found myself with enough T3 that my dyslexia not a constant challenge, the suspected dementia gone, and my health and well being slowly improving over around the next 18 months.

[sparkly]

Hi, not sure of your age but could peri/ menopause be an issue?Also with Dr starting you on metformin do you fit the criteria for metabolic syndrome?

I understand how soul destroying it is unable to lose weight when your diet is good and you exercise

[Tiredofthis77 in reply to sparkly]

I’m 47 but took some tests recommended by my doc to see if perimenopause was the problem. Results said it wasn’t that.

Looking at the symptoms of metabolic syndrome I don’t think I’m a candidate. Well I hope not anyway. Thank you for responding.

[sparkly in reply to Tiredofthis77]

Perimenopause is based off symptoms rather bloods as these are not reliable due to constant change of oestradiol levels. Symptoms of peri vary but this a just a few of the common ones. Anxiety, stress, mood swings, depression, anger, lighter/ heavier/ more frequent/ less frequent periods, night sweats, hot flushes, aches and pains, weight gain with no change of diet, hair changes/loss, loss of libido..the list goes on.

I'd never even heard the word perimenopause when I had obviously been going through it so knew nothing and blamed my thyroid when it was my sex hormones causing the issues.

Have a read up and learn as much as you can. Sex and thyroid hormones can have a rocky relationship and I feel we sometimes blame thyroid when actually perimenopause is the culprit or later on post menopause.

Just something to keep in the back of mind if things start to change

[Tiredofthis77 in reply to sparkly]

I’ll do some reading. Thank you