Weight loss injections

[Salkas]

Dear thyroxine patients.Anyone tried mounjaro injections for weight loss with hasimotos?

[SlowDragon Administrator]

looking at previous post, you only just started on standard STARTER dose levothyroxine of 50mcg

Dose levothyroxine will be slowly increased in 25mcg steps over next year or so

Thyroid levels should be retested 6-8 weeks after each dose change or brand change in Levo

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)

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

NHS only tests TG antibodies if TPO are high

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Essential to test vitamin D, folate, ferritin and B12

Lower vitamin levels more common as we get older

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels

What vitamin supplements are you taking

How old are you and approximately how much do you weigh in kilo

[SlowDragon Administrator]

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 somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

nhs.uk/medicines/levothyrox...

Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.

Some people need a bit less than guidelines, some a bit more

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).

sciencedirect.com/science/a...

The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg

[Salkas in reply to SlowDragon]

Thanks

[Tina_Maria]

As slowdragon has pointed out, you are still on a very low dose of levothyroxine and if you have been under-medicated for a while, this is the reason why you have put on weight, as your metabolism is slowed down.

A replacement dose you should work towards is 1.6 mcg levothyroxine per kg of weight (as stated in the NICE guidelines on levothyroxine therapy) and your GP should comply with these guidelines. So for example if someone weighs 80kg, they should be on 128 mcg levothyroxine, once they are fully titrated up. If you have been on 50mcg for 6-8 weeks, you need another blood test to see where you are and then have another 25 mcg increase. Same after that increase until you reach your full replacement.

In many people, the weight will come down once you are on the correct dose, as you will have sufficient T3 concentrations to kickstart your metabolism.

I would not consider taking a weight loss jab, until your thyroid hormones are fully adjusted. At present, this is a metabolism problem, not a dietary problem, hence you need to address the lack of thyroid hormones first.

[Salkas in reply to Tina_Maria]

Thank you. I have a feeling endo will think that dose is very high. Do most people reach that NICE guidelines?

[Tina_Maria in reply to Salkas]

Each of us is different, so it is not a hard and fast rule, but if you are having symptoms (and I read in a previous post that you have), your dose should be increased according to those guidelines.

If you feel good with a lower dose, that's great too, and some people might even need some more, but your free T4 and free T3 should be your guide and certainly not TSH being somewhere in the wide range.

As an example, I weigh 58 kg, so according to the guidelines I would need 92.8 mcg of levothyroxine. I am on 100 mcg levothyroxine, where my T4 is near the top and the T3 around 75% through the range. Only this way I feel okay. My GP tried to reduce my dose to 87.5 mcg (based on a low TSH), it did not go well and I had severe symptoms. All these disappeared, once I was on the correct higher dose again.

I have included the NICE guidance for you, which you can show your GP, if he refuses an increase:

cks.nice.org.uk/topics/hypo...

Under-medication is in most cases the root cause of all problems and symptoms, hence it is so important to sort out your thyroid hormones before addressing anything else.

[Salkas in reply to Tina_Maria]

Understand. My worry is not the GP but the endocrinologist. If endocrinologist says I'm in range range being 0.5-4.0 tsh.

How do I combat this as my understanding is that at 3.8 I have low thyroid symptoms. Including low body temp, weight gain, depression, tiredness and slight bradycardic Heart rate. All which are congruent with low thyroid tsh. But I'm not truly confident endocrinologist will listen if I say I'm not at optimum 0.5 -2.0tsh.

[Tina_Maria in reply to Salkas]

Even an endocrinologist has to go by the guidelines and if you have symptoms and you have not been titrated up, he should agree to an increase in medication. You could soften the blow and say that you would like to do a trial increase and see how you respond.

If your GP is more understanding, I would ignore the endocrinologist and discuss this with the GP? In any case, the guidelines are on your side here and you have a good argument that you have not reached your full replacement or are even near it - since they are sticklers to ranges and guidelines in general, you can turn it on the head and argue that they are not fulfilling their guideline obligation in your case, even when the TSH is apparently in range, especially as you have symptoms, which indicates sub-optimal replacement.

You do need to stand up for yourself and be prepared to argue for your treatment. I know it is difficult when you feel they are all against you, but without advocating for yourself, you will not get out of the vicious cycle. Be strong - you can do it!

[Salkas in reply to Tina_Maria]

Thank-you. I'm prepared to fight if need be. Just can't be arsed with the stress lol. I want to find evidance somewhere where it explains why if treated on levo that needs to be brought to range of 0.5-2.0

[helvella Administrator in reply to Salkas]

How about starting with this?

This is a link to a very good article in the British Medical Journal discussing what the 'normal range' really is. Very readable.

The normal range: it is not normal and it is not a range

This blog has the abstract of this paper plus link to the original full paper. Also includes some extra links to a video and some other related information.

Last updated 03/10/2024

helvella.blogspot.com/p/the...

[SlowDragon Administrator]

When dose of Levo is first increased, TSH drops

After 2-3 months on starting dose …..your body is ready for next increase and TSH will start to creep upward

The most important results are ALWAYS Ft3, followed by Ft4……and essential to maintain GOOD vitamin levels.

Medics will only test/treat vitamin deficiencies

Down to you to test and maintain GOOD levels

A referral on NHS to endocrinologist

A) typically takes a year or more

B) if TSH is “normal “ often nothing else is tested and referral will be refused

C) vast majority of endocrinologist are diabetic specialists, not thyroid

Next step

Get FULL thyroid and vitamin testing 2-3 months after each dose increase

ALWAYS test early morning and last dose levothyroxine 24 hours before test

Pay attention to brand of Levo, especially when dose is increased

Many patients find different brands are not interchangeable

Only change one thing at a time ……dose or brand….not both

[Salkas]

Thanks. My endo requested bloods at 6 week mark which is fine but only requested tsh and t4. I asked if they will do free t3, they said no.