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I Am A 220lb / 5’8” Woman In Her 40s.
Question: I am a 220lb / 5’8” woman in her 40s.
For YEARS I’ve been working with my doctor to try to find out why I’m gaining weight when I eat 1400-1600 calories a day (more typically makes me feel ill). I’ve even sat with a nurse who works with diets of people in pre-diabetes (my blood sugar levels are optimal, we’re just running out of ideas) and she evaluated my diet and activity levels and said the were just fine.
On top of this, recently I had a bout of dysphasia which was making it difficult to eat. When I DID eat solid food, the feeling of things caught in my throat cause me to throw it up. I was getting so few nutrients for long enough I could barely get out of bed, my skin was dry, and my hair was thinning. (I’m eating now but still have some swallowing issues).
During these months of eating next to nothing, I STILL didn’t lose weight.
My TSH levels are perfect. Cholesterol. Blood pressure. Kidney function. No indication of inflammation. They only things out is a high iron level and extreme bradycardia (30-40bpm)
The doctor will not do a thyroid panel because of my right smack in the middle of normal range TSH and, here, you need a referral to an endocrinologist (which I can’t get because of my damn TSH), though I can assure you I have almost all textbook symptoms of a hypothyroidism.
Any advice? I don’t know what else to do and this weight is not healthy.
For YEARS I’ve been working with my doctor to try to find out why I’m gaining weight when I eat 1400-1600 calories a day (more typically makes me feel ill). I’ve even sat with a nurse who works with diets of people in pre-diabetes (my blood sugar levels are optimal, we’re just running out of ideas) and she evaluated my diet and activity levels and said the were just fine.
On top of this, recently I had a bout of dysphasia which was making it difficult to eat. When I DID eat solid food, the feeling of things caught in my throat cause me to throw it up. I was getting so few nutrients for long enough I could barely get out of bed, my skin was dry, and my hair was thinning. (I’m eating now but still have some swallowing issues).
During these months of eating next to nothing, I STILL didn’t lose weight.
My TSH levels are perfect. Cholesterol. Blood pressure. Kidney function. No indication of inflammation. They only things out is a high iron level and extreme bradycardia (30-40bpm)
The doctor will not do a thyroid panel because of my right smack in the middle of normal range TSH and, here, you need a referral to an endocrinologist (which I can’t get because of my damn TSH), though I can assure you I have almost all textbook symptoms of a hypothyroidism.
Any advice? I don’t know what else to do and this weight is not healthy.
Brief Answer:
About obesity causes and treatment;
Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.
Your very slow metabolism can be a result of different causes ( genetic predisposition, altered gut microbiome, Cushing syndrome, absence of physical activity ect).
Of course the thyroid panel should include Ft4 and Ft3 too, as your symptoms are consistent with hypothyroidism.
A dexamethasone supression test is also suggested.
If diet and physical activity do not work, than you may discuss with your physician to start trulicity ( one injection per week) to loose weight.
BMI should over 40 for bariatric surgery as you do not have chronic complications of obesity.
Hope the information will help.
Best wishes,
Dr.mirjeta
About obesity causes and treatment;
Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.
Your very slow metabolism can be a result of different causes ( genetic predisposition, altered gut microbiome, Cushing syndrome, absence of physical activity ect).
Of course the thyroid panel should include Ft4 and Ft3 too, as your symptoms are consistent with hypothyroidism.
A dexamethasone supression test is also suggested.
If diet and physical activity do not work, than you may discuss with your physician to start trulicity ( one injection per week) to loose weight.
BMI should over 40 for bariatric surgery as you do not have chronic complications of obesity.
Hope the information will help.
Best wishes,
Dr.mirjeta
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you for your answer. While I’m finding it a bit general (i.e. mentioning physical activity multiple times when I mentioned a medical professional has reviewed my activity levels and found them sufficient) I was wondering if you could expand on a few items:
1. Altered gut microbiome: what would be your suggestion for this? I have taken high count probiotics repeatedly to no effect. I would be interested in knowing if there was something else to try.
2. Your answer mentions a thyroid panel, but my doctor has refused to pull one because of my TSH levels (stated in post). Do you have any suggestions about this?
3. You mention Trulicity, but the drug company’s own site says that research patient’s lost only 2-6lbs on this drug and says it is not effective for weight loss. Could you expand on the reason for this suggestion?
4. In the event of a genetic predisposition, what would your advice be?
1. Altered gut microbiome: what would be your suggestion for this? I have taken high count probiotics repeatedly to no effect. I would be interested in knowing if there was something else to try.
2. Your answer mentions a thyroid panel, but my doctor has refused to pull one because of my TSH levels (stated in post). Do you have any suggestions about this?
3. You mention Trulicity, but the drug company’s own site says that research patient’s lost only 2-6lbs on this drug and says it is not effective for weight loss. Could you expand on the reason for this suggestion?
4. In the event of a genetic predisposition, what would your advice be?
Brief Answer:
About treatment of obesity;
Detailed Answer:
Hi again,
After excluding hormonal imbalance as a cause of obesity, there are many theories today ( like alterations of instinal microbiome , genetic mutations ect) that do not have any specific treatment yet ( except of bariatric surgery that may be efficient due to alteration of microbiome and improvement of hormonal production by gastric fundus).
So, the idea is that the cause of weight gain or difficulty to loose is still mysterious.
But of course thyroid panel ( you can probably do it privately) and dexamethasone supression test should be done to exclude known causes.
I apologize for trulicity, my intention was for saxenda ( liraglutide 3 mg) that is approved by FDA as anti-obesity drug and can help to loose 5-10% of your weight in 1 year.
So, you can discuss with your physician again about the above exams and treatment with Saxenda.
Wish you good health.
Best wishes,
Dr.mirjeta
About treatment of obesity;
Detailed Answer:
Hi again,
After excluding hormonal imbalance as a cause of obesity, there are many theories today ( like alterations of instinal microbiome , genetic mutations ect) that do not have any specific treatment yet ( except of bariatric surgery that may be efficient due to alteration of microbiome and improvement of hormonal production by gastric fundus).
So, the idea is that the cause of weight gain or difficulty to loose is still mysterious.
But of course thyroid panel ( you can probably do it privately) and dexamethasone supression test should be done to exclude known causes.
I apologize for trulicity, my intention was for saxenda ( liraglutide 3 mg) that is approved by FDA as anti-obesity drug and can help to loose 5-10% of your weight in 1 year.
So, you can discuss with your physician again about the above exams and treatment with Saxenda.
Wish you good health.
Best wishes,
Dr.mirjeta
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Yogesh D
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