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Suggest Remedy For Weight Loss When On Synthyroid
Question: Hello, I am a 44yo female. I have been diagnosed with Hashimoto's for 15 years (confirmed with FNA). I do have a benign nodule on the right that on ultrasound is the same size as one of my other thyroid lobes- otherwise uneventful on ultrasound.
I am currently taking Synthroid 150mcg and Cytomel 5mcg. I exercise 5 days/wk, keep track of steps/calorie intake…can not seem to budge weight. In fact, I have gained another 10 pounds in the past month. I feel terrible: tired, foggy, some hair loss, heavy, regular menstrual periods (but bleeding only 4 days)- all of my normal hypo symptoms but I have HOT FLASHES. Also, I am a nurse- I work 12 hours shifts. I routinely have 2-3+ pitting edema (tibial) by night time. I diurese all night, or when I have a day off. I rarely sleep well.
My labs this week:
TSH 0.45
FT4 0.8
FT3 2.4
TPO 650
Please help. I have got to lose this weight, I am miserable. There is no way I am taking in the calories required for this weight gain. We are currently overseas military stationed in Yokosuka, Japan….there are only family practice and internal medicine physicians here- no endo's. My FP wants to decrease my Synthroid, says that my labs are otherwise normal.
I am currently taking Synthroid 150mcg and Cytomel 5mcg. I exercise 5 days/wk, keep track of steps/calorie intake…can not seem to budge weight. In fact, I have gained another 10 pounds in the past month. I feel terrible: tired, foggy, some hair loss, heavy, regular menstrual periods (but bleeding only 4 days)- all of my normal hypo symptoms but I have HOT FLASHES. Also, I am a nurse- I work 12 hours shifts. I routinely have 2-3+ pitting edema (tibial) by night time. I diurese all night, or when I have a day off. I rarely sleep well.
My labs this week:
TSH 0.45
FT4 0.8
FT3 2.4
TPO 650
Please help. I have got to lose this weight, I am miserable. There is no way I am taking in the calories required for this weight gain. We are currently overseas military stationed in Yokosuka, Japan….there are only family practice and internal medicine physicians here- no endo's. My FP wants to decrease my Synthroid, says that my labs are otherwise normal.
Brief Answer:
Thyroid
Detailed Answer:
Sorry to learn about the challenges with weight gain.
It is nice to note you are a nurse.
I also understand the lack of your access to an endo while stationed abroad.
1 You have compelling symptoms suggestive of hypothyroidism. However, the symptoms of hypothyroidism are notoriously non specific. So as much as we acknowledge their presence, ultimately it is the TSH and free T4 that guide us in terms of decision making.
2 Your thyroid labs seem fine, except that free T3 is not an accurate method to determine T3 levels in blood. It is not necessary to monitor it anyway.
3 Cytomel is not generally recommended by thyroid experts. Synthroid alone is deemed sufficient.
4 You have clear evidence of Hashimoto's, I agree.
5 The nodules on ultrasound appear stable as you are saying. It is good they tested benign on FNA
6 See if you can discuss the possibility of running two more tests with your doctor to rule out 2 rare causes of weight gain.
A) Acromegaly
The screening test for this is called IGF1
B) Cushings syndrome
You can either do a midnight salivary cortisol, or the 1 mg Overnight Dexamethasone Suppression tests.
Be careful in interpreting the results because owing to your shift work, the levels may be abnormal at conventional times
Thyroid
Detailed Answer:
Sorry to learn about the challenges with weight gain.
It is nice to note you are a nurse.
I also understand the lack of your access to an endo while stationed abroad.
1 You have compelling symptoms suggestive of hypothyroidism. However, the symptoms of hypothyroidism are notoriously non specific. So as much as we acknowledge their presence, ultimately it is the TSH and free T4 that guide us in terms of decision making.
2 Your thyroid labs seem fine, except that free T3 is not an accurate method to determine T3 levels in blood. It is not necessary to monitor it anyway.
3 Cytomel is not generally recommended by thyroid experts. Synthroid alone is deemed sufficient.
4 You have clear evidence of Hashimoto's, I agree.
5 The nodules on ultrasound appear stable as you are saying. It is good they tested benign on FNA
6 See if you can discuss the possibility of running two more tests with your doctor to rule out 2 rare causes of weight gain.
A) Acromegaly
The screening test for this is called IGF1
B) Cushings syndrome
You can either do a midnight salivary cortisol, or the 1 mg Overnight Dexamethasone Suppression tests.
Be careful in interpreting the results because owing to your shift work, the levels may be abnormal at conventional times
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Without the Cytomel, my FT3's were never in range, I felt much worse…so I have to respectfully disagree with you on that one. My stateside endo tried to keep it around 3.0-3.2 with the addition of the Cytomel, and I felt great. You would not try a trial of increased Cytomel dosing?
The only two times I ever felt like this (minus the hot flashes) were about 3-4 months postpartum. I had hyper swings at that time period after both pregnancies. Do you think any of this could be age/hormonally related?
Also, 3 months ago my TSH was almost 4- on the same dose. I just do not feel right.
The only two times I ever felt like this (minus the hot flashes) were about 3-4 months postpartum. I had hyper swings at that time period after both pregnancies. Do you think any of this could be age/hormonally related?
Also, 3 months ago my TSH was almost 4- on the same dose. I just do not feel right.
Brief Answer:
Follow up
Detailed Answer:
The vast majority of endocrinologists including myself do not believe in prescribing Cytomel.
I can understand the hot flashes are bothering you. But if your periods are regular then you dont have premature menopause as the explanation for that. And if your TSH and free T4 are at goal then it is not the thyroid either.
The TSH of 4 three months back is a tad high. So its understandable that you didnt feel right. I generally aim for a TSH of 0.4 to 2 with free T4 towards the higher end of the normal range. There are a few exceptions to this though such as an individual with
1 Severe untreated osteoporosis
2 Heart problems such as chest pain or irregular heart rhythm
In these cases, the TSH target is more lenient
Follow up
Detailed Answer:
The vast majority of endocrinologists including myself do not believe in prescribing Cytomel.
I can understand the hot flashes are bothering you. But if your periods are regular then you dont have premature menopause as the explanation for that. And if your TSH and free T4 are at goal then it is not the thyroid either.
The TSH of 4 three months back is a tad high. So its understandable that you didnt feel right. I generally aim for a TSH of 0.4 to 2 with free T4 towards the higher end of the normal range. There are a few exceptions to this though such as an individual with
1 Severe untreated osteoporosis
2 Heart problems such as chest pain or irregular heart rhythm
In these cases, the TSH target is more lenient
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So, you believe that 0.8 (the very bottom of the range- 0.8-1.6) is target? Three months ago when my TSH was 4, my FT4 was 0.7. My FT3 is bottom of range as well. I understand that you don't believe in Cytomel. My previous endocrinologist, Dr. Ghobad Azizi did, and I felt a huge improvement after starting to take it.
I appreciate your suggestions above. Anything else that you can think of? You don't prefer the FT4 to at least be in range or above the bottom of the range?
I appreciate your suggestions above. Anything else that you can think of? You don't prefer the FT4 to at least be in range or above the bottom of the range?
Brief Answer:
Second follow up
Detailed Answer:
I have mentioned above that I like to see FT4 closer to the upper end of the normal range. So yes your FT4 of 0.8 is definitely on the low normal side.
But your TSH is also 0.45 concurrently and that is most likely due to the effect of Cytomel. If you were to discontinue Cytomel, then there would be considerable room to increase your Synthroid dose in order to increase your FT4 levels without pushing the TSH too low.
Second follow up
Detailed Answer:
I have mentioned above that I like to see FT4 closer to the upper end of the normal range. So yes your FT4 of 0.8 is definitely on the low normal side.
But your TSH is also 0.45 concurrently and that is most likely due to the effect of Cytomel. If you were to discontinue Cytomel, then there would be considerable room to increase your Synthroid dose in order to increase your FT4 levels without pushing the TSH too low.
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. Chakravarthy Mazumdar
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