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What Causes Difficulty In Losing Weight With Low TSH Level?

Posted on Mon, 23 Jun 2014

Question: Hello - I am wondering if I have Grave's Disease. I see that some people GAIN weight not lose weight with it. I have puzzled many doctors: I have normal T3, T4, free T3, free T4 and a low TSH of .4 to .7 in the face of hypothyroid symptoms and all of them. I recently had a TSH of .07. I would have much more to tell you but just wondering what tests I should have to find out why I cannot lose weight (exercise, organic food, good clean diet, etc) and yet cannot lose the needed 30 lbs. No one can give me an answer about my TSH. I basically want to know which thyroid tests I should have besides the usual ones. I would like to know any suggestions as to leads I can follow for diagnosis. I have been to doctors who range from totally uneducated in thyroid issues (but purport to be) to ones who would like to help but don't have enough knowledge. I have a high IQ, do lots of research, and have medical books, and I still have no answer as to the weight loss and fatigue. I have a primary doctor who is Chief of Staff of a clinic and hospital, is very intelligent and thinks out of the box, and who practices traditional doctoring and also functional medicine. He has not said too much about my TSH and has not suggested any extra tests. I have not yet had TSI, TSAb, TBAb, TG, T7, TRH, Thyroglobulin antibodies, anti-thyroid antibodies. I have had all the other thyroid tests, including rT3. I had high rT3 at one time, but taking 5 mcg of liothyronine daily eliminated that long ago. I have been taking 5 mcg of T3 for energy and that has NOT raised my TSH in 2 1/2 years. But now I am at a very low .07 and so I discontinued taking it. Thanks, XXXXXXX

Answered by Dr. Raju A.T (11 hours later)

Brief Answer:
Need some more details

Detailed Answer:
Hi,

Thanks for your query.

The symptoms related to any sort of thyroid hormone imbalance depends on the levels of circulating T3 and T4 and not Tsh. Tsh level is a good but indirect indication of the thyroid status.

Normal T3 and T4 levels and low Tsh indicates Hyperthyrodism, but in a compensatory phase. The feedback thyroid inhibition good and active for now, once the feedback mechanisms fails to compensate then the free T3 and T4 start shooting up resulting in symptoms and effects of hyperthyroid state which may include weight loss, restlessness etc.

I would like to know for how long where you on the 5 mcg of liothyronine ?

If on any medications for long time please do mention the same.

I would also consider a need to rule out Subclinical Hypopitutarism. For the same you may need to get Serum ACTH, Serum Cortisol, Serum IGF1 and Serum LH .

The thyroid tests you mentioned above may not be of much help in a well compensated thyroid status.

I shall guide you further, kindly provide the details I asked and please do attach the reports of the tests you got done recently.

Waiting for your response,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Raju A.T (17 hours later)

Hello Dr. XXXXXXX

I am working outside planting and need to get back out, but will give you a few facts now and then provide the rest this evening when I am through working.

I was on 2.5 mcg of liothyronine for two months beginning XXXXXXX 26, 2012. In August 24, 2012 I began the 5 mcg liothyronine and have been on this up until two days ago.

I had IGF1 done recently and the LH, Cortisol done this year some time. The ACTH is probably from last fall. How recent do they need to be? Do they need to be run from the same blood sample, same day?

I will get back to you with more information.

Sincerely,
XXXXXX

Answered by Dr. Raju A.T (5 hours later)

Brief Answer:
Could be the effect of Liothyronine

Detailed Answer:
Hi,

Thanks for the information.

The low Tsh normal T3 and T4 could be a effect of Liothyronine dosage. I would prefer a Thyroid hormone test 2 months after stopping the Liothyronine completely. The levels after such a period can be considered reliable.

The LH, cortisol and ACTH if are of the times when the Tsh showed low, then can be considered reliable. If they are normal then hypopitutarism can be ruled out.

I shall wait for some more information which may help me to conclude.

Waiting for your response,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Raju A.T (14 hours later)

I wrote several paragraphs of information, sent it off, they asked for a new password, and I lost all that I wrote. I did get off test results for you.

I do not take any daily required drugs. I use valium 5 mg sparingly and occasionally for insomnia - one RX per year. I use fioricet one RX every two years for MCS headaches - exposure to inhalant chemicals.

I have gene mutations 667 and 1298 to MTHFR. I have experienced alopecia three years ago in August. I was sleeping very well and losing weight and then recently I began to sleep just every other night. When I have not slept most of the night, the next day I am very very sick feeling and also 'wired and tired' and can barely function.

If I ask for the LH, cortisol, ACTH, and IGF-1 do I have a window of opportunity whereby they need to be done, considering my very low TSH of .07? I just recently had the LH and IGF-1 done so would not want to repeat them unless they are needed to be done concurrently with LH and cortisol. Please let me know as I doubt Medicare will pay for them being done so close together. If you feel strongly that I might have hypopituitarism then I will be very happy to have them done and pay out of pocket.

Thank you,
XXXXX

Answered by Dr. Raju A.T (4 hours later)

Brief Answer:
Do not test now

Detailed Answer:
Hi,

Thanks for the information.

Any of the medications you have taken apart from Liothyronine could have any effect on the Thyroid status.

I strongly believe the present Tsh could be due to influence of the Liothyronine you were on til recent days, the other possibility is that you could be in a compensatory phase of the hyperthyroidism.

All I ask you is to wait for a period of 2 to 3 months, not taking any thyroid related medications and then get the Tsh, T3 and T4 estimation. The time period is to wait for the Liothyronine effect to wane of or the compensatory phase to give off. If Tsh then seems to be on lower side then you may have to get the pituitary hormone levels estimated.

Hope, I answered your query.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Raju A.T (14 hours later)

Dr XXXXXXX

Would you please explain what the compensatory phase of the hyperthyroidism is? I did go on NIH site but did not find a definition of that phrase.

Upon that, I will conclude as you have helped and I appreciate that.

Sincerely,
XXXXXXX XXXXXXX

Answered by Dr. Raju A.T (2 days later)

Brief Answer:
Its a transient phase of balance

Detailed Answer:
Hi,

Thanks for writing back.

Sorry for the delayed response.

Imbalance in Tsh does not cause the symptoms, its the thyroid hormone imbalance which is responsible for symptoms. Tsh is a hormone from the pitutary which stimulates the thyroid gland to release the thyroid hormones.

In people with either low or high levels of thyroid hormones (T3 T4) the pitutary tries to compensate or cope with the imbalance by changing the production of the Tsh and inturn the thyroid hormones. In the beginning for few months or years this process actually works well by either down-regulating or increasing the amount of Tsh which stabilize the thyroid hormone levels. At this time the Tsh levels will be out of range but the thyroid hormones will be within range and there will be no clinical features of the imbalance. This compensation doesn't long enough. Once this compensation fails the person starts showing symptoms of hypo or hyperthyroidism.

Hope, I answered your query.

Wish you good health.

Regards,

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar