Gained 10 lbs without changing diet

[Jenn1302]

I’ve gained 10 lbs over the past year even though I eat the same and work out a lot. My clothes fit the same but I’m a bit concerned. I've had Hashimotos antibodies for years now and I was borderline hypo 3 years ago. 4-5 years ago when I was hyperthyroid I lost 10 lbs. Now I gained 10 lbs without changing anything and I suspect that I may be hypo.

This weight is not normal for me and some of my other conditions have been flaring to the point where they’re worse than they’ve ever been. My heart PVCs and stomach symptoms have gotten worse than ever as of late. Last time my thyroid was checked my TSH was over 3 but no one seemed to care because it was under 4. I’m not sure what to do.

[gimel]

With Hashi's sometimes the person will go through a hyper period and thens switch to being hypo.  Refraining from taking thyroid med is the wrong thing to do.   The med will drop your TSH level and reduce your output of natural thyroid hormone.  Since serum thyroid levels are the sum of both natural and thyroid med, when the med dosage is high enough to essentially suppress TSH,  further dose increases will start to raise your serum levels toward symptom relief.  At that point your serum thyroid levels  will be fully dependent on the thyroid med.

There is an old saying, "If you do what you did you will get what you got."  LOL  You are going to have to get your PCP on board by giving her info like I mentioned, or else you will need to find a good thyroid doctor.  Otherwise your symptoms are only going to get worse.    

[Jenn1302]

Thank you so much for your response. I could try to talk to my PCP but I'm a bit hesitant to start taking T4 because my thyroid tends to fluctuate a lot and occasionally it goes closer to hyper/hashimotoxicosis. Also my PCP tends to be pretty strict when it comes to medication and I'm not sure I'm going to be able to get her on board.

[gimel]

You don't necessarily need a specialist.  Take the one page overview I mentioned above and give it to your PCP and explain that you have many symptoms of being hypothyroid.  Explain that symptoms are the most important for diagnosis of potential hypothyroidism, confirmed by Free T4 and Free T3 levels in the lower part of their ranges.   You also have Hashi's and should not delay treatment until your thyroid hormone levels are actually bad enough to be out of range.   And ask to be started on 50 mcg of T4, which I am sure is all that the doctor would potentially agree with doing as a start.    If this works for you, stay in touch and we can continue to help guide you.

[Jenn1302]

Thank you for your informative response. I wish I had access to a good thyroid doctor but I only get to see the specialists my PCP refers me to. I haven't been referred to an endocrinologist because my labs are "normal" and I'm a broke student so I can't afford to pay out of pocket.

[gimel]

First thing to understand is that even though most doctors believe that a TSH is all they need to know to diagnose and treat a potential hypothyroid patient.  that is totally incorrect.  TSH is a pituitary hormone that supposedly accurately reflects levels of the actual thyroid hormone Free T4.  In reality TSH is affected by so many things that it is useful as a diagnostic only when at extreme values, either high or low, and only when a patient is in the untreated state.   TSH has only a weak correlation with Free T4 or Free T3, the biologically active thyroid hormones, and a negligible correlation with symptoms, which is the patient's concern.  

A good thyroid doctor will diagnose a potential hypothyroid patient first by evaluating for symptoms that occur more frequently with hypothyroidism.  If such symptoms are present, then the next step should be confirmation with biochemical tests.   Those tests should include Free T4, Free T3, Reverses T3 at least at the beginning, cortisol, Vitamin D, B12 and ferritin.    To assess FT4 and FT3 test results, note the words of an excellent thyroid doctor,In the words of a good thyroid doctor, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."   So basically if FT4 and FT3 are in the lower half of their ranges, hypothyroidism should be suspected and treatment with thyroid med initiated.    

In addition,  Reverse T3 is a mirror image  molecule of T3, but RT3 is biologically inactive.  RT3 is a normal product of conversion of T4, but if excessive, it can interfere with metabolization of FT3.  So if RT3 is at high end of range, it can sometimes be a problem to be addressed.  Cortisol should be neither too low or too high.  Vitamin D, B12 and ferritin are also important for a possible hypothyroid patient, so they also need to be optimal.   D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

Since your doctor is fixated on TSH, you will need to either change his practice, or find a doctor that will diagnose as outlined above and treat clinically, by adjusting Free T4 to mid-range, and Free T3 to the upper third of its range.  If you want to try changing the doctor's practice, please click on my name and then scroll down to my journal and read the one page overview of a paper on Diagnosis and Treatment of Hypothyroidism" A Patient's Perspective, and note the link to the full paper.