Hashimoto & surgical weight loss, have labs

[Chris_monster]

Hoping someone can give ideas on how I might proceed. Been treated with levothyroxine for hashimoto's over 15 years and levels prior to surgery were fine even if I was freezing,  swollen face and steady weight gain. I asked pcp and endo to try me on natural thyroids and off synthetic and neither of them would because on 112mcg of synthroid my tsh level was 1, like perfect score.  Pcp said at the time that the dosage varied too much  and wouldn't try other options.

I have a lot of health problems  and was told by pcp, neurologist, and endocrinologist to pursue weight loss surgery. Had Roux-en-y (gastric bypass)  at beginning of December.  I lost 20 lb in December but since January (over a month) I haven't lost any on 500 calories a day and exercising, least not hungry . Seriously went back to doctors and there measurements were loss of 1 ounce, very disappointed . Nutritionist wanted new thyroid messurements due to absorbtion issues after bypass. Went to pcp and luckily saw different doctor that ran more extensive labs then my normal pcp who I really like and won't change him.

While taking 112mcg of levothyroxine these are levels.
TSH : 15.26 (range 0.5-5)
T4 Free: 1.08 (range 0.89-1.76)
T3 Free: 2.4 (range 2.3-4.2)
Thyroid peroxidase antibodies:  349 u/ml
Thyroglobulin antibodies: 6 (range <4)

So it does sound like thyroid is preventing weight loss even right after weight loss surgery, thank goodness for super smart nutritionist and not blaming me.
My concerns are if anyone knows which thyroid is not fat soluble or easiest to digest. Would it be better for me to try something other then synthroid since I was symptomatic with perfect tsh score previously.  I have no experience with any thyroid med other then levothyroxine and if I'll want my normal pcp to prescribe anything different. .i'm gonna have to be armed with information and insist like crazy.  
Any help would be appreciated.

[Red_Star]

My mother has adrenal fatigue so her cortisol isn't high (high cortisol raises blood sugar and therefore insulin).  She has lost weight with untreated hypothyroidism since cutting out all simple carbs except fruit (which contains fibre so that's okay).

She doesn't eat a lot of carbs in general; traditional rolled oats for breakfast, if she eats bread which isn't often it is Burgen bread with low GI on the label.  The faster carbs are digested the more it spikes blood insulin levels.

"Insulin shunts sugar to fat. Period. Insulin makes fat. Period. More insulin, more fat. Period. Insulin drives weight gain." - Dr Lustig.

You cannot gain weight without insulin in other words. Period. :)

Excerpt from Hypothyroid and Weight Issues–how to tackle it...

"So I’ve asked other patients over and over ‘”what do you eat?” And I’ve compiled a resource of answers from an embarrassingly large compilation, and culled out all the “losers”. So with those patients who did lose and maintained the loss, whether they are optimal on thyroid meds or not, I found out what they are doing.

First, most of the people have lowered their carb intake–stopped the incoming sugar as well as most anything white. Surprisingly, the majority are eating about 40 to 50 net grams carb a day (ages: 35 to 75)."

[goolarra]

Yes, your FT3 and FT4 are very low at the moment, so you will need an increase, and/or you will need to change the delivery system so that your meds actually make it to your blood stream.  

Until your symptoms are resolved, you should be tested every 4-5 weeks, see your doctor after that, evaluate test results, re-evaluate symptoms and adjust meds as necessary.  You should stay on a schedule similar to that until you feel well and have not made any changes for a couple of testing cycles.  After that, you can spread the timeframe out a little.

Your PCP is a little out of touch...if he's responsive to teasing, go for it!  LOL

I suggested the gelcap because I thought it might be easier to take sublingually.  My endo was really excited when Tirosint came out because he saw its potential for his patients who take their meds sublingually.  Of course, no matter how you take it, you should consult your nutritionist.

Best of luck.  Let me know what your doctor has to say and what approach you decide to take.  

[Chris_monster]

Thank you very much for your fast response and information. I can expect now based on your response that I should expect them to raise amount of levothyroxine,  and to retest me and go from there. I'll insist on those 3 tests from now on. Maybe tease my pcp that he's outta touch, lol.

It's just time consuming and the surgery only really helps people lose for 18 months. I shoulda known better, I knew I was only eating 800-1000 calories before surgery and not losing weight. I just had higher hopes based on the gastric hormone changes after surgery.  

  I'll ask nutritionist if gel capsule would be okay, a lot of medications you think would be okay just aren't. When I first had surgery I had to crush the levothyroxine and it really didn't taste bad in comparison to other stuff: ) Unaware I could take it under tongue or woulda done that then and will look into it now.

Thank you again

[goolarra]

I'm glad you lucked into the different doctor who did more extensive testing.  Both FT3 and FT4 are low in range, especially FT3.  T3 controls metabolism to a large extent, so that's probably part of why you haven't lost any more weight.

"Would it be better for me to try something other then synthroid since I was symptomatic with perfect tsh score previously."

TSH should never be used alone to manage meds.  If you were symptomatic prior to your surgery, you were under medicated or improperly medicated.  Your TSH was "perfect" yet you still had symptoms; that shows how reliable TSH is.  Your doctor should be ordering FT3 and FT4 every time you have labs drawn.

Have you considered the same meds with a different delivery system?  Levo can be taken sublingually as can Tirosint (same active ingredient as Synthroid, but it's a gelcap)  You might have to add in some T3 meds down the road, but your FT4 is really too low at the moment to determine that.  FT4 target is midrange, and FT3 upper half of range.  At the moment, I'd probably want to try stabilizing your FT4 before making any other big changes.