Thyroid issue? What could be causing weight gain?

[Alyssamo]

My obgyn had me do a blood test last week because there was a possible concern for thyroid or diabetes. I had my son 12/2/14 and weighed 185. I have continued to gain weight and now weigh 214. I was active during my pregnancy and maintained a healthy diet. I now am still active and maintain a healthy diet but cannot loose weight. I am Prozac and have an IUD but that my obgyn doesn't think that those are a contributor to the weight gain. The nurse called me with my results and said they were normal but offered no addition advice or reasoning to my weight gain and fatigue. Any advise or suggestions would be greatly appreciated.
TSH 1.93mlU/L
Free T4 .94ng/dL
Hemoglobin A1c 4.7%

[gimel]

The only test result that is flagged is the MCH.  When I read about MCH, I found this.  

"MCH levels in blood tests are considered high if they are 35 or higher. A normal hemoglobin level is considered to be in the range between 26 and 33 picograms per red blood cell.

High MCH levels can indicate macrocytic anemia, which can be caused by insufficient vitamin B12. Insufficient folic acid can be another cause of macrocytic anemia.

Alcohol abuse can be a contributing factor, and should be disclosed in the diagnostic process to better enable accuracy in diagnosis and in treatment determination."


So that is another reason to get the additional tests done that we suggested"  Free T3, Vitamin D, B12 and ferritin.    You also need to discuss with your doctor all the symptoms that you have that can be related to being hypothyroid and ask about clinical treatment, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.   Symptom relief has to be all important, not lab test results.  If the doctor only pays attention to TSH and believes that a test result that falls anywhere within its reference range is adequate, then you will need to find a good thyroid doctor.

[Alyssamo]

Here is the most current blood work results and ranges.

13d ago
(5/25/16)

WBC      4.0-10.0 K/uL      7.4
HGB       12.0-16.0 g/dL    13.0
HCT        36.0-48.0 %         38.5
PLT         150-400 K/uL      348
RBC        3.90-5.00 M/uL  3.91
MCV      79.0-99.0 fl          98.5
MCH      27.0-32.0 pg        33.2 (H)
MCHC   32.0-35.0 g/dL    33.8
RDW      11.5-15.0 %         11.7
MPV      9.0-12.2 fl            9.3


Sodium 136-146 mmol/L                140
Potassium 3.5-5.0 mmol/L            4.4
Chloride 98-108 mmol/L                105
CO2 22-34 mmol/L                           30
Urea Nitrogen 8-20 mg/dL            14
Creatinine 0.50-1.00 mg/dL           0.93
Glucose   73-100 mg/dL                 89
Calcium   8.6-10.3 mg/dL               9.4
Protein 6.0-8.3 g/dL                        7.1
Albumin   3.5-4.9 g/dL                      4.1
AST        8-30 IU/L                              21
ALT         59 mL/min        >60
EGFR, Non-Black >59 mL/min     > 60

[flyingfool]

As stated a symptom of low thyroid is anxiety and depression.  Many people have found that once they properly balanced out and optimized their thyroid levels, they were able to reduce or eliminate altogether their anti depression medications etc.

Your Free T4 is only at 21.3% of the range. When the rule of thumb is to be at or even slightly above 50%.

You really should be tested and get the Free T3 level as well which is the most important hormone to be tested reallyl since that is what is ultimately the ONLY hormone that is used at the cellular level and best correlates with symptoms.

I also ocncurr with Gimel for the other testing of D3, B-12 and iron and Ferritin.  All of which if low in any one or more will also cause fatigue.

[gimel]

It may well be that your symptoms that caused you to go on Zoloft and now Prozac could have been from hypothyroidism.  From an extremely long list of symptoms that may be related to hypothyroidism, just have a look at this section.

Emotional:

Tension
Irritability
Wanting to be solitary
Mood swings
Anxiety
Personality changes
Feelings of resentment
Jumpy
Easily startled
Lack of confidence
Nervousness

So it may be that you have been hypothyroid all the time.  Regardless of the cause it appears that you need to get the doctor to do the additional testing and accept that you are hypothyroid and need thyroid medication adequate to relieve your symptoms.  A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  If your doctor is unwilling to treat clinically, as described, then you will have to find a good thyroid doctor that will do so.  You can get some good insight from this link written by a good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

You also should test for Vitamin D, B12 and ferritin and supplement as needed to optimize.  D should be about 55, B12 in the upper end of its range, and ferritin should be about 70.

[Alyssamo]

I was never tested for thyroid hormone before I started the Zoloft. I began taking Zoloft July 2015 and stayed on it until I discussed w/ my pcp about it possibly being contributed to weight gain. Switched to Prozac April 2016.

[gimel]

When did you start on the Zoloft?  The reason I ask is that there have been studies that concluded something like the following.

"Patients with normal thyroid function who were treated with fluoxetine demonstrated a significant reduction of T(3) after 15 and 30 days of treatment (p = 0.034 and p = 0.011) and a significant reduction of T(4) throughout the intervention period (p = 0.04 after 15 days; p = 0.015 after 30 days; and p = 0.029 after 90 days)."

So this makes me wonder if you had low levels of thyroid hormone before starting on the Zoloft, or if it was caused  by those meds.  Were you ever tested for thyroid hormone levels before starting the Zoloft?

[Alyssamo]

Additional symptoms are fatigue, I'm just so tired all the time. And it's not just because we are busy and I have a toddler, I never feel rested no matter how much sleep I get. Anxiety and unusual emotional responses to situation has been better now that I have switched from Zoloft to Prozac...I made the switch April 5th 2016.  Unusual emotional response like crying for no reason and getting extremely angry when I normally won't in a situation.
TSH 1.93 ml/UL [standard range: 0.30-5.50]
Free T4 0.94 ng/dL [standard range: 0.76-1.70 ng/dL]
Hemoglobin A1c 4.7% [standard range: 4.2-5.6%]

[gimel]

Obviously there are a number of things that can cause weight gain.  You seem confident you are maintaining a healthy diet and exercise program.  Another possible contributor is low metabolism due to low levels of thyroid hormone.  There is a lot we need to discuss, but please start by posting the reference range shown on the lab report for the Free T4, and also tell us about any other symptoms you have noticed besides weight gain.