Weight Loss Program - Hypothyroid

[kate0417]

Before  I head to my endocrine doctor, i wanted to get some suggestions.  I have been dieting and exercising for 6 months now, max 5-6 times a week for at least an hour each time on a 1200 calorie diet.  (Zumba, Strength Training)  I feel that I am just exercising just to maintain my current weight.  I am 144lb 5'3.  I was at my heaviest in Oct 2014 at 150.  I do feel toned, but it's getting a little frustrating that i can't get down anymore.  My goal would be at some point to be 130 but I just want to get down to 140 right now.  I am also on Levothyroxine 0.50 mcg.  
Anyone have any suggestions?  

My labs are below:


My current TSH 0.55 (ref range: 0.450-4.500)
Free T4 1.38 (ref range: 0.82-1.77)

[gimel]

I think the first thing I would do is to go back and get tested for Free T3, and for the future, always make sure that they test for both Free T4 and Free T3 each time you go in for tests.  I would also get a new test for Vitamin D.  I would also test for Vitamin B12 and ferritin and selenium.  Low D, B12 and ferritin can cause symptoms that mimic hypothyroidism.  Also D and ferritin are very important for metabolizing thyroid hormone.  Ferritin and selenium are very important in the conversion of T4 to T3, which you seem to have a problem with.  

While you are having a discussion with the doctor, I would bring up the conversion problem and the need to raise your Free T3 level in order to relieve symptoms.  It may well be that increasing your ferritin and selenium levels to optimal will resolve the conversion issue, but short term you may need to add some T3 to your med.  

[kate0417]

yes.. i forgot to put fatigue, hair loss, brittle nails

[gimel]

Sorry, I overlooked the symptoms you listed above.  Were there any others?

[kate0417]

fatigue, hair loss, cold feet at night, memory loss,depression, exercise like a maniac but can't lose weight (5'3 - 144lb),  throat feel like it need a blanket underneath to separate by skin, High LDL, low Vitamin D.

The endo told me that it would be possible that i get Hashi's but it won't be until 5-10 out.  He was going to do a 'wait n see' approach. :(  
I was just happy he gave me meds, but it feels that i may need a new doctor.  

[gimel]

In Feb. your Free T4, at 1.29, was at 56% of its range, while your Free T3, at 2.8, was only at 17 % of its range.  So even before starting on the thyroid med, you were having a problem with conversion of T4 to T3.  Also, even though your TPO ab test was slightly over range, your TSH was low in its range.  I would not expect that low TSH since the TPO test was indicating the possibility of Hashi's, unless you were in the very early stages of Hashi's.  

At that time, before starting on meds, what symptoms were you having?  

[kate0417]

Hi Gimel,

I posted an inquiry back in Feb and found a doctor that would treat my symptoms below.  He was reluctant because my labs were quote 'in range' but gave me levo 0.50.  (He initially wanted to give me antidepressants)

I do have a goiter: right lob measures: 1.1x1.7x5.4cm
                          left lob measures:  1.0x1.6x4.2 cm

Doctor say it's normal


Since taking the med from March 2015 til now, the following symptoms have subsided
cold feet at night (subsided) , memory loss,depression (subsided), exercise like a maniac but can't lose weight (5'3 - 144lb),  throat feel like it need a blanket underneath to separate by skin, High LDL, low Vitamin D.


My results in parenthesis below from Feb 2015:

Thyroid Stimulating Hormone serum - 0.30 - 5.10 (1.12)
anti-thyroid peroxidase antibody - <35.0 (38.3) (in July 2014 it was 28)
thyroglobulin antibody  - <40 (<15 IU/ML)
thyroxine serum, free - 0.73-1.95 (1.29)
triiodothyronine, free, serum 2.3-4.2 (2.8)

The endocrine only drew blood 6 weeks after and gave me these results only:

My current TSH 0.55 (ref range: 0.450-4.500)
Free T4 1.38 (ref range: 0.82-1.77)

Let me know your thoughts.

[gimel]

Weight gain and inability to lose is very frustrating and can be related  to a number of things, including low metabolism due to low thyroid levels.   Your current thyroid test results are inadequate to really assess your status there.  You need to make sure they always test for both Free T4 and Free T3 every time.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 levels as necessary to relieve symptoms.  Symptom relief should be all important, not just test results and especially not TSH results.  When already taking thyroid med, TSH frequently becomes suppressed below range, and is no longer a useful test.  

You can get some good info from this link written by a good thyroid doctor.

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

For background, please tell us what was the identified cause for your being hypothyroid, when first diagnosed?  Also, what symptoms do you have besides weight gain?  

The 50 mcg of T4 med is a relatively small, starter dose.  I expect that your Free T3 will show it to be too low in the range, indicative of inadequate conversion of T3 to T4.  Also, since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you need to get those tested and optimized.  D needs to be about 55-60. B12 in the very upper end of its range, and ferritin should be 70 minimum.  Too low levels of these three can cause symptoms that mimic hypothyroidism.  Low D and ferritin can also adversely affect metabolism of thyroid hormone.

When you are able to get the additional testing done, please post results and reference ranges shown on the lab report and we will be glad to help interpret and advise further.