I had RNY gastric bypass surgery on Dec. 03, 2008. In my six week post op blood work, the only thing abnormal was my TSH, which is 39.54, the doctor did not check T3 or T4. My doctor doesn't believe post surgical malabsorption is the reason but I am very concerned. I have been treated for hypothyroid/goiter since age 12 (I am now 45) and have been able to keep my lab values in check. Now I can't lose my excess weight after having the weight-loss surgery because my thyroid has shut down my whole metabolism. Isn't this a drastic shift in such a short time? One doctor wants to put me on Armour Thyroid but I've always done well on synthroid. Is there a better option for me? I hired a personal trainer to work with me on exercise and since I told her of my extreme fatigue and extreme TSH level, she refuses to work with me saying that the added stress to my body wouldn't be good. She said I should look into transdermal thyroid medication. I've never heard of such a thing. Any comments? My regular dose of Synthroid was 225mcg and has since been increased to 275mcg. My pharmacist said 300mcg is the highest daily dosage, is this true?