Maintaining & Recomp with Thyroid Issues

flrancho

I hope this is ok on this board, as its kind of a two part question.

I was recently diagnosed with Graves Disease. I'm relatively asymptomatic... some heart palpitations, eye pain, and neck pain, but not really anything else. Not even loosing weight unexpectedly which is a Graves hallmark.

Anyway, my white cell count is low and my endocrinologist doesn't feel safe giving me immuno-suppressants for the Graves, even though he feels they would work and send me into remission. My other option is radioactive iodine therapy to destroy my thyroid and make me hypothyroid. I'd then have to take lifetime thyroid medication (Synthroid). He's decided to give me a couple of months to see if my white cell count will come up so he can just give me the pills, but if not my thyroid is going to get fried.

Over the past few years I've lost 130 pounds and have managed to keep it off for almost two years now. This diagnosis and treatment option is obviously a blow. Any tips for maintaining my current weight if I have to get turned hypo and put on synthroid? I don't want to gain any of my weight back.... it took me a long time and a lot of work to get where I am now, and I don't want to see it all unravel.

Secondly, though I'm at the weight I want, I am skinny fat and have been trying to recomp without much success. I'm just not losing the fat or putting on muscle, despite being able to increase my weights. I'm getting stronger, but not less fat or more visible muscle. Anyway, in terms of recomp and hypothyroid (if it comes to that), would anything need to change with technique? I've been hearing horror stories of hypo patients not having energy to work out, or not being able to put on muscle, gaining body fat like crazy, etc.

not_a_runner

I've been hypo for around 10 years (I'm 23). It may take a bit of time to get your meds straightened out so that you can feel your best, but once you do you should function pretty normally as far as hypo goes.
If you have been doing well in maintenance for this long, I don't think you have much to worry about! You understand how to manage your weight, which is the biggest struggle for most people. (Any of my weight gain has been totally due to over eating. I have heard similar from many others.) Maybe you will experience some scale gain from water retention as your body adjusts to its new "normal", but any effect on calories in/out should be minimal. (There are others on here who can explain this much more eloquently than me though! )
I've had no problems working out or putting on muscle despite being hypo. Muscle building is a slow process, especially when trying to recomp. If you're increasing your lifts and following a good program you are likely on the right track.

heybales

The effect of hypo is mainly about energy levels you have for daily movement.

Base metabolism for vast majority is within 5% of expected for gender/age/weight/height, probably closer for bodyfat % method.

But considering daily activity is such a great fat burner and decent amount of calories - it's all about keeping motivated even if meds aren't doing the best job at it, to just keep active.

That feeling may effect ability to push as hard at lifting as you might otherwise - that would be the effect on muscle growth - not actually overloading as much as you could if no issues.

But as mentioned - slow process anyway at recomp, so the % of effect is really minor.

canadjineh

If you are relatively asymptomatic, why rush into aggressive therapy? http://www.elaine-moore.com/Articles/Graves’DiseaseArticles/WhatstheRushinTreatingGravesDisease/tabid/169/Default.aspx
It is part of an autoimmune disease process you may want to find out more about.

gdatf.org/about/about-graves-disease/patient-education/treatment-of-gravesdisease-an-overview/ Graves Disease & Thyroid Foundation website
"Hyperthyroidism is of several types, although Graves’ disease is by far the most common. For young people, pregnant women, and patients with recent onset of hyperthyroidism, antithyroid drugs should be the first approach to treatment. About 30% of patients with Graves’ disease will go into a long-term remission following a course of such drugs." I would personally try approaches other than the frying of your thyroid right off the bat. Once it is done, you can never go back, but if you try other things first and they don't seem to help, you can always get the surgery done. Of course it is totally your choice, it's just good to get as much info as you can before proceeding with anything that is irreversible.

CharlieBeansmomTracey

flrancho wrote: »

I hope this is ok on this board, as its kind of a two part question.

I was recently diagnosed with Graves Disease. I'm relatively asymptomatic... some heart palpitations, eye pain, and neck pain, but not really anything else. Not even loosing weight unexpectedly which is a Graves hallmark.

Anyway, my white cell count is low and my endocrinologist doesn't feel safe giving me immuno-suppressants for the Graves, even though he feels they would work and send me into remission. My other option is radioactive iodine therapy to destroy my thyroid and make me hypothyroid. I'd then have to take lifetime thyroid medication (Synthroid). He's decided to give me a couple of months to see if my white cell count will come up so he can just give me the pills, but if not my thyroid is going to get fried.

Over the past few years I've lost 130 pounds and have managed to keep it off for almost two years now. This diagnosis and treatment option is obviously a blow. Any tips for maintaining my current weight if I have to get turned hypo and put on synthroid? I don't want to gain any of my weight back.... it took me a long time and a lot of work to get where I am now, and I don't want to see it all unravel.

Secondly, though I'm at the weight I want, I am skinny fat and have been trying to recomp without much success. I'm just not losing the fat or putting on muscle, despite being able to increase my weights. I'm getting stronger, but not less fat or more visible muscle. Anyway, in terms of recomp and hypothyroid (if it comes to that), would anything need to change with technique? I've been hearing horror stories of hypo patients not having energy to work out, or not being able to put on muscle, gaining body fat like crazy, etc.

how long have you been recomping?

flrancho

Trust me, I'd like to do something less drastic than frying my thyroid.... but as I said, my white cell count is too low for my doctor to safely give me anti-thyroid medications. That's the only reason radioactive iodine is even being thought about - because it and surgery may be my only options if my white count doesn't go up.

As far as recomp - I've been doing it almost two years. Not much success.

sijomial

As far as recomp - I've been doing it almost two years. Not much success.

What is your exercise routine?
Are your lifts going up?
How are you measuring progress (or lack of progress)?

skymningen

flrancho wrote: »

Trust me, I'd like to do something less drastic than frying my thyroid.... but as I said, my white cell count is too low for my doctor to safely give me anti-thyroid medications. That's the only reason radioactive iodine is even being thought about - because it and surgery may be my only options if my white count doesn't go up.

As far as recomp - I've been doing it almost two years. Not much success.

So your doctor does not bother to try and find a cause for your low white cell count that could maybe be handled easily enough? The whole frying a thyroid seems very excessive for someone who as you state is mostly asymptotic. I would definitely go and get a second opinion on your options.

flrancho

Three to four days a week I hit the gym for weight lifting. I don't do a specific program, just a bunch of free weight and machine exercises, and some calisthenics that I alternate throughout the week. I aim for a full-body workout each time I go and try to do 5x5. If I can hit my 5x5 at the weight I'm using easily, next time I come I increase the weight by 5 pounds. The days I'm not in the gym I'm usually doing some sort of low impact cardio... walking, yoga, pilates, sometimes swimming. I don't really see any difference in my body appearance or how my clothes are fitting... I have a scale that tracks body fat percentage (though admittedly I haven't used that feature in a while) though the last few times I'd used it, it was showing no progress with fat loss.

As far as my thyroid, I think the low white cell count is pretty much assumed and attributed to my thyroid itself. Having a thyroid disorder go untreated for a long time (I'm going on a year with mine) can cause a low white count, especially with Graves.

sijomial

Three to four days a week I hit the gym for weight lifting. Nice.

I don't do a specific program, just a bunch of free weight and machine exercises. That's a concern. There's a world of difference between training towards a goal and "going to the gym" or "working out".

I aim for a full-body workout each time I go and try to do 5x5. Full body is good but 5x5 is primarily a strength focussed routine and light on volume.

If I can hit my 5x5 at the weight I'm using easily, next time I come I increase the weight by 5 pounds. Good you are pushing but are you steadily increasing strength or basically stalled out?

I don't really see any difference in my body appearance or how my clothes are fitting... Are you tracking with photos? Very hard to see small incremental changes otherwise. Are you taking measurements with a tape measure?

I have a scale that tracks body fat percentage (though admittedly I haven't used that feature in a while) though the last few times I'd used it, it was showing no progress with fat loss. They vary from somewhat OK to plot a trend over time if you ignore the random spikes to completely useless.

CSARdiver

I feel you. I was in your shoes 17 years ago, but with thyroid cancer. Do not let this get you down and only get information from peer reviewed sites. Thyroid impacts your Resting Energy Expenditure (REE) by ~5% from clinical observation.

Ensure you get a full thyroid panel tested - TSH (0.2-2.0), fT3, fT4, and rT3. After thyroidectomy protocol dictates trending towards hyper, so you want TSH as low as possible - closest to 0.2.

Check out the work of Jeffrey Brown - endocrinologist. He treats several elite level athletes/Olympians with various thyroid disorders.

Hit me up if you have any questions - been managing this for 17 years now. I used to manage the pharmacovigilance profile for Synthroid and been on both sides of this.

flrancho

What would be the difference between training for a goal as opposed to "going to the gym"? I always figured my goal was to increase strength through progressive weight training and loose fat in the process by eating at maintenance and that I didn't need a specific program to attain that. Back when I first started I did Ice Cream Fitness and Stronglifts 5x5 but I found the workouts rather repetitive and got tired of training with the same exercises over and over.

What do you recommend for recomp instead of 5x5?.... I've always been told by others here to do 5x5 and that if I was able to do more sets than that I was lifting too light for building muscle.

With most excercises I am gradually building weight.... there are a few motions I've stalled out on, but for the most part I'm adding weight.

And I'll keep all that thyroid stuff in mind. I'm hoping my white count will go up and I won't need the RAI, but I want to be prepared if I do. I joined a FB thyroid group and have been hearing all kinds of horror stories and that you need to make sure your endocrinologist has your thyroid at "optimal" as opposed to just "normal". The more prepared I am, the better off I'll be.

sijomial

What would be the difference between training for a goal as opposed to "going to the gym"?
Some (harsh & judgemental!) examples from recent experience of people who "exercise" or "go to the gym":

• A 100kg person than can comfortably manage stairs doing 20kg leg press.
• A person spending all their time fiddling with their pony tail and phone while sitting on the adductor/abductor machine.
• A person waving round such tiny weights that it provides no challenge or benefit.
• A person doing cardio at a intensity rather lower than walking around a supermarket.

Better than sitting on the sofa? Sure - but hardly a good use of precious time.
(It's not where you go but what you do when you get there....)

A training (as opposed to exercise) program needs to be aligned with goals, capabilities and have a defined purpose.

I always figured my goal was to increase strength through progressive weight training and lose fat in the process by eating at maintenance and that I didn't need a specific program to attain that. Back when I first started I did Ice Cream Fitness and Stronglifts 5x5 but I found the workouts rather repetitive and got tired of training with the same exercises over and over.
Increasing strength and increasing muscle are only loosely related. Hence my comment about 5x5 being primarily a strength focussed routine.
It's far from uncommon to see women with relatively little muscle mass who are remarkably strong for their musculature. That's far more uncommon with men.

What do you recommend for recomp instead of 5x5?.... I've always been told by others here to do 5x5 and that if I was able to do more sets than that I was lifting too light for building muscle.
Yes 5x5 programs are great for beginners to build a foundation of strength and technique. But are you still a beginner after two solid years of training would be my question.
Is what you are doing still genuinely challenging? Is the last set a struggle? Is what you are doing aligned and complimentary to all your goals? (I can't give you the answers to these questions.)
Here's a useful link.
http://community.myfitnesspal.com/en/discussion/10332083/which-lifting-program-is-the-best-for-you/p1

With most exercises I am gradually building weight.... there are a few motions I've stalled out on, but for the most part I'm adding weight.
So if your only metric for success and progress is strength increase then to a degree it's still working.
But from your comments you are disappointed that you aren't seeing or measuring change in body composition.

vjd317

@flrancho Just my 2 cents - if you are not seeing results with such a dedicated weight program, have you considered bulking (eating above calorie needs) with an intense weight program to build the muscle you want? After you reach that point (typically a 6 month bulk), you slowly move into a deficit until you reach your desired body composition.

CharlieBeansmomTracey

vjd317 wrote: »

@flrancho Just my 2 cents - if you are not seeing results with such a dedicated weight program, have you considered bulking (eating above calorie needs) with an intense weight program to build the muscle you want? After you reach that point (typically a 6 month bulk), you slowly move into a deficit until you reach your desired body composition.

you do realize that for a woman to bulk it could take more than 6 months? it takes time to build muscle and its even slower for a woman.

CSARdiver

flrancho wrote: »

And I'll keep all that thyroid stuff in mind. I'm hoping my white count will go up and I won't need the RAI, but I want to be prepared if I do. I joined a FB thyroid group and have been hearing all kinds of horror stories and that you need to make sure your endocrinologist has your thyroid at "optimal" as opposed to just "normal". The more prepared I am, the better off I'll be.

Just a warning - there's a ton of victim mindset on thyroid groups and CICO is not well regarded in these circles. People greatly overstate the impact this has on metabolism.

...and @sijomial is well known for outstanding advice.

not_a_runner

CSARdiver wrote: »

flrancho wrote: »

And I'll keep all that thyroid stuff in mind. I'm hoping my white count will go up and I won't need the RAI, but I want to be prepared if I do. I joined a FB thyroid group and have been hearing all kinds of horror stories and that you need to make sure your endocrinologist has your thyroid at "optimal" as opposed to just "normal". The more prepared I am, the better off I'll be.

Just a warning - there's a ton of victim mindset on thyroid groups and CICO is not well regarded in these circles. People greatly overstate the impact this has on metabolism.

...and @sijomial is well known for outstanding advice.

SO MUCH THIS.

I steer clear of those groups now for the reasons above. I find I'm much better off when I stay far away from the victim mindset. I wasted too many years with that.

Understanding how to manage your weight and staying active so you feel good is a huge key.
You see similar posts on these boards all the time-- "eating 1000 cals and not losing!?!", but it turns out they aren't even logging, or they eat 10,000 cals once a week and negate their entire deficit.
Being able to say you're hypo is like validation. Having a group to go to where everyone pats them on the back and says "I understand, let's commiserate" feels great.
I'm not saying we shouldn't reach out to others, just that I much prefer the mindset here. (Which is often that we don't do things any differently than anyone else, aside from taking medication.)

deannalfisher

yup - the number of times I see - I'm hypo and can't lose weight, or I have to eat 1000 cal in order to lose weight - it drives me nuts - I've been thyroidless for 4 years now (cancer) and maintain on 2600cal(ish) as an endurance athlete

Fitnessgirl0913

deannalfisher wrote: »

yup - the number of times I see - I'm hypo and can't lose weight, or I have to eat 1000 cal in order to lose weight - it drives me nuts - I've been thyroidless for 4 years now (cancer) and maintain on 2600cal(ish) as an endurance athlete

Ugh same drives me nuts! I have battled with a hypothyroid for 6 years now and lost 80 pounds just fine, people need to get over the victim mindset. I always try and offer helpful advice about losing with a hypothyroid (get more sleep, more fiber to help if you get constipated etc) to try and shift their victim mindset, not sure it if works but I try!

CSARdiver

The problem many run into if you look at the older medical texts is that metabolics testing was not available at the time, so there is an entire generation of medical professionals that believe hypothyroid patients experience a drop of 40% of their metabolic rate. This was established in early patients by monitoring weight.

Going full stop on thyroid hormone impacts your Resting Energy Expenditure (REE) by ~5%. With any dramatic shift in hormonal imbalance the body tends to take on water to protect the cells, so people have an immediate 5-10 lb weight increase. Many women experience this on their TOM. This will go away in a few days once the body adjusts.

What really happens to impact weight (and this is true of most hormone imbalances) is an impact on satiety and hunger triggers, so people continually feel hungry when they are not. Again the best course is to track caloric intake.

deannalfisher

I also get told that I should go "low carb" because of my thyroid issues...thanks but no thanks - I'm quite happy eating nearly 400g a day and maintaining weight on that - thank you very much

Fitnessgirl0913

My favorite part is that I started my weight loss journey before I knew I was hypothyroid and lost 30 pounds before I was even diagnosed. If my "metabolism was really slowed" I would have not lost that weight. When people claim they cannot lose weight because their thyroid is "slowing their metabolism" I like to see the look on their face when I tell them that story lol. Sure you have an increased appetite with a hypothyroid but it is nothing unmanageable and your metabolism is not "crawling". Okay I suppose those was more of a rant then a helpful post but man did it feel good!
Edited for typos

not_a_runner

Fitnessgirl0913 wrote: »

My favorite part is that I started my weight loss journey before I knew I was hypothyroid and lost 30 pounds before I was even diagnosed. If my "metabolism was really slowed" I would have not lost that weight. When people claim they cannot lose weight because their thyroid is "slowing their metabolism" I like to see the look on their face when I tell them that story lol. Sure you have an increased appetite with a hypothyroid but it is nothing unamenable and your metabolism is not "crawling". Okay I suppose those was more of a rant then a helpful post but man did it feel good!

I had a similar scenario, I lost weight just fine a few years ago - 60+ lbs (although I was already on meds for several years by that point, but content in my fatness I suppose? lol)
Finally I decided I was done losing, so I stopped tracking food and exercising, and of course starting gaining it back. Suddenly I was the victim of hypothyroid!! It was making me fat and miserable and I was doomed!!
I now know better


I think a lower TDEE because of low activity is sometimes confused as a "slow metabolism" as well...
If a person was very active and suddenly stops, that could make a large difference in TDEE, and result in weight gain over time. Comparing a sedentary person's intake to an active person's is also very different for the same reason.
People love to say "I wish I could eat that much!/That's not fair!" But the active person is working for that food! For me, the difference between sedentary and pretty active is 500+ calories a day.

AnnPT77

Just weighing in as another data point: Hypothyroid for 17 years (maybe related to breast cancer treatment?), well controlled on generic levothyroxine, lost 50+ pounds straightforwardly in less than a year at age 59-60 & now in 2nd year of maintenance. Despite the hypo, my NEAT is significantly higher than the calculators estimate: Over 2000 when it 'should' be 1500-1600ish.

It's certainly possible that different people have different experiences with hypothyroidism, but it obviously doesn't universally sabotage metabolism.