Hypothyroidism and Weight Management
CSARdiver
Posts: 6,252 Member
Hypothyroidism and Weight Management
I wrote this to address misinformation/disinformation regarding what hypothyroidism is and what it is not. What is important and what is not. Be wary folks as there are a disturbing number of charlatans looking to make a profit without offering any meaningful benefit.
I had a total thyroidectomy in 2000 due to thyroid cancer. I bought into much of the bad information out there and ended up putting on ~70 lbs over the next 14 years. Despite all thoughts to the contrary - none of this was due to my thyroid, but everything to do with my transitioning from a high active military career to a cushy life in academia. I started tracking my caloric intake and output in MFP in 2014 and lost 60 lbs the first year gradually decreasing my intake and increasing my activity. I’ve been in maintenance ever since and compete in several obstacle course races and multisport races throughout the year.
Starting in 2006 I managed the pharmacovigilance profile of Synthroid (levothyroxine sodium tablets, USP). Having access to this information forced me to realize the impact thyroid has on weight management, what this influences and more importantly does not influence.
Thyroid and Hormonal Impact:
The thyroid gland is part of the endocrine system works in conjunction with the pituitary gland. The pituitary gland releases Thyroid Stimulating Hormone (TSH). The hypothalamus releases TSH Releasing Hormone (TRH).
The thyroid gland produces two primary hormones:
Triiodothyronine (T3)
Thyroxine (T4)
Symptoms of Hypothyroidism (low T3/T4):
• Sleeping disorders
• Tiredness / fatigue
• Difficulty concentrating (brain fog)
• Dry skin and hair
• Depression
• Sensitivity to cold temperature
• Frequent, heavy periods
• Joint and muscle pain
Resting Energy Expenditure (REE): the amount of energy expended by a person at rest. Basal metabolic rate (BMR) is more precisely defined as the REE measured just after awakening in the morning. In practice, REE and BMR differ by less than 10% so the terms can be used interchangeably. In testing the most extreme conditions – thyroidectomy patients off supplementation showed a similar variation to the control group ~5% shift from the mean.
What this amounts to in daily consumption is 80 kcals/day out of a 1600 kcal/day caloric budget.
Increased Cellular Uptake (Water Weight)
Any hormonal shift will result in an increase of cellular uptake – water weight. This was noted in early medicine as the increase weight noted with hypothyroidism. If hormones balance out this will trend back to normal weight after 5-7 days as long as sodium intake is fairly constant and hydration is maintained.
Note that hormones are free cycling – meaning your body mass has tremendous impact on hormonal balance. If you’re at a healthy BMI your endocrine system operates normally with little issue. If you are significantly under or overweight this causes a terminal cascade within the endocrine system – causing massive stress as glands attempt to respond to and produce hormones, continually struggling to keep up.
Testing:
When one begins to show symptoms or suspect they have a thyroid disorder the first step is a physical examination in conjunction with testing – initially TSH, but should always be followed up with a full thyroid panel.
Thyroid Panel
TSH 0.4-4.0 uU/ml (0.5-3.0 for supplemented patients) (0.2-2.0 for thyroid cancer patients)
fT3 230-619 pg/d
fT4 0.7-1.9 ng/dl
rT3 10-24 ng/dL
TRH stimulates TSH, which stimulates production of T4 and T3. T4 converts to T3 to specifically target tissues. Knowing how this works helps you identify what is going wrong in this cycle. Note that analysis takes multiple readings over time, so don’t get overly concerned with one reading. Lab errors are frequent, body changes are continual, and hormones are notoriously difficult to track and trend.
I need to add clarification on TSH and how this is often misinterpreted. The established ranges are stated above and pretty accurate (updated in 2002). What may be confusing is what feels normal to you. This is established during your adolescence and early adulthood, so whatever that number is feels “normal”. Looking back at my life I was very likely at the lower end and hyperthyroid, so this feels normal to me. I’m usually in the 0.2 currently with a dosage of 175/200 mcg alternating daily. Don’t get overly concerned with one test result out of this range though. Medical protocol should still be followed, but one high or low result should be taken in context with a full range of results.
Medication:
Hormones are incredibly powerful actors on the body – something you can see from the dosage – these are measured in micrograms and incredibly challenging to manufacture in pill form (even in pill form consistency and potency remains one of the most challenging issues). So these tablets are mostly filler.
TSH - Synthroid is the brand name of levothyroxine sodium tablets, USP – the generic version.
T3 – Cytomel (liothyronine sodium)
Generics must follow the precise formulation in regards to the active ingredient there may be a difference in the inactive ingredients, so take notes of your reaction when beginning any long term medication.
Synthetic vs. glandular – there isn’t much evidence supporting a difference, but I caution the use of any hormone supplementation due to the level of risk associated. Always discuss usage with your endocrinologist.
Hormones also take a long time to act, so you won’t be able to feel or detect any difference for weeks after beginning or changing dosages.
Diet:
There isn’t much that angers me, but this is a big one. There are several woo peddlers out there using their credentials (letters behind your name) to promote books/diets/services. You cannot “heal” your endocrine system with diet. You can only treat this with medicine.
While there is no “thyroid diet”. There are specific foods you want to avoid taking at the same time as your supplement:
Many simply avoid taking food when taking your supplement. I recommend at least 60 mins before eating anything following taking thyroid medication.
Treatment:
Calories
If you have a thyroid disorder your struggle is pretty much identical to that of anyone else. There is no measurable impact to basal metabolism. There may be an impact to appetite due to a hormonal imbalance or shift, so it makes it critical to understand the difference between hunger and appetite.
Hunger is your body’s physiological need for food. The urge comes slowly over time and builds up. It is satiated with any food.
Appetite is your desire for food. These urges are more sudden and specific – driven hormonally. This results in these cravings of salty, sweet, crunchy, chocolate, etc.
There are several methods of managing this – if you have the urge to eat drink water and wait 30 mins. Establish a routine around eating and meal times.
Another important element is satiation. This is a very personal issue and something you need to experiment with your diet. Many find higher fiber foods more satiating. Spicing up foods is another common practice as the taste lingers in your mouth; people tend to feel the urge to eat diminish if taste is present.
Exercise
This is where I think many people sabotage themselves. When the majority of people make the decision to do something about their weight, they turn to a search engine – find “The Fastest Way to Lose Weight – Guaranteed!” and implement some drastic change. When you already have a problem regulating hormones this can be disastrous. You start out strong, but over time motivation fails and your body cannot keep up with the stress you’re putting it under. Pain increases as tissue repair begins to fall behind and eventually you miss a workout, then another, then depression. If coupled with a very low/low calorie diet this increases the chance of failure as your caloric deficit is too great.
The key to success is slow and gradual progress with a condition like this. Elite athletes with hypothyroidism still compete and are successful, but they plan ahead and gradually increase challenges. Note that thyroid disorders are increasingly common within endurance athletes as we tend to put our bodies through incredible endocrine stress. Warm up/cool down times should be increased. Hydration becomes all the more critical. Recovery times should be strictly adhered to.
Medical professional
Never attempt to diagnose or treat yourself and stay away from over the counter supplements. Without proper diagnosis you risk making things worse.
Finding a good physician may be the most challenging issue, although it is getting much better in the US. Talk to people who have succeeded. Research profiles on search engines. Specifically look for endocrinologists specializing in thyroid disorders. When you find a good one never let them go and let them know – spread the word! When you find a bad one let them know and fire them promptly if you can.
Dr. Jeffrey Brown revolutionized much of the treatment for elite level athletes and his methods are carrying over through the specialty. I cannot stress how much of a difference having a sound relationship with your primary physical and endocrinologist means to your life.
Bring data to every discussion. Document in MFP or a diary and share this with your doctor.
What Does Not Matter:
Pretty much everything else. It doesn’t matter much how you developed this or what variation of disorder you have – the treatment is all the same.
There are a multitude of primary causes for hypothyroidism, none of which matter in weight management. Regardless of how you came to a non-functioning thyroid gland there is nothing preventing you from maintaining a healthy weight.
What to focus on:
Prioritization
Prioritize what matters – Medical treatment > Caloric Intake > Exercise
The Pareto Principle
“80% of the effects come from 20% of the causes.”
Known as the 80/20 rule this remains a factor that continually presents throughout disciplines. What this means for you is to focus on the 20% of your life that matters and disregard the 80%. Now this is going to change over time and there will be competing priorities throughout your life. Keep this principle in mind when you feel out of control and thinking you need to control it all – you only need to be concerned with 20% of it.
168 Hours
When I first entered into the military I was thrown into one of the highest operational tempo fields and found myself continually struggling for time. My Chief saw this and sat me down explaining “Listen – there are 168 hours in the week. There’s always time to do what needs to be done.” If you’re struggling thinking I don’t have time – first review if it’s even worth the energy following the 80/20 rule, then budget it into your 168 hours/week.
Fatigue
All hormonal shifts result in fatigue so coping mechanisms against this are critical. Caffeine helps, but don't overuse. What helped me was to force myself to be 100% focused and excited about whatever was in front of me and to consider every opportunity as if it were the greatest opportunity in the history of the universe. Not going to say I was always successful at this, but it certainly helped. You have to remember that the hormonal imbalance will trend back to normal and focus on the future. Meditate. Pray. Do whatever it takes to get yourself through the low troughs.
Perspective & Attitude
I save this for last as I believe this to be the most important. When I was first diagnosed with cancer I spent a great deal of time researching survivors and found a common link – they went into this realizing that holding a positive attitude was going to be critical to success. I also noticed a disproportionate percentage of elite level athletes, academics, professionals in all areas. A majority reported similar epiphanies that could be summed up as “Life is incredibly short and we have a limited amount of time on this Earth to do good, so get to it.”
You can look at this from two perspectives - two stories:
1. “Crud. I have to take this stupid pill for the rest of my life”
2. “Incredible! All I have to do is take this little pill to live my life”
Both stories are true, but which would you rather be in.
I wrote this to address misinformation/disinformation regarding what hypothyroidism is and what it is not. What is important and what is not. Be wary folks as there are a disturbing number of charlatans looking to make a profit without offering any meaningful benefit.
I had a total thyroidectomy in 2000 due to thyroid cancer. I bought into much of the bad information out there and ended up putting on ~70 lbs over the next 14 years. Despite all thoughts to the contrary - none of this was due to my thyroid, but everything to do with my transitioning from a high active military career to a cushy life in academia. I started tracking my caloric intake and output in MFP in 2014 and lost 60 lbs the first year gradually decreasing my intake and increasing my activity. I’ve been in maintenance ever since and compete in several obstacle course races and multisport races throughout the year.
Starting in 2006 I managed the pharmacovigilance profile of Synthroid (levothyroxine sodium tablets, USP). Having access to this information forced me to realize the impact thyroid has on weight management, what this influences and more importantly does not influence.
Thyroid and Hormonal Impact:
The thyroid gland is part of the endocrine system works in conjunction with the pituitary gland. The pituitary gland releases Thyroid Stimulating Hormone (TSH). The hypothalamus releases TSH Releasing Hormone (TRH).
The thyroid gland produces two primary hormones:
Triiodothyronine (T3)
Thyroxine (T4)
Symptoms of Hypothyroidism (low T3/T4):
• Sleeping disorders
• Tiredness / fatigue
• Difficulty concentrating (brain fog)
• Dry skin and hair
• Depression
• Sensitivity to cold temperature
• Frequent, heavy periods
• Joint and muscle pain
Resting Energy Expenditure (REE): the amount of energy expended by a person at rest. Basal metabolic rate (BMR) is more precisely defined as the REE measured just after awakening in the morning. In practice, REE and BMR differ by less than 10% so the terms can be used interchangeably. In testing the most extreme conditions – thyroidectomy patients off supplementation showed a similar variation to the control group ~5% shift from the mean.
What this amounts to in daily consumption is 80 kcals/day out of a 1600 kcal/day caloric budget.
Increased Cellular Uptake (Water Weight)
Any hormonal shift will result in an increase of cellular uptake – water weight. This was noted in early medicine as the increase weight noted with hypothyroidism. If hormones balance out this will trend back to normal weight after 5-7 days as long as sodium intake is fairly constant and hydration is maintained.
Note that hormones are free cycling – meaning your body mass has tremendous impact on hormonal balance. If you’re at a healthy BMI your endocrine system operates normally with little issue. If you are significantly under or overweight this causes a terminal cascade within the endocrine system – causing massive stress as glands attempt to respond to and produce hormones, continually struggling to keep up.
Testing:
When one begins to show symptoms or suspect they have a thyroid disorder the first step is a physical examination in conjunction with testing – initially TSH, but should always be followed up with a full thyroid panel.
Thyroid Panel
TSH 0.4-4.0 uU/ml (0.5-3.0 for supplemented patients) (0.2-2.0 for thyroid cancer patients)
fT3 230-619 pg/d
fT4 0.7-1.9 ng/dl
rT3 10-24 ng/dL
TRH stimulates TSH, which stimulates production of T4 and T3. T4 converts to T3 to specifically target tissues. Knowing how this works helps you identify what is going wrong in this cycle. Note that analysis takes multiple readings over time, so don’t get overly concerned with one reading. Lab errors are frequent, body changes are continual, and hormones are notoriously difficult to track and trend.
I need to add clarification on TSH and how this is often misinterpreted. The established ranges are stated above and pretty accurate (updated in 2002). What may be confusing is what feels normal to you. This is established during your adolescence and early adulthood, so whatever that number is feels “normal”. Looking back at my life I was very likely at the lower end and hyperthyroid, so this feels normal to me. I’m usually in the 0.2 currently with a dosage of 175/200 mcg alternating daily. Don’t get overly concerned with one test result out of this range though. Medical protocol should still be followed, but one high or low result should be taken in context with a full range of results.
Medication:
Hormones are incredibly powerful actors on the body – something you can see from the dosage – these are measured in micrograms and incredibly challenging to manufacture in pill form (even in pill form consistency and potency remains one of the most challenging issues). So these tablets are mostly filler.
TSH - Synthroid is the brand name of levothyroxine sodium tablets, USP – the generic version.
T3 – Cytomel (liothyronine sodium)
Generics must follow the precise formulation in regards to the active ingredient there may be a difference in the inactive ingredients, so take notes of your reaction when beginning any long term medication.
Synthetic vs. glandular – there isn’t much evidence supporting a difference, but I caution the use of any hormone supplementation due to the level of risk associated. Always discuss usage with your endocrinologist.
Hormones also take a long time to act, so you won’t be able to feel or detect any difference for weeks after beginning or changing dosages.
Diet:
There isn’t much that angers me, but this is a big one. There are several woo peddlers out there using their credentials (letters behind your name) to promote books/diets/services. You cannot “heal” your endocrine system with diet. You can only treat this with medicine.
While there is no “thyroid diet”. There are specific foods you want to avoid taking at the same time as your supplement:
- Walnuts
- Soybean flour
- Cottonseed meal
- Iron supplements or multivitamins containing iron
- Calcium supplements
- Antacids containing aluminum, magnesium, or calcium
- sucralfate (Carafate)
- cholestyramine (Prevalite) and colestipol (Colestid)
Many simply avoid taking food when taking your supplement. I recommend at least 60 mins before eating anything following taking thyroid medication.
Treatment:
Calories
If you have a thyroid disorder your struggle is pretty much identical to that of anyone else. There is no measurable impact to basal metabolism. There may be an impact to appetite due to a hormonal imbalance or shift, so it makes it critical to understand the difference between hunger and appetite.
Hunger is your body’s physiological need for food. The urge comes slowly over time and builds up. It is satiated with any food.
Appetite is your desire for food. These urges are more sudden and specific – driven hormonally. This results in these cravings of salty, sweet, crunchy, chocolate, etc.
There are several methods of managing this – if you have the urge to eat drink water and wait 30 mins. Establish a routine around eating and meal times.
Another important element is satiation. This is a very personal issue and something you need to experiment with your diet. Many find higher fiber foods more satiating. Spicing up foods is another common practice as the taste lingers in your mouth; people tend to feel the urge to eat diminish if taste is present.
Exercise
This is where I think many people sabotage themselves. When the majority of people make the decision to do something about their weight, they turn to a search engine – find “The Fastest Way to Lose Weight – Guaranteed!” and implement some drastic change. When you already have a problem regulating hormones this can be disastrous. You start out strong, but over time motivation fails and your body cannot keep up with the stress you’re putting it under. Pain increases as tissue repair begins to fall behind and eventually you miss a workout, then another, then depression. If coupled with a very low/low calorie diet this increases the chance of failure as your caloric deficit is too great.
The key to success is slow and gradual progress with a condition like this. Elite athletes with hypothyroidism still compete and are successful, but they plan ahead and gradually increase challenges. Note that thyroid disorders are increasingly common within endurance athletes as we tend to put our bodies through incredible endocrine stress. Warm up/cool down times should be increased. Hydration becomes all the more critical. Recovery times should be strictly adhered to.
Medical professional
Never attempt to diagnose or treat yourself and stay away from over the counter supplements. Without proper diagnosis you risk making things worse.
Finding a good physician may be the most challenging issue, although it is getting much better in the US. Talk to people who have succeeded. Research profiles on search engines. Specifically look for endocrinologists specializing in thyroid disorders. When you find a good one never let them go and let them know – spread the word! When you find a bad one let them know and fire them promptly if you can.
Dr. Jeffrey Brown revolutionized much of the treatment for elite level athletes and his methods are carrying over through the specialty. I cannot stress how much of a difference having a sound relationship with your primary physical and endocrinologist means to your life.
Bring data to every discussion. Document in MFP or a diary and share this with your doctor.
What Does Not Matter:
Pretty much everything else. It doesn’t matter much how you developed this or what variation of disorder you have – the treatment is all the same.
There are a multitude of primary causes for hypothyroidism, none of which matter in weight management. Regardless of how you came to a non-functioning thyroid gland there is nothing preventing you from maintaining a healthy weight.
What to focus on:
Prioritization
Prioritize what matters – Medical treatment > Caloric Intake > Exercise
The Pareto Principle
“80% of the effects come from 20% of the causes.”
Known as the 80/20 rule this remains a factor that continually presents throughout disciplines. What this means for you is to focus on the 20% of your life that matters and disregard the 80%. Now this is going to change over time and there will be competing priorities throughout your life. Keep this principle in mind when you feel out of control and thinking you need to control it all – you only need to be concerned with 20% of it.
168 Hours
When I first entered into the military I was thrown into one of the highest operational tempo fields and found myself continually struggling for time. My Chief saw this and sat me down explaining “Listen – there are 168 hours in the week. There’s always time to do what needs to be done.” If you’re struggling thinking I don’t have time – first review if it’s even worth the energy following the 80/20 rule, then budget it into your 168 hours/week.
Fatigue
All hormonal shifts result in fatigue so coping mechanisms against this are critical. Caffeine helps, but don't overuse. What helped me was to force myself to be 100% focused and excited about whatever was in front of me and to consider every opportunity as if it were the greatest opportunity in the history of the universe. Not going to say I was always successful at this, but it certainly helped. You have to remember that the hormonal imbalance will trend back to normal and focus on the future. Meditate. Pray. Do whatever it takes to get yourself through the low troughs.
Perspective & Attitude
I save this for last as I believe this to be the most important. When I was first diagnosed with cancer I spent a great deal of time researching survivors and found a common link – they went into this realizing that holding a positive attitude was going to be critical to success. I also noticed a disproportionate percentage of elite level athletes, academics, professionals in all areas. A majority reported similar epiphanies that could be summed up as “Life is incredibly short and we have a limited amount of time on this Earth to do good, so get to it.”
You can look at this from two perspectives - two stories:
1. “Crud. I have to take this stupid pill for the rest of my life”
2. “Incredible! All I have to do is take this little pill to live my life”
Both stories are true, but which would you rather be in.
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Replies
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And when the suggestion banner at the bottom of your meat chassis flash, "FREQUENTLY COMORBID WITH:" do not buy. SRSLY. None of the recommended ailments go well with water retention.2
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@CSARdiver super informative as ever. I wish everyone would be educated/informed by their doctors properly. I wasn't!
I wasn't told about foods to avoid etc and only learnt this after 5 years on levothyroxine. The next 5 years I spent fasting for an hour after taking my meds (which was difficult for me)
Now I finally know what foods to avoid (none of which I regularly eat)
The only other one I was told to avoid when taking my meds is coffee. Can't remember who told me that but I think it was a medical professional.
I have a number of friends blaming their obesity on their thyroid issues. When I tell them I've lost weight despite my thyroid they tell me they can't for various reasons (mostly their meds don't work as well as mine)
When I tell them I just eat less, no special diet,- they make a face like I'm lying. I give up, I can't help them.
The worst is obese friends, with NO thyroid problem, blaming their obesity on 'i think I have a thyroid problem but it doesn't show on a blood test'. They take repeat tests and are disappointed when a magic diagnosis doesn't she up.
Sorry for ranting, you've touched one of my pet peeves...17 -
The only other one I was told to avoid when taking my meds is coffee. Can't remember who told me that but I think it was a medical professional.
I believe coffee can somewhat blunt the effectiveness of the synthroid/levothyroxine, but only if you're inconsistent.
Dosing levothyroxine is a pain in the butt, because it takes so long to level off (6-8 weeks?)
My doc told me either to NOT take it with coffee or ALWAYS take it with the same amount of coffee. Consistency is the critical issue. Similarly I was told to either ALWAYS take it with my birth control or NEVER take it with my birth control, but to DECIDE WHICH ONE while we were sorting out the dosage of my pills.
It's all been working just fine for me for the last 20 years with the coffee and the birth control pill, but I'm very consistent with my meds.7 -
@CSARdiver super informative as ever. I wish everyone would be educated/informed by their doctors properly. I wasn't!
I wasn't told about foods to avoid etc and only learnt this after 5 years on levothyroxine. The next 5 years I spent fasting for an hour after taking my meds (which was difficult for me)
Now I finally know what foods to avoid (none of which I regularly eat)
The only other one I was told to avoid when taking my meds is coffee. Can't remember who told me that but I think it was a medical professional.
I have a number of friends blaming their obesity on their thyroid issues. When I tell them I've lost weight despite my thyroid they tell me they can't for various reasons (mostly their meds don't work as well as mine)
When I tell them I just eat less, no special diet,- they make a face like I'm lying. I give up, I can't help them.
The worst is obese friends, with NO thyroid problem, blaming their obesity on 'i think I have a thyroid problem but it doesn't show on a blood test'. They take repeat tests and are disappointed when a magic diagnosis doesn't she up.
Sorry for ranting, you've touched one of my pet peeves...
There isn't much data to support coffee or caffeine inhibiting thyroid hormones - the molecules are substantially different and follow separate pathways.
It's such a touchy subject and one I tip toe around, which is not my nature. I'm a blunt instrument and resent people not being direct. I recognize that it takes all manner of attempts to reach people and appreciate all efforts seeking good results.
At the core of this is confirmation bias and cognitive dissonance. Many lack the ability to even think that they could be wrong. It's especially worse if being wrong means their problems are due to their own behavior.
I've been researching this for some time and see the objective evidence supporting the rise of thyroid disorders and several other disorders being due to obesity and not the reverse.6 -
Thank you for such an informative overview. I had an adrenal issue and feel similarly irritated about people peddling adrenal insufficiency cures: if people want to know what adrenal insufficiency feels like, try living normally after the removal of a sizeable dopamine-secreting pheochromocytoma. It’s not fun. And as I’m now being investigated for thyroid issues, I really appreciate the information provided. So thanks.4
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Thank you so much @CSARdiver. This makes me feel so much better. I have been worrying myself sick because my doc wants to reduce my meds. Apparently it is showing up as though I am overmedicated now. He's waiting 6 months for a new test but I admit I've had issues sleeping at night and my moods have been swinging wildly so I probably need it adjusted. Losing weight has really messed with all my medications. Your post made me realize I'm not going to gain all the weight back from a reduction.11
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I'm so glad to see a detailed post like this. I had my thyroid removed last December after YEARS of being hyper. My biggest fear was gaining weight because I'd worked so hard to lose it. I did a lot of research. I whole lot of research. I managed to wade through the fluff and scare tactics to find the real research and discovered that a well-medicated person without a thyroid is just the same as a person with a normal functioning thyroid.
Since removing my thyroid I have lost weight just as easily as before. I still put the time in the gym that I used to. Basically my life has moved on with barely a ripple of change.
Thank you for this post.6 -
I'm so glad to see a detailed post like this. I had my thyroid removed last December after YEARS of being hyper. My biggest fear was gaining weight because I'd worked so hard to lose it. I did a lot of research. I whole lot of research. I managed to wade through the fluff and scare tactics to find the real research and discovered that a well-medicated person without a thyroid is just the same as a person with a normal functioning thyroid.
Since removing my thyroid I have lost weight just as easily as before. I still put the time in the gym that I used to. Basically my life has moved on with barely a ripple of change.
Thank you for this post.
Thank you for sharing!
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I've been researching this for some time and see the objective evidence supporting the rise of thyroid disorders and several other disorders being due to obesity and not the reverse.
I think root cause analysis is important for each instance of a particular condition, due to my aforementioned and utterly unwanted list of comorbid conditions.
If the root cause is cancer, doctors tend to stay alert for other types of cancer. If the root cause is autoimmune, then it would be nice if one's doctor stayed alert for other autoimmune disorders with similar or *masked* symptoms to the original condition.
I suspect this is why normally sane and reasonable people start attributing things they should not to their thyroid problem.
They don't have any other explanation and that's the only problem they knew of - even though their doctor told them the problem was solved.
It's easy to buy snake oil if you're desperate for an answer if people around you think you're non-compliant to normal advice and your doctor just writes you of as a hypochondriac.
I can't decide if it would be more or less helpful for doctors to tell people what to be on the look out for, though I firmly believe it would be helpful for them to take the time to explain medications and dosing regimens properly instead of just handing out slips of paper and trotting people out the door in 15 minutes or less, leaving the rest to the pharmacist to sort out.4 -
Thanks so much for explaining this. As someone who has never had thyroid problems, I didn’t understand any of this, wasn’t familiar with the terms. My daughter has thyroid problems. I tried to research, but always got lost. By reading this, I can now understand a little, and even lend a sympathetic ear, really knowing what’s going on.3
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Great post! Lots of helpful info.
I will just give a little perspective from someone in Canada. I have hypothyroid and have been taking Synthroid for years and years. While circumstances will be different for those who lose function of their thyroid via cancer or some other disease, the USUAL case is that your family doctor will do a simple blood test. You don't get to request anything. They don't care about your paperwork or what you ask for. This has been my experience over many GPs in the last 15 years. This is the Canadian system. Unless you can afford to go to a private clinic or you're seeing a specialist, there's just not much you can request. I suppose you could request to see a specialist, but if it's just a low thyroid with no other extenuating circumstances, the likelihood of that happening is slim to none.
I go for regular blood tests (have a standing order that lasts 2 years) and just make sure I take my medication every day, as prescribed. I have no issues with losing weight, at all.3 -
cheryldumais wrote: »Thank you so much @CSARdiver. This makes me feel so much better. I have been worrying myself sick because my doc wants to reduce my meds. Apparently it is showing up as though I am overmedicated now. He's waiting 6 months for a new test but I admit I've had issues sleeping at night and my moods have been swinging wildly so I probably need it adjusted. Losing weight has really messed with all my medications. Your post made me realize I'm not going to gain all the weight back from a reduction.
I went through exactly this! I lost 40lbs with MFP and started having hyper symptoms (heart palpitations and hair loss)
I totally panicked when my blood test showed I'm over-medicated. I posted about it in another thread (being honest, I was a lot less educated back then) and was reassured there will be no dramatic changes. And that's how it was.
Sadly, I'm now eating wrong, so no longer losing weight.
An interesting angle here, which my doctor couldn't confirm not deny, is whether weight loss might directly reduce the need for meds i.e. improve one's thyroid function.3 -
Great Post! I remember my endocrinologist explaining how my thyroid was basically being a slug and that I needed the synthroid/levothyroxine. And he went over each test he had run and what the results meant. And how often and which tests would be run ongoing.
I received a great tip from someone in their office. I was asked do you get up early in the morning to go the bathroom? I said yes, the suggestion was take your levothyroxine then. Which is about 2 hours before I normally get up and start my day. So solved the issue of it causing issues with food. And have never had an issue with odd test results.
But very detailed post, I enjoyed it.3 -
maureenkhilde wrote: »Great Post! I remember my endocrinologist explaining how my thyroid was basically being a slug and that I needed the synthroid/levothyroxine. And he went over each test he had run and what the results meant. And how often and which tests would be run ongoing.
I received a great tip from someone in their office. I was asked do you get up early in the morning to go the bathroom? I said yes, the suggestion was take your levothyroxine then. Which is about 2 hours before I normally get up and start my day. So solved the issue of it causing issues with food. And have never had an issue with odd test results.
But very detailed post, I enjoyed it.
I do the same thing - set my alarm for 5am, take the pill and drink 16 oz water. I now just get up and workout, but yeah - this set a barrier between meals as I don't eat anything until 10am.1 -
I do the same, set my alarm for 5am, but I usually am up to use the bathroom at that time anyway. Works fine for me!2
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I take my fist full of stuff with a glass of water, do a quick mile on the treadmill while the coffee maker produces my go-juice, and then I shower, drink coffee and try to be a human.5
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cheryldumais wrote: »Thank you so much @CSARdiver. This makes me feel so much better. I have been worrying myself sick because my doc wants to reduce my meds. Apparently it is showing up as though I am overmedicated now. He's waiting 6 months for a new test but I admit I've had issues sleeping at night and my moods have been swinging wildly so I probably need it adjusted. Losing weight has really messed with all my medications. Your post made me realize I'm not going to gain all the weight back from a reduction.
I went through exactly this! I lost 40lbs with MFP and started having hyper symptoms (heart palpitations and hair loss)
I totally panicked when my blood test showed I'm over-medicated. I posted about it in another thread (being honest, I was a lot less educated back then) and was reassured there will be no dramatic changes. And that's how it was.
Sadly, I'm now eating wrong, so no longer losing weight.
An interesting angle here, which my doctor couldn't confirm not deny, is whether weight loss might directly reduce the need for meds i.e. improve one's thyroid function.
Yeah I wondered about some of this too. What I’m really curious about is how my new walking program might have affected it.0 -
AFAIK, losing weight made no difference with my medication. I lost 55 lbs and have kept it off for the past few years, but my medication didn't change at all between my high weight and my low weight. I get a blood test every year to check levels, though they only do TSH, not T3 and T4.3
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spiriteagle99 wrote: »AFAIK, losing weight made no difference with my medication. I lost 55 lbs and have kept it off for the past few years, but my medication didn't change at all between my high weight and my low weight. I get a blood test every year to check levels, though they only do TSH, not T3 and T4.
I've gained and lost the same 30-40 lbs and my dose didn't change much, because a lot of that is retained fluid. My dose DOES change though, when I go through an intermittent period of thyroid function or interacting vitamin deficiency. That said, my thyroid has probably been good and dead for about a decade now, so my dose has been fairly stable for the last 10 years out of 20.
Last time my dose was lowered it was because I started getting B12 by injection after being deficient for years. You apparently need B12 to use the synthroid or thyroid hormone efficiently. Once I had B12 available, I didn't need as much synthroid. (by like 12mcg per day).2 -
@CSARdiver Thank you for the great post. A question for you. I am on the generic levothyroxine but heard from a pharmacist years ago that the name brand Synthroid is better. The reason being that, with the generic, you won't consistently receive the same generic and it can effect a person. Therefore the Synthroid provides consistency.
Any thoughts on this? I have a long-standing struggle with low mental energy. Probably from my depression, but I am always looking for any micro-mini improvements I can make in my life.2 -
Pamela_Sue wrote: »@CSARdiver Thank you for the great post. A question for you. I am on the generic levothyroxine but heard from a pharmacist years ago that the name brand Synthroid is better. The reason being that, with the generic, you won't consistently receive the same generic and it can effect a person. Therefore the Synthroid provides consistency.
Any thoughts on this? I have a long-standing struggle with low mental energy. Probably from my depression, but I am always looking for any micro-mini improvements I can make in my life.
Normally I'm all about the generics - simply because they are cheaper and identical. Synthroid is a bit different to the challenges associated with manufacturing. The safety profile on Synthroid is just better, so if there isn't a price difference - opt for the branded name in this instance.4 -
cheryldumais wrote: »cheryldumais wrote: »Thank you so much @CSARdiver. This makes me feel so much better. I have been worrying myself sick because my doc wants to reduce my meds. Apparently it is showing up as though I am overmedicated now. He's waiting 6 months for a new test but I admit I've had issues sleeping at night and my moods have been swinging wildly so I probably need it adjusted. Losing weight has really messed with all my medications. Your post made me realize I'm not going to gain all the weight back from a reduction.
I went through exactly this! I lost 40lbs with MFP and started having hyper symptoms (heart palpitations and hair loss)
I totally panicked when my blood test showed I'm over-medicated. I posted about it in another thread (being honest, I was a lot less educated back then) and was reassured there will be no dramatic changes. And that's how it was.
Sadly, I'm now eating wrong, so no longer losing weight.
An interesting angle here, which my doctor couldn't confirm not deny, is whether weight loss might directly reduce the need for meds i.e. improve one's thyroid function.
Yeah I wondered about some of this too. What I’m really curious about is how my new walking program might have affected it.
This is very common. As you lose weight you should expect TSH to decrease accordingly and ultimately lower your dosage over time.1 -
Pamela_Sue wrote: »@CSARdiver Thank you for the great post. A question for you. I am on the generic levothyroxine but heard from a pharmacist years ago that the name brand Synthroid is better. The reason being that, with the generic, you won't consistently receive the same generic and it can effect a person. Therefore the Synthroid provides consistency.
Any thoughts on this? I have a long-standing struggle with low mental energy. Probably from my depression, but I am always looking for any micro-mini improvements I can make in my life.
Normally I'm all about the generics - simply because they are cheaper and identical. Synthroid is a bit different to the challenges associated with manufacturing. The safety profile on Synthroid is just better, so if there isn't a price difference - opt for the branded name in this instance.
My health insurance will not pay for Synthroid or Cytomel, so what I do is always request the same manufacturer for the generic versions and so far, they have been working OK. I have been hypo for more than 16 years and the doses of both meds have been steady for the last 7 years.1 -
Pamela_Sue wrote: »@CSARdiver Thank you for the great post. A question for you. I am on the generic levothyroxine but heard from a pharmacist years ago that the name brand Synthroid is better. The reason being that, with the generic, you won't consistently receive the same generic and it can effect a person. Therefore the Synthroid provides consistency.
Any thoughts on this? I have a long-standing struggle with low mental energy. Probably from my depression, but I am always looking for any micro-mini improvements I can make in my life.
Normally I'm all about the generics - simply because they are cheaper and identical. Synthroid is a bit different to the challenges associated with manufacturing. The safety profile on Synthroid is just better, so if there isn't a price difference - opt for the branded name in this instance.
Unless you are me - the one time I got switched to synthroid (when I was on military orders) - my levels could not be stabilized - I went through 4 different doses in the 10mths I was on orders; back to Levo and stabilized within 3mths5 -
maureenkhilde wrote: »I received a great tip from someone in their office. I was asked do you get up early in the morning to go the bathroom? I said yes, the suggestion was take your levothyroxine then. Which is about 2 hours before I normally get up and start my day. So solved the issue of it causing issues with food. And have never had an issue with odd test results.
!!!!! Brilliant!!! I will start doing this tomorrow morning! Thanks for sharing that
1 -
deannalfisher wrote: »Pamela_Sue wrote: »@CSARdiver Thank you for the great post. A question for you. I am on the generic levothyroxine but heard from a pharmacist years ago that the name brand Synthroid is better. The reason being that, with the generic, you won't consistently receive the same generic and it can effect a person. Therefore the Synthroid provides consistency.
Any thoughts on this? I have a long-standing struggle with low mental energy. Probably from my depression, but I am always looking for any micro-mini improvements I can make in my life.
Normally I'm all about the generics - simply because they are cheaper and identical. Synthroid is a bit different to the challenges associated with manufacturing. The safety profile on Synthroid is just better, so if there isn't a price difference - opt for the branded name in this instance.
Unless you are me - the one time I got switched to synthroid (when I was on military orders) - my levels could not be stabilized - I went through 4 different doses in the 10mths I was on orders; back to Levo and stabilized within 3mths
Absolutely! I should have expanded upon this - as these pills are 99% filler there's likely something in the filler you're having a reaction to.
0 -
deannalfisher wrote: »Pamela_Sue wrote: »@CSARdiver Thank you for the great post. A question for you. I am on the generic levothyroxine but heard from a pharmacist years ago that the name brand Synthroid is better. The reason being that, with the generic, you won't consistently receive the same generic and it can effect a person. Therefore the Synthroid provides consistency.
Any thoughts on this? I have a long-standing struggle with low mental energy. Probably from my depression, but I am always looking for any micro-mini improvements I can make in my life.
Normally I'm all about the generics - simply because they are cheaper and identical. Synthroid is a bit different to the challenges associated with manufacturing. The safety profile on Synthroid is just better, so if there isn't a price difference - opt for the branded name in this instance.
Unless you are me - the one time I got switched to synthroid (when I was on military orders) - my levels could not be stabilized - I went through 4 different doses in the 10mths I was on orders; back to Levo and stabilized within 3mths
Absolutely! I should have expanded upon this - as these pills are 99% filler there's likely something in the filler you're having a reaction to.
no doubt...unfortunately, the endocrinologists response was that obviously i was taking my medicine wrong and that i needed to be reminded how to take it...(after being on it for 3 years with no issues)
i was on 125 at the time and now on 150 since then3 -
Great post. I had a total thyroidectomy several years ago and haven't noticed a difference in my ability to lose (or gain) weight over the long term, but I have noticed a difference in weight loss patterns, which I chalk up to some sort of shift in water retention. When eating at a calorie deficit, my weight will be stable or go up slightly for a week or more, then I'll drop a pound or two a day for several days in a row. Then the pattern will repeat. It's very consistent. That is a definite change from what weight loss was like for me prior to my surgery. But it doesn't seem to vary with the amount of synthroid I take -- my endocrinologists have had me all over the place in terms of dosage, and the weight loss pattern (and the amount I need to eat to stay in a deficit) stays the same.3
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This is AMAZING!! Thank you! I found much of this information when I was first diagnosed with hypothyroidism many years ago. I am really struggling with losing weight right now and have been questioning all of this and really needed the affirmation that this is accurate and I need to talk with my Dr rather than looking at supplements or other diets.3
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Absolutely! I should have expanded upon this - as these pills are 99% filler there's likely something in the filler you're having a reaction to.
It isn't life threatening or anything, but I usually end up taking my doses as some multiplier of the 50mcg white pills, because one of the dyes (either blue #2 or yellow #6) makes me break out for whatever reason, so I try to avoid it in my maintenance drugs.2
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