# Weight Control After Partial Thyroidectomy



## Isthmus123 (May 19, 2016)

For those of you who have also undergone a partial thyroidectomy, have you had weight gain issues? If so, any success in getting the extra weight off and how did you do so?

I underwent a partial thyroidectomy about 2 years ago. The first year was mostly fine but after my TSH slowly changed, I started meds last April. I have gained about 25 pounds since then. I have more soft fat and less muscle than I ever had, and I work out and lift. I am still a bit hypo in my numbers and working on that.

I walk, swim, bike, lift and eat as best I can- only occasional dessert and glass of wine. Mostly whole foods, seafood, nuts, veggies, fruit. No fast food, no soda, now no pizza.

:mellow:


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## Lovlkn (Dec 20, 2009)

> 2/2015 TSH 1.96, Free T3 2.2


6/2015 TSH 2.5

12/2015 TSH 3.5

03/2016 TSH 3.09

4/17/2016 Start .25mcg Levothyroxine

4/30/2016 TSH 2.09

5/01/2016 Reduce to 0.125mcg Levo

5/31/16 TSH 2.66, Free T4 0.73

8/12/16 TSH 2.77

10/13/16 Switch to Naturethyroid

12/8/16 TSH 2.1, Free T4 0.86, T3 134



> 1/16/2017 TSH 2.4, Free T4 0.8 (range 0.8-1.8), Free T3 3.3 (range 2.3-4.2)


You have been hypo since your surgery. Until you get your FT-3 to 3/4 range being on Naturethyroid, you likely will struggle with weight gain.


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## joplin1975 (Jul 21, 2011)

Ditto every thing Lovlkn said!


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## Isthmus123 (May 19, 2016)

So how do I do that when I feel terrible every time I try to go up on Naturethyroid?

For example, when I do go up energy is solid but I feel zoned out/stoned. When I go lower that symptoms goes away and initially I feel better. But then a few days later I get tired again.

My FT 3 is in the 50-75% range (closer to 50% I know) but I can't deal staying on it long enough to get up to 75%.


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## joplin1975 (Jul 21, 2011)

How long are you staying on/trying out the higher dose?


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## Isthmus123 (May 19, 2016)

In December I gave it (1/2 grain) 3 weeks. By that last week I felt the effects all through the day. Felt better by evenings.

Then I tried again in early January for another week- same thing.

Then I tried again in mid January and did every other day for a week- same thing. After taking 0.375 grain for the last 2 weeks, I started feeling it again. So went down to 1/4 grain again. Felt wonderful the first few days, then was way too tired and hypo by day 4 or 5.

I've been taking 0.375 for the last 3 days again. Felt good on day 1 and day 2. As of today I feel the effects again.

Wondering if it is too much T3 all at once to tolerate because I tend to feel relief by evening. Any thoughts on that?

I say that because I remember a few months prior to surgery my Free T3 tested out at around 2.2. All other numbers were solid. I know that is on the low side unmedicated but that was MY normal before all of this!


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## Lovlkn (Dec 20, 2009)

Changing medication doses without a lab draw prior to the dose change is like a dog chasing its tail.

Frequent dose changes makes
It impossible to dial in ideal replacement doses. This is one time when sticking to dose regardless of how you feel - until you can have a lab draw is necessary.


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## jenny v (May 6, 2012)

Have you ever had a reverse T3 test done? Sometimes when people have trouble raising their dose, you need to check rT3 to see if your body has a build up of that and it's causing issues (if you do have high rT3, look to other issues like iron issues or adrenal issues that can cause it).


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## Isthmus123 (May 19, 2016)

Thank you. Yes I just had a reverse T3 test done a few weeks ago. I do not have that appointment for a few weeks so I might not see the results for a while. I think the provider suspected something was up so they ordered that.

I do have an iron deficiency, so I've been taking iron for about a month. My ferritin was quite low (9, I think). I take it every night now. I will get my cortisol tested soon for adrenals.


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## Lovlkn (Dec 20, 2009)

> but that was MY normal before all of this!


I picked this out of one of your posts - so post surgery you tended to be on the low side.

Why not consider dosing your Naturethyroid this way for awhile and be sure to test both FT-4 and FT-3 prior to adjusting any dosing routine. Alternate the 37mcg and 1/2 grain. Start only 1/2 grain 2 days a week, alternate 37.5mcg and see how you feel.

I had a horrible time adding Cytomel post TT. While I have no thyroid you may be experiencing the same thing - that is being on the hypo side for awhile and trying to raise FT-3. If you did not know your FT-4 and FT-3 results prior to your surgery I want to point out that TSH can be impacted by either so if you are basing post surgery labs with pre surgery labs and do not know your FT-3 number that may be the issue. I want to point out that FT-3 has always been the hormone that made me lose weight- but dialing in that dose after being hypo can be challenging.

I realize you changed medications and wonder if after the trial I suggested above you might be a better candidate for Levothyroxine and Liliothyronine ( Cytomel).

Incidentally post TT after complaining about unrelenting fatigue, I also found out I was low in Ferritin, and Vit D with slightly lower than optimal B-12. My labs were also on the hypo side at this time of testing.


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## Isthmus123 (May 19, 2016)

Ok thank you I will talk with my Endo on Monday at my appointment, although I hate that zoned out (not tired) and kinda irritable feeling I get when I take more NT...but also don't like the hypo heart palps I'm getting from not not having enough.

I know I'm hypo right now and also thinking about the switch back to Synthroid. Will discuss monday...

And alas! I do have pre-surgery results!
10/13/14
FreeT3 2.2 (2.39-6.79)
Free T4 0.81 (.58-1.64)
TSH 1.83 (.34-5.6)
T3 Reverse 17 (7-24)
0 antibodies


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## Lovlkn (Dec 20, 2009)

> I know I'm hypo right now and also thinking about the switch back to Synthroid.


As suggested - you do not appear to be a good converter, since you are already taking a heavy T3 hormone, why not give it one more try with alternating before you switch medications again.

You will likely need Cytomel if you go onto levothyroxine.


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## BurntMarshmallow (Feb 26, 2016)

Hi there,

What is your hemoglobin? A ferritin of 9 is really low. I know I felt awful with a ferritin at 30. People with anemia do have a harder time tolerating taking thyroid hormone, and they experience more side effects, like heart palpitations and a racing heart, dizziness, etc. I struggled with anemia for a year while also struggling with being hypothyroid. As my anemia blood work improved, so did my thyroid symptoms.

It sounds like you eat really well and exercise. What kind of iron are you taking? Are you taking any other supplements?

Taking vitamins and minerals has been the thing that helped me get better, but I made plenty of mistakes with them too. One thing to watch out for if you are anemic is getting too much vitamin C. Doses above 400mg a day (for a long time) will decrease ceruloplasmin, a copper carrying protein needed for iron metabolism. Ceruloplasmin isn't something routinely checked, even in anemic patients. I had to ask for mine to be checked. So many popular multivitamins have too much vitamin C.

If you're only supplementing with iron, then you should consider taking a trace mineral supplement (zinc, copper, molybdenum, chromium, etc) and a b-complex to help you make new red blood cells.

How do your fingertips look when they are dry? Are they wrinkled? This is a great indicator of your electrolyte levels. If you have low electrolytes it could be part of what is effecting you, especially if you work out hard and often. And it could be why you're having problems tolerating thyroid hormones. The serum test for electrolytes won't show a problem unless you have kidney disease or until your levels are life threateningly low, like if you ran a marathon and only drank water. Actually, Pedialite has the perfect balance of electrolytes without the sugar, if you don't mind the taste.

Another thing to try is lipothiamine - a fat soluble B1 supplement. Especially if you notice you feel worse after drinking or eating something sugary. Hypothyroidism can cause problems absorbing B1 in the small intestine. Low B1 leads to low taurine, an amino acid the body needs thiamine to make. Taurine is needed for maintaining potassium and magnesium levels inside cells, and being low then leads to heart palpitations.

Anemia and thyroid problems are a catch 22. When you improve your anemia you may tolerate thyroid hormone better, and when you can take more thyroid hormone it will help your anemia. I was stuck for months with a ferritin of 30 but slowly things shifted, I got a little less anemic and then my thyroid really improved, and now my ferritin is a 70, which is like a miracle. I almost thought they had the wrong results because it's never been that high.

Good luck to you,

Amy


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## Isthmus123 (May 19, 2016)

Hi Burnt Marshmellow,

I don't know what my current hemoglobin is but last March it was 14.6. It has been slightly high for the last few years that I have records for. That and hemotocrit. I always tested fine for the finger-prick iron test at my Gyno's office, and this was the first time I saw ferritin. Now it is something like 20! I take an iron chelate pill in the evening around dinner time.

I also take a multivatim (with 60mg Vitamin C in it). There are also trace minerals in there and vitamin Bs. I take 400 mcg of Methyfolate (for the MTHFR gene mutation), and 1 probiotic as well.

My fingertips look very normal. No wrinkles.

Thanks for the info! Funny, my doctor today was saying the same thing about iron being related to thyroid as well as vitamin D (and more than those obviously).

So next steps: move to Synthroid .50 mcg. My Endo prefers Naturethyroid but he said that some people just don't do well with the T3, so he suggested Synthroid.

I still feel somewhat hypo at the 0.375 grain of Naturethyroid so I can see that I might need 50mcg Synthroid at some point. I do wonder if this is a good starting point when you're switching or too high from where I'm at now? It sounds like pretty much all of the T3 will be out of my system tomorrow. I was leaning toward starting at Synthroid .25mcg but he said 0.5 would be fine...


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## BurntMarshmallow (Feb 26, 2016)

It sounds like you're doing everything right. It may just be a matter of finding the right thyroid hormone type and dose.

Here's a chart that shows conversions between all the different thyroid hormone medications and dosages:

http://centraldrugsrx.com/pdf/Thyroid_Conversion_Chart_08-13a.pdf

Looking at the chart, 0.375 of Nature Thyroid is right in between the 0.25 and 0.50 dose of Synthroid. If you've been feeling hypothyroid, then I'd go with the 0.50 dose.


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