# Confused after new doctor visit...input?



## hnybeeliss (Apr 29, 2014)

Hi, I'm new to the boards and after reading through this forum I was hoping to get some insight on something my doctor said today.

A little background will probably help as well, lol.

I was diagnosed with Hashimoto's when I was 16 (I'm 27 now); after being extremely sick with symptoms (anxiety, not being able to sleep, weight loss), basically, I was in the hyperthyroidism stage. I was finally referred to an endocrinologist and she looked at my numbers and immediately diagnosed me with Hashimoto's. Anyway, I was on whatever you take for hyperthyroid (sorry, it's been so long I can't remember exactly what it was) for about a month, until my levels stablized. I felt better, like myself again, agreed to see her every 3 months, and that was basically that. She did tell me that I would probably eventually "go hypo" because most people with Hashimoto's do, and when that happened she would just treat me before it got out of control.

Alright, so fast forward to now. In the past 2 years I've gained about 20 pounds. At first, I was able to lose weight, but now, even after eating better and exercising 3x a week, I can barely lose 1. I've also been noticing (sorry, don't mean to be TMI) constipation and I do feel more tired.

When I first noticed the weight gain (10 pounds ago, ugh, lol) my endo, the same one who I had been going to since I was 16, prescribed me vitamin D supplements. They didn't help with it. Before she took my labs, she mentioned how she was expecting me to come in with symptoms of hypothyroid, because, again, most people with Hashimoto's do. She put me a small dose (25 mcg) of levothyroxine (which again, did nothing about my weight). But when my labs looked "normal", she basically said she could not help me with my weight gain, it wasn't related to my thyroid, to see a nutritionist. Around this time I had also developed a nodule, which she said was due to vitamin D calcification. I had a biopsy and it was fine. (This was in Oct. 2012)

So...yeah, lol that was my first experience with an endo who just looks at numbers. I tried another, and when I mentioned weight gain she did the same thing: looked at my TSH, T4, and said it's in normal range, you don't need treatment. She does not even DO any other tests, according to the nurse I talked to.

So I was extremely frustrated, and found a new doctor (Surgeon, Thyroid Specialist) who was recommended by a family friend and specifically told me that he tests for a number of things, and goes by symptoms. I saw him today and he went over my lab results: turns out my Thyroid Peroxidase Antibodies are at 395, Thyroglobulin is 44.5. Also, he looked at my other numbers (TSH, T4 free, T3 free) and said they are typical of someone with Hashimoto's, even though they are in the supposedly normal range. He also noticed that my nodule has grown (had an ultrasound last month), and wants another biopsy in a few months.

He put me on 50 mcg of Synthroid, told me to make sure I get the name-brand, and that he would probably raise it to 75 in a few months, but wanted to start out slow, just in case-- also to get Vitamin D3 supplements, as those levels were pretty low (one was at 12!). At this point, I had told him all of my symptoms, especially the weight gain and inability to lose.

What he said that confused me was this: "This will probably not address the problems you are having--the weight gain. You will probably lose about 5-10 percent." I asked him if the Hashimoto's was not, in fact causing the weight gain/inability to lose. "It's a small contributor."

So...I'm really confused. I might call his office and ask, but does this make sense to anyone? If it won't help with my symptoms, why wouldn't he prescribe a higher dose? Or did he just mean that I wouldn't see results at first, or that it would take time?

I guess I always figured that going on Synthroid (or any kind of replacement) with hypothyroidism would help with weight loss. I know it's not a ton of weight, but it has bothered me for a while--I'm always worried I'm going to gain more, and not seeing results from working out is really frustrating.  I had been on Lexapro, an anti-depressant known for causing weight gain, for a few years, went off it a few months ago (Feb.), but that did not seem to help either.

Anyway, I'm sorry if this post is super long! Thank you all in advance for any advice you can give me.


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## Jo853 (Aug 16, 2013)

Hi there,

I was diagnosed Hashimoto's in January this year and I still can't get my head around it all.

Unfortunately I had problems different to yours - I'm 29yrs old and had a high TSH in November 2011 (I was 26). But my doc didn't treat me as my FT4 was normal. She even told me I had hyperthyroidism! 

So another year goes by and in the summer of 2012 I get severe leg cramps. A nurse at A and E said I showed classic thyroid symptoms and wrote a letter to my doc requesting I be urgently tested and treated. Did they reply? Nope. Did they act on the letter? Nope.

So in January 2013 I get told I have high Anti-TPO antibodies at 84 - nowhere near as high as yours - wow! And within 4 months my TSH goes through the roof at 22. FT4 was at 10.9. Then I get put on levothyroxine.

I can understand your frustration with doctors, really, I do. I've been with 3 different doctors since having all these problems and I'm trying to get hold of T3 medication since my FT3 is quite low. Unfortunately I have some hypo symptoms and some hyper ones. It's so maddening! I get constipation, depression, heavy periods, PMS, cold intolerance, low BBT, fatigue, headaches, pallor, muscle aches, muscle twitches, anxiety and as for the hyper ones? I cannot gain weight!

Ah, anti-depressants. Yup, been there, done that. I've been on 3 different anti-depressants before being diagnosed hypo - Lustral, Sertraline and Citalopram. Doctors thought I had general anxiety when I had trouble swallowing - all because the goiter I had at the time had reduced in size. On the ultrasound it was "mildly enlarged". This report never made it to the doctor. So whenever I quizzed the doctor about it they skirted the issue. I expected them to chase the hospital up for it as they were the ones who referred me.

Unfortunately my previous doctor didn't even act on my weight loss. Surely they would be concerned that a hypo person suffers weight loss as it so often is the other way round? Concerned - it didn't seem like it and instead they blamed my weight loss on my depression. So they prescribed me more anti-depressants!

So, in short, I can understand your frustration with the docs, and don't worry about the long post. Is your consultant keen to start you out on T3 medication? Sorry, but what are your FT3 levels and the reference range? Also what Vitamin D supplement are you on? I currently take Vitamin D at 3000IU in spray form as my Vitamin D was 43.6 (>75).

Jo xxx


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## CA-Lynn (Apr 29, 2010)

Given the moderate amount of weight gain, I'd put that on the back burner for now and focus on the thyroid issues. But remember: weight gain is always the result of insufficient exercise to compensate for increased caloric intake.

Now, with high antibodies and insufficient or deficient Vitamin D, you may not feel like exercising adequately. So in that regard, hypothyroidism is an incidental reason for weight gain. But at the end of the day, regardless of hypothyroidism or not, the law of physical mathematics [caloric intake and amount of exercise] always comes out in the wash.

A lot of people too often are looking for a quick fix to weight gain. Again, focus on getting the hypothyroidism under control.


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## hnybeeliss (Apr 29, 2014)

Lynn--I definitely see your point--but usually, if I had not been exercising for a while (i.e. in college, lol) and then started to, I would lose weight. Now, I lose a pound the first week and then nothing--and I have exercised consistently. It's not so much the gain, but not being able to lose it if I work at it, that is frustrating.

Since I've always read that the thyroid is associated with metabolism, I guess I thought eventually, I will be able to lose weight again. I have been counting calories (well, using my Fitness Pal, that is, lol) and exercising. In the past, weight would usually come off, as long as I stuck to eating healthy (Weight Watchers, usually) and exercised a few times a week. It was a matter of knowing my body and then, knowing that something was wrong. I've never had a problem with over-eating, either. My caloric intake did not, as far as I know, change.

But I agree about putting this on the backburner--I am going to try my hardest not to worry about this anymore. Now that I know I'm doing what I can to fix my thyroid (again, lol), I'm just going to make sure I eat healthy and exercise, and see what happens. Life is too short. Reading the forum and seeing how out of control people's symptoms can get kind of puts things into perspective, which I am grateful for. 

Jo: I'm taking D3, 2,000 IU, just a soft gel. T3: 2.9, range is 2.3-4.2; T4 1.1, range is 0.8-1.8. I can definitely relate to the anti-depressants! I went on the Lexapro after my thyroid was leveled out when I was 16, (I still had anxiety symptoms) and have been on one or another pretty consistently ever since. it's only 10 mg, but sometimes I really wonder if it was my thyroid--the only time now that I really have symptoms is during my PMS week--my GP said I have classic symptoms of PMDD, which is basically bad PMS. :/ Anyway, now I take Well-butrin, which is not supposed to cause weight gain. Wierdly enough, almost 3 months after starting it, I have randomly lost 2.5 pounds. I'm not sure if this will continue or not, but I guess we'll see, lol. It sounds like you have been through the ringer with doctors, sorry to hear that!


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## Jo853 (Aug 16, 2013)

hnybeeliss said:


> Jo: I'm taking D3, 2,000 IU, just a soft gel. T3: 2.9, range is 2.3-4.2; T4 1.1, range is 0.8-1.8. I can definitely relate to the anti-depressants! I went on the Lexapro after my thyroid was leveled out when I was 16, (I still had anxiety symptoms) and have been on one or another pretty consistently ever since. it's only 10 mg, but sometimes I really wonder if it was my thyroid--the only time now that I really have symptoms is during my PMS week--my GP said I have classic symptoms of PMDD, which is basically bad PMS. :/ Anyway, now I take Well-butrin, which is not supposed to cause weight gain. Wierdly enough, almost 3 months after starting it, I have randomly lost 2.5 pounds. I'm not sure if this will continue or not, but I guess we'll see, lol. It sounds like you have been through the ringer with doctors, sorry to hear that!


Hi hnybeeliss,

Ouch -- a T3 of 2.9 and a T4 of 1.1! Unfortunately with Hashi's, symptoms and results do wax and wane and they do this interchangeably by the sounds of things. All the more frustrating LOL.

Yes, I've been through the ringer with my doctors too, but never mind. So many other people have this problem. It's such a confusing illness.

With the Vitamin D supplement, you may not notice a difference in your symptoms/lab results for up to six months. That's what my endo has told me but it depends on the actual result at the time. If your most recent result was 12 or lower then it may take a while. I'm not sure how long it will take but hang in there. hugs1

Good luck with taking the Well-butrin and that it has helped you. Time will tell, definitely, but it's going in the right direction for you and that's what counts.

Jo xxx


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## joplin1975 (Jul 21, 2011)

Regarding the weight gain, I think you've got two things in play that are hard to tease apart: you are getting older and you have thyroid issues.

Both make weight harder to manage than what it was when you were younger. It's a hard, hard lesson to learn, but I think CA-Lynn is right: focus on getting the thyroid issues straightened out and then turn to the weight.

Just to give you an idea of what I need to do to maintain a healthy weight: I track all my calories on Everyday Health app (basically, a free WW program) and focus on high protein, low carbs. I have to work out Every. Single. Day. I would be absolutely massive if I only worked out three times a week. Four days a week of high intensity cardio, three days a week of heavy weight lifting. Plus riding horses everyday.

It's not fun and honestly I feel like kicking a puppy when I see how other people "just" go for leisurely walks on a treadmill a couple of times and week and don't pay attention to what they eat and lose weight, but it is what it is. I presume as I get older, it will get more challenging.


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## bigfoot (May 13, 2011)

I'm going to respectfully disagree somewhat with some of what Lynn said about weight gain. (Sorry Lynn )

Sure, it could be from a lack of energy leading to a lack of activity or eating a little too much. But... since the thyroid is so central to our metabolism, I also have to believe that it has a significant role behind the scenes. If it isn't optimized, it isn't functioning properly, which means your body isn't going to burn those calories as efficiently. I also think there can be a lot of other reasons for weight gain. It could be a side-effect of a medication, a sign of a different medical issue, other hormones out of balance, etc.

I'll throw out an example: I had gained about twenty pounds from when I had first gotten sick years ago. Even when I addressed my diet and activity and was started on thyroid treatment (under-medicated), most of that weight stuck around. So I modified my diet even further, to no avail. Eventually, after being treated for autoimmune liver disease, going GF, and trying to optimize both thyroid and sex hormones, much of that weight slowly vanished. I absolutely still have to watch what I eat and try to keep active, but no longer am I feeling totally bloated and slug-like.

I agree with everybody on getting your thyroid straightened out first. That is a big number one priority. You may even find that some of the other issues you were dealing with improve, too. (In all reality, with your young age at diagnosis, they should have been turning over a lot of other stones, too.) You want your doctors to be optimizing your thyroid levels, not just running a TSH and calling your results "normal". Don't be surprised if they ignore or dispel many of your signs & symptoms as "that can't be thyroid related" or "that's not possible". There is much we don't know about our bodies. (Heck, we used to think the world was flat.) Another example: I had blotchy rashes on my arms. No doc could figure it out. Once I was started on thyroid medication those rashes literally vanished overnight. So don't expect doctors to agree with everything or be all-knowing. Some if it will just have to remain a mystery. Ultimately, in the end it doesn't matter -- it's about getting you feeling well and being able to live your life. The key is having a doc (whether that's an MD, DO, ND, endo, ENT, or other specialist) you can trust, without a huge ego, that is an active listener and thinks outside the box.

This new doctor you found who happens to be a surgeon & thyroid specialist sounds like he really knows what he is doing. You always want to run a TSH, Free T3, and Free T4 at a minimum. Checking those antibodies is great. And the ultrasound is excellent, too. As is raising your from 50 mcg to 75 mcg of name-brand thyroid medication. A lot of folks around here shoot for a suppressed TSH at 1.0 or below, and Free T3 & Free T4 levels at 50-75% of the range. Some of that is easier said than done, but it makes for a good starting goal. Be sure to keep copies of all of your lab work and tests, and keeping a daily journal can help, too. If taking only T4 medication (aka Levothyroxine) doesn't get you where you want to be, you can look into adding in a little bit of Cytomel (T3), or even trying a desiccated product (Armour, Nature-Throid, etc.). The desiccated offerings are completely safe and have to meet the same USP and FDA standards as the pharma big boys, despite what some docs think.

Allrighty... well, that turned into a bit of a ramble on my end, but feel free to ask us anything else, and be sure to let us know how you are doing! hugs3 Spend a little time browsing the forums, too. Many of us are dealing with similar issue(s).


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## hnybeeliss (Apr 29, 2014)

Hi bigfoot! Thanks for your advice; it's good to hear that the doctor I switched to seems to know what's up.  Also, I agree about the metabolism--I think that while I do want to focus on getting my levels where they need to be (at the very least, getting the antibodies down, because dear lord--lol, I never would have known if my new doctor hadn't tested those!), once they are, I should have an easier time losing weight.

I've heard so many different things, not only from this board but also fitness boards and others (just by googling Hashimoto's and weight gain/loss you get a lot of results coming at you, lol) and in the end, it seems that everyone's body is different. Some people found it easier to lose after just going on D3 supplements for a while, others have a harder time, etc. I just am going to listen to my body and hopefully, with time my metabolism will get back to where it's naturally supposed to be. If, after a few months, losing weight is still difficult, I might look into a naturopath because I've heard good things. I will definitely keep you all updated! Thanks for being so friendly and forthcoming with info and advice.


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