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Weight Loss with Hypothyroidism Success Story [Step by Step Case Study]

​Are you frustrated with trying to lose weight with your sluggish Thyroid? 

In this post I am going to go "behind the scenes" of what I do inside my clinic and show you how balancing your hormones is the KEY to weight loss success in patients with Hypothyroidism (or any medical condition!).​

Note: This is an actual patient from my office, and this is what THIS patient needed for her weight loss. I don't recommend you use any of the therapies listed below for you personally unless you are evaluated by a Doctor. 

Let's jump in:

This patient presented to me with multiple symptoms and was looking to lose weight and balance her hormones

She is 69, a mother of 3 kids, and has been struggling with her weight ALL of her life.

Her primary goals of treatment:

  1. Lose weight (100 pounds ideally)
  2. Feel better and have more energy
  3. Improve her sleep

Throughout her life she tried numerous diets including: HCG diet x3 (she lost 40 pounds the first time, 20 the second and 10 the last time) and different yo-yo diets throughout the last 20 years...

**Update: Patient now has a lost a total of 60 pounds which is 20 pounds lower than what she was able to do with her gastric bypass surgery - more info at the end of the article including testimonial**

More...

  • My Thoughts: Chronic yo-yo dieting leads to increased levels of Reverse T3 and Thyroid resistance. It can also lead to Leptin resistance. NEVER do these kind of diets!

Before she came to see me she was most recently seen by another "holistic" provider who put her on a ton of supplements - but she never actually lost weight.

  • My Thoughts: Stay clear of providers who only want to put you on a diet or supplements to help you lose weight. Weight loss is a problem with your hormones, NOT calories

​As part of trying to lose weight she had a lap band surgery, and with the lap band she was able to lose 40 pounds initially - but eventually plateaued and over the last several years put all of that weight back on + 15 pounds. 

Her weight has been a huge source of stress in her life, and is taking a toll on both her self esteem and her health. She has elevated blood pressure, high cholesterol and diastolic dysfunction stage II.

​Brief review of organ systems:

​Gastrointestinal tract: She has daily diarrhea - and has for many years (ever since her surgery).

​Energy Levels: 4-5 out of 10 on good days. (10 being "optimal" energy levels)

Sleep: Suffers from insomnia, unable to "slow down her mind" at night and requires the TV on at all times to fall asleep.

​Exercise: She gets on a bike daily for 30-40 minutes

Pain: She suffers from chronic pain in her neck, back and both knees. ​

Diet: Consists of Salads every day, very little fat and high protein in the form of lean meats. ​

  • My Thoughts: Low fat diets with lots of low intensity exercise do NOT help with weight loss. For more information you can see my recommendations on diet and exercise for those with hypothyroidism here

After our initial consultation, I sent her for a Comprehensive Functional Blood Chemistry Panel, which I will go over below:

Comprehensive Functional Blood Chemistry Analysis​

Abnormal lab results hypothyroid patient

​The following labs were "out of range" by the laboratory standards, for the tests that were "in-range" but suboptimal we will go over below (including thyroid studies):

Elevated Homocysteine - ​An inflammatory marker and high levels are associated with an increased risk of developing heart disease. 

Low testosterone - Women need testosterone too! Low levels of testosterone are associated with a depressed mood, inability to lose weight and inability to create and maintain lean muscle mass (lowers overall metabolism of the body).

Elevated blood sugar - By conventional standards she falls into the Diabetes range (we will go over this below).

​Low Vitamin D - Low levels of Vitamin D make hypothyroidism worse, and low levels are associated with an increased risk of developing autoimmune disease. 

Now for going over the more subtle (but probably more important), functional lab tests that are in the "normal range" but still sub optimal.

​Cholesterol

Cholesterol panel with high triglycerides

​This patient was on a Statin medication (Simvastatin) when she came to see me, which explains her lowish LDL. 

In this patient I'm more interested in her high triglycerides and HDL. This ratio can act as a surrogate marker for insulin resistance (which she does have) and when combined with elevated homocysteine makes me worried about her overall risk for developing heart disease.

​She is also suffering from Diastolic heart dysfunction and High blood pressure - which can stem from insulin resistance

​Luckily these conditions can be reversed VERY quickly - in fact in as little as 1-2 months with intensive diet and exercise routines. 

*Note: If a patient doesn't have a history of heart disease (previous heart attack), the data does not necessarily support the use of Statin medications - Statins have been associated with an increased risk of developing diabetes, ​muscle damage, and are associated with an increased risk of developing breast cancer

Blood Sugar and Insulin​

Insulin resistance in hypothyroid patients
Uric acid and fructose
Fasting insulin and hypothyroidism

​Insulin resistance and blood sugar issues are VERY common in hypothyroid patients. 

As you can see above this patient has Insulin resistance AND elevated blood sugar which puts her in the range of Type II diabetes mellitus.

Her insulin is also elevated - which is a huge part of the reason she is unable to lose weight.

​Recall that with high levels of insulin (I use 5 as a cutoff) your body will store all calories you consume as FAT. Insulin literally turns off the enzymes in your body that allow you to burn fat as an energy source. 

In this patient a FASTING (12 hour) insulin level os 23.8 will be a huge issue for her and explains her inability to lose weight - especially when combined with her other hormonal imbalances. ​

As you can see her Uric acid is also elevated - this tells me that her liver has a problem metabolizing fructose and that she is likely consuming extra sugar in her diet. 

Thyroid Studies​

Patient with hypothyroid labs
Slightly elevated thyroperoxidase antibodies
Elevated reverse T3 in Hypothyroid patient

These thyroid studies definitely fall within the "normal" range by definition of the labs. 

Despite that this patient suffers from multiple hypothyroid symptoms, and also has several other signs of hypothyroidism including: Low resting pulse, decreased body temperature and symptoms of hypothyroidism.

​Because of these findings and because insulin resistance is associated with low levels of T3 in the serum and a hypothyroid state - I did treat her with Thyroid hormone. 

As you can also see, her free T4 and free T3 levels are suboptimal - both falling within the lower first and second quartile of the reference range.

In addition her Reverse T3 is elevated which is causing an inappropriately increased free T3 level. ​

SHBG and hypothyroidism

In tricky cases you can also look to Sex Hormone Binding Globulin to assess liver tissue levels of thyroid hormone. 

Low SHBG is associated with tissue level hypothyroidism, and tracking SHBG levels with treatment can be used to get an idea of how much Thyroid Hormone is actually getting to the target tissues.

In this case you can see that low levels of SHBG are consistent with tissue level hypothyroidism and high levels of reverse T3. ​

Note: It's unclear to me whether her insulin resistance caused her hypothyroidism or if her hypothyroidism contributed to her insulin resistance - but in either event, both need to be treated!

Iron Studies

Low iron levels in hypothyroid patients

​Iron is critical to measure because low levels are associated with decreased thyroid function

​In this patient you can see that her levels are "normal" but they all fall within the lower portion of the reference range. 

Through treating hundreds of patients I've found that optimal thyroid function happens when Ferritin is around the 70-80 range. ​

Vitamin B12

Low serum B12 levels

​Vitamin B12 deficiency is a BIG deal and often missed by many providers who aren't looking for it. 

​Absorption of B12 is dependent upon hydrochloric acid, and with hypothyroidism stomach acid is generally low - this results in decreased absorption of Vitamin B12 in many hypothyroid patients. 

In addition - ​subclinical vitamin B12 deficiency is VERY common and often undiagnosed. 

Because of this I treat patients with Vitamin B12 (methylcobalamin) if they have: Low or mid range serum B12 levels, an MCV > 92 on red cell analysis, or elevated homocysteine levels.

This patient has several of these lab values and so I opted to treat with methylcobalamin injections to saturate the tissues with B12. ​

​Diagnoses

After going over the results with her above, and assessing her symptoms she ended up with the following diagnoses:

  • Thyroid Resistance, Hypothyroidism
  • Insulin Resistance, Type II Diabetes Mellitus
  • Low Testosterone
  • Adrenal Fatigue
  • Insomnia
  • Diastolic Heart Disease
  • Iron Deficiency
  • Chronic Diarrhea, with multiple nutrient deficiencies
  • Vitamin B12 Deficiency
  • Vitamin D Deficiency
  • Hyperlipidemia
  • Hypertension

As a side note:

Don't let this list of symptoms and diagnoses scare you.

These are just names of her conditions, what we really care about is WHY. 

In this case my suspicion is that something like this occurred:

​Her history of multiple episodes of recurrent yo-yo dieting lead to her thyroid resistance. In an attempt to lose weight her gastric bypass likely lead to malabsorption of iron and B12 with chronic diarrhea, further worsening her hypothyroidism. 

Her insulin resistance and Hypothyroidism are likely contributing to her high blood pressure and abnormal cholesterol panel.

​High levels of stress lead to adrenal fatigue and symptoms of insomnia, extreme fatigue and food cravings. 

Following this logic our treatment should be aimed at reversing these conditions (which I will go over below)...​

Treatment

​Here I will go over the treatment that this particular patient needed, and then give some follow up thoughts on why I did what I did. 

Please remember that this treatment is specific for THIS patient!

Do not take any treatment recommendations and apply them to your health. Every patient needs to be treating differently because no two patients are alike.

How to use Functional Medicine for Optimal Treatment:

​Hormones and Medications:

In her case I replaced hormones that were identified as being suboptimal with her blood work:

  • Armour Thyroid
  • Bio-identical Testosterone (In organic base) 
  • Phentermine (To be used with Fasting protocol)

​Even though it is likely that her thyroid and testosterone are both low due to insulin resistance, I still prefer to treat patients in this position because they will often get faster results and they will feel better quicker. 

My goal is to always reduce medications whenever possible, so if her hormones balance out after treatment I will attempt to decrease her dosing of these medications. 

Because of her age and symptoms, I started with 30mg of Armour Thyroid (She is currently on 60mg and doing well). 

Supplements:

Her supplements were targeted to her comprehensive functional chemistry panel:

​To learn more about what supplements I use and why I use them I encourage you to check out this post here

Most of these supplements were targeted at specific deficiencies in the blood work, the only exception being adrenal support. 

​The probiotic was used to help balance out intestinal dysbiosis from the gastric band and chronic diarrhea. 

Physical Work/Chiropractic work:

This patient had significant pain and multiple tender points along her neck, mid back and low back.

My suspicion is that these tender points were potentiated by low levels of thyroid hormone.

Because of this I recommended soft tissue physical manipulation and low intensity vibration therapy on a weekly basis, in addition to cranial sacral work. 

Fasting Routine: ​

​Elevated insulin levels (especially in the fasted state) contribute to weight loss resistance. 

The combination of fasting and a low carb/high fat diet will reverse Diabetes very quickly. 

Unfortunately, fasting can be tricky in patients with Hypothyroidism. Especially when most Hypothyroid patients also suffer form Adrenal Fatigue.

For this reason, I don't recommend fasting unless these hormonal systems are optimized.

In this case I waited 4 weeks before implementing a fasting routine.

After 4 weeks I started her off with a 24 hour fast and then checked her 24 hour fasting insulin. 

24 hour fasting insulin

​As you can see below she dropped her fasting insulin from 23.8 (12 hour fast) to 10.3 (24 hour fast). 

Our goal is to get insulin levels below 5 but each time her body drops her insulin level it will become more sensitive and subsequent fasting episodes will further drop her insulin level.

​In this case I continued with a 24 hour fast x2 and then increased to 36 hours once per week. 

Before and after each fast I checked her percent fat mass, muscle mass and water weight.

With each fasting period she lost anywhere from 5-7 pounds of pure fat mass in addition to several pounds of water weight. ​

Stress Management:

Emotional and Stress reduction therapies are critical to managing both weight loss and overall health.

​This patient had a history of being unable to sleep due to her mind being constantly "turned on" at night. 

Because of this I had her practice a combination of biofeedback, mindfulness and guided meditation to lower stress levels and help her sleep. 

This therapy was done in office.

Dietary changes:

Diet is critical to weight loss, but by itself isn't always enough.

In this case I started the patient off on gluten free, dairy free, soy free and sugar free.

Her diet was high in healthy fats, nutrient dense and filled with real whole food.

She met with my health coach/nutritionist weekly to help her integrate new food groups and menu plans into her daily life. 

​Exercise:

​Due to her untreated hypothyroidism and adrenal fatigue, I started her off on low intensity exercise. 

After 1 month I started her on HIIT - in the form of 10-15 minute bursts once per week.

Detox: ​

​Many hypothyroid patients need to eliminate endocrine disruptors from their body in order to improve their thyroid function. 

In addition, as the body starts to burn fat stores for energy, the fat cells can dump excess fat soluble toxic compounds into the body.

This is especially important during fasting routines when the body burns TONS of fat for energy.

I had this patient do weekly FAR infrared sauna therapy for several reasons:

Results​

In using this multi faceted functional medicine approach to care, the results can be very impressive.

This patient was able to improve almost ALL of her symptoms within 1 month of treatment - which I will go over below:​

Weight loss​:

*Note: Weight loss is measured in percent fat mass lost by impedance analysis of the body. Note that the total weight did drop more than just percent fat mass, but I consider this a more accurate measure (along with body measurements) of fat loss. ​

Week 1 - 5 pounds of fat mass lost

Week 2 - 7 pounds of fat mass lost

Week 3 - 4 pounds of fat mass lost

Week 4 - 5 pounds of fat mass lost

​Total lost over 1 month of treatment: 21 pounds of fat mass

This weight was lost without losing any muscle mass and without persistent calorie restriction. 

​Insomnia:

By the end of week 2 this patient was sleeping a full 8 hours through the night and was able to sleep without turning on her TV at night for background noise. ​

In her case I believe her insomnia was due to a combination of adrenal fatigue and some degree of undiagnosed anxiety.

Both were improved with hormone balancing, supplements, mindfulness and physical work. ​

Energy:

Current Energy levels = 8/10, an increase from 4-5/10​

Energy levels are subjective, but can be used as a general "marker" for how well her thyroid and adrenals are functioning. ​

Chronic pain: ​

​At the end of 4 weeks of treatment her pain had almost completely resolved, and at this point she no longer has back pain. 

In this patient I believe her pain was due to her elevated insulin levels and anatomical changes which were dealt with by physical work and a fasting regimen.​

​Final Thoughts

​This patient is still undergoing treatment with me, and I will continue to update her results from time to time. 

At this point I believe she will continue to lose fat mass, and improve her energy over the next 4-6 months.

​I wanted to use this patient as an example to show what a comprehensive, functional medicine approach to care actually looks like. 

Many people are stuck in the conventional medicine mentality and they wrongly believe that changing up their medication from Synthroid to Armour thyroid will solve all of their health problems.

This couldn't be further from the truth.

In many cases switching medication will help symptoms, but it won't be enough by itself.

Whenever possible your Doctor should attempt to go after the primary cause of your symptoms, and reverse that.

Updates:

​8/15/2016 update: Patient is now down a total of 60 pounds (20 lower than she was able to achieve after her gastric bypass) with continuing her fasting protocol and adding in a GLP-1 agonist for her leptin resistance. 

Her weight loss plateaued at around 50 pounds of weight loss, so we checked her leptin level:

Leptin resistance labs

​You can see from the above that her leptin levels are > 12 indicating that she has leptin resistance. 

Even though she was able to lose weight initially this was the cause of the plateau at around 50 pounds.

After adding a GLP-1 agonist to her regimen she was able to lose another 10 pounds total. ​

You can find her review and testimonial below:

ruth review

​I want to hear from you!

What kind of treatment have you received for your thyroid? What worked and what didn't? Is your doctor using a similar approach to treat you?

Let me know in the comments below!​


Dr. Westin Childs
 

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

Click Here to Leave a Comment Below 22 comments
Joanne wingate - March 12, 2016

I’ve had Hashimotos for at least 2 years but only just been put into Levothyroxine about a year ago as my doc said my levels were “normal” which turned out I had Hashimotos I have gained at least 20lbs my hair is falling out, my joints are in agony and I’m physically exhausted most of the time! Please could you help ?I’m so unhappy feeling so uncomfortable all the time, I feel this is affecting my quality of life, many thanks j Wingate

Reply
    Westin Childs - March 13, 2016

    Hey Joanne,

    I’m sorry to hear about your situation – unfortunately it isn’t that uncommon nowadays. The best advice I can give is to look for a functional medicine doctor close to you (you may have to travel to one) to help put you on the right path.

    It sounds like you may benefit from adding T3 to your regimen in some form, but realize that this is just a small piece of a larger puzzle.

    Reply
Jennifer Pfeifer - March 13, 2016

So what’s one to do? I have a doctor’s appt next week and I will ask to change my prescription to Armour, but then what? I don’t have the energy to educate my doctor. And I shouldn’t have to. I am willing to take the supplements you outlined but what if i need further tests? I guess I will have to wait and see what he says.

Reply
    Westin Childs - March 13, 2016

    Hey Jennifer,

    Each person is unique and needs to be evaluated based on their personal history and treatment should be targeted to their lab tests and symptoms. I can’t say for sure what tests or treatment you would need. I would also point out that changing to armour is only a small part of the equation for some people (not even everyone needs it or does well on it), the rest is going after your specific hormonal imbalances and treating those.

    In general, you will find the most help in seeking out a doctor that practices functional medicine.

    Reply
Maria Villalobos - March 13, 2016

Hi! I had hypothyroid since 1991 two years ago í moved to the border of texas and when ivstart seeing a de. Here he took my levothyroxin away he said It was normal . í went to other doctors and they said since í do not have a record here in the valley.So they wont give me meds for my thyroid. I feel really fatigue, gain alot of wait, cold and in pain. What should I do? Please help

Reply
Claire Hinton - March 20, 2016

My doctor told me to go on slimming world diet and just up’d my thyroid tablet to 150.

Reply
    Westin Childs - March 20, 2016

    Hey Claire,

    Increasing your thyroid hormone is a good place to start, but you can’t ignore all of the other hormones that may be interfering with your weight loss! Make sure to get properly evaluated and have your other hormones checked as well.

    Reply
Nicole - April 3, 2016

Hi Dr. Childs,

Do you pay much attention to the TSH test? I used to see a doctor (who is now retired) and he and I agreed that if you are taking thyroid medication your TSH will likely be suppressed. Why would your body tell your thyroid gland to make more thyroid if you are giving your body thyroid with medication daily? I can’t seem to find another doctor who shares the same view. I’m more concerned with it being too low than too high because everyone thinks you’re HYPERthyroid when the TSH is low even with many obvious hypothyroid symptoms. What are your thoughts on TSH and do you think there is an optimal range for it?

Reply
    Dr. Westin Childs - April 3, 2016

    Hey Nicole,

    Taking thyroid medication (T4 or T3) will ALWAYS decrease the TSH. The reason is because the pituitary is the most sensitive tissue in your body to thyroid hormone because it has special deiodinases which do NOT create reverse T3 which compete for free T3 binding. As a result using the TSH to measure peripheral tissues for thyroid hormone is horribly inaccurate. I will order the TSH as part of the picture, but I employ a host of other tactics including resting heart rate, resting pulse, subjective symptoms, and a complete thyroid panel when diagnosing and hypothyroid patients.

    I will write a post about your question, because it is far too complicated to get into in the comments section here – but after monitoring hundreds (if not thousands) of patients on thyroid medication and watching the TSH I’ve found that thyroid blood tests in general do not always give a clear picture on what is happening in the body.

    You are not likely to find Doctors who share my view (or the view of your previous Doctor) because it differs from the standard of care. It’s far easier to order the TSH and call it “normal” and kick the patient out of your office than it is to do what I do.

    Great question, though!

    Reply
Katie - May 3, 2016

Hi Dr. Childs,

I’m so glad I stumbled across your website. I was recently diagnosed with Hasimoto’s disease. I have gained about 40 lbs in the past year with constant fatigue. My synthroid was increase to 150mcg a day for 3 days a week and 300mcg a day for the other 4. I still feel awful. I have tried to get the doctor I see prescribe Armour Thyroid but they are sticking to Synthroid. I have been dealing with thyroid issues since my early twenties and now I’m 36 and 225 lbs. I’m only 5’4″. I just want to feel good again! HELP!

Reply
    Dr. Westin Childs - May 3, 2016

    Hey Katie,

    The best thing you can do for yourself is to find a Doctor who is willing to work with you. I do online consultations for this reason, but if you can’t do that then search around your area for someone local!

    Reply
Susan - May 22, 2016

Hello Dr. Childs,

You have a good site here and I appreciate your work. Thank you so much. 🙂

I am seeking more direction and info because I feel I have a sub clinical thyroid condition even though I have been addressing my health for the last over 3 years. I have studied non stop for 3 years about health and my conditions and follow Dr. Ron Rosedale and Dr. Richard Bernstein who recommend low carb high fat diets to correct Leptin and insulin resistance and diabetes, with good result. I was pre-diabetic and morbidly obese with extreme insulin resistance. Blood pressures up and arthritis.

I have been following a low carb high fat whole foods diet and eliminated all grains and starches. I eat very healthy and well. I make my own pro-biotic sauerkraut and take organic turmeric daily for inflammation, bone broth, organic and clean food. I managed to lose 90 lbs in 3 years. At Christmas I took a fall and blacked my eye badly, ( my first shiner), found out I had a heart condition ( no intervention required as it turns out) and suffered a personal setback. I ate a bunch of bad juju and because of my insulin resistance put 20 lbs back on instantly. I need to lose more than that. Now I am back to eating low carb, 30-50 grams per day and not losing or gaining.
My thyroid labs are normal per my doc but I am have dry skin,a little hair loss, cold hands and feet and plummeting body temps. Using a basal thermometer I check when I am cold. Yesterday it was at 96.54 at my coldest.

I am so energy-less I feel like crying/dying because I have so many projects and no energy to do them. I am a massage therapist and have no motivation due to tiredness. I have little stress and know how to manage that at least. ( Yin person. :-)I need to make money. Yesterday I barely got through a massage and was perspiring profusely and weak in my muscles. Hadn’t eaten for about 4 hrs., possible Keto flu…

Chris Kressor says a very low carb diet causes low T3 conversion to T4. He recommends 150 carbs. If I eat that I can’t lose weight either because of leptin and insulin resistance. I have a clear understanding of those. Makes sense that my body seems to have down-regulated more due to this diet but my blood sugars and pressure are awesome compared to what they were as long as I don’t eat sugar. If I do they both shoot up drastically almost instantly and I feel like DEATH! My energy levels and body temp were better before I began the diet.

Recent thyroid labs were all in the normal mid range. I did not have a RT3 done. My insurance won’t pay.

What’s scary is sudden plummeting of the body temp and energy. It does come back up if I eat/ rest and relax for awhile.

I am in good general health other than a screwed up metabolism which I am trying to repair.

No stomach issues, digest well, a bit of constipation which sometimes goes with this diet but offset with coconut oil, food enzymes, psyllium, lots of fluids.

One day this month I had energy that I hadn’t seen in forever and chortled all day long to everyone I met!! I was joyous! And I probably did too much.) All that day I felt normal. 🙁

I take a full range of supplements including Berberine and Selenium, Zinc, Vitamon D3, K2 etc.

I must take Cocoa Well to get fake caffeine energy, 146 mgs. if I have to do a lot in a day just to get through.

Some advice says cook all veg, and get off dairy which will be hard but I am prepared to do if necessary. I tolerate it well and love it but I am willing.

Please advise me on these points when you can.

I appreciate any advice you can give.

A healer trying to heal myself.

Gratefully,
Susan

Reply
    Dr. Westin Childs - May 23, 2016

    Hey Susan,

    I don’t know how much else you can actually do on your own without the addition of bioidentical hormones. It would be helpful for you to take thyroid medication (preferably T3) and a leptin sensitizer to get your body back on track. The last thing you could try is fasting, but I’m not sure I would recommend it without addressing your thyroid first.

    Reply
Nancy - May 31, 2016

I have been seeing a Holistic doctor for about 5 years, he dx’d me with hyperthyroidism and adrenal fatigue. The doctor put me on a compound of c-t3/t4 1:4 75mcg caps he also had me take Homocysteine Supreme, Dr. Wilsons Super Adrenal Stress Formula, Adrenal DMG, Grapeseed, Fish oil. I have had alot of test over those 5 years and the doctor said I have high histomine levels and that I am at an incressed risk for a heart attack, he alos had me on a hormone replacement compounded for me and used vaginaly. Never got optimal results, never had weight loss after being faithfull to WW for a year and a half. He took me off the hormone replacement when I told him I didn’t want to do another expensive saliva test. I went to my GP and he said he would take over my thyroid disease and put me on synthroid 75MCG tab, I am shakey,not sleeping, and irritable. I checked my resting pulse it was 84, but my axiallary temp was 96.7. I have gained 3 pounds in 2 weeks with incressed activity and continued diet. I feel like stopping everything. PLEASE help.

Reply
    Dr. Westin Childs - May 31, 2016

    Hey Nancy,

    It sounds like you need someone to manage your thyroid hormone replacement. Going off of all of your hormones is not likely to help and it doesn’t matter how much you exercise or diet if your hormones are off – you will continue to gain weight.

    Reply
Wendy - August 2, 2016

Dr. Childs,

This is fantastic info. I’m 34 yrs old and have hypothyroidism. I’ve been on Nature Throid and more recently Armour Thyroid and have optimal levels on full Thyroid panel. I’ve had a sonogram done on my neck as it seems to be very swollen and they mentioned it was very thick, possibly hashimitos. However, the tests came back normal (I’ve been on meds for years). Not sure if this could be related, but I feel I might actually have hashi’s because I’ve also broken out in shingles 3 times within the past year and I’m very healthy. The docs ALWAYS ask if I have an autoimmune disorder.

I cannot seem to lose a pound and take CrosFit workouts 4 times a week with a healthy diet. I also have zero sex drive. I wonder if I might need an additional hormones to assist?

Thanks! You seem to be VERY educated on this!

Reply
    Dr. Westin Childs - August 2, 2016

    Hey Wendy,

    Yes, you most likely do have hormonal issues or you’re under treated. The hard part is finding a doctor to help you figure out what is going on and how to fix it.

    Reply
Sheryl - October 16, 2016

My story is JUST like your patient. FINALLY. A gastric bypass patient who had trouble losing weight!! I had a gastric bypass surgery (RNY) in January of 2008. Back then, I couldn’t find evidence of anyone like me.

I lost 60 pounds within 6 months and then *POOF* nothing. Everyone kept telling me it’s “just a plateau”. I exercised more, ate less. I drank more water, changed the type of exercises, more fruit, less fruit, less carb, more carb, more protein, different types of protein . . . on and on and on.

I went back to my endo, back to doctors. No one could tell me anything, including the doctors who coordinated my surgery. The only thing that showed up abnormal in THEIR tests was my Vitamin D. I point-blank asked if that could stop me from losing weight. “No” was the answer.

It was devastating to go to the doctor to get help and be treated as if you’re lying about what you’re eating. Pray tell: if you go to the doctor, aren’t you supposed to tell them what’s wrong? And guess what? If they don’t believe you, YOU CAN’T GET HELP. The shame I would feel when a doctor’s mouth would fall open at the words, “I had gastric bypass and can’t lose weight.” I could only affect my weight if I ate less than 1000 calories. But I knew it was only water – not fat. And my thought was, “If I’m 235 pounds right now, how in the world am I going to lose another 65 pounds if I plateau again? I can’t go lower STILL!”

The doctor who initially authorized my surgery thought he knew my motives for seeing him and thought he would preempt it by telling me, “You can’t have a revision.” He didn’t know what to say when I told him, “I don’t WANT a revision. I want the surgery I HAD to WORK.”

I went back to my surgeon 2-3 times, went to several endos, all within my HMO. I drove 45 minutes in Los Angeles traffic to see one endo, only to cry all the way home. My tests always said I was normal. They flat-out said they didn’t know why I couldn’t lose weight. And I couldn’t find any testimonials online of any RNY patients who were having the same difficulty I did. Maybe I was stressing my body? Maybe I needed a break? All I DID know was that I was regretting the decision to have the surgery.

I am 44 years old and have been overweight ALL my life. I don’t remember what it’s like to be thin. Having surgery and not being able to lose the weight felt like a cruel joke. Before the surgery, my body worked but I didn’t have the motivation. Now I had all the motivation in the world, and nothing I did would get the weight off.

So for the last 8 years, I have had a cycle of give up, start again — over and over. Weight loss is hard enough as it is. If it was easy, I wouldn’t have had the surgery. But to be doing all the right things AND get no results is maddening. I’d get tired of being fat and somehow gather up the courage to try again. I’d tell myself I just didn’t stay consistent long enough the last time. All the while I’m making the decision to start again, I’m scared that I still won’t get any results.

I am currently 276-281 pounds. I started a lifestyle change (again) on July 28. I was all in. I went out and bought free weights, a weight machine and a treadmill. I have exercised 5x per week faithfully since that time, except for the week I was sick. I’ve dropped my calories to 1/2 of what I was eating before, cutting sugar, cutting carbs, cutting even artificial sweeteners, eating salads, increasing protein, tracking it all on FitnessPal.com. The result: all I did was yo-yo back and forth between the SAME 5-6 pounds. I can gain fat, but I can’t lose it. I can’t get below 276.5.

That kind of drastic change in my lifestyle should produce a change! Weight fluctuates daily, but there should be a downward trend. There isn’t one. I also measure with a tape measure regularly, so it’s not like the scale is going up but my inches are coming down. Not so. No inches lost. In three months. I’m not burning fat. As I’ve been trying to tell my HMO doctors – something is WRONG.

A ferritin test hasn’t been run on me since 2009. I asked for a Free T3 test several years ago and was told that Kaiser “doesn’t run that test.” I was prescribed 50,000 ius of Vitamin D2 for my low vitamin D – instead of Vitamin D3. And the ONLY reason they ran a Vitamin D test was because I ended up having to call Member Services and submit a grievance when my doctor refused to run one. Her reason? She said she didn’t know how to read it.

I understand that weight loss isn’t supposed to be easy. I’ve lost weight enough times to know that. I’m not looking for a miracle. I know that 1-2 pounds a week is reasonable. But what weight loss ISN’T supposed to be, is impossible. I, doctor, am living in the realm of the impossible. After 8 years, I know that for sure now. It’s like trying to run a marathon with your leg chained to a tree. No matter how hard I run, I’m not going anywhere. It’s not about me or my habits or my effort. It’s about my body – the “tree”.

I am usually a very driven person. In the last two years, I have struggled with a lack of motivation. I have described it to my husband as “feeling weary on the inside”. I sweat a lot in my sleep, but maybe that’s menopausal. I can, however, go to sleep any time I sit down long enough. At about 7-8 p.m., I’m DONE for the day. And it’s very hard to get up in the mornings.

I’ve told myself, “If I just make myself exercise, I’ll have the energy I need. Maybe I’m to blame for how I feel.” But, as you exercise, your fitness level is supposed to get higher, and you should be able to do more as your body gets lighter. I’m not getting any lighter, so I’m stuck at 20 minutes. Because I am not burning fat, I can’t get past doing more than 20 minutes.

I looked at the lab ranges in your article above and was SHOCKED.
Her RBC was considered low at 4.65. Mine was lower than hers — 4.41 on 3/12/16. Her lab’s range was 4.70-5.90. The Kaiser range is 4.20-5.40.

Her HCT was considered low at 40.5. Mine was lower than hers — 39.1 on 3/12/16. Her lab’s range was 41.9-53.1. The Kaiser range is 37-47.

The point: as long as I continue going to Kaiser on this matter, they’re never going to say there’s anything wrong with me. But I don’t even know where to start to get help . . . what kind of doctor to see? What to ask for? Kaiser isn’t going to cover it. If I’m going to get help, I’m going to have to pay for it myself. I’ve been trapped for eight years, so I’ve finally conceded that this is the ONLY way I can get help.

Reply
    Dr. Westin Childs - October 17, 2016

    Hey Sheryl,

    You are right that you will most likely have to seek care outside of the insurance model. No matter how hard you try, or how many tests you ask for, you won’t be able to make a Doctor treat you a certain way and in the end that is all that matters.

    Reply
Mark H - January 24, 2017

Hey, found this article very interesting. Especially the mention of leptin levels as my Doctor has never mentioned this.

I was diagnosed with hypothyroidism in 2013, after my initial diagnosis I managed to lose 42lbs in weight. I felt great.

However….. my weightloss has hit a huge plateau. I’m now stuck at 215lbs and nothing is shifting the weight! I actually work as an exercise therapist, so I know my levels of exercise are what you would usually prescribe for fat loss. This makes me even more frustrated!!

I would like to lose another 20lbs or so, so any advice you could give me would be great.

I’m currently trying the 16:8 intermittant fasting ‘diet’ but after 2 weeks of this i’ve seen no change. Exercise wise i’m completing 4 20min HIIT workouts per week, plus a 5k run.

I’m currently on 175mg of Levothyroxine a day.

Any advice would be gratefully recieved.

Reply
    Dr. Westin Childs - January 24, 2017

    Hey Mark,

    You will need to have the following levels tested: insulin, leptin, testosterone (free and total), reverse T3.

    No amount of exercise will help you lose anymore weight until those hormones are addressed above. I wouldn’t waste time getting them checked by your PCP or endo either, they won’t really know what to do with the results.

    Reply

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