Layla hits a plateau in her treatment of hypothyroidism

Layla inquires about how to approach this common situation in the treatment of hypothyroidism:

Hello, I am a 23-year-old girl, and at the beginning of 2013 I started rapidly putting on weight, where I ballooned from 128 lbs to 155 within a few months, despite extremely healthy eating and exercise. I had my TSH tested and it was 4.71. I was put on 25 mcg of levothyroxine, which was eventually increased to 50 mcg (I am still currently taking this). It decreased my TSH to 0.69 and increased my free T4 t0 1.2, but recently my weight loss has slowed and I put on a little fat despite an extremely low carb diet. I retested and it showed that my TSH had gone up to 2.1, and my free T4 had gone down to 1.0. My endo was not tested T3, but she finally gave in when I asked, though she refused to test free T3. My total T3 came in at 40 (range 50 – 180, though I’ve seen 80 as the lowest amount for health), which is extremely low. I have always had incredibly slow metabolism, and even when I was at 128 lbs, I had a lot of body fat. I keep asking for Cytomel, and the endo is almost there in giving it to me, but she insists that my low T3 is due to some mystery illness that she thinks is temporary, and wants me to retest. My question is this: how much T3 should I end up taking, to get rid of my excess weight and body/belly fat, and improve my symptoms (dizziness, extreme fatigue, depression, PCOS)? I want to be around 115 – 120 lbs. I figure the starting dose will be around 5 mcg, but do I need more than this for optimal functioning and metabolism? Should I split the dose? Any advice is appreciated.

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  • Linda S.

    Layla, you should get a different, better doctor who would give you a complete thyroid panel: TSH, free T3, free T4. It would be good to be tested for Rt3 (reverse T3) and antibodies. You need a doctor that will give you these tests because much can be learned from the results. You shouldn’t have to beg a doctor for these widely used tests. Most endo’s are close-minded MDs. You should look for an open-minded integrative MD who already prescribes T3. You can ask when you call around or call compounding pharmacies for referrals. There are two types of T3, Cytomel (quick release) and compounded time-release (slow release), which I find better. The exact doses are tricky and so individualized that no one on a blog can tell you. Good luck.