Can treating subclinical hypothyroidism help lose weight in obese patient?

Hi doctor,

Based solely on a TSH (Thyroid-stimulating hormone) of 4.8 and unnamed observed symptoms, my PCP (primary care physician) declared me to have hyperthyroidism and prescribed 25 mcg Levothyroxine daily. I started the regimen and thought I saw a reduction in the edema in my feet (I sit all day for work). Still, I also noticed developing isolated systolic hypertension, with the systolic going up as much as 20 points and the diastolic dropping as much as 20 points from my normal (120/80). I was only taking 12.5 mcg per day rather than the 25 because I am highly sensitive to most medications and wanted to minimize any side effects. After about a week, I went off the Levothyroxine, and my BP returned to normal (but my feet ballooned back up). I went back on the hormone, and within two days, the TSH has returned (the feet are still balloons, not the legs, just the feet and lower ankle). I do not have any symptoms that I know of, except I am very overweight (that occurred over the last three years). I have foot or ankle edema, elevated cholesterol, and an A1C (glycated hemoglobin test) of 6. I believe these are all lifestyle-related, and I am working on correcting my weight. I had a TSH of 9 three years ago with a normal T4 (Thyroxine), and no treatment was prescribed. The PCP did not do a T4 or T3 (Triiodothyronine) test, so we do not know for a fact that my T4 or T3 levels are low (they have never been). I could really use some thoughtful consideration on what I ought to do.

Hi doctor,

Thanks for your reply.

I decided to have a quick test done. The tests were done yesterday, and these were capillary blood tests (the original TSH above was from a draw). The results of the capillary blood tests were: TSH - 10.9 / FT4 - 1.0 / FT3 (free Triiodothyronine) - 2.65. This means my TSH went from 9 (three years back) to 4.78 a month ago and to 10.9 yesterday (I realize there can be variations). Does this tell you anything useful that would lead to further, or a change, in your advice? I still have no symptoms and have been exercising more, increasing my activity levels (after the mostly sedentary 3-year stretch that led to this weight gain). Thank you.

Hi doctor,

Thank you for your reply.

My cholesterol level has traditionally varied with weight. I would expect it to return to my normals as I get back to normal weight. However, I have attached the test results from last month. You do not need to respond unless you have something else I need to know. Otherwise, I will follow your previous advice. Thank you.

Hi doctor,

Thank you for your reply.

I am having trouble getting the weight loss ball rolling. I am eating fewer calories and almost no added sugar but have not dropped a pound. I have attached a file that shows what happened with my weight over the last 3 years. The curve should be steeper because I hit this weight 11 months back (but there were no in-person clinic visits). But would you look at a curve like that and find yourself with any questions? It started at about 191 (which would be my normal peak), then 10 months back, the increase started. I have gained weight in the past from not exercising enough and eating poorly, but I could always get it to drop with the same changes I am making now. This time, it just shot up, and it was like a load I could not carry (breathing hard walking half a block). I am slowly increasing the nightly walking (1.5 miles in about 35 mins now), but still, this weight stays the same. If you have any thoughts, let me know. Thanks.

Thank you doctor,

Hi. As you are a specialist, I wanted you to take a look at this as a whole. I also want to know whether you think that I should see a local endocrinologist or something. Do not say GP. They are scarce here and they are too busy to deal with actual patients. I gained 40+ lbs over the two year period that ended about a year ago. Since then, my weight has risen maybe another 6 to 8 lbs. Basically, lifelong issues for me is acid reflux, generally not heartburn, but there is regurgitation, sore throat, and cough. When I was in my 20 years, I got severe stomach pain after eating that was diagnosed as hyperacidity and I was also not able to eat. I have also had BP of 120/80 mmHg since as far as at 8 years old. I have also been diagnosed with generalized anxiety disorder and depression related to PTSD (or the newer C-PTSD), possibly dysthymia.

I am medication sensitive and so far, none of the various pharmaceutical approaches has worked (either it made things worse or the side effects were near fatal). My thyroid and blood sugar have always been normal range until recently. My cholesterol has risen and fallen with my weight. It got fluctuated up and down within a 20 lb range since my late 20s, with a couple of exceptions. Total cholesterol got to about 280 once in my late 30s. I lost about 40 lbs and it dropped to 205, which made my doctor happy.

I got back to about 200lbs in my late 40s. I was seriously depressed and suicidal at the time. Because of something that I thought would change my life for the better, I then dropped over 50 lbs., back to 148 lbs. (I'm 5'10") over the course of a year. I never seen total cholesterol below 180, although my HDL has always been above 45. The life change turned out to be psychologically and emotionally abusive which lasted for seven years. I gained about 45 lbs. During that time, in my 50s, over the course of the decade and passing through menopause, my blood pressure seemed to shoot up and it did not get below 140/80 mmHg. So I put myself on a high protein and no sugar diet and regular strenuous exercise. I dropped 30 lbs in less than 3 months. Then came the gain from about 170 lbs to 190 over the two years and then to 232 lbs, while seeing a doctor, over the next two years.

I was still pretty normally active during the first period of weight gain, but much more sedentary and depressed during the second. My BP still drops to normal range at rest, but seems a little elevated (maybe 130s/80s) more often than usual). The A1C was 6. The thyroid suggests Hypothyroidism (even if subclinical). The LDL was 192 mg/dL with a total cholesterol of 286 mg/dL (again, a number that remained close to before, but at nowhere near this weight). (If it matters, my vitamin D is low (26.3) and there are liver enzymes showing up in my blood (ALT/SGPT 52; AST 40).

The common symptoms is definitely obese. Since I started work again about a year ago, my feet swell up every day, and it takes a lot of effort to get them to go down. I do not seem to have the strength (muscle strength, mostly, and maybe emotional as well) to exercise as much as I used to, though I am trying. Finally, I have no idea what to eat, and so far the nutritionist I saw. The diet, she suggested would not work (it was like she forgot everything before sending me the suggested diet). I am supposed to be getting another referral, but they have not called yet. I choke a lot. My swallowing timing is off somehow. I choke on food, water, even saliva. I do not eat much, but I admit to eating more carbs because they are easier on my stomach. A lot of fiber, seeds, whole grains, vegetables and such and I actually get nauseated, not mention that the regurgitation of gas, fluids and solids increases. I have used a diet since my late 20s to control the reflux, but it definitely makes weight control harder and now I am obese and I am sure the reflux is worse, plus I am probably developing apnea. Keep in mind, the anxiety alone can cause me to forget to breathe or to breathe too shallowly. I have to consciously work on that daily, and it's not easy. I don't know how to find a balance if I am almost diabetic, almost having hypothyroidism, almost hypertensive, almost likely to have arterial disease (I assume from the cholesterol), and god knows what else.

I also have some osteoarthritis, TMD, a neck injury that causes imbalance and occasionally vertigo, feet that can cramp severely (again for 30+ years) and what seems like chronic posterior tibial tendinitis, and all my life — even now— it is painful to sit on nearly any chair or surface, and for as long as I can remember (even in kindergarten), I had trouble with my legs and feet getting weak or even "falling asleep" if I had to sit on a firm or hard surface. I've always been very inflexible (only kid in my 3rd grade gym class who could not touch her own toes), and I have a lot of tactile pain, meaning pretty much anywhere you poke with your finger, it hurts like it was bruised. I've also always blacked out if I squatted or kneeled and then stood up (I'd hold onto something till my vision came back and the pressure in my head passed). NO doctor has ever looked at me as a whole and tried to consider the whole picture. This sudden obesity has me terrified and having all these numbers suddenly go bad makes me wonder what the heck is happening, but no one seems interested in helping me figure it out. The PA went right for the thyroid, for which I have NO symptoms except the TSH number, and it seems the other tests looked a lot worse. I don't want to give up, but after decades of figuring things out for myself and for my doctors, I am finally at a loss for resources. I can't figure this out. Daily exercise and dietary adjustment has not resulted in a single pound lost. And your diary idea, while good, shows what I already know: I don't eat enough or often enough; and I don't eat a lot of calories. Maybe a max of 1500 on a day when I remember to eat; usually closer to 1000 to 1200 or less (I've had 400 calorie days). When I tell my therapist, my psychiatrist and my PA and now you that I can NOT live like this, I am telling you something you must take literally. I watched my sister suffer for six months before she finally asked them to let her die. Her ordeal started because her 440 lbs. dropped onto her left leg and shattered it, almost severing her foot. I could not be there for her because COVID. My mother suffered from RA for decades. She looked for a way to die for more than ten years as she lost all physical function. Finally, she figured out a way that was acceptable. In the hospital with pneumonia yet again, she asked for the breathing assistance to be removed. I couldn't be there either because my father was upset with me and didn't tell me she was in the hospital. My brother died suddenly in the shower. I found out about that a couple days later and was not even allowed to go take care of his affairs for him (what there was; he was thin, by the way; never had the weight problem his sisters did, but he smoke and drank and suffered severe depression). My uncle took the easy way out and jumped in front of a freight train. My little sister is somehow surviving, weighing around 300 lbs. She keeps her distance, so I don't know how she's doing, but she works about 7 days a week. My father lives 30 minutes away, is 98, refuses to get vaccinated and is as abusive as he ever was. So, my life has generally sucked since I was born, but now it feels utterly out of control. I'm not asking for your help with my psychological problems, I'm asking for help to figure out how all these hormonal issues could go wrong all at once, how I got here, and how I crawl back to something I recognize and can maybe control. Somewhere there must be someone who can help me; I don't want to give up yet. I don't want to quit yet. Please.

Thank you doctor,

I saw an upper GI specialist. Despite my long history with GERD and the regurgitation problem (even a drink of water will wash back up), she seems reluctant to do the endoscopy (she wanted to blame allergies, yet my last ENT said he saw significant damage that indicated reflux). I gather they can stretch the esophagus in places where it may be scarred to help in some way, but if the LES is damaged, that is a surgical problem. We have not gone forward with that yet. I have tried to contact more than one medical weight-loss program, I guess I will have to chase them down if I want help (they're not very responsive even though we have good universities around here). I know the obesity is the thing that really scares me right now and feeling like I were being proactive would sure help. Maybe it would help some of the other problems as well. I take omeprazole (40mg/2x a day; recommended by the upper GI doctor), but it does not seem to help much. I take diazepam as needed for the anxiety (it is the only drug that seems to have no side effects, but I am not sure it is more than minimally effective - 5 to 15 mg/day max). I take an OTC antihistamine as needed. I take Melatonin in the evening (20 mg), Cyclobenzaprine (10 mg) when my foot cramping becomes severe, every kind of vitamin supplement including extra D3, calcium or magnesium, fish oil, Benfotiamine (for the feet again - nerves), a B12 supplement, a potassium bicarbonate supplement, nicotinimide and Metamucil (capsules). I know my diet does not provide adequate nutrition and probably never has, but again, have not found much help on that front, especially considering my inability to eat much at a sitting (and never having experienced a sensation of being hungry that I can recall). I will look into online. I want to be monitored if I try anything radical to kick my system into the right mode metabolically, but I have got to do something, and soon. Thank you.

As you suggested, I started a medical weight loss and lifestyle management program at Duke Health. We were looking at the Optifast option, but it would end up being basically all liquid and I wanted to try to reach an equivalence with actual food. I've only been on it since last Sunday, but my weight appears to be down 3 lbs. On the other hand, I have a bad feeling about the labs you were most interested in, the TSH, FT4 and TPO antibody. I'm attempting to attach all the labs in case some of the other weirdness means something, but I'd like your advice on whether levothyroxine makes sense now. I should be talking to my P.A. on Monday about it. I'd still like to continue the weight loss to see how much the lipids improve. I gained weight since August, which would make them go in the wrong directions if history is any indication, however, I want to see what happens over the next few months on this diet plan. OptiFast is still an option if I'm not getting good results on the equivalent food diet. Anyway, attaching the files. Appreciate your thoughts on anything or everything.

My only concern with treating for hypothyroidism is that I have absolutely no symptoms that aren't attributable to something else (like dysthymia). I don't doubt that my immune system is taxed; I have issues with tendonitis and of course, there is my nearly lifelong generalized anxiety, panic and severe regurgitative GERD. But so many doctors have check my thyroid manually and said "normal" in the last six months, you wouldn't believe it. Is this reversible? Is it possible that the lab results don't mean what they appear to mean? I'm wondering if my best route would be to get a local endocrinologist (because working with you has been really helpful, but you can't be hands-on), maybe get a needle biopsy on the thyroid and see if there is any actual damage, then make a treatment decision. My sensitivity to medications would probably mean halving the lowest of the low starting doses and much closer monitoring by a specialist. When I read about hypothyroidism, the literature is not definitive, but often speaks of the patient "feeling better" after a period of time on the medication. I have no clue what that means because, again, I don't have any of the symptoms they suggest should make me feel "bad." This would be a numbers-only process, if we can count on what the numbers are really telling us.Note: As high as my anxiety levels are continuously, there is definitely a correlation between my father moving to my area (abusive childhood; not much different as an adult), and the weight gain and squirrelly lab results. After 64 years of this, I guess having a weakened immune system is par for the course, but I would like to try to fix this if there is a way. Thanks again for your advice. I will try to get a good referral to a local specialist to consider next steps.