Navigating Hypothyroidism and Weight Loss Challenges
I recently achieved a significant weight loss of 60 pounds while using the medication Zepbound. My journey with hypothyroidism began 15 years ago, during which I was prescribed levothyroxine in doses ranging from 50 to 75 mcg for many years. However, I lost my health insurance in 2022, which made it difficult to access my medication. Although I have a doctor now, she has hesitated to prescribe levothyroxine, stating she wants me to focus on weight loss first to reassess my situation. My thyroid hormone levels, T3 and T4, consistently fall within the normal range, and I lack any indicators for Hashimoto's or Graves' disease. Nevertheless, my TSH level has been hovering at the higher end of normal, and as of my last lab results in July, it sat at 5.16. This persistent fatigue has been troublesome, and I’ve been grappling with feelings of depression alongside noticeable hair loss. I find myself questioning whether these issues are purely related to my thyroid condition, my weight, or perhaps a combination of both. I also have developed ridges on my fingernails, which adds another layer of concern. My doctor expressed that TSH can fluctuate significantly, which is why she is hesitant to initiate thyroid medication at this time. I can’t help but wonder if she doubts the validity of my long-term medication use or believes my thyroid problems are attributable to my weight. Does Zepbound have any impact on hypothyroidism? I'm in need of insights regarding her reluctance to prescribe my thyroid medication. Should I advocate more strongly for its reinstatement? What steps would you recommend in my situation? Any advice would be greatly appreciated. Thank you!
Answers (1)
8/5/2025, 4:02:15 PM
OpenHealth AI
It's commendable that you've achieved significant weight loss. Your concerns about hypothyroidism and the challenges you're facing are completely valid. Let’s work through your main points and identify some actionable steps to help you navigate this situation.
Key Points:
- Thyroid Function: Your T3 and T4 levels are normal, but your TSH is slightly elevated, which can contribute to symptoms like fatigue and hair loss.
- Current Medication: The weight loss medication (Zepbound) you are using may impact your mental and physical health, but its direct effects on your thyroid function are not well established.
- Doctor's Approach: Your doctor's reluctance to prescribe levothyroxine may stem from her observation of your TSH levels and a belief that weight loss might alleviate some of your symptoms.
Explanation: Thyroid-stimulating hormone (TSH) is a hormone that helps regulate your thyroid's function, and an elevated TSH can indicate that your body is trying to stimulate the thyroid gland to produce more hormones. This doesn't necessarily mean you need immediate thyroid medication, particularly if your other thyroid hormone levels are normal.
Regarding Zepbound, weight loss medications can sometimes lead to fluctuations in mood and energy, but they do not directly impact thyroid hormone production. Your feelings of depression and fatigue are important concerns that should be addressed as they can affect your overall well-being and your weight loss journey.
Actionable Steps:
- Monitor Symptoms: Keep a daily log of your energy levels, mood, hair loss, and any changes in your physical health. This information can be invaluable for discussions with your doctor.
- Communicate with Your Doctor: Schedule a follow-up appointment to discuss your symptoms in detail. Express your concerns about fatigue, hair loss, and nail changes. Bring up your previous experience with levothyroxine and how it helped manage your symptoms. Ask if temporary trials of medication could be considered.
- Consider a Thyroid Specialist: If you’re feeling unsure about your current care, consult an endocrinologist specializing in thyroid issues. They can provide a second opinion on your treatment plan.
- Support for Mental Health: Since you're experiencing feelings of depression, consider seeking support from a mental health professional. Addressing mental health can assist in your overall health recovery.
- Healthy Lifestyle Choices: Maintain a balanced diet rich in nutrients, engage in regular physical activity, and prioritize sleep. These lifestyle factors can have a positive impact on both weight and thyroid symptoms, regardless of your medication status.
Feel free to advocate for your health, especially when it comes to discussing the potential need for thyroid management. Your health journey is uniquely yours, and it's important to find a plan that prioritizes your needs. Let me know if you have further questions or need more support!
Related Questions
Understanding When Heart Palpitations Are Considered Normal
As a 32-year-old female, I can recall experiencing occasional heart palpitations that triggered coughing, usually once a year since I was a child. Recently, however, I’ve noticed a significant change. Over the past couple of months, these palpitations have become more frequent, particularly when I transition between positions like reclining and standing. Just a month ago, I would feel only one or two flutters, but now it seems to occur throughout the day after being triggered. For instance, after my hairdresser reclined me to wash my hair at around 4 PM, I’ve been experiencing these flutters and coughing on and off since about 7 PM. I suspect this might be linked to the timing of my tirzepatide injections, as it tends to happen around the peak day when my caloric intake drops quite significantly. Additionally, I’ve noticed that I sometimes experience presyncope when standing up too quickly, although I haven’t encountered any dizziness or changes in my vision. When lying down, my pulse may rise briefly, but it could just be my imagination playing tricks on me. I also deal with fluctuations of 5 to 7 pounds in water weight weekly, which I’m currently monitoring through a careful diet to minimize. My daily medications include mirabegron, trileptal, and amitriptyline, alongside tirzepatide at a dose of 7.5 mg every three to four weeks to help with maintenance and reduce food-related noise. At my current height of 5'4" and weight of 107 pounds, I’ve started strength training while keeping my caloric intake around 1440 calories daily. My primary care provider regularly performs EKGs and has mentioned that the palpitations could be due to vagus nerve irritation, reassuring me that it isn’t a cause for major concern. He has also evaluated intermittent calf pain in my left leg, which improved when I stopped wearing high heels. However, I can’t shake the feeling that the left calf appears slightly more purplish than the right, but I question whether I am just imagining this difference, as I can only discern it in the shower. I’m reaching out here as I’ve been told previously that I’m alright, and the emergency department is quite crowded at the moment. As a rehab physician, I’m sharing what I know from a general perspective about the body, though I’m not sure how relevant that is to my situation. While I plan to seek help at around 2 AM, I would appreciate any insights that might help alleviate my stress and anxiety in the meantime. What are your thoughts?
Seeking Medical Insight on My Husband's Adderall Use and Behavioral Changes
I’m reaching out regarding my husband, who is 32 years old, stands 6 feet 1 inch tall, and weighs around 235 pounds. Approximately two years ago, he was diagnosed with ADHD and subsequently prescribed medication. His current regimen includes: - Adderall XR at a dosage of 30 mg in the morning, taken twice. - Adderall at 20 mg in the afternoon, also taken twice. This amounts to a daily total of 100 mg of Adderall. While I am not a medical professional, my research indicates that this could be an excessive dosage. When I confront him about my concerns, he often mentions that children might receive similar amounts and insists that his doctor has sanctioned his treatment plan. Since he began this medication, I have observed several concerning changes: - A marked emotional detachment from both me and our children. Although he communicates with them, he no longer engages fully in family life. - An increase in anger and irritability, which seems to have intensified with the medication. - He appears to have delusions or irrational beliefs that he seems to act upon. - A decline in personal grooming and self-care; he hasn’t gotten a haircut in over a year, giving him an untidy appearance. - He frequently links his anger and issues back to me, despite these problems becoming more noticeable as his medication dosage increased. Additionally, he has been experiencing erectile dysfunction for the last two years, which I suspect could be connected to the medication, although he attributes this issue to me. I am genuinely concerned about his mental health and overall well-being. **I have several important questions:** 1. Is this dosage considered unusually high for someone of his age and weight? 2. Can Adderall at this dosage lead to symptoms such as emotional detachment, hostility, delusions, neglect of personal hygiene, and sexual dysfunction? 3. Are these behavioral changes likely to stem from the medication rather than being inherent personality traits? I would deeply appreciate any insights from healthcare professionals. Am I possibly overreacting, or could these issues genuinely relate to his medication regimen? Thank you for your assistance.
Elevated Free Testosterone and Mood Fluctuations
At 19 years of age, standing 5'11" and weighing 192 lbs, I lead a lifestyle free from smoking and alcohol consumption. Currently, I am not on any medications and have no known health concerns. Recently, I underwent a blood test, prompted by my ongoing struggles with mood swings, to investigate the possibility that these fluctuations might be linked to my testosterone levels. The results revealed a total testosterone reading of 5.25, which falls within the normal range of 2.8 to 8. However, my free testosterone level was significantly elevated at 35, where the normal range is typically from 3.6 to 25. This finding raises questions about whether it could be causing my mood-related issues.
Seeking Guidance for Health Issues
Hello everyone, I'm reaching out in hopes that someone here can offer some guidance. I'm a 34-year-old woman who neither smokes, drinks alcohol, nor has a history of drug use. For more than a year now, I’ve experienced a range of troubling symptoms. My heart rate unexpectedly plunges to alarming lows (as low as 39 beats per minute) and rapidly escalates to highs in the 190s, often leaving me feeling faint or as if I might suffer a heart attack. Alongside this, I endure severe pain in my neck and debilitating pressure in my ears that seems persistent. I have sought help from both an ear, nose, and throat specialist (ENT) and a cardiologist, but the latter is puzzled. My echocardiogram and EKG indicated a normal sinus rhythm, with the echo appearing normal as well. On the other hand, my ENT has stated that my ears are fine. These episodes are occurring with increasing frequency, and honestly, it frightens me. I experience dizziness and have been diagnosed with dysautonomia, yet the root cause remains unclear. As a mother, I worry about my health and the possibility of something serious happening. I would greatly appreciate any thoughts or suggestions. Who else should I consult? Are there particular specialists I should consider? Have any of you encountered similar issues? Your advice would mean a lot to me.
Weight Loss Achieved, But Cholesterol Concerns Persist?
**Context:** Over the last four years, I have embarked on a weight loss journey in preparation for bariatric sleeve surgery. My initial weight was 470 pounds, with a peak at 490 pounds. The program mandates that individuals must weigh under 400 pounds to qualify for the procedure. I committed to this challenge by joining a gym and transforming my eating habits. I delved into nutrition and fitness literature, meticulously tracked my caloric intake to maintain a deficit, engaged in meal prep, and significantly increased my physical activity. I worked out regularly, dedicating two hours, three times per week, and ultimately reduced my weight to 390 pounds before my surgery, which took place in September 2025 when I weighed 370 pounds. Prior to the operation, I carefully planned my post-surgery diet, breaking it down into phases: two weeks of clear liquids, followed by one week of non-clear liquids, then one week of pureed soups, progressing to soft foods, and finally reintroducing solid foods gradually. Since undergoing the surgery, I have maintained a consistent exercise routine that includes swimming three times a week. On days I cannot swim, I switch to gym workouts that incorporate cardio and resistance training. Currently, my schedule involves gym sessions on Mondays, Wednesdays, Fridays, and Saturdays, while swimming takes place two times a week on Tuesdays and Thursdays. I continue to prioritize meal prep and track my calories, and I recently visited the doctor, revealing my weight has dropped to 296 pounds. **My Inquiry:** After undergoing lab tests three months post-operation, the majority of my results were favorable, but my cholesterol levels are concerning. Despite my efforts, not only has my cholesterol remained elevated, but some figures have even risen. This predicament is both frustrating and disheartening, prompting me to seek advice on additional measures I can take. I am incorporating regular exercise, achieving weight loss, and consuming an ample amount of fiber through vegetables, fruits, beans, and even adding psyllium fiber to my protein shakes. Here are my results from 2024 to the present: - Cholesterol: 189 → 210 - HDL (Good Cholesterol): 42 → 45 - Triglycerides: 345 → 147 - LDL (Bad Cholesterol): 101 → 139 - Cholesterol/HDL Ratio: 4.5 → 4.7 - Non-HDL Cholesterol: 147 → 165 Is this a common occurrence? Am I missing something in my approach? I am at a loss regarding what I might be doing incorrectly, and I would appreciate any medical insights. I plan to follow up with my primary care physician and my bariatric team, though I anticipate some delay in their response—a delay that adds to my stress, as I am eager to implement changes swiftly.