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Cannot find stable thyroid dose after gastric bypass
had total thyroid removal in 2016, ever since ddj surgery for SMA syndrome in 2019. ever since then my once stable dose of levothyroxine has gone up and up and up. I switched to a sublinqual (tirosint i think) and now im on injections, and both do the same. I was 95mcg in 2016, then it went up to 150 for the oral sodium tablet. The tirosint was also 150, TSH still high, injections were 200 twice weekly, then it went up to 400 twice weekly, TSH was in the 30s. I do not understand how this is possible what on earth i could be doing wrong. I feel worse on the other two than i did back on the levothyroxin sodium, but if i took more than 150 id wind up hyper and sick as well. Now I am doing 200mg injections every other day and still i feel super sick as I did back when the TSH was in the 20s. I'm at a loss, i feel like I have to do more than one thing to make this work, with just the tablet my stomach stops completely, on the injections its better but worse in every other sense, dies off so much faster. My endorcineologist is lost too, she has never seen anything like this. Has anybody had to be on more than one type of thyroid med to get it to work? I also have scleroderma and EDS on top of the gastric bypass.
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Welcome @jjfrish223, I added your message to the Bariatric Surgery & Weight Loss group (https://connect.mayoclinic.org/group/bariatric-surgery-weight-loss/) as well as the Endocrine System group. I did that so you can connect with other members like @ldramjet @grandmar @gailb @roch who have experience with gastric bypass surgery and managing thryoid levels.
Fellow members like @jimana @cherriann and @astaingegerdm might also have thoughts to add about managing TSH levels with multiple conditions.
Finding the right dose of thyroid meds is so challenging. Is your endocrinologist suggesting more than one medication or switching thryoid medication?
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3 ReactionsThank you so much, I am not very well versed in navigating this site so it helps a ton <3
My provider is mostly suggesting I simply move back onto the tirosint because she believes it worked best. It absolutely was not and I was in the ER quite frequently on that medication. My bloodwork from when I was on that medication for a month suggested it was very low TSH, however I was a without it for over a week at that time and since I couldnt get in contact with my provider to get the refills I went back onto the levothyroxine tablet and just took half of a pill extra, which would easily explain the low TSH at the time and I was feeling a lot better though very clearly beginning to have hyperthyroidism symptoms. I'm really stuck here because not only is this provider incredibly hard to get in contact with (she let the injections prescription lapse twice and even failed on 3 separate occasions to include sodium chloride with the injections so they were unusable) but she also is fresh out of college and does not seem to be very knowledgable on complex cases. I dont think shes a bad provider but just not a very good one for a complex case like me. I've never even heard of t4 vs t3 medications until researching today, if it's possible to take the injections (which I believe are t3) and a t4 like the tablet, I think this can work out. Not really possible to switch providers at the moment as there is a massive lul in available doctors and everything in a 50+ mile radius has been bought up by two competing hospital/college conglomerates 🙁 nobody wants to work under them anymore and they quit and move away within months of graduating/being acquired
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1 Reactionjjfrish223 @jjfrish223
I have had thyroid problems for 50 years, but never had thyroid removed. I have also had gastric bypass. My TSH fluctuates, and no-one ever explained why can be fine for years and then becomes outside normal range. Mine does not fluctuates as much as yours. I take levothyroxine.
I am assuming that your endocrinologist has checked T3 and T4 and told you not to take any vitamins at same time as when take thyroid meds. Same applies to calcium supplements or antacids.
Hope you find a solution
Laurie
Hi JJ,
I previously ran a large bariatric program in Houston, Texas at Memorial Hermann Memorial City Hospital. As the bariatric program manager, I recruited Drs. Robert & Garth Davis of BIG MEDICINE "fame" away from The Methodist Hospital-Houston Medical Center (big fun!), and we built an amazing program at The Davis Clinic (my branding efforts) on the MHMCH campus.
In my role, I designed and coordinated the build-out of the clinic and ensured everything was up to city and OSHA codes. I was also responsible for ensuring that protocols were followed per the ASMBS Centers of Excellence and that both the hospital and The Davis Clinic achieved CoE designation. I had the pleasure and sheer joy of facilitating educational bariatric support groups at the hospital for many years (2nd Tuesday of every month!), and met so many wonderful people excited to be given a "do-over". 🙂
After leaving the hospital to take on the role of Marketing & Administrative Director at The Davis Clinic, we continued filming BIG MEDICINE there (you can still catch re-runs on various networks). That said (long-winded, sorry!), I am NOT a doctor or a nurse but have lived as a bariatric post-op since 2001 (lap RNY).
My thyroid went ka-poot about a year ago (runs in my family, but I am also experiencing other issues that point to vaccine injury). Anyhoo ... I am on a daily dose of Levothyroxine (100 mcg daily). Laurie (above) is absolutely correct. Thyroid should not be taken with other vitamins, calcium, antacids, or food. My doctor said I should eat my breakfast half an hour AFTER I take my thyroid on an empty stomach at the same time every morning.
Keep us posted! Until your thyroid gets back up to acceptable levels, you may need to do bloodwork every 2-4 weeks, depending on what your doctor recommends. That said, I thought I'd attach one of the articles I wrote for WLS Lifestyles magazine as a word of encouragement. You are on an amazing journey to a NEW YOU and there are wonderful and challenging times ahead.
* Do your labs.
* Keep all of your follow-up appointments with your surgeon and his/her team.
* Go to support groups. You're going to need the support as you figure out who the new you is.
Welcome to your new, exciting adventure to the NEW YOU! Woo hoo!
I will not let my past dictate my future. How about you?
~ Kimberly Taylor