Levothyroxine/Hypothyroid

[J.Ayden]

Hi everyone, I'm wondering whether anyone else has found that their levothyroxine seems to work better now that they're taking semaglutide? To give some background, I was diagnosed with hypothyroidism back in 2019. My levothyroxine dose eventually reached 150mcg before my numbers improved (the highest my TSH ever got was 120, back in December of 2025, though that was during a stretch of several months when I couldn't get my medication, so it wasn't a surprise). Anyway, after I'd been on Sema for a while, I began needing to reduce my levothyroxine dose. My levels had been sitting in the 30's, but after a year on semaglutide they fell to .17 even though my levothyroxine dose hadn't changed at all -- so the dose was cut to 125mcg. These days I'm at 112mcg, and my latest labs from January of this year came back at 2.49. I've got labs coming up again this month, so I guess I'll find out what's going on then.

There's another thing I keep wondering about too: am I really the only person who doesn't feel any different no matter what their thyroid levels are doing? Even back in December, when my thyroid was obviously not functioning at all, I still had zero symptoms. At one point I even asked myself whether taking the medication was worth the trouble, since it never seemed to make any difference for me. No weight came off, I wasn't any less exhausted, my skin looked the same, and so on. Then I came across information about myxedema coma/crisis, and figured it was smarter to just deal with it and take the damn pill lmao.

The one other possibility I can come up with is that I changed pharmacies around the same time I started semaglutide, so I honestly wonder whether one generic version happens to work better for me than another? Has that happened to anyone else, maybe? In the end I suppose it doesn't really matter as long as my levels look good, I just think it's interesting.

 

[randompersonrandom]

Graves disease here, and not once have I experienced any symptom — not while I was hypER, and not after it burned out, when I slacked off on my meds and ended up hypO for a stretch. Thinning hair shows up at both ends of the spectrum for me, and maybe the bug eyes too (although everyone in my family has bug eyes, so it's hard to say whether that was the cause), but I've only ever felt fine.

 

[whimsps]

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

 

[PineCone99]

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

 

[J.Ayden]

randompersonrandom said:

Graves disease here, and not once have I experienced any symptom — not while I was hypER, and not after it burned out, when I slacked off on my meds and ended up hypO for a stretch. Thinning hair shows up at both ends of the spectrum for me, and maybe the bug eyes too (although everyone in my family has bug eyes, so it's hard to say whether that was the cause), but I've only ever felt fine.

Hearing that I'm not alone in having zero symptoms is a relief! Checking my thyroid was never something I'd have done by choice — my best guess is it came up incidentally during an emergency back surgery? How that even happened, I can't recall lol. It does seem to be genetic in my case, though: once I was on Levo, I went to see my Grandma and mentioned how shocked I was to have hypothyroidism, and she revealed that she has it too.

 

[J.Ayden]

whimsps said:

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

Huh. I had no idea dosing was tied to weight. Do my doctors even know that, I wonder? My starting dose was 25mcg, and at the time I was roughly 200 pounds lol. T4 has been checked 5 times for me, and every time it came back within normal limits — except for the latest one in December, which was low at .32, and that was after I'd skipped Levo for a few months. So it seems that despite my TSH staying high the whole time, my T4 itself stayed fine right up until my TSH hit 120 and my T4 dropped to .32. Whether this makes a difference I'm not sure, but the labs they usually order for me are TSH w/rflx free T4, and about half the time they also throw in "T4 free." As best I can tell, T3 on its own has never been tested for me.

All told, since I began Sema, I'm down 100+ pounds. These days I float between 110-120, having started out around 220-240ish.

PineCone99 said:

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

Next month I'll come back with an update once my levels get checked again, to see whether they adjust my dose down or anything. Kind of funny — the January appointment was the first time in several years they'd put me on a scale, and the woman actually had to look twice because the system flagged it: the previous weight on file was from May of 2023, not long after I'd started Sema, when I still weighed 184. So as far as the system was concerned, I'd gone from the 180's straight to 122 lol.

 

[Mayostardayonnaise]

A few months back, when I had dropped 70 lb, my thyroid medication still didn’t require a lower dose—I found that really strange. Prior to that weight loss, my dosage had stayed unchanged for a long stretch of years.

 

[bbbilly]

if your weight changes a lot in either direction, your dose will likely have to change too. for me it fluctuates constantly since i do bulk and cut cycles for the gym.

over the years my symptoms have been pretty rough. my hands dry out badly, with deep cracks that bleed even when i'm diligent about moisturizing. once my levels drift too far off, my arterial flutter worsens a lot, my heart skips beats nonstop, and i'm up all night so i barely sleep. add to that fatigue that's close to disabling.

idk how i managed to function before getting a Hashimoto's diagnosis. the day after squat day at the gym, i'd be so wiped at work that i'd spend my break staring at a wall, forget to breathe and then gasp for air.. sort of like sleep apnea while awake, and i'd almost never recall the drive home either. it was just a poof and i was stepping out of my car in the driveway.. or when i did remember, i'd see shadows shifting (night shift, so i was driving home at 2am and thought i was developing schizophrenia) all because my tsh sat in the high 80s the entire time

 

[PineCone99]

J.Ayden said:

whimsps said:

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

Huh. I had no idea dosing was tied to weight. Do my doctors even know that, I wonder? My starting dose was 25mcg, and at the time I was roughly 200 pounds lol. T4 has been checked 5 times for me, and every time it came back within normal limits — except for the latest one in December, which was low at .32, and that was after I'd skipped Levo for a few months. So it seems that despite my TSH staying high the whole time, my T4 itself stayed fine right up until my TSH hit 120 and my T4 dropped to .32. Whether this makes a difference I'm not sure, but the labs they usually order for me are TSH w/rflx free T4, and about half the time they also throw in "T4 free." As best I can tell, T3 on its own has never been tested for me.

All told, since I began Sema, I'm down 100+ pounds. These days I float between 110-120, having started out around 220-240ish.

PineCone99 said:

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

Next month I'll come back with an update once my levels get checked again, to see whether they adjust my dose down or anything. Kind of funny — the January appointment was the first time in several years they'd put me on a scale, and the woman actually had to look twice because the system flagged it: the previous weight on file was from May of 2023, not long after I'd started Sema, when I still weighed 184. So as far as the system was concerned, I'd gone from the 180's straight to 122 lol.

Haha! She's basically going "hold on just a gosh darn second here.." Curious to find out next month whether your doses get tweaked at all.

 

[whimsps]

J.Ayden said:

whimsps said:

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

Huh. I had no idea dosing was tied to weight. Do my doctors even know that, I wonder? My starting dose was 25mcg, and at the time I was roughly 200 pounds lol. T4 has been checked 5 times for me, and every time it came back within normal limits — except for the latest one in December, which was low at .32, and that was after I'd skipped Levo for a few months. So it seems that despite my TSH staying high the whole time, my T4 itself stayed fine right up until my TSH hit 120 and my T4 dropped to .32. Whether this makes a difference I'm not sure, but the labs they usually order for me are TSH w/rflx free T4, and about half the time they also throw in "T4 free." As best I can tell, T3 on its own has never been tested for me.

All told, since I began Sema, I'm down 100+ pounds. These days I float between 110-120, having started out around 220-240ish.

PineCone99 said:

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

Next month I'll come back with an update once my levels get checked again, to see whether they adjust my dose down or anything. Kind of funny — the January appointment was the first time in several years they'd put me on a scale, and the woman actually had to look twice because the system flagged it: the previous weight on file was from May of 2023, not long after I'd started Sema, when I still weighed 184. So as far as the system was concerned, I'd gone from the 180's straight to 122 lol.

Only fairly recently did this become clear to me, after spending a long time digging into the subject, because I've felt for ages that my hypothyroidism hasn't been managed well enough. I'll need to search around again for the source of that information; my memory is that it came from thyroid.org. My impression, though, is that it functions more as a rough starting point for dosing people than as a strict, unbreakable rule. Every BODY differs, as the saying goes, and what it takes to get the results you want could be more or less. These days my TSH sits in a range I find more comfortable, and since I wasn't converting the T4 from Levothyroxine into T3 properly, adding a T3 component has personally done me a lot of good.

 

[J.Ayden]

whimsps said:

J.Ayden said:

whimsps said:

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

Huh. I had no idea dosing was tied to weight. Do my doctors even know that, I wonder? My starting dose was 25mcg, and at the time I was roughly 200 pounds lol. T4 has been checked 5 times for me, and every time it came back within normal limits — except for the latest one in December, which was low at .32, and that was after I'd skipped Levo for a few months. So it seems that despite my TSH staying high the whole time, my T4 itself stayed fine right up until my TSH hit 120 and my T4 dropped to .32. Whether this makes a difference I'm not sure, but the labs they usually order for me are TSH w/rflx free T4, and about half the time they also throw in "T4 free." As best I can tell, T3 on its own has never been tested for me.

All told, since I began Sema, I'm down 100+ pounds. These days I float between 110-120, having started out around 220-240ish.

PineCone99 said:

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

Next month I'll come back with an update once my levels get checked again, to see whether they adjust my dose down or anything. Kind of funny — the January appointment was the first time in several years they'd put me on a scale, and the woman actually had to look twice because the system flagged it: the previous weight on file was from May of 2023, not long after I'd started Sema, when I still weighed 184. So as far as the system was concerned, I'd gone from the 180's straight to 122 lol.

Only fairly recently did this become clear to me, after spending a long time digging into the subject, because I've felt for ages that my hypothyroidism hasn't been managed well enough. I'll need to search around again for the source of that information; my memory is that it came from thyroid.org. My impression, though, is that it functions more as a rough starting point for dosing people than as a strict, unbreakable rule. Every BODY differs, as the saying goes, and what it takes to get the results you want could be more or less. These days my TSH sits in a range I find more comfortable, and since I wasn't converting the T4 from Levothyroxine into T3 properly, adding a T3 component has personally done me a lot of good.

Next month I plan to request a T3 test, just to see what comes back. My T4 has consistently stayed in a good range, except for when my TSH hit 120 — which leaves me wondering whether the real problem is T3 rather than T4. Could that explain why I never seem to get side effects? Or rather, why I don't notice anything different — though to be fair, I'm tired basically around the clock, my skin is extremely dry, and my memory is terrible, but none of that shifts whether my TSH is 40 or 2. Like I mentioned, my latest test came back in a good range, yet I feel no different from before. Nothing has improved, and nothing has worsened either. I hope that comes across clearly.

 

[gusterbuster]

J.Ayden said:

whimsps said:

J.Ayden said:

whimsps said:

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

Huh. I had no idea dosing was tied to weight. Do my doctors even know that, I wonder? My starting dose was 25mcg, and at the time I was roughly 200 pounds lol. T4 has been checked 5 times for me, and every time it came back within normal limits — except for the latest one in December, which was low at .32, and that was after I'd skipped Levo for a few months. So it seems that despite my TSH staying high the whole time, my T4 itself stayed fine right up until my TSH hit 120 and my T4 dropped to .32. Whether this makes a difference I'm not sure, but the labs they usually order for me are TSH w/rflx free T4, and about half the time they also throw in "T4 free." As best I can tell, T3 on its own has never been tested for me.

All told, since I began Sema, I'm down 100+ pounds. These days I float between 110-120, having started out around 220-240ish.

PineCone99 said:

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

Next month I'll come back with an update once my levels get checked again, to see whether they adjust my dose down or anything. Kind of funny — the January appointment was the first time in several years they'd put me on a scale, and the woman actually had to look twice because the system flagged it: the previous weight on file was from May of 2023, not long after I'd started Sema, when I still weighed 184. So as far as the system was concerned, I'd gone from the 180's straight to 122 lol.

Only fairly recently did this become clear to me, after spending a long time digging into the subject, because I've felt for ages that my hypothyroidism hasn't been managed well enough. I'll need to search around again for the source of that information; my memory is that it came from thyroid.org. My impression, though, is that it functions more as a rough starting point for dosing people than as a strict, unbreakable rule. Every BODY differs, as the saying goes, and what it takes to get the results you want could be more or less. These days my TSH sits in a range I find more comfortable, and since I wasn't converting the T4 from Levothyroxine into T3 properly, adding a T3 component has personally done me a lot of good.

Next month I plan to request a T3 test, just to see what comes back. My T4 has consistently stayed in a good range, except for when my TSH hit 120 — which leaves me wondering whether the real problem is T3 rather than T4. Could that explain why I never seem to get side effects? Or rather, why I don't notice anything different — though to be fair, I'm tired basically around the clock, my skin is extremely dry, and my memory is terrible, but none of that shifts whether my TSH is 40 or 2. Like I mentioned, my latest test came back in a good range, yet I feel no different from before. Nothing has improved, and nothing has worsened either. I hope that comes across clearly.

Hypothyroidism is likely the condition that most often goes under-treated. Testing for T3 rarely happens, since insurers won't cover it and the bulk of research finds little outcome variation between t4 alone versus a t4/t3 combination. The reasoning being: why bother testing if you're only going to prescribe t4?

That said, it's pretty typical that when your thyroid is garbage, your t4-to-t3 conversion is garbage too. And from what people report, a lot of them do better once t3 is added into their regimen.

Also worth noting, t3 clears the body quickly, so plenty of folks find that splitting the dose into 2 takes per day works better. Could that be why studies fail to show much difference in outcomes? Taking it in the morning and again at lunch seems to do the trick, based on anecdotal reports.

 

[J.Ayden]

gusterbuster said:

J.Ayden said:

whimsps said:

J.Ayden said:

whimsps said:

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

Huh. I had no idea dosing was tied to weight. Do my doctors even know that, I wonder? My starting dose was 25mcg, and at the time I was roughly 200 pounds lol. T4 has been checked 5 times for me, and every time it came back within normal limits — except for the latest one in December, which was low at .32, and that was after I'd skipped Levo for a few months. So it seems that despite my TSH staying high the whole time, my T4 itself stayed fine right up until my TSH hit 120 and my T4 dropped to .32. Whether this makes a difference I'm not sure, but the labs they usually order for me are TSH w/rflx free T4, and about half the time they also throw in "T4 free." As best I can tell, T3 on its own has never been tested for me.

All told, since I began Sema, I'm down 100+ pounds. These days I float between 110-120, having started out around 220-240ish.

PineCone99 said:

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

Next month I'll come back with an update once my levels get checked again, to see whether they adjust my dose down or anything. Kind of funny — the January appointment was the first time in several years they'd put me on a scale, and the woman actually had to look twice because the system flagged it: the previous weight on file was from May of 2023, not long after I'd started Sema, when I still weighed 184. So as far as the system was concerned, I'd gone from the 180's straight to 122 lol.

Only fairly recently did this become clear to me, after spending a long time digging into the subject, because I've felt for ages that my hypothyroidism hasn't been managed well enough. I'll need to search around again for the source of that information; my memory is that it came from thyroid.org. My impression, though, is that it functions more as a rough starting point for dosing people than as a strict, unbreakable rule. Every BODY differs, as the saying goes, and what it takes to get the results you want could be more or less. These days my TSH sits in a range I find more comfortable, and since I wasn't converting the T4 from Levothyroxine into T3 properly, adding a T3 component has personally done me a lot of good.

Next month I plan to request a T3 test, just to see what comes back. My T4 has consistently stayed in a good range, except for when my TSH hit 120 — which leaves me wondering whether the real problem is T3 rather than T4. Could that explain why I never seem to get side effects? Or rather, why I don't notice anything different — though to be fair, I'm tired basically around the clock, my skin is extremely dry, and my memory is terrible, but none of that shifts whether my TSH is 40 or 2. Like I mentioned, my latest test came back in a good range, yet I feel no different from before. Nothing has improved, and nothing has worsened either. I hope that comes across clearly.

Hypothyroidism is likely the condition that most often goes under-treated. Testing for T3 rarely happens, since insurers won't cover it and the bulk of research finds little outcome variation between t4 alone versus a t4/t3 combination. The reasoning being: why bother testing if you're only going to prescribe t4?

That said, it's pretty typical that when your thyroid is garbage, your t4-to-t3 conversion is garbage too. And from what people report, a lot of them do better once t3 is added into their regimen.

Also worth noting, t3 clears the body quickly, so plenty of folks find that splitting the dose into 2 takes per day works better. Could that be why studies fail to show much difference in outcomes? Taking it in the morning and again at lunch seems to do the trick, based on anecdotal reports.

Yeah, that clears things up quite a bit. Unfortunately, though, my insurance is almost certainly not going to pay for it. Since I'm covered through the state, anything they deem unnecessary is off the table. The clinic I go to is free/low income, though, so there might be a chance I can talk them into ordering the test regardless — particularly if my TSH comes back in a good range the way it did previously. If TSH were the whole picture, I'd figure I should be feeling better, wouldn't I? Then again, I'm not sure. One thing I really wrestle with is whether what I'm experiencing is genuinely hypothyroidism side effects, or whether it's simply... how I am? That's the only way I can think to put it.

It's kind of funny — thyroid problems seem to be the go-to joke or excuse whenever someone brings up weight gain, so discussing my broken thyroid with people who haven't lived it always makes me feel odd, like they assume I'm fabricating it. So hearing it framed as an under treated ailment is genuinely interesting to me.

 

[gusterbuster]

J.Ayden said:

gusterbuster said:

J.Ayden said:

whimsps said:

J.Ayden said:

whimsps said:

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

Huh. I had no idea dosing was tied to weight. Do my doctors even know that, I wonder? My starting dose was 25mcg, and at the time I was roughly 200 pounds lol. T4 has been checked 5 times for me, and every time it came back within normal limits — except for the latest one in December, which was low at .32, and that was after I'd skipped Levo for a few months. So it seems that despite my TSH staying high the whole time, my T4 itself stayed fine right up until my TSH hit 120 and my T4 dropped to .32. Whether this makes a difference I'm not sure, but the labs they usually order for me are TSH w/rflx free T4, and about half the time they also throw in "T4 free." As best I can tell, T3 on its own has never been tested for me.

All told, since I began Sema, I'm down 100+ pounds. These days I float between 110-120, having started out around 220-240ish.

PineCone99 said:

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

Next month I'll come back with an update once my levels get checked again, to see whether they adjust my dose down or anything. Kind of funny — the January appointment was the first time in several years they'd put me on a scale, and the woman actually had to look twice because the system flagged it: the previous weight on file was from May of 2023, not long after I'd started Sema, when I still weighed 184. So as far as the system was concerned, I'd gone from the 180's straight to 122 lol.

Only fairly recently did this become clear to me, after spending a long time digging into the subject, because I've felt for ages that my hypothyroidism hasn't been managed well enough. I'll need to search around again for the source of that information; my memory is that it came from thyroid.org. My impression, though, is that it functions more as a rough starting point for dosing people than as a strict, unbreakable rule. Every BODY differs, as the saying goes, and what it takes to get the results you want could be more or less. These days my TSH sits in a range I find more comfortable, and since I wasn't converting the T4 from Levothyroxine into T3 properly, adding a T3 component has personally done me a lot of good.

Next month I plan to request a T3 test, just to see what comes back. My T4 has consistently stayed in a good range, except for when my TSH hit 120 — which leaves me wondering whether the real problem is T3 rather than T4. Could that explain why I never seem to get side effects? Or rather, why I don't notice anything different — though to be fair, I'm tired basically around the clock, my skin is extremely dry, and my memory is terrible, but none of that shifts whether my TSH is 40 or 2. Like I mentioned, my latest test came back in a good range, yet I feel no different from before. Nothing has improved, and nothing has worsened either. I hope that comes across clearly.

Hypothyroidism is likely the condition that most often goes under-treated. Testing for T3 rarely happens, since insurers won't cover it and the bulk of research finds little outcome variation between t4 alone versus a t4/t3 combination. The reasoning being: why bother testing if you're only going to prescribe t4?

That said, it's pretty typical that when your thyroid is garbage, your t4-to-t3 conversion is garbage too. And from what people report, a lot of them do better once t3 is added into their regimen.

Also worth noting, t3 clears the body quickly, so plenty of folks find that splitting the dose into 2 takes per day works better. Could that be why studies fail to show much difference in outcomes? Taking it in the morning and again at lunch seems to do the trick, based on anecdotal reports.

Yeah, that clears things up quite a bit. Unfortunately, though, my insurance is almost certainly not going to pay for it. Since I'm covered through the state, anything they deem unnecessary is off the table. The clinic I go to is free/low income, though, so there might be a chance I can talk them into ordering the test regardless — particularly if my TSH comes back in a good range the way it did previously. If TSH were the whole picture, I'd figure I should be feeling better, wouldn't I? Then again, I'm not sure. One thing I really wrestle with is whether what I'm experiencing is genuinely hypothyroidism side effects, or whether it's simply... how I am? That's the only way I can think to put it.

It's kind of funny — thyroid problems seem to be the go-to joke or excuse whenever someone brings up weight gain, so discussing my broken thyroid with people who haven't lived it always makes me feel odd, like they assume I'm fabricating it. So hearing it framed as an under treated ailment is genuinely interesting to me.

If it fits what you can spend, labcorp or quest will let you pay out of pocket. Fitnomic works as a subscription: 75 covers 3 months, and the complete thyroid panel I got—t3 and reverse t4 included—came to 40 bucks.

T3 on indiamart is also quite cheap. You don't need much, and the t4 dose may have to come down since t3 hits tsh around 3x as hard as t4 does.

Thyroid is an invisible disease. When mine shit the bed I put on 20lbs within a month, felt like I was on the brink of suicide and didn't want to live, my lipids went to shit, and I lost alot of strength in the gym.

Wish you the best of luck on your journey. You will likely have to take this in your own hands, to get it properly managed. Most docs treat your tsh and not you, the patient.

 

[meeklady]

After I lost weight, my dose went from 125 mcg down to 100 mcg.

 

[lastresort]

gusterbuster said:

J.Ayden said:

whimsps said:

J.Ayden said:

whimsps said:

Levo is dosed according to weight - what's your total weight loss during that period? Have you gotten free T3, free T4, and reverse T3 tested? It's possible your body has trouble turning T4 into T3.

Huh. I had no idea dosing was tied to weight. Do my doctors even know that, I wonder? My starting dose was 25mcg, and at the time I was roughly 200 pounds lol. T4 has been checked 5 times for me, and every time it came back within normal limits — except for the latest one in December, which was low at .32, and that was after I'd skipped Levo for a few months. So it seems that despite my TSH staying high the whole time, my T4 itself stayed fine right up until my TSH hit 120 and my T4 dropped to .32. Whether this makes a difference I'm not sure, but the labs they usually order for me are TSH w/rflx free T4, and about half the time they also throw in "T4 free." As best I can tell, T3 on its own has never been tested for me.

All told, since I began Sema, I'm down 100+ pounds. These days I float between 110-120, having started out around 220-240ish.

PineCone99 said:

Since the last time my levo and liothyronine doses were reviewed, I've dropped 55 pounds. I told my doctor about it, and because of that weight loss she ordered labs (Free T3/T4, TSH) to determine whether a reduction was needed. Every result landed in the ideal range. So the doctor said the doses stay as they are. I did think it was odd, given that I'd assumed it was "weight-based"..

That said, when it comes to symptoms, I definitely experienced the fallout of hypothyroidism before starting the 2 medications. Deep sleep was something I never got; I could be in bed for 10 hours, sleep straight through, and still get up each morning as if only 1 hour had passed. It was maddening. My hair was thinning. I was moody and irritable, unable to put up with minor annoyances. There was no libido at all. Levo improved certain things, but the DRASTIC change only came once I added liothyronine (T3 - it seems I'm not very good at converting T4 into T3 on my own). Sleep quality, mood, tolerance, and so on. A difference that changed my life. Thank F for T3 meds.

Next month I'll come back with an update once my levels get checked again, to see whether they adjust my dose down or anything. Kind of funny — the January appointment was the first time in several years they'd put me on a scale, and the woman actually had to look twice because the system flagged it: the previous weight on file was from May of 2023, not long after I'd started Sema, when I still weighed 184. So as far as the system was concerned, I'd gone from the 180's straight to 122 lol.

Only fairly recently did this become clear to me, after spending a long time digging into the subject, because I've felt for ages that my hypothyroidism hasn't been managed well enough. I'll need to search around again for the source of that information; my memory is that it came from thyroid.org. My impression, though, is that it functions more as a rough starting point for dosing people than as a strict, unbreakable rule. Every BODY differs, as the saying goes, and what it takes to get the results you want could be more or less. These days my TSH sits in a range I find more comfortable, and since I wasn't converting the T4 from Levothyroxine into T3 properly, adding a T3 component has personally done me a lot of good.

Next month I plan to request a T3 test, just to see what comes back. My T4 has consistently stayed in a good range, except for when my TSH hit 120 — which leaves me wondering whether the real problem is T3 rather than T4. Could that explain why I never seem to get side effects? Or rather, why I don't notice anything different — though to be fair, I'm tired basically around the clock, my skin is extremely dry, and my memory is terrible, but none of that shifts whether my TSH is 40 or 2. Like I mentioned, my latest test came back in a good range, yet I feel no different from before. Nothing has improved, and nothing has worsened either. I hope that comes across clearly.

Hypothyroidism is likely the condition that most often goes under-treated. Testing for T3 rarely happens, since insurers won't cover it and the bulk of research finds little outcome variation between t4 alone versus a t4/t3 combination. The reasoning being: why bother testing if you're only going to prescribe t4?

That said, it's pretty typical that when your thyroid is garbage, your t4-to-t3 conversion is garbage too. And from what people report, a lot of them do better once t3 is added into their regimen.

Also worth noting, t3 clears the body quickly, so plenty of folks find that splitting the dose into 2 takes per day works better. Could that be why studies fail to show much difference in outcomes? Taking it in the morning and again at lunch seems to do the trick, based on anecdotal reports.

That matches what happened with me exactly.

My Hashimotos diagnosis came in 2021, and my TSH only settled down once T3 was added. Prior to that, it swung around unpredictably.

On top of that, synthroid is no longer covered by my insurance. It's the single brand-name drug I take, since the generic version never came close to resolving things

 

[J.Ayden]

I should have come back to this thread right after my appointment — sorry about that! My numbers remain in a good range, so the drop in my dosage could be explained either by the generic levothyroxine I switched to simply suiting me better, or by semaglutide. Weight loss doesn't seem to be the cause, given that I haven't needed another reduction.

When I asked my doctor about testing T3, she declined because my TSH looked fine — they didn't even run T4. My guess is that they start with TSH and only order further tests if something looks off, as a way to keep costs down at a free/low income clinic. I may put money aside and get it checked independently someday, though that's a task for later. The reason I've been away for a while is that my younger sister lost her apartment at the start of this month, so I've been busy handling that. I promised to help cover the cost of a new place for her, because otherwise she'd have to stay with me, and it would be seriously cramped — she has a lot of animals. Still, there's no way in hell I'd let her and my nephew end up without a home, so I'll work something out.

Thank you to everyone who shared thoughts and insight in this thread. Overall I found the discussion really interesting. Regarding my thyroid, I even brought up to my doctor that I'd never had symptoms or noticed anything (she asked whether I was experiencing any, or whether I simply wanted my levels checked after six months), but she didn't have much to say. In the end I guess it doesn't matter, so long as my levels are good now. I'm just naturally a very curious person, and it strikes me as odd that no matter what my TSH levels look like, I feel exactly the same. I'd also like to figure out why I have hypothyroidism, but it seems like as long as it's treated, doctors aren't really interested in figuring out what's causing it. Which makes sense I suppose, the underlying reasons behind it won't change the treatment or outcome, so why spend time/money to figure that out? I just have an annoying desire to learn lmao. I've always been like that -- I'd get in arguments as a kid when adults told me to do something without telling me the reason why.

 

[Enyola]

Hi everyone, I'm wondering whether anyone else has found that their levothyroxine seems to work better now that they're taking semaglutide? To give some background, I was diagnosed with hypothyroidism back in 2019. My levothyroxine dose eventually reached 150mcg before my numbers improved (the highest my TSH ever got was 120, back in December of 2025, though that was during a stretch of several months when I couldn't get my medication, so it wasn't a surprise). Anyway, after I'd been on Sema for a while, I began needing to reduce my levothyroxine dose. My levels had been sitting in the 30's, but after a year on semaglutide they fell to .17 even though my levothyroxine dose hadn't changed at all -- so the dose was cut to 125mcg. These days I'm at 112mcg, and my latest labs from January of this year came back at 2.49. I've got labs coming up again this month, so I guess I'll find out what's going on then.

There's another thing I keep wondering about too: am I really the only person who doesn't feel any different no matter what their thyroid levels are doing? Even back in December, when my thyroid was obviously not functioning at all, I still had zero symptoms. At one point I even asked myself whether taking the medication was worth the trouble, since it never seemed to make any difference for me. No weight came off, I wasn't any less exhausted, my skin looked the same, and so on. Then I came across information about myxedema coma/crisis, and figured it was smarter to just deal with it and take the damn pill lmao.

The one other possibility I can come up with is that I changed pharmacies around the same time I started semaglutide, so I honestly wonder whether one generic version happens to work better for me than another? Has that happened to anyone else, maybe? In the end I suppose it doesn't really matter as long as my levels look good, I just think it's interesting.

When the T4-dose is nominally the same, varying products and their varying ingredients may still produce varying outcomes. This is common knowledge. So yes, this could definitely be a factor.

To some degree body weight matters, though not in every case (for me, a change of 30 kgs in either direction changes nothing).

I should have come back to this thread right after my appointment — sorry about that! My numbers remain in a good range, so the drop in my dosage could be explained either by the generic levothyroxine I switched to simply suiting me better, or by semaglutide. Weight loss doesn't seem to be the cause, given that I haven't needed another reduction.

When I asked my doctor about testing T3, she declined because my TSH looked fine — they didn't even run T4. My guess is that they start with TSH and only order further tests if something looks off, as a way to keep costs down at a free/low income clinic. I may put money aside and get it checked independently someday, though that's a task for later. The reason I've been away for a while is that my younger sister lost her apartment at the start of this month, so I've been busy handling that. I promised to help cover the cost of a new place for her, because otherwise she'd have to stay with me, and it would be seriously cramped — she has a lot of animals. Still, there's no way in hell I'd let her and my nephew end up without a home, so I'll work something out.

Thank you to everyone who shared thoughts and insight in this thread. Overall I found the discussion really interesting. Regarding my thyroid, I even brought up to my doctor that I'd never had symptoms or noticed anything (she asked whether I was experiencing any, or whether I simply wanted my levels checked after six months), but she didn't have much to say. In the end I guess it doesn't matter, so long as my levels are good now. I'm just naturally a very curious person, and it strikes me as odd that no matter what my TSH levels look like, I feel exactly the same. I'd also like to figure out why I have hypothyroidism, but it seems like as long as it's treated, doctors aren't really interested in figuring out what's causing it. Which makes sense I suppose, the underlying reasons behind it won't change the treatment or outcome, so why spend time/money to figure that out? I just have an annoying desire to learn lmao. I've always been like that -- I'd get in arguments as a kid when adults told me to do something without telling me the reason why.

Still, one symptom is present in your case: tiredness. Being tired doesn't strike me as normal. At least you haven't brought up insufficient sleep or any other reason that could account for the tiredness.

Numerous studies have examined "how reliable is tsh alone as a predictor of thyroid status?" Every one I've come across ended with the same finding: a good tsh doesn't guarantee good thyroid levels. For certain people, fine tuning via tsh is effective, but not for everyone.

A few illustrations from my own numbers while on T4-substitution:

TSH __ fT3 __ fT4

2,33 ...... 2,36 ... 1,88+

1,94 ...... 2,53 ... 1,90+

1,37 ...... 2,81 ... 1,80+

(reference: fT3: 2,15-4,12 pg/ml, fT4: 0,70-1,70 ng/dl)

As you can see, here the tsh was entirely normal, yet fT4 sat above range (and I could feel it as well). Relying on the tsh by itself would have pointed me the wrong way in this instance.

Ultimately, I also needed to add some T3 in order to keep my energy levels consistently stable. Trying that without a way in place of having all 3 levels checked is not something I would advise.

 

[Foggy-Hollow]

J.Ayden said:

I should have come back to this thread right after my appointment — sorry about that! My numbers remain in a good range, so the drop in my dosage could be explained either by the generic levothyroxine I switched to simply suiting me better, or by semaglutide. Weight loss doesn't seem to be the cause, given that I haven't needed another reduction.

When I asked my doctor about testing T3, she declined because my TSH looked fine — they didn't even run T4. My guess is that they start with TSH and only order further tests if something looks off, as a way to keep costs down at a free/low income clinic. I may put money aside and get it checked independently someday, though that's a task for later. The reason I've been away for a while is that my younger sister lost her apartment at the start of this month, so I've been busy handling that. I promised to help cover the cost of a new place for her, because otherwise she'd have to stay with me, and it would be seriously cramped — she has a lot of animals. Still, there's no way in hell I'd let her and my nephew end up without a home, so I'll work something out.

Thank you to everyone who shared thoughts and insight in this thread. Overall I found the discussion really interesting. Regarding my thyroid, I even brought up to my doctor that I'd never had symptoms or noticed anything (she asked whether I was experiencing any, or whether I simply wanted my levels checked after six months), but she didn't have much to say. In the end I guess it doesn't matter, so long as my levels are good now. I'm just naturally a very curious person, and it strikes me as odd that no matter what my TSH levels look like, I feel exactly the same. I'd also like to figure out why I have hypothyroidism, but it seems like as long as it's treated, doctors aren't really interested in figuring out what's causing it. Which makes sense I suppose, the underlying reasons behind it won't change the treatment or outcome, so why spend time/money to figure that out? I just have an annoying desire to learn lmao. I've always been like that -- I'd get in arguments as a kid when adults told me to do something without telling me the reason why.

Some people, I figure, are simply built with the urge to track down the underlying cause.

Digging for explanations is an option. Each answer tends to open up further rabbit holes. Jot things down along the way. What has an impact on thyroid? Nutrients? Other hormones? Stress?

What I've come to understand is that a lab result labeled "normal " for blood levels isn't necessarily "optimal." My endo gets that. The target he's treating me toward is a TSH of 1 or a touch under. BUT prior to the removal of half my thyroid, he wouldn't treat me at all. Everything read as "lab normal" even while I was foggy and exhausted.

Vitamin D makes a strong case here. Across most of the US, people run low. On my lab report, the normal range is listed as 30-100. That range is enormous. In some countries, anything under 50 counts as low. Feeling tired can come from low D, and likewise from low iron and/or ferritin.

The thing that triggered my reframing was depression getting handed to me as a diagnosis rather than being handled as a symptom. Tiredness, which was my primary symptom, can stem from any number of causes. Doctors had no interest in looking beneath the surface.

Where levo is concerned, absorption is a tricky matter, notoriously finicky, which I suspect is why docs are content to treat by blood numbers. Rules and guidelines abound, this one is an hour window either side of dosing, this one a four hour either side. Start adding a GLP-1 to the mix and it gets complicated. Another rabbit hole if you care to look. If not: just be consistent in how and when.

On the subject of symptoms: my spouse will notice symptoms I do not. I won't pick upon some of it until it crosses into uncomfortable. So I've learned that while I do try to listen to my body, other inputs are valuable too.