Levothyroxine/Hypothyroid

[J.Ayden]

Hi all, I'm kind of curious if anyone else has noticed their levothyroxine has become more effective since being on semaglutide? Basically, I got diagnosed with hypothyroidism in 2019. I got up to 150mcg on levothyroxine before my levels came down (my highest TSH level was 120, in December of 2025, but that's when I hadn't had access to my medication for several months so it was fully expected) but basically, after being on Sema for a while, I started having to lower my levothyroxine dose. My levels were hovering in the 30's but then dropped to .17 after a year of taking semaglutide, with no change in my levothyroxine dose -- so they lowered it to 125mcg. I'm now on 112mcg, with my most recent test results being 2.49, in January of this year. I'm due back for labs this month, so we'll see what happens I suppose.

The other thing I'm kind of curious about, am I the only one who literally notices no difference at all with their thyroid levels? Like, even in December when my thyroid clearly wasn't doing jack shit, I still wasn't having any side effects. At one point I was even wondering if it was worth it to actually bother with my medication because it didn't feel like it was doing anything for me. I wasn't losing any weight, wasn't any less tired, my skin wasn't any different, etc etc. But then I read about myxedema coma/crisis and decided it'd be a lot better to just suck it up and take the stupid pill lmao.

The only other alternative I can actually think of is I switched pharmacies at around the same time as I started semaglutide, so I'm honestly wondering if for some reason, one generic works better for me than the other? Has anyone experienced that, maybe? In the long run I guess it doesn't matter as long as my levels are good, I just find it interesting.

 

[randompersonrandom]

I have graves disease, and I have never felt a single symptom; either when it was hypER, or after it burned out and I got kind of lazy about taking my meds and was hypO for awhile. I get the thinning hair at either extreme, and possibly the bug eyes (though my whole family has bug eyes, so who knows if it was that), but I've never actually felt anything but fine.

 

[whimsps]

Levo dosage is weight based - how much weight have you lost in that time? Have you had a free T3, free T4 and reverse T3 run? Maybe your body isn't converting T4 into T3 well

 

[PineCone99]

I've lost 55 pounds (since my levo and liothyronine doses were last looked at). I informed my doc and she ran tests (Free T3/T4, TSH) based on the weight loss to see if it should be lowered. All labs came back in the perfect range. So, no change to the doses doc said. Did find it curious since I thought it was "weight-based"..

However, symptom-wise, before I was on the 2 medications, definitely felt the ramifications of being hypothyroid. Was never getting any deep sleep, could sleep 10 hours, stay asleep the entire time, still woke up every day feeling like I'd slept 1 hour. Was crazy-making. Hair thinning. Moody/irritable unable to tolerate small nuisances. Libido non-existent. The levo helped with some things, but it wasn't until I got the additional liothyronine (T3 - apparently I don't make the conversion from T4 to T3 very well on my own) that I noticed a DRASTIC improvement. Sleep quality, mood, tolerance, etc. A life-changing difference. Thank F for T3 meds.

 

[J.Ayden]

randompersonrandom said:


I have graves disease, and I have never felt a single symptom; either when it was hypER, or after it burned out and I got kind of lazy about taking my meds and was hypO for awhile. I get the thinning hair at either extreme, and possibly the bug eyes (though my whole family has bug eyes, so who knows if it was that), but I've never actually felt anything but fine.

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Well I'm glad I'm not the only one without symptoms, then! I literally never would've even gotten my thyroid checked on my own, I think maybe they just happened to check it when I got emergency back surgery? I don't remember how it came up lol. Apparently it runs in my family though, after I started Levo I visited my Grandma and was talking to her about how I was surprised I had hypothyroidism and she told me she has it as well.

 

[J.Ayden]

whimsps said:


Levo dosage is weight based - how much weight have you lost in that time? Have you had a free T3, free T4 and reverse T3 run? Maybe your body isn't converting T4 into T3 well

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Huh. I didn't know it's weight based. I wonder if my doctor's know that? I started on 25mcg and weighed around 200 pounds lol. I've had T4 run five times and it's always been in normal ranges except the most recent test in December, when it was low at .32 and I hadn't been taking my Levo for a few months. So it looks like even though my TSH was consistently high, my actual levels of T4 were fine until my TSH was at 120 and my T4 was at .32. I don't know if it's different, but when I get my levels checked they normally do TSH w/rflx free T4, and occasionally do "T4 free" about half the time as well. As far as I can tell, I've never gotten T3 tested itself.

Overall since starting Sema, I've lost 100+ pounds. I now hover between 110-120, and started at 220-240ish.

PineCone99 said:


I've lost 55 pounds (since my levo and liothyronine doses were last looked at). I informed my doc and she ran tests (Free T3/T4, TSH) based on the weight loss to see if it should be lowered. All labs came back in the perfect range. So, no change to the doses doc said. Did find it curious since I thought it was "weight-based"..

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I'll post an update to this next month when I get my levels checked again and see if they lower my dose or anything. It was funny, the visit I did in January was the first time they'd weighed me in several years and the lady literally had to double check because it got flagged in the system because the last time they'd weighed me was in May of 2023, shortly after I'd started taking Sema and still weighed 184. So the system thought I went from the 180's to 122 instantly lol.

 

[Mayostardayonnaise]

My thyroid meds also didn’t need to be reduced when I was at a 70 lb loss a few months ago, I thought that was bizarre. Before the loss, my dose had been the same for many years.

 

[bbbilly]

well if you gain/lose a large amount of weight your meds will probably need to be adjusted accordingly. mine is always going up and down because i bulk/cut for the gym.

i have had pretty severe symptoms with mine over the years. my hands will get so dry and have deep cracks that will bleed no matter how well i moisturize them. when my levels get too far out of whack my arterial flutter will get way worse and my heart will be skipping beats like crazy and keep me up at night so i wont sleep hardly at all. not to mention the fatigue will be almost debilitating.

idk how i use to function before i got diagnosed with Hashimoto's. the day after a squat day in the gym i would be so exhausted at work i would take my break and just stare at the wall, forget to breath and gasp for air.. basically like walking sleep apnea or something, and i pretty much never remember driving home from work either. it was just a poof and i was getting out of my car in the driveway.. or when i did i would see shadows moving (night shift so id be driving home at 2am and thought i was developing schizophrenia) all because my tsh was sitting in the high 80s the whole time

 

[PineCone99]

J.Ayden said:


I'll post an update to this next month when I get my levels checked again and see if they lower my dose or anything. It was funny, the visit I did in January was the first time they'd weighed me in several years and the lady literally had to double check because it got flagged in the system because the last time they'd weighed me was in May of 2023, shortly after I'd started taking Sema and still weighed 184. So the system thought I went from the 180's to 122 instantly lol.

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Haha! Lady is like "now wait a gawddamn minute.." Will be interested to hear next month if they make any adjustments to your doses or not.

 

[whimsps]

J.Ayden said:


Huh. I didn't know it's weight based. I wonder if my doctor's know that?

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I didn't realize it was until recently when I went down a long rabbit hole as I feel my hypothyroidism has been under treated for a long time. I'll have to go dig around to see where I found that info, I believe it was on thyroid.org? But I think it's more of a general guideline for where to start people's meds than a hard and fast rule. As they say, every BODY is different and may need more or less to achieve desired results. My TSH is now in a range that makes me more comfortable and adding a T3 component since I wasnt converting T4 from Levothyroxine to T3 well has helped me a lot, personally.

 

[J.Ayden]

whimsps said:


I didn't realize it was until recently when I went down a long rabbit hole as I feel my hypothyroidism has been under treated for a long time. I'll have to go dig around to see where I found that info, I believe it was on thyroid.org? But I think it's more of a general guideline for where to start people's meds than a hard and fast rule. As they say, every BODY is different and may need more or less to achieve desired results. My TSH is now in a range that makes me more comfortable and adding a T3 component since I wasnt converting T4 from Levothyroxine to T3 well has helped me a lot, personally.

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I'm gonna ask next month if they can maybe run a T3 test because I'm curious what the results would be. Especially since my T4 was always in a good range until my TSH was at 120, which makes me wonder if my hypothyroidism is more of a T3 issue and not a T4 issue. Maybe that's why I don't get any side effects? Or at least, I don't notice any difference -- to be clear, I'm exhausted pretty much all the time, my skin is hella dry, and I have a ton of memory issues, but...that's all the same when my TSH is 40 vs 2. As I said, my most recent test was in a good range, but I feel exactly the same as I did before. Nothing's gotten better, but nothing's gotten worse. Hopefully that makes sense.

 

[gusterbuster]

J.Ayden said:


I'm gonna ask next month if they can maybe run a T3 test because I'm curious what the results would be. Especially since my T4 was always in a good range until my TSH was at 120, which makes me wonder if my hypothyroidism is more of a T3 issue and not a T4 issue. Maybe that's why I don't get any side effects? Or at least, I don't notice any difference -- to be clear, I'm exhausted pretty much all the time, my skin is hella dry, and I have a ton of memory issues, but...that's all the same when my TSH is 40 vs 2. As I said, my most recent test was in a good range, but I feel exactly the same as I did before. Nothing's gotten better, but nothing's gotten worse. Hopefully that makes sense.

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Thyroid is probably the most common under treated ailment. T3 is almost never ran because insurance doesn't pay for it and most studies dont show much difference in outcomes with t4 only or combo t4/t3 treatment. Logic is why run the test if going to treat with t4 only.

But, nor uncommon if you have a shit thyroid, the conversion of t4 to t3 is shit to. And anecdotally many people feel better with t3 added to their treatment plan.

Also t3 has a short half life and many find dosing twice a day helps. Possibly why studies dont show much difference in outcomes? Morning and lunch dosing seems to work well, anecdotally.

 

[J.Ayden]

gusterbuster said:


Thyroid is probably the most common under treated ailment. T3 is almost never ran because insurance doesn't pay for it and most studies dont show much difference in outcomes with t4 only or combo t4/t3 treatment. Logic is why run the test if going to treat with t4 only.

But, nor uncommon if you have a shit thyroid, the conversion of t4 to t3 is shit to. And anecdotally many people feel better with t3 added to their treatment plan.

Also t3 has a short half life and many find dosing twice a day helps. Possibly why studies dont show much difference in outcomes? Morning and lunch dosing seems to work well, anecdotally.

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Ah, that makes a lot of sense. And is unfortunate, my insurance almost definitely won't cover it, then. I have insurance through the state so they obviously don't cover anything they don't consider necessary. But the doctor I see is at a free/low income clinic, so maybe I can convince them to run the test anyway, especially if my TSH levels are in a good range like they were before. I'd expect to be feeling better if TSH was telling the whole story, right? I don't know though. Something I struggle with a lot is trying to figure out if I'm actually having side effects from hypothyroidism or if it's just...the way I am? I don't know how else to really explain that.

It's funny, I feel like thyroid issues are always the joke/excuse that people immediately use for weight gain, so I always feel weird when I talk about my broken thyroid with people who don't experience it because I feel like everyone thinks I'm making it up or something. So it's interesting to me to consider it being an under treated ailment.

 

[gusterbuster]

J.Ayden said:


Ah, that makes a lot of sense. And is unfortunate, my insurance almost definitely won't cover it, then. I have insurance through the state so they obviously don't cover anything they don't consider necessary. But the doctor I see is at a free/low income clinic, so maybe I can convince them to run the test anyway, especially if my TSH levels are in a good range like they were before. I'd expect to be feeling better if TSH was telling the whole story, right? I don't know though. Something I struggle with a lot is trying to figure out if I'm actually having side effects from hypothyroidism or if it's just...the way I am? I don't know how else to really explain that.

It's funny, I feel like thyroid issues are always the joke/excuse that people immediately use for weight gain, so I always feel weird when I talk about my broken thyroid with people who don't experience it because I feel like everyone thinks I'm making it up or something. So it's interesting to me to consider it being an under treated ailment.

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Not sure if in your budget, but can self pay at labcorp or quest. Fitnomic is a subscription, 75 for 3 months and my full thyroid panel inclusing t3 and reverse t4 was 40 bucks.

And t3 is very affordable on indiamart. A little goes a long way and may need to reduce t4 dose as t3 effects tsh like 3x that of t4.

Thyroid is an invisible disease. When mine shit the bed I gained 20lbs in a month, didnt want to live like brink of suicidal, and lipids went to shit and 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]

I was on 125 mcg, after weight loss had to go down to 100.

 

[lastresort]

gusterbuster said:


Thyroid is probably the most common under treated ailment. T3 is almost never ran because insurance doesn't pay for it and most studies dont show much difference in outcomes with t4 only or combo t4/t3 treatment. Logic is why run the test if going to treat with t4 only.

But, nor uncommon if you have a shit thyroid, the conversion of t4 to t3 is shit to. And anecdotally many people feel better with t3 added to their treatment plan.

Also t3 has a short half life and many find dosing twice a day helps. Possibly why studies dont show much difference in outcomes? Morning and lunch dosing seems to work well, anecdotally.

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Definitely my case.

I have had Hashimotos since 2021 and only after adding T3 my TSH level finally stabilized. Before then it would fluctuate wildely.

Meanwhile my insurance no longer covers synthroid. Its the only brand medication i take because the generic one never got me close to fixing it

 

[J.Ayden]

Sorry I didn't update this thread sooner after my appointment! My levels are still good, which makes me think the lowering of my dose is either due to the generic levothyroxine I'm on now works better for me, or it's because of semaglutide. I don't think it's weight loss related since my dose didn't need to be lowered again.

I couldn't get my doctor to run for T3 since my TSH was good, they didn't even check my T4. I suspect they check TSH first and only then check other things next if they need to, to cut down on costs, since it's a free/low income clinic. I might save up and try to get it tested on my own, but that'll be a project for another day -- the reason I've been gone for a bit is my little sister got evicted from her apartment at the beginning of this month, so I've been dealing with that. I told her I'll help her pay for a place because the alternative is she moves in with me which would be really crowded, especially since she has a ton of animals. But there's no way in hell I'm gonna let her and my nephew be homeless, so I'll figure it out.

Thanks everyone for your thoughts/insight on this thread. I found the discussion really interesting overall. On the topic of my thyroid stuff, I even mentioned to my doctor how I never had symptoms or noticed anything (she asked me if I was having any, or if I just wanted to check my levels since it'd been six months), but she didn't really have much to say about it. I suppose in the end it doesn't matter, as long as my levels are good now. I'm just naturally a very curious person, and I find it odd that it seems like regardless of what my TSH levels are 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]

The only other alternative I can actually think of is I switched pharmacies at around the same time as I started semaglutide, so I'm honestly wondering if for some reason, one generic works better for me than the other?

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Different products with different ingredients can cause different effects at the same nominal T4-dose. That's a well known fact. So it is absolutely possible this plays a role.

Body weight does to a certain extent, but not for everybody (30 kgs up or down make no difference for me).

On the topic of my thyroid stuff, I even mentioned to my doctor how I never had symptoms or noticed anything (she asked me if I was having any, or if I just wanted to check my levels since it'd been six months), but she didn't really have much to say about it.

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But you do have a symptom: tiredness. I don't think it's normal to be tired. You don't mention lack of sleep or anything else that would explain the tiredness at least.

There are various studies dealing with the question "how good is tsh as a sole predictor of a thyroid situation?" All I have seen came to the conclusion that a good tsh doesn't guarantee good thyroid levels. Fine tuning by tsh works for some people, but not for everybody.

Here some examples from my own data under 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)

So you see, in this case totally normal tsh, but fT4 above range (and I felt it, too). The tsh alone would have been misleading here.

In the end, I had to take some T3 also, to get constantly stable energy levels. But I wouldn't recommend trying it without a way in place of having all 3 levels checked.

 

[Foggy-Hollow]

J.Ayden said:


I'd also like to figure out why I have hypothyroidism,

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I think there are some of us just wired to find out root cause.

You can look for reasons. And you’ll find more rabbit holes. Take some notes as you go. What affects thyroid? Nutrients? Other hormones? Stress?

I’ve learned that lab “normal “ for blood levels may not be “optimal.” My endo knows this. I’m being treated toward TSH of 1 or slightly below. BUT before I had half my thyroid removed he wouldn’t treat me for anything. Things were “lab normal” even though I felt foggy and tired.

Vitamin D has a good case for this. Most of the US is low. My lab shows 30-100 as normal range. That’s a huge range. Some countries say anything below 50 is low. Low D will also make you feel tired as will low iron and or ferritin.

My trigger on the reframing was depression being a diagnosis for me not treated as a symptom. There are a number of things that can cause tiredness which was my main symptom. Doctors weren’t interested in digging below the surface.

With levo, absorption is a tricky matter, it’s notoriously finicky which I think why docs are willing to treat to blood numbers. There’s a lot of rules and guidelines, 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.

As to 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.