u/Jaded_Ad_3191

tldr: Free T4 and TSH all crazy after big weight loss. Anyone else?

Hi, I tried searching for info but couldn't find it, so sorry if this gets asked a lot. I (59f) was diagnosed with hypothyroidism about 20 years ago at 39, been on levothyroxine ever since. And I gained 3-4 pounds per year, most years, for 20 year. You know how it is: ate right, exercised, blah blah. Was a buys single mom, never really dieted, just tried to stay active.

Started Zepbound in Sept 2024 and by June 2025 I had lost 70 pounds. Since June 2025 to May 2026 I have lost another 10 pounds as I figured out maintenance dosing. Current BMI is 22, and in general I feel amazing and strong!

During that time work switched insurance at away from Kaiser to Blue Shield. New doc diagnosed me with Hashimoto's, old doc had just assumed that I had it. Old doc lowered my Levo dose right before the insurance switch due to early weight loss. My TSH went up so the new doc raised my levo dose in mid 2025, even though my free t4 was high.

In Jan my work insurance went back to Kaiser and I returned to my old doc, who I like. TSH was 1.6, Free T4 was 2.0. Since my free T4 was high she explained that I needed to drop my Levo dose again, that dosing is in part based on weight, and that it takes awhile for my pituitary to "see" my new weight and stop demanding so much hormone from my thyroid. So we dropped dose from 112 to 100 and retested in March. She said that my TSH would go up, but that it was basically "fake news" while the pituitary adjusted to my new size. In March, TSH was 3.9 and Free T4 1.9. She dropped dosage again to 75 and after 2 months at this dose I just retested on Friday.

TSH is way up to 6.6, I am still waiting on the Free T4 results. Kaiser usually releases them quick so I'm paranoid that they are being held for her review because they are problematic...

As far as symptoms, in the past week my fatigue has increased, joint pain and sense of inflammation are all up. All very different after a year at this size, a year in which I have become quite the gym rat! Zepbound has been amazing for inflammation, so that worries me. Hopefully I get my free T4 results today and some answers from my doc. Maybe we have found my "floor" and need to go up little bit.

Anyone else have anything similar after a big weight loss?

Here is my Dexa from yesterday compared to last June at my initial goal, as well as Jan 2025 when I had already lost 40lbs! Just look at my elbow placement....I wish I had done a DEXA at the start.

I'm 5'4", SW 205, CW 125. Body fat is 28% currently. My current goal to be about 130lbs and 25% body fat. This goal is based on nothing...just sounds nice, so if anyone has advise let me know.

My original goal was 135, which I hit last June. I kept losing about 2 pounds per month for the first few months of maintenance, despite increasing cals and lowering dose. Kept increasing cals and lowered dose again to 7.5mg in November. Now that loss has slowed to less than 0.2 pound per month if I keep my cals around 1850-1900 per day, or even a little more.

I'm keeping a close eye on the Foundayo pill roll out and may switch to that in late summer if my pcp agrees.

I get quarterly DEXA scans and lean mass is holding steady, while fat is sloowwwlllyyy dropping. I strength train 3-4x per week for about 40 minutes and walk 3-5 miles per day. I turn 59 next month, and started menopausal hormone therapy in Jan, so I'm hoping that the MHT will help the muscles grow a bit faster. My OB has recommended adding testosterone gel to my MHT, and I'm getting the blood work next week to see if it's safe for me. While it is for libido, it may help the muscles as well. My libido has been gone for so long that I'm honestly more excited about muscle gains than sexy time, lol.

After almost a year of maintenance and body recomp, I have more definition in my arms, which have always been skinny, and my bra strap area is leaner, much less pooch over the strap. Shoulders are looking nice, just in time for summer. My boobs are mostly gone (a moment of silence for our fallen sisters, please), but the booty is still there, both with muscle and fat. Inner thighs and lower belly still holding onto the typical female softness, which is fine with me. Quads and hams have a modest amount of definition. All in all, I am tickled pink.

https://preview.redd.it/ll2rynsat40h1.jpg?width=826&format=pjpg&auto=webp&s=46981ecdf4e95898062a94296b14e6a1a81c3482

Started E and P in January, slowly titrating up. Yesterday I was given 0.075 patches and 200mg P. My usual patch change day is Saturday. It was Thursday at first, but a month ago it fell off into the toilet on a Saturday and just like that Saturday became my new day.

I liked Thursdays better. Can I just make the switch?

Both my mom (96) and me (58) use estradiol cream. I have Kaiser, she has Medicare, obvs. She had a backlog of cream for months since it was on auto re-order. She is finally running low, time to order.

Her Medicare pharmacy benefit changed providers this year, which is why it was no longer on auto reorder. Both the company running the benefit, and their mail order pharm are new for us. I logged into their site and they are charging over $100 for the cream. Wild. And...it was out of stock, of course.

I looked at local pharmacies, still expensive, still out of stock. Look at cash pay, like CostPlus drugs: cheaper, out of stock.

So I googled 'mail order pharmacies that will show me if they have a med in stock.' Came up with Health Warehouse. Never heard of it before. Cash pay. They have the cream in stock.

I had her doc send the rx, and asked if they could send it for 2 tubes since it was cheaper and to guard against the shortages. Doc did, and the order is showing as processing. With the 10% first order promo code it was $31.75 for 2x 42.5g tubes with free shipping.

Since I did this over the weekend not much happened for a few days, so it may not be the speediest option. But it is an option nonetheless if you are in a bind.