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Levothyroxine/Hypothyroid

27 replies14 peopleJun 3, 2026☆ Follow
Summary

Does semaglutide or major weight loss change the levothyroxine dose needed for hypothyroidism, and why do some people feel no different even when labs shift?

Several users report needing lower levothyroxine doses after starting semaglutide or losing substantial weight, though others see no change despite similar losses. TSH alone often fails to capture how people actually feel, and adding T3 helps some who convert T4 poorly. Many never notice clear symptoms even at extreme TSH values, and doctors at low-cost clinics tend to test TSH first and skip T3 unless pushed.

What this discussion establishesWhere people disagree

Whether weight loss or the medication itself drives the dose reduction, and how reliable TSH is as the only marker.

Still open

Why some patients feel nothing even with very high or very low TSH, and whether routine T3 testing would change outcomes for them.

Nothing here is advice.

27 replies · 14 people
WryPebble36archiveopening postJun 3

Hi everyone, I'm wondering if anyone else has seen their levothyroxine working better after starting semaglutide. I was diagnosed with hypothyroidism back in 2019 and reached 150 mcg before my numbers settled. My TSH hit 120 once when I went months without meds. After some time on semaglutide my levels fell to 0.17 with no dose change, so they dropped me to 125 mcg and then to 112 mcg. My latest result was 2.49. I'm curious if I'm the only one who feels no difference at all from thyroid levels, even when my TSH was sky high.

SteadyQuill55archiveJun 3

I have Graves and never felt symptoms whether it was overactive or underactive after it burned out. I get thinning hair at both extremes and maybe eye changes, but otherwise I just feel fine.

PlainLedger95archiveJun 3

Levo dose is based on weight, so how much have you dropped? Did they ever check free T3, free T4, and reverse T3? You might not be converting T4 to T3 properly.

WryLedger77archiveJun 3

I dropped 55 pounds since my last dose review. My doctor tested free T3, free T4, and TSH because of the loss and everything landed in the normal range, so no adjustments. I used to feel the effects of low thyroid badly before treatment, especially terrible sleep quality, thinning hair, irritability, and zero libido. Adding T3 made a huge difference in sleep, mood, and daily tolerance.

WryPebble36archiveJun 3
↳ replying to @SteadyQuill55

Glad I'm not alone in having no symptoms. I probably would never have checked my thyroid on my own. It came up during emergency back surgery. It does run in the family though.

WryPebble36archiveJun 3
↳ replying to @PlainLedger95

I didn't realize the dose was weight-based. I started at 25 mcg while weighing around 200 pounds. They've run T4 several times and it stayed normal until my TSH hit 120 and T4 fell to 0.32 after months off meds. They usually order TSH with reflex free T4 and sometimes free T4. I've never had T3 checked. Since starting semaglutide I've lost over 100 pounds and now stay between 110-120. I'll update after next month's labs.

LevelTimber10archiveJun 3

My thyroid dose also stayed the same after a 70-pound loss a few months ago, which seemed odd since the dose had been stable for years before that.

PlainQuill53archiveJun 3

Large weight swings usually require dose changes. Mine goes up and down because I bulk and cut for lifting. I've had bad symptoms over the years, especially very dry cracked hands, worse heart flutter that keeps me awake, and crushing fatigue. Before diagnosis I would be wiped out the day after squats and sometimes couldn't even remember the drive home.

WryLedger77archiveJun 3
↳ replying to @WryPebble36

The scale surprise sounds funny. Curious to hear if they adjust anything next month.

PlainLedger95archiveJun 4
↳ replying to @WryPebble36

I only learned it was weight-based after reading up because I felt undertreated for years. It's more of a starting guideline than a strict rule since everyone responds differently. Getting my TSH where I feel better and adding T3 because I don't convert well has helped a lot.

WryPebble36archiveJun 4
↳ replying to @PlainLedger95

I'm going to ask next month about running T3 since I'm curious. My T4 stayed fine until TSH reached 120, so maybe my issue is more with T3. That could explain why I notice no change in how I feel. My recent labs were good but I still feel exactly the same, tired all the time with dry skin and memory problems whether TSH is 40 or 2.

GreyAlder96archiveJun 4
↳ replying to @WryPebble36

Thyroid problems are often undertreated. T3 testing is rarely done because insurance won't cover it and studies show little difference between T4 alone and combo therapy. Many people with poor thyroid function also convert T4 to T3 poorly. Adding T3 helps a lot of people feel better, and splitting the dose can be useful since it has a short half-life.

WryPebble36archiveJun 4
↳ replying to @GreyAlder96

That explains a lot and it's frustrating because my state insurance probably won't cover T3. The clinic is low-income so maybe they'll run it anyway if TSH looks fine. I keep wondering if what I feel is from low thyroid or just how I am. It's awkward talking about it because weight-gain jokes make it sound made up.

GreyAlder96archiveJun 4
↳ replying to @WryPebble36

You might be able to pay out of pocket at a lab for a full panel. T3 is inexpensive from certain sources and a small amount can go far, though you may need to lower T4 because T3 affects TSH more strongly. Thyroid issues are invisible. When mine failed I gained weight fast, felt suicidal, lipids worsened, and lost gym strength. Most doctors only treat the TSH number.

LevelCompass91archiveJun 6

I went from 125 mcg down to 100 mcg after losing weight.

KeenKettle50archiveJun 7
↳ replying to @GreyAlder96

Same here. Adding T3 finally stabilized my TSH after years of wild swings with Hashimoto's. My insurance stopped covering the brand name I was on even though the generic never worked well for me.

WryPebble36archiveJul 20

Sorry for the late update. My levels stayed good at the last check, so the dose drop might be from switching to a different generic or from the semaglutide itself rather than weight loss, since the dose didn't drop further. They wouldn't run T3 because TSH was fine and didn't even check T4. I may pay for it myself later. I've been busy helping my sister after her eviction.

LevelPebble88archiveAug 9

Different brands with different fillers can give different results at the same T4 dose. Weight matters for some people but not everyone. Tiredness is still a symptom even if you don't notice other changes. TSH alone doesn't always reflect actual thyroid status, and studies show it isn't a perfect predictor. In my own labs a normal TSH sometimes came with free T4 above range and I could feel it.

BrightMeadow15archiveAug 10
↳ replying to @WryPebble36

Some of us like to find the root cause and end up going down more rabbit holes. Lab normal ranges aren't always optimal. My endo aims for TSH around 1 or lower. Low vitamin D, iron, or ferritin can also cause tiredness. Levo absorption is finicky, which is why many doctors just go by numbers.

WryPebble36archiveSep 7

So yeah, that makes me lean toward the newer generic version I'm taking now being the one that suits me better, rather than the semaglutide. Hard to pin it down exactly though because both changes happened close together and my recall is terrible. >.> Not that it really matters in the end, I'm just nosy about these things, especially when it comes to my own body. Back when I was 16 my therapist was shocked I hadn't figured out I had anxiety and panic issues, since she thought I was so self-aware I'd already know, but nope, I had no clue. I even wondered if I was turning schizophrenic because the anxiety sometimes brings on auditory hallucinations at its worst. I only put two and two together while flipping through the DSM-5 while she stepped out. ...this might sound dumb and I'm not kidding around, but isn't constant tiredness just normal? I'm wiped out pretty much daily. I chew caffeine gum instead of drinking coffee or energy drinks and take in 250-6

PatientHarbour28archiveSep 7

Posted this just in case anyone hadn't seen the update. A company recalled certain batches of levothyroxine sodium tablets nationwide last July as a Class II action because some lots came out weaker than labeled. The agency put out the notice about the thyroid drug recall over potency worries. People on the med should keep taking it and stores don't have to reach out to anyone. [link removed]

BrightMeadow15archiveSep 7
↳ replying to @PatientHarbour28

That assertion seems off to me. During ongoing treatment without changes, blood tests occur yearly for most. Detection often starts with a call about not feeling well, followed by ordering tests and scheduling a consultation. What qualifies as important might not align with my view. It really comes down to the degree of incorrect dosing. Experiencing discomfort like that takes a toll on psychological state as well. The tracking code listed on the medication packaging corresponds to the particular formulation and its maker, functioning much like a unique identifier.

PatientMarble52archiveSep 8
↳ replying to @BrightMeadow15

Those tablets are long gone by now. I was only on the possibly weaker ones while traveling last summer. Since then I've been working to get my TSH back where it was. It's been swinging around even though things had been steady for a long stretch before that trip. Generics never gave me trouble before, but the ones from that warehouse were from a different maker than the usual pharmacy because the strength matched but the tablets looked different.

KeenThistle22archiveSep 8

Is there any peptide that could help the thyroid work better?

PatientMarble52archiveSep 9
↳ replying to @KeenThistle22

Just my guess, but maybe something that lowers inflammation.

BrightMeadow15archiveSep 9
↳ replying to @KeenThistle22

It depends what started the problem. Half of mine is gone so no peptide is going to change that. If it's Hashimoto's though, then cutting inflammation could be the angle. Still, it hinges on how far along the damage is. Once the gland is gone it's gone. Spotting it sooner is better. It's a one-way process like osteoarthritis, so slowing it down counts as progress.

KeenThistle22archiveSep 13

I find these interesting: 1) View: [link removed] 2) View: [link removed] 3) View: [link removed] 4) View: [link removed]

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