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A 38-year-old female asked:

What's causing me to be tired all of the time and unable to lose weight? i'm 38 years old and weigh 224 lbs. i have been diagnosis w/ hypothyroidism & polycystic ovarian syndrome. all of my blood work comes back within the normal ranges & i take 112mg lev

2 doctor answers4 doctors weighed in
Dr. Elizabeth Lyster
Obstetrics and Gynecology 31 years experience
Yours : Yours is a very challenging situation. The fatigue and inability to lose weight that you are experiencing could have many causes. First, there is a hormonal imbalance involved - this is evidenced by the diagnoses of hypothyroidism and pcos. The interpretation of "normal" range for labs usually does not acknowledge "low in the reference range" as relevant, and may be the case with you. You also may not be getting all the labs that give useful information, such as a reverse T3 (liothyronine) level and anti-thyroid antibody levels. Second, your body may be registering the exercise you are doing as too much, in which case your body will paradoxically hold on to your excess weight despite exercise. Your body may also be doing this regarding your lower calorie intake; the metabolism experiences lower calorie intake as starvation and adapts by going even lower and not allowing weight loss to happen. I think metformin is a good medication to include in your regimen, and others may be helpful. It helps with metabolic syndrome, even when there is no overt diabetes yet. Not commonly discussed in conventional medical circles, there may also be infectious causes of your fatigue and inability to lose weight, such as viral and bacterial (tick-borne) infections. Your situation is complex, and you need a specialist who will look at all these aspects of your case and offer you a wide array of treatment options.
Dr. Pouya Shafipour
Family Medicine 23 years experience
Diet and supplements: Are critical for proper weight loss. Since you have polycystic ovaries, you have Insulin resistance and need to be on a very low carb diet to make sure you don't get diabetes and also your Insulin levels are low so you can lose weight. Also since you're taking levothyroxine (t4), you have to make sure your body is converting it to the active hormone T3 (liothyronine) and vit c, b complex, selenium, zinc help.

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