fluctuating tsh levels without medicationfluctuating tsh levels without medication

What causes tsh level to go up and down without medication? A way that reconciles the fact that so many patients have a normal TSH, and yet, still experience the symptoms of hypothyroidism. Hey There! Here are 4 ways you can get more help right now: #1. For people with thyroid disease, certain things can cause fluctuations in thyroid hormone levels. Why do I still feel sick? Hashimoto's disease. level is far too high, indicating your thyroid is not sending out enough thyroid, to support your body. has a different demand for thyroid hormone depending on the situation, time of day, stress you are under, etc, never seen a healthy individual with a TSH > 1.0, That means it is entirely possible to have a normal but less than optimal TSH, several conditions where the TSH can be decidedly normal in fact it can even be sometimes < 1.0 but the patient can still be hypothyroid, free T3 levels that are either at the low end of the reference range or barely below it, Generally, this means you will have to look outside of the insurance model (I know its not what you want to hear but its just the truth right now) because most Doctors practice what is known as the standard of care and that standard is to test only the TSH, calorie restriction can even cause low T3 syndrome, in fact some providers have recommended we change the range to include anything > 2.5 as abnormal, 3x more potent at decreasing your TSH than T4 thyroid hormone, B12 Shots Benefits: Weight Loss, Energy & More, Victoza Weight Loss Case Study: 50 Pounds Lost with Victoza & LDN, Thyroid Hormone Resistance: What is it & How to Diagnose it, Hypothyroid Supplements for Women: My Top Picks, How Thyroid Supplements Work & Why They Help you Feel Better. metabolism slows down. Ive created a resource designed to help you find knowledgeable doctors which you can use here. Have your T3 and T4 levels tested, if you haven't already. Other factors that affect TSH levels include thyroid peroxidase (TPO)-antibody positivity, BMI, obesity, smoking, critical illness, and many xenobiotics, including environmental pollutants and drugs. medications, including nonprescription (over-the-counter) ones, can affect the Muscle aches, tenderness and stiffness, especially in your shoulders and hips Pain and stiffness in your joints and swelling in your knees or the small joints in your hands and feet Muscle weakness, especially in your lower extremities Excessive or prolonged menstrual bleeding (menorrhagia) Depression However, many organizations agree that a reading of 2.5 or less is truly ideal for normal thyroid levels, with anything 2.5 - 4.0 mIU/L considered "at risk". Find inspiration for a healthy way to support your thyroid. I've had rapid weight gain. That's because food may delay or reduce the drug's absorption by changing the rate at which it dissolves or by changing acid levels in the stomach. Content on HealthTap (including answers) should not be used for medical advice, diagnosis, or treatment, and interactions on HealthTap do not create a doctor-patient relationship. Second trimester: 0.11 - 3.98 uIU/mL. You start titration with Natural desiccated thyroid and after 2 months your TSH drops to 1.0 on 2 grains (130-135mg) of NDT. If the TSH level is elevated due to a thyroid related issue, you may need treatment. You can read more about my own personal health journey and why I am so passionate about what I do. Synthetic T4. 2014;24(12):1670-751. doi:10.1089/thy.2014.0028. That means if thyroid hormone is floating around in your body it will eventually make it to the thyroid gland which will cause your TSH to drop. For example, TSH naturally rises somewhat during colder months and drops back down in the warmest months. But while some studies suggest that adding T3 to T4 may help weight loss, "it is not a skinny pill," says Dr . Read More By these new standards, you can consider a TSH which is greater than 2.0 to be an early indicator of some thyroid dysfunction in the body. The big problem is that this condition is relatively new and our understanding is limited. My mom is also hypothyroid and has been on meds for a long while now. TRAb antibody levels can fluctuate widely and unexpectedly, and when they do, they can immediately begin to affect thyroid biochemistry. Hypothyroidism, sometimes called underactive thyroid, is a condition in which your thyroid gland doesn't produce enough T3 or T4. This would indicate, at least subjectively, that the ideal TSH (provided the disease is not present in any form) is somewhere around 1.0. It must make it inside your cells to turn on your genes and have an impact. That would explain a lot. I was nervous about going on medication after only one blood test and so I asked for a second. Things that may help keep your thyroid levels stable include taking your thyroid medication at the same time every day and on an empty stomach; sticking with the same brand or manufacturer of your thyroid medication; talking to your doctor about other medicines, herbs, and supplements you currently take; and asking your doctor about adjusting your medication dose with the change of seasons. But compare those lab tests to both reverse T3 and free T3 which show changes much earlier than the other lab tests. If you are pregnant, it's normal for TSH levels to become slightly elevated. Obviously, there is a better approach and that is to look at and evaluate all thyroid laboratory tests (in addition to the TSH) and treat if there is a combination of symptoms + abnormal lab tests (even if those abnormal lab tests are just antibodies). We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. why do i still feel sick? Several factors can affect your TSH level, such as stress, lifestyle choices, medication, age, and thyroid function. When you understand how inflammation (indicated by her high CRP) leads to T4 to reverse T3 conversion (7), her thyroid labs make perfect sense. Too much levothyroxine can cause side effects, such as: Tiredness. I love to write and share what I've learned over the years. As this enzyme increases in activity, it can do a lot with a little and it can make what little thyroid hormone you have more effective by keeping it active inside the cell. So why does the free T4 stay relatively preserved in some patients? In fact, you can see her before/after pictures and her entirecase study here. In general, normal TSH levels during pregnancy include: First trimester (9 to 12 weeks): 0.18 - 2.99 (uIU/mL). I am a 57 year old female who has had hypothyroidism for 20 years. Never disregard or delay professional medical advice in person because of anything on HealthTap. Didn't find the answer you were looking for? Free T3 is an active thyroid hormone. Need better symptom control? Hypothyroidism What about patients who have normal TSH levels but every hypothyroid symptom? The rate at which your TSH drops can be helpful in determining your total dose of thyroid hormone needed. So how are these newer T4 medications different, and how do you know which T4 medication might be the best for you? The amount of levothyroxine needed Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. Tsh is secreted in spurts and may vary depending upon when it's drawn. This guide will walk you through everything you need to know about TSH including why it isnt always the best marker of thyroid function in the body and which conditions make the interpretation of TSH less accurate. Having said that they can be quite helpful, especially if you are thyroid hormone naive (meaning you havent been on medication before). results. TSH can actually be very helpful in initially diagnosing hypothyroidism and (sometimes) in helping to determine the ideal dose of thyroid hormone medication. I am talking specifically about insulin and leptin resistance: Both of these conditions reduce T4 to T4 conversion (studies showing this link for insulin resistance here(10), studies showing this link for leptin resistance here(11)). Tsh tests are very sensitive but often not real reproducible. Some mild cases However, the changes in these levels are more extreme if you already have a thyroid condition before becoming pregnant. indicates that your Thyroid is not producing enough, ). Sometimes an initial level of 0.1 to 0.5 mU/L is acceptable, even though these numbers are mostly below the normal range. If not ask him for these to be done. Reverse T3 may also be measured, however it is inactivated T3. A TSH level lower than normal indicates there is usually more than enough thyroid hormone in the body and may indicate hyperthyroidism. May 18, 2020. She was a non-smoker and mother of two (last childbirth 2 years previously). TSH is often the only test performed when you get the "everything is normal" news - and this is not only incomplete, but this methodology is totally unreliable when you have Hashimoto's. Not to say it is not an important test, it most definitely is. Is identical to that produced in the human thyroid gland; T4 has higher serum levels, slower metabolic clearance, and a longer half-life than T3; Example: Levothyroxine sodium tablets why not all thyroid lab tests are created equal and why the TSH falls short if used by itself. The problem is that this condition extends beyond the typical acute illness that so many Doctors relate it to. Addressing these issues can help keep your thyroid levels stable. Again, it highlights the importance of not focusing solely on the TSH but instead using other markers to help diagnose thyroid-related problems. You may have Hashimoto's Thyroiditis. It would be prudent to consult a gastroenterologist as you may not be absorbing your. Inflammation of the thyroid gland can disrupt normal thyroid hormone levels in numerous ways. PTH controls blood levels of calcium, phosphorus, and vitamin D. The parathyroid glands produce more PTH when calcium levels in the body are low. Outside factors may affect the results of your thyroid blood test. Her tsh levels are 8, is it ok to start or wait till the tsh levels come down? Oops! Some medications and supplements may also affect your results. I'm Westin Childs D.O. Thyroid hormones help control heart rate . A previously abnormal TSH level should be rechecked in, at minimum, 7 weeks or 2 month intervals until levels stabilize. This may be because they change your thyroid function. Finding the right treatment and the proper dosage is a step-by-step process that takes time and requires monitoring. change would not help with this. shaws Administrator 8 years ago Have you been diagnosed with Hypothyroidism? TSH levels in children, babies, and pregnant women can fall outside of the normal range for adults. weeks after you start taking the medication. In cases of low T3, subclinical hypothyroidism, partial thyroidectomy, and autoimmune thyroiditis the TSH may NOT accurately reflect the thyroid status of your body. Above you can see a chart that depicts all thyroid lab tests over time and based on disease severity. Some women have high prolactin levels without any symptoms. Switching to a new brand of thyroid medication may lead to fluctuation in thyroid levels as your body adjusts.. In fact, T3 thyroid hormone is 3x more potent at decreasing your TSH than T4 thyroid hormone(14), so put that into perspective when using medications like cytomel, liothyronine, or NDT. These attacks make your thyroid less able to produce thyroid hormone on its own. Their effects are different from what's known as "Hashitoxicosis." The doctor told me he didn't see a reason but it was my blood and money and so getting another test was fine. Follow-up appointments are important to monitor hypothyroidism over time, however. What causes blood pressure to go down while the heart rate goes up with exercise. of hypothyroidism, called subclinical hypothyroidism, are associated with an Have you gone through a calorie-restricted diet in your life? ", Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. She also has hashimotos syndrome. Signs and symptoms will be expected to progress without thyroid supplementation such as with Synthroid. Jonklaas J, Bianco AC, Bauer AJ, et al. And patients who are in this situation feel frustrated because they are symptomatic with abnormal labs, but still arent getting treatment. But, as a result, its not well recognized by many providers or physicians who arent trained to identify or look for it despite the fact that it is highlighted in the medical literature. Created for people with ongoing healthcare needs but benefits everyone. Do TSH levels fluctuate during menstrual cycle? Standard treatment for hypothyroidism involves taking a daily oral medication called levothyroxine, a synthetic form of thyroid hormone. This illustration helps explain (in addition to the differences in deiodinases, tissue level demands, etc.) Its also important to remember that both T3 and T4 will cause your TSH to decrease. They can be very helpful for the initial diagnosis and sometimes for management, but once you introduce thyroid hormone into the system exogenously (from the mouth) you have changed the dynamics of the system. Why was the test ordered? Tsh is secreted in spurts, and sometimes the lab test can detect a peak one time and a valley the next, but it's usu Dr. Maritza Baez and another doctor agree, warrants investigation. If the body is able to preserve thyroid function after a partial thyroidectomy (as evidenced above) then it is certainly able to preserve function if 10-50% of the thyroid gland is destroyed. Understanding the way that these enzymes work is essential to understanding why treating TSH doesnt work for all people. 1 Current research suggests that TSH serum levels peak at between 2 am and 4 am and . Assessment ofthyroidfunction duringpregnancy: the advantage of self-sequential longitudinal reference intervals. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. and will that comes to control again ? often is recommended. This highlights that each patient has a unique demand for thyroid hormone in their body and standard dosing should not apply to everyone. Most doctors agree that any TSH above 10, especially when combined with an abnormal T3 or T4 reading, should be. . This resource is dedicated to helping people with thyroid problems, hormone imbalances, and weight loss problems get the help that they need. Mary Shomon is a writer and hormonal health and thyroid advocate. If you're already being treated for a thyroid disorder, your doctor will probably consider. Can You Eat Soy If You Have a Thyroid Condition? 2011 Aug;7(4):679-84. doi:10.5114/aoms.2011.24139, By Mary Shomon On the left is a mild disease state (inflammation, autoimmunity, chronic infection, dieting, etc.) They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins. The thyroid gland is a small butterfly-shaped gland in the front of the neck that makes the hormones triiodothyronine, or T3, and thyroxine, or T4. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. All rights reserved. As we age, especially women, our thyroid function tends to slow down. Suppression of thyroid-stimulating hormone (TSH) after thyroidectomy for low-risk cancer can increase the risk of osteoporosis in women without cutting back on cancer recurrence, according to. TSH is a sensitive hormone that will respond to low thyroid hormone levels, it is important. TSH levels change inversely with how much thyroid hormone is in your body. And it wasnt until she was started on Nature-throid (she was previously on levothyroxine but didnt feel any improvement) that she had a near complete resolution in all of her symptoms over about a 6 month period. Since TSH is secreted in a pulsatile manner, TSH levels also fluctuate over minutes. Thyroid disease can progress or stabilize as the year's pass due to any number of reasons: One of the most common contributing factors of fluctuation in your thyroid levels is your age. Other laboratory . Instead, each of the cells in your body has a different demand for thyroid hormone depending on the situation, time of day, stress you are under, etc. A high TSH level indicates that the body does not have enough thyroid hormone. Some prescription meds that can influence thyroid hormones: We suggest regular monitoring of your thyroid function during the long-term use of any of the therapies listed above. Work with your health care provider to set up a schedule for your follow-up visits. TSH levels change inversely with how much thyroid hormone is in your body. Ask him to test TPO ab and Tg ab. It restores the body's hormone levels to normal, which reverses the signs and symptoms of hypothyroidism. And stress, your diet, medications, and having your period can all make TSH fluctuate. If the TSH level is between 4mIU/L and 10mIU/L, treatment may still be warranted in various situations: if the levels of actual thyroid hormones in the bloodknown as thyroxine (T4) and triiodothyronine (T3)are abnormal The Standard Treatment Protocol for Hypothyroidism. do i take it or stop it? Most people who develop hypothyroidism after radioactive iodine treatment can expect to take some form . TSH Optimal range: 0.5-2 IU/L. . Her TSH was still 2.37 (so within the normal range) with a reference range of 0.45 to 4.5 uIU/mL: At first glance her labs look decent but how can you reconcile these labs with her clinical symptoms? Does a child with tsh level of 6.0 need medication? Without making it too complex the pituitary gland has only the enzyme which activates thyroid hormone. Patients with little or no residual thyroid function require replacement doses of LT4 at approximately 1.6 g/kg/d, based on lean body weight. Third trimester: 0.48 - 4.71 uIU/mL. That means a 100-mcg pill can be considered potent even though it delivers anywhere from 95 mcg to 105 mcg of the active ingredient. Many mechanisms may be involved in fluctuating thyroid function: hormonal supplementation, antithyroid drugs and levels of TSAbs and TBAbs. My white blood cells are whacked out at 2.5 (4.0-11.0) Doctor told me to get my thyroid tested once a year but another doctor said that would be crazy, I still need to keep getting it re-checked? Follow me on Facebook, TikTok, and Instagram for up-to-date thyroid tips, tricks, videos, and more. An expecting mom should test their thyroid hormone levels every month in the first half of pregnancy and may be checked less often during the second half of pregnancy.. The normal range of TSH levels in non-pregnant adult women is 0.5 to 5.0 mIU/L. The normal range of TSH levels in non- pregnant adult . T4 is inactive unless it is converted to T3. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. In order to find out if it is normal, we have to first understand what this test is actually testing for. But in order to come to this conclusion you really have to look at the whole picture. These fluctuations can occur as your thyroid disease progresses. Thyroid function tests confirmed the diagnosis of . Standard treatment for hypothyroidism involves taking a daily oral medication called levothyroxine, a synthetic form of thyroid hormone. Leptin resistance and hypothyroidism both appear to be caused and sustained by calorie-restricted diets (chronic yo-yo dieting) which cause high reverse T3 and low free T3 levels leading to clinical hypothyroidism. So if you are started on any medication containing T3 and your TSH does not drop very quickly then that is an indication you might need higher doses of thyroid hormone. In the winter, your body may have difficulty keeping up with its hormonal needs, resulting in the TSH rise. Lets go through some examples so you have a better idea of what I am talking about. Ideally, you should take your thyroid medicine in the morning, on an empty stomach, about one hour before eating breakfast and drinking coffee. Signs and symptoms will be expected to progress without thyroid supplementation such as with. Taking your medication at the same time every day is essential. Welcome to my website! Some known interactions occur between thyroid medication and corticosteroids, cholesterol-lowering drugs, corticosteroids, amiodarone, and lithium. The downside is that unlike other tissues in the body the pituitary is the MOST sensitive tissue to thyroid hormone in your body. Is Hormone Pellet Therapy A Treatment Option For Hypothyroidism? Hyperthyroidism is when an overactive gland produces too much thyroid hormone. Living with an autoimmune condition and having been let down by the traditional healthcare system, Katie has a personal and professional interest in improving patient access to better care. We are going to go over them below, but I need to say something first: Thyroid lab tests shouldnt be used as THE definitive test for diagnosing and managing hypothyroidism by themselves. To find the right dosage of levothyroxine for you, your health care provider checks your level of TSH about 6 to 8 weeks after you start taking the medicine. I started a new anxiety med I'm now on prozac. This is a big problem because T3 is the active thyroid hormone. Often, over time, the thyroid hormones and TSH eventually return to normal. Thyroid hormone doesnt do anything if its in your bloodstream. I also happen to formulate the best supplements on the market (well, at least in my opinion!) Learn which foods you should avoid if you have thyroid disease of any type. It could be a gland, or a nodule, spurting out a bit too much every once in a while sending you out of balance. A normal Total T4 level in adults ranges from 5.0 to 12.0g/dL. absorption or metabolism of thyroid hormone tablets, so you should notify your health Win Prizes. DEAR MAYO CLINIC: I recently was diagnosed with mild hypothyroidism that isn't causing symptoms. Well, the pituitary gland is just another tissue in the body that has a demand for thyroid hormone and sensitivity to thyroid hormone. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. How likely would you say I am positive for hashi's I've never been tested yet. The list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose and manage thyroid disease correctly! This is where things can get a little more complicated. In your level of thyroid hormone. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Both rT3 and T3 can be used as sensitive markers for assessing thyroid disease severity because they become abnormal earlier than other thyroid lab tests. Thank you! Furthermore, elevated TSH levels have been observed with ageing. Truly healthy people have a TSH < 1.0 and yet the normal range extends all the way out beyond 5 in this case. There are several conditions where the TSH can be decidedly normal in fact it can even be sometimes < 1.0 but the patient can still be hypothyroid. TSH can vary wildly based on your age, sex, and stage of life. Some people developthyroiditis after pregnancy. Follow-up appointments are important to monitor hypothyroidism over time, however. Is the level too low? Once you start treatment with thyroid hormone the TSH generally has less utility than the other thyroid lab tests indicated above, but it still can be useful under certain circumstances. It restores the body's hormone levels to normal, which reverses the signs and symptoms of hypothyroidism. Each patient may have any number of these symptoms, varying in severity. Below you'll find 7 reasons your TSH may be increasing. Differences Between Thyroid Issues And Menopause, Estrogen Dominance And Hashimoto's Disease, Weight gain or increased difficulty losing weight, Amphetamines (Vyvanse, Ritalin, Adderall, phentermine) used for ADHD and weight loss, Beta-blockers (propranolol, metoprolol, atenolol) used for blood pressure, Bile acid sequestrants used for cholesterol-lowering, Cancer therapies like ipilimumab, Nivolumab, Octreotide, Cimetidine (Tagamet) used for stomach ulcers, Diuretics (Acetazolamide, Lasix) used for blood pressure, Estrogens and estrogen disruptors (including Femara, Clomid, and Tamoxifen) used for birth control, hormone replacement, or fertility treatment, Glucocorticoids (and prednisone) used as anti-inflammatory, Methimazole used for hyperthyroidism or Graves' disease, Phosphate binders used for kidney disease, Propylthiouracil used for Graves' disease, Spironolactone used for PCOS or blood pressure. , Then, of course, we have the situation of autoimmune thyroiditis. Get answers from Endocrinologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. A partial thyroidectomy is a surgical operation in which only half of your thyroid gland is removed and should be compared to a complete thyroidectomy in which the entire thyroid gland is removed. Some If hypothyroidism doesn't go away on its own within several months, then treatment is necessary. You can see the range from different lab tests below: As you can see the TSH reference range is 0.35 to 5.5. As part of the endocrine system, the thyroid gland makes and stores hormones that help regulate the body's metabolism in the form of blood pressure, blood temperature and heart rate. Disease progression can impact thyroid hormone levels. DEFINITION: WHAT DO THE FOLLOWING PATIENTS OVER THE AGE OF 60 YEARS HAVE IN COMMON? This research was supported by the National Institute on Aging Intramural Research Program and grant R56AG064256. Therefore, they may not raise the issue with their doctor or seek treatment., Your thyroid levels may also vary due to medication type, potency, and dosage. Yes, hypothyroidism can cause a slow heart rate, or bradycardia, in some individuals. But it can be turned into Reverse T3 instead of free T3 which can put the brakes on the thyroid and your metabolism. This helps your cells get what they need, but it also may falsely make your lab tests look more normal than they really are. I'm Dr. Westin Childs. And in case you are wondering here are other conditions that can cause Low T3 syndrome and put the brakes on your thyroid function: If so, then there is a good chance you may have low T3 syndrome which is causing hypothyroidism but NOT altering your TSH. In fact, it has been shown that calorie restriction can even cause low T3 syndrome(5). develops when the thyroid doesn't make enough hormones. Thyroid disease and pregnancy. Also, keep in mind that prescription errors can occur. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. How old is the child? Low T3 syndrome is exactly as it sounds. 1 Since the case patient weighs 84 kg, the expected LT4 dosage would be around 125 to 150 g/d. Problems can be either short term and transient, or longer and chronic. Around 10 years ago i was diagnosed with hashimotos diease and my tsh level was 13. i recently attempted to get back on medication because i feel awful but my tsh was 3.80. does this mean i don't have hashimotos anymore? They may affect your hormones by: Starting or stopping prescription drugs that you take for other conditions can affect your thyroid levels and symptoms. Check out my thyroid supplements. Arch Med Sci. Now having said all of those things it doesnt mean that the TSH is entirely useless (in fact I will talk about how it can actually help somewhat helpful later). Your submission has been received! If your TSH is outside of this range then you should be evaluated further and you should consider a trial of thyroid medication. Several factors can alter your symptoms and thyroid test results. Specific medications may interfere with your thyroid function and absorption of thyroid medication. A 72 year old woman with "fluttering of the heart" and vague chest discomfort on climbing stairs It has a different set of deiodinases(3)(these are the enzymes that either activate or inactivate thyroid hormone). Depending on the results, they may adjust your medication dosing. Endocr Pract. Sign up to receive 20% off your first order. medication because too little levothyroxine won't adequately control Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Go see your doctor and seek medication to correct your problem which can become serious if you do not do what I have said. This often leads patients with autoimmune thyroiditis until their TSH finally increases to a point where providers feel thyroid hormone is indicated. Hashimoto's thyroiditis is an autoimmune disorder, and one of several diseases that causes inflammation of the thyroid 3. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Think of your pituitary gland as a . They can produce a significant change in thyroid status within weeks or months. Now that you have a basic understanding of thyroid physiology we can discuss another physiologic change that may make understanding your lab tests difficult. elevated TSH while the T4 level stays within the normal range. If you have questions regarding your health you should seek qualified information from a medical professional or your doctor. It's the TSH levels that are the source of all the squabble among doctors. After that, blood levels generally #supplements #lifestyle #medication #thyroid doctors #symptoms #hashimoto's #blood tests #diet & recipes Have you gone through the HCG diet or some other medically assisted weight loss program?

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