Dear Dr. Roach: Does losing weight fast when you are first trying mean you will always gain it back? — L.R.S.

Answer: We used to think that fast weight loss universally led to regaining it, but more careful studies have shown that weight loss of at least 5 pounds in the first four weeks of trying to lose weight is a marker for future success, not failure, at keeping weight off.

The keys to a successful weight management plan are long-term changes in diet and exercise. The body has a powerful tendency to return to its “set point,” so continued adherence to a plan that has significant changes over the lifestyle that was associated with weight gain is essential.

Many people do regain weight, and in those cases, treatment with medication or even with weight-loss surgery may be appropriate for a subset of people at higher risk. However, some people find that maintaining the changes that got them to lose weight become second nature after a while. Getting help from professional weight-loss programs can definitely help people successfully lose and keep weight off.

Dear Dr. Roach: I am a 71-year-old woman with a history of several thyroid symptoms, yet my TSH, T3 and T4 are normal. My TPO antibody, however, continually goes up and is now over 13,000! My family physician and endocrinologist both refuse to acknowledge this.

Although imaging shows my thyroid is getting smaller and is “beaten and bruised,” they will no longer discuss or test for TPOAb. I have already switched doctors a couple of times. Why is my autoimmune disease dismissed? How do I find the medical support I feel is necessary? — M.A.

Answer: Antibodies to thyroid peroxidase are found in about 20% of healthy women, up to 40% of people with Type 1 diabetes, and in 90% to 100% of people with autoimmune thyroiditis (Hashimoto’s thyroiditis). The very high level of antibody you have and the ultrasound findings of your thyroid make the diagnosis of Hashimoto’s a near certainty.

However, not all people with autoimmune thyroid disease need treatment. When the thyroid hormone levels are normal (T3 and T4 are the thyroid hormones) and the control by the pituitary gland also shows normal hormone level, then treatment with thyroid hormone is unnecessary. Thyroid stimulating hormone, TSH, is made by the pituitary and is abnormally high when the brain senses too low a hormone level and is abnormally low when the brain senses too high a thyroid level.

Your thyroid hormone levels should be carefully monitored, as you are at high risk for developing hypothyroidism, in which case you would need to be treated. Some experts treat people in your situation when the TSH level is even modestly elevated and the T3 and T4 levels are still normal.

What I am not certain of is what you mean by thyroid symptoms. Many symptoms of low thyroid hormone level (fatigue, low energy, weight gain) are nonspecific and might be caused by another condition. Autoimmune diseases often run together, and your endocrinologist may wish to consider other conditions, such as low cortisone level caused by autoimmune disease (Addison’s), which can cause similar symptoms.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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