How to Lose Weight with Hashimoto’s: Step-by-Step Guide

How to Lose Weight with Hashimoto’s: Step-by-Step Guide

Do you have Hashimoto's and feel like it's impossible to lose weight?

You're not alone:

Many patients with Hashimoto's struggle with the same problem! In fact, it's one of the biggest complaints I get from patients who see me in my office.

The truth is...

Losing weight with Hashimoto's can be difficult but it isn't impossible - you just need to have the right information so you can start taking action today.

I'm going to teach you how to lose weight with Hashimoto's and give you the exclusive tips that I give to my patients who see me in the office which have helped HUNDREDS of Hashimoto patients lose weight. 

You can also find out more information about my weight loss program for hypothyroid patients here.


The Calorie-in Calorie-out Model of Weight Loss is Outdated and Harmful

I'm just going to say it:

The old model of energy balance for weight loss based on calories in and calories out is flawed and outdated. 

Not sure what I mean? Let me show you in a simple graphic:

Good dietary advice

The old model says that if you burn more calories than you consume by either eating less or exercising more you will lose weight.

Say that to all of my Hashimoto's patients, many of which can't lose weight despite a 1,000 calorie diet.

Why is this?

I've written about it before here, but to summarize it boils down to hormonal balance in your body (of which thyroid is included). 

Unfortunately, Hashimoto's sets your body up for multiple hormonal problems that ALL lead to weight gain:

Increased insulin levels A.K.A. Insulin resistance

Insulin resistance will make your thyroid worse by inhibiting T4 to T3 conversion (1). Insulin resistance also makes your cells more resistant to thyroid hormone floating around in the blood. This is why many people may have "normal" levels of thyroid hormone in the blood but low levels of thyroid hormone in the cells (this phenomenon is known as thyroid resistance). 

Increased insulin leads to obesity

Increased Cortisol levels A.K.A. Adrenal problems

Cortisol causes weight gain by making insulin resistance worse (2). And if you didn't already know, stress increases cortisol levels - so, yes, stress can make you fat (3). 

My adrenal profile

Low Thyroid Hormone A.K.A Hypothyroidism

This one goes without saying, but Hashimoto's causes hypothyroidism which results in decreased thyroid hormone and ultimately weight gain (by decreasing metabolism and whole body energy production). By the way - this is also why Hashimoto's causes extreme fatigue!

Hypothyroid lab tests

Increased Estrogen Levels A.K.A. Estrogen Dominance

It's no secret that low thyroid hormone leads to abnormal menstrual cycles and estrogen dominance. What you might not have known is that increased estrogen leads to weight gain in the butt, thighs, and hips in women!

Estrogen dominance symptoms

Calorie-Restricted Diets are Harmful to Patients with Hashimoto's and Hypothyroidism

Diet is important for weight loss but DIETING is not! 

Let me explain:

When we talk about dieting most people refer to reducing calories in hopes that they will lose weight. THIS is harmful.

Eating a healthy diet, full of nutritious whole foods is a diet.

There is a big difference - when it comes to overall health and thyroid health.

You want to be eating a healthy diet and you want to avoid dieting at all costs. 

Calorie-restricted diets are especially harmful to patients with Hashimoto's and Hypothyroidism. They result in decreased metabolism, decreased T4 to T3 conversion and an increase in reverse T3 (the thyroid blocking hormone).

As little as 25 days of calorie-restricted diet can reduce thyroid function (4) by up to 50%. 

Compare this to eating a diet filled with healthy, nutritious foods that avoid common antigenic foods which can result in a reduction of antibodies, autoimmunity and ultimately provide you with the weight loss you are looking for. 

For more information on which diet is best for improving autoimmunity and inflammation, you can see my post here. You can also get specific dietary recommendations by checking out my 10-day thyroid reset diet.

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

The Complete List of Thyroid Lab Tests:

This list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose thyroid hypothyroidism correctly!

Download more free resources on this page

Most Frequently Missed Reasons for Weight Loss Resistance (Your Doctor isn't Looking for these)

I hear the same story from patient after patient...

They know something is wrong with their body when they can't lose weight despite eating a 1,000 calorie diet made up of broccoli and chicken breasts.

When they go to the doctor they are told to "eat less and exercise more".

Unfortunately this a recipe for disaster as it only makes your thyroid function worse (read above).

Your doctor is most likely missing these main reasons for your trouble with weight loss:

1. Body Set Point Malfunction

Body set point malfunction

The idea is that your body has a built-in mechanism to maintain a certain weight (5) to maintain normal physiologic health.

If you feel like you can lose weight but you always end back up at your "normal weight" this may be an issue for you.

2. Low Resting Metabolic Rate

Reduced metabolic rate after dieting

This is where your body sets its metabolism at a lower rate than it should be (imagine your body burning only 1,400 calories per day instead of 2,000 calories per day). 

It usually happens as a result of recurrent yo-yo dieting with calorie-restricted diets. (We will talk about diagnosing metabolism problems at home below)

3. Leptin Resistance 

How leptin is supposed to work

Leptin is a hormone pumped out by fat cells that regulates metabolism and weight.

Under healthy conditions, as you gain fat mass your body increases leptin to tell the body to burn more calories. Unfortunately, just like insulin resistance, your body can become resistant to leptin resulting in weight gain and a slower than normal metabolism. 

4. Gut Imbalances

Obesity as a consequence of Gut bacteria

This includes disorders like SIBO, intestinal dysbiosis, yeast overgrowth, acid reflux, etc.

Imbalances in certain bacteria (6) in the gut can lead to the extraction of more calories when you eat, and the secretion of chemicals that make you crave foods and eat more frequently!

Treating your gut (if you have issues) is critical to weight loss.

If you think you have any of these conditions listed above contributing to your weight loss keep reading...

I'm going to go over how I treat and diagnose these conditions in my practice and some tips I give to my patients to help them with weight loss.

9 Weight Loss Tips for Hashimoto's Patients


1. Check Your Metabolism

Having a normal metabolism is absolutely critical for weight loss. 

Unfortunately for Hashimoto's patients, the thyroid is one of the major hormones involved in setting and regulating your metabolism.

If there is a problem with your thyroid hormone levels then there will be a problem with your metabolism.

Low thyroid hormone = low metabolism.

How do you check your resting metabolic rate? 

There is actually a very simple and cost-effective way to get a decent idea of what your resting metabolic rate is...

That's by checking your basal body temperature FIRST thing in the morning.

Here's how you do it:

Put a thermometer and piece of pen and paper by your bed while you're sleeping. As SOON as you wake up, check your body temperature (either by mouth or using your underarm) and write down your body temperature each morning. 

Repeat this process for at least 7 days (you will need to do it more if you are an ovulating woman).

If your metabolism is contributing to your weight loss resistance then your numbers may look something like this...

Basal body temperature when hypothyroid

This is a set of basal body temperatures from one of my patients who took her body temperature every day over the course of a month. 

The graph easily depicts the chaotic nature of body temperatures that are common when your body doesn't have enough tissue levels of thyroid hormone. 

In her case, you can clearly see the numbers not only increase but become less chaotic during ovulation and after her menstrual cycle after 1 month of treatment with Armour Thyroid. 

What else causes chaotic basal body temperatures? 

Like many tests in medicine checking your basal body temperature is not a perfect test.

Body temperatures can be off for a number of reasons, but it is a very cheap and cost-effective way for estimating your basal metabolic rate.

There are other conditions which alter your body temperature:

  1. Adrenal fatigue/problems - Adrenal issues are common in Hashimoto patients and can also result in decreased basal body temperature. If you feel your thyroid dose is optimized then look to your adrenals.
  2. Ovulation (in a woman) - The ovulatory process causes about a 1-degree increase in body temperature which stays elevated for about 10 days. Checking your basal body temperature is a great way to help determine if you are having anovulatory cycles (which many women with Hashimoto's experience). 
Ovulation and basal body temperature
What can you do to treat a slow metabolism?

Most of the time in Hashimoto's patients (or any patient with Hypothyroidism) a slow metabolism is due to undertreatment of thyroid hormone or using the wrong type of thyroid hormone medication (we will elaborate on how to get on the right dosing and type of medication below). 

While proper medication may be the most important factor there are still a number of recommendations you can start implementing today to improve your metabolism...

Consider the following tips:

  1. Check and treat your adrenal function -  Advanced cortisol tests such as salivary cortisol are not always necessary
  2. Avoid calorie-restricted diets!
  3. Make sure you are on the right type and dosing of thyroid hormone - Elaboration below. 
  4. Reduce and avoid (if possible) medications that slow metabolism - I realize this may not be possible for everyone but many medications can slow metabolism: anti-depressants, narcotics, anti-seizure medications, blood pressure medications, steroids and diabetic medications that cause an increase in insulin levels. 
  5. Get 7-8.5 hours of quality sleep every night.
  6. Incorporate weight training into your exercise routine to build muscle mass.


2. Get on the Right Type and Dose of Thyroid Hormone Replacement

A huge problem with patients that I see in my practice is that they aren't on optimal medication or dosing of medication. 

This happens frequently because many Doctors will treat only your lab numbers instead of a combination of your symptoms and lab values...

The truth is that your pituitary gland (the organ that secretes TSH) is exquisitely sensitive to thyroid hormone (T4 and T3) because it has different deiodinases than every other cell in the body. 

Deiodinase type II in the pituitary

What that means is that your pituitary will be getting enough thyroid hormone (thus lowering your TSH) while many other cells in your body are still starving for thyroid hormone - resulting in symptoms despite a normal TSH. 

This results in doctors assuming every cell in your body has enough thyroid hormone when instead really on the pituitary does.

Getting on the right type of thyroid medication

We need to talk about some basics:

There are two forms of thyroid hormone floating around in your body...

T4 or thyroxine - This is the carrier form of thyroid hormone.

T3 or triiodothyronine - This is the active form of thyroid hormone and the majority in your body comes from T4 conversion to T3 via the various deiodinases. 

Most doctors give out T4 only medication and make the assumption that the body will have no problem converting the T4 into the active thyroid hormone T3. 

Unfortunately, that rarely seems to be the case nowadays because this process of conversion is inhibited by a number of things: Stress, Insulin resistance, Leptin resistance, Prescription medications, Chemical toxins (just to name a few).

Factors that affect thyroid function

For this reason, many patients seem to do better on some form of T3 (triiodothyronine) included in their medication.

Thyroid medication options:

1. T4 only medications

Synthroid, levothyroxine, Tirosint

2. T3 only medications

Cytomel (liothyronine) or Sustained Release T3 (only available from compounding pharmacies). 

liothyronine t3 only medication
3. Combination of T3 and T4 medications

Natural Desiccated Thyroid - Armour Thyroid, WP thyroidNature-throid, etc. 

Combinations of T4 and T3: Cytomel + Synthroid or Combos from compounding pharmacies.

If you are on a T4 only medication (like Synthroid or levothyroxine) and you are still symptomatic, then you are likely to benefit from adding in T3 in some form. 

Many people opt to take Natural Desiccated Thyroid (NDT), but some people do require higher amounts of T3 only medication and benefit from taking Cytomel alone or a combination of Cytomel and Synthroid together. 

Remember that the type of thyroid medication and the dose you need is highly individualized. Don't make the assumption that if a certain medication worked for someone you know that it will work for you. 

The best way to find your type of medication and dose is through trial and error.

Understanding Thyroid Resistance and Reverse T3

Thyroid resistance is a newer term that refers to your cells being resistant to thyroid hormone. 

This happens when your body converts T4 to the inactive hormone reverse T3 (recall from above that T4 can turn into either the active T3 or the inactive reverse T3). 

When you have too much reverse T3 in your blood, it sits on top of the T3 receptor and blocks T3 from entering the cells.

This results in "normal" blood levels of active hormones and elevated levels of reverse T3 in the blood.

You can diagnose this condition by checking reverse T3 and dividing free T3 by reverse T3 to get a ratio. If the ratio is <0.2 then you have too much reverse T3 relative to free T3.

Thyroid resistance on labs

If your reverse T3 is > 15 or if your free T3/reverse T3 ratio is <0.2 you likely have thyroid resistance. 

The treatment for which is...

Take T3 hormone and cut back on T4 medications!

Weight Gain with Synthroid

Yes, it's true. Synthroid can cause you to gain weight and it happens because of thyroid resistance. 

Weight gain with synthroid

Some people do not convert T4 to T3 very well at all (for a number of reasons) and in these individuals, they can actually convert the majority of T4 to reverse T3 and thus block their active thyroid hormone.

So for these people, taking T4 only medication can actually make them worse.

If you think you fall into this category get your reverse T3 levels checked, and check your basal body temperature to get an idea of how your body is utilizing thyroid hormone.

How to get on the Right Thyroid Medication and Dose

Changing your medication can be difficult because it's really up to the Doctor you are seeing. Having said that I have a couple of recommendations:

  1. Have an open discussion with your doctor about your symptoms and the research you've done. If your doctor isn't willing to at least trial a different medication then it may be time to find a new one.
  2. Call local pharmacies or compounding pharmacies and ask for a list of physicians that prescribe natural desiccated thyroid hormone and/or cytomel. Once you have this list you can reach out to them. 
  3. Search locally for anti-aging clinics or hormone clinics that focus on optimizing health instead of managing diseases. 
  4. In most situations, it's better to avoid practices and locations that take insurance. Realize you may need to pay out of pocket to get high-quality care as Doctors that accept insurance tend to practice the same way and don't necessarily have the time to spend with you on all of your problems.
  5. Before seeing a doctor call in and ask how they evaluate thyroid function. Specifically, ask if they look at reverse T3 and use the free T3 to reverse T3 ratio. If they do there is a good chance they have a solid understanding of thyroid function.

Use these tips to find a doctor that will work with you and get you on the right dose and type of thyroid hormone replacement therapy. 

What if you can't Change your Thyroid Medication?

Sometimes it can be difficult (or impossible) to convince your physician to prescribe you different medication or to try new thyroid medication dosages. 

If this happens to you, don't worry because you have a couple of options. 

The second best thing you can do (aside from switching or changing medication) is to put extra attention on your free T3 and total T3 levels. 

You can naturally increase these numbers by taking certain supplements and by following this guide

Several substances have been shown to naturally increase T4 to T3 conversion including anti-inflammatory supplements, guggul extract and the combination of zinc + selenium


3. Find the Best Hashimoto's Diet for YOU

I've talked extensively about finding the right diet if you have Hashimoto's here

But I will summarize some of the most important points here as well...

Diet is absolutely critical to weight loss and reducing the inflammation and autoimmunity associated with Hashimoto's disease (7).

Influence of diet in hashimoto's disease

For this reason, diet has to be a critical part of how you lose weight.

I will leave you with some recommendations... (but see my previous post for further detail): 

#1. Diet is highly individualized - what works for you may not work for everyone else. 

#2. Most points (the vast majority) do better when avoiding gluten, dairy, and soy products. I've seen some patients who couldn't lose weight suddenly start shedding points when they remove these food groups. 

#3. Don't count calories! Instead focus on nutrient dense, high-quality, real whole food. 

#4. Avoid excessive sugary carbohydrates and try to maintain around 20-30% of your total calories from carbohydrates (this varies based on certain hormone imbalances). 

#5. Avoid calorie-restricted diets or very low calorie diets at all costs as these do not lead to long-term weight loss. 

#6. Tailor your diet to your specific medical conditions. Many patients with Hashimoto's suffer from blood sugar dysregulation, adrenal fatigue, and GI imbalances. Each of these problems should be taken into account when searching for your ideal diet. 

#7. Avoid excessive goitrogens but only if you are sensitive to them. Most people can tolerate healthy foods with minor amounts of goitrogens without issue. Read this article for more information

Avoid goitrogens
  • Quick tip: If you don't know where to start with diet, I would start by eliminating wheat (including gluten), dairy and soy. You may ultimately need a more restrictive diet but 60-80% of patients will see HUGE improvements with this alone. 

4. Choose the Right Type of Exercise

I know, I know...

You're not getting the whole "Eat less and exercise more" spiel from me, but we can't talk about weight loss without mentioning how to exercise. 

The problem with Hashimoto's patients is that they have to be VERY smart about how much to exercise and what types of exercises they do.

Dealing with the Extreme Fatigue of Hashimoto's

Are any of these scenarios familiar? 

  1. You're told to exercise but you are so fatigued you can barely get out of bed.
  2. You want to exercise but after exercising you feel like you've hit the wall. 
  3. You're exercising 5 times per week but no matter what you do you can't lose weight.

These are all too common in Hashimoto's patients and they are all signs of a deeper problem. 

Let me be clear:

You should be exercising, but if your Thyroid medication isn't optimized or you have Adrenal problems you may be doing more harm than good with excessive exercise. 

If you fall into one of the scenarios above I would recommend further evaluation of your adrenal function. You would also benefit from checking your basal body temperature.

If the above tests show any issues, then address those problems FIRST before you start exercising again!

While you are fixing those problems make sure you stay active by simply walking for at least 30 minutes per day.

Start High-Intensity Interval Training 

If you feel like your energy level is good enough to incorporate exercise then you may be asking: 

What is the best type of Exercise?

For weight loss, the answer is simple: high-Intensity Interval Training. 

This type of exercise has been shown to be VERY effective in burning fat and sensitizing your body to insulin (8).

High intensity interval training

In many people, high-intensity interval training is more effective and requires less time than "cardio" exercises like jogging on a treadmill for 45 minutes per day. 

HIIT results in fat loss over 12 weeks

What's more...

You only have to exercise for 10-15 minutes 1-2x per week to get this benefit.

High-intensity interval training (also called Burst training) is a form of exercise where you perform short bursts of all-out maximum effort exercises (9) for about 30 seconds with periods of rest in between. 

The science behind HIIT

Not sure what HIIT is or how to do it? Just look at the picture below. 

30 minute HIIT workout

HIIT can also be done with circuit weight training, on an elliptical or while jogging/sprinting. 

  • Quick Tip: Ditch the treadmill and start doing HIIT. You will save time, burn more belly fat, sensitize your body to insulin and reverse leptin resistance. But don't overdo it! Start with 1-2x per week and see how your body tolerates it before adding more days. 
Consider Syncing your Exercise Routine to your Cycle

If you're a woman you know how your cycle can affect your mood, energy levels, sex drive and even desire to work out!

What you may not have realized is that these feelings correlate very well with your hormones during the menstrual cycle.

Cycle synching exercises

You can read more about the topic here (10).


5. Address Gut Health

It seems we can't have a conversation without including gut health in the mix!

The reason is simple: the 100 trillion little bugs in your gut (known collectively as the microbiome) have a HUGE impact on your health.

These little bugs can increase metabolism, change how you digest food, alter inflammation, release chemicals that speak to your brain and even drive behavior (11)!

Most importantly (for our discussion) is that your gut health can impact your ability to lose weight.

Yes, it's true:

The microbiome and weight loss

It's now clear that certain species of bacteria that live in your gut will either help you lose weight, or help you pack on the pounds. 

Akkermansia (12) (part of the ancestral core microbiota) and bacteroidetes (13) seem to be associated with being lean and thin. Whereas higher amounts of Firmicutes are seen in higher amounts in people who have larger waistlines. 

The moral of the story?

You need to make sure your gut health is up to par if you want to lose weight.

That means if you are suffering from: bloating, alternating constipation/diarrhea, upper abdominal pain, acid reflux/GERD, IBS, IBD, SIBO, leaky gut, yeast overgrowth or any other gut-related problems you HAVE to get your gut fixed if you want to lose weight!

Unfortunately, Hashimoto's patients are incredibly susceptible to gut problems because thyroid hormone controls the movement of your bowels and it controls how much stomach acid you put out. 

If either of these slow down or are not working properly then you are a perfect set up for gut dysfunction.

How do you fix your gut?

Treating the gut can be difficult if you are trying to make the journey alone. 

In order to treat your gut correctly, you must find out what the problem is and to do that you need the proper testing. In many cases, you may need advanced testing.

Tests such as the comprehensive stool analysis and parasitology x3 from Doctor's Data can provide further information and help guide treatment.  

If you have severe gut issues I would recommend seeing a functional medicine trained practitioner right away for further evaluation, but...

If you have slight GI related issues then you can absolutely start with some steps right away:

1. Start Taking a High Quality, Multi-Species Probiotic

Remember: not all probiotics are created equal. And what works for your friend may not work for you.

This is especially true for patients with Hashimoto's and hypothyroidism. 

In order to get the best results, you need to be using probiotics that contain multiple species and at high enough dosages. 

This is critical for helping to improve GI function and reverse autoimmunity. 

I recommend using at least 10+ different species of probiotics and at dosages higher than 100 billion CFU per serving. 

Using probiotics in this manner will actually help with weight loss as they reduce your appetite, alter caloric absorption of food and directly modulate fat storing hormones. 

You can find my probiotic recommendation here and you can also read more about how to use probiotics for weight loss here

2. Consider Taking Proteolytic Enzymes

Proteolytic enzymes serve three purposes:

  1. They help you digest your food by taking some of the strain off of the stomach and pancreas. 
  2. They help to destroy immune complexes in both the gut and bloodstream (these particles stimulate and activate the immune system and lead to autoimmunity). 
  3. They help you absorb nutrients!

Proteolytic enzymes can be a huge help to patients with Hashimoto's because of the low stomach acid associated with low thyroid hormone. 

There are several brands you can use but I will typically start with Super Enzymes because they are affordable and work very well.

  • Quick Tip: Improving Gut Health requires a comprehensive treatment program that involves Dietary changes, proper supplements, prebiotics, probiotics, and sometimes nutrition to kill bad bacteria and yeast. 

6. Reduce Inflammation in your Body

Many diseases, including the inability to lose weight (14), have roots in chronic low-grade inflammation. 

The kind of inflammation that is caused by...

  1. Chronic Daily Stress (Work, Family, Social, etc.)
  2. Lack of Sleep (less than 7 hours per night)
  3. Poor Diet (Standard American Diet)
  4. Untreated Gut imbalances (SIBO, IBS, IBD, Reflux, Yeast overgrowth, etc.)
  5. Disturbances in the Gut Microbiome (Dysbiosis)
  6. Visceral Abdominal Fat (belly and organ fat)
Standard American Diet definition

If you want to lose weight you HAVE to address the causes of low-grade chronic inflammation. 

Fixing the problem is usually pretty easy once you have figured out what your problem areas are.

In most cases, I recommend starting with the basics. By doing the following things you would be able to reduce the inflammation in your body significantly:

  1. Focus on relaxing and managing your stress: I recommend 20 minutes per day of Yoga, Meditation, or Spiritual Prayer.
  2. Focus on getting at least 7 hours of sleep per night. You may need to supplement with relaxing herbs, botanicals or even hormones like melatonin.
  3. Eat nutrient dense, real whole foods. If your food has a label or more than three ingredients don't eat it! When in doubt leave it out. 
  4. Fix your gut using some of my recommendations above. 
  5. Take a probiotic and replace nutrient deficiencies (most common being Vitamin B12, fish oil, Magnesium and Zinc
  6. Exercise (1-2x sessions of HIIT per week) and stay active on days you don't exercise by walking at least 10,000 steps. 
  • Quick Tip: Using the strategies above you should be able to completely eliminate inflammation from your body within 1 month. But please note that some people may require further blood testing to get to the root cause of their problem. 

7. Balance your Adrenal and Cortisol Levels

Cortisol is another HUGE player in weight gain and obesity. 

Cortisol works in tandem with insulin and they both tell your body to take whatever calories you've consumed and turn them straight into belly fat.

The problem is this:

We as humans were never designed to battle the continuous and constant stress that we put on our bodies on a DAILY basis.

Our Adrenal glands were meant to provide us excess energy when we need it most: like bursting away from a lion or another form of danger.

Our bodies don't know how to deal with the constant stress from working 12 hour days, dealing with social distractions, eating poor quality manufactured food or the sedentary lifestyle of working form a desk 8+ hours per day. 

Our little adrenal glands can only keep up for so long. When they decide to poop out you get what is known as Adrenal Fatigue.

What is Adrenal Fatigue?
Adrenal Fatigue and Hashimoto's 

Unfortunately, people with Hashimoto's have another reason to develop adrenal fatigue.

Thyroid hormone works in tandem with adrenal hormones (epinephrine and norepinephrine) to provide your body with energy in the form of ATP, and to maintain your basal metabolic rate.

When your thyroid hormone is low, your adrenals have to work overtime (15) to make up for the difference. Leading to debilitating and crushing fatigue that many Hashimoto's patients suffer from.

Thyroid hormone and cortisol

Symptoms of Adrenal Fatigue:

  1. Crushing and debilitating fatigue even after 8 hours of sleep
  2. Salt and Sugar cravings
  3. Weight gain, especially in your abdomen
  4. Racing thoughts or feelings of anxiety, especially at night
  5. Increased energy in the evening
  6. Reliance upon caffeine or sugar for energy
  7. Problems maintaining blood sugar or the sensation of feeling dizzy at times
  8. Low blood pressure or unstable blood pressure when standing
  9. Brain fog or sluggish brain function
  10. Low sex drive
  11. You can read more about the symptoms of adrenal fatigue here...
Symptoms of adrenal fatigue

If you find yourself with the symptoms listed above or if you've been evaluated and treated for your Hashimoto's/Hypothyroidism but still aren't 100% then you may be suffering from adrenal fatigue. 

The treatment of Adrenal Fatigue deserves its own blog post but I can give you some quick recommendations to get started with right away...

  1. Avoid Caffeine at all costs - it may be providing you with energy but at the cost of burning out your adrenals.
  2. Increase your consumption of salt (preferably Celtic sea salt or Himalayan pink salt). I even recommend putting 1 tsp in a large glass of water each morning. 
  3. Consider taking adaptogens such as Rhodiola, Ashwagandha, Siberian Ginseng, or Holy Basil. I find that supplements containing Ashwagandha or rhodiola are superior to other adrenal adaptogens due to how they increase thyroid function and directly help with weight loss. I've found the best success with this supplement in patients with Hashimoto's. 
  4. Consider taking adrenal glandulars. Adrenal adaptogens directly help improve energy levels by providing adrenal hormone precursors. 
  5. Take 2 grams of Vitamin C daily to help nourish adrenal function. 
  6. Consume several meals throughout the day, you may need to eat every 2-3 hours to stabilize blood sugar levels. 
  7. Consider evaluation for adrenal hormones such as DHEA, Pregnenolone, and or Hydrocortisone (Bioidentical hormone replacement therapy for late stage Adrenal fatigue/exhaustion). 
  • Quick Tip: Healing your adrenals may take months, and in my experience, it may take up to a month of treatment before you start to notice a difference so stick with it!

8. Reverse Leptin Resistance and Insulin Resistance

Leptin resistance and insulin resistance cycle

Do you find it impossible to lose weight despite doing "everything right"? 

Leptin, more specifically leptin resistance, may be playing a major role.

What is leptin?

Leptin is a hormone that is pumped out by your fat cells (Yes they do more than just give you cellulite!).

The idea is that as you gain fat cells, the fat cells pump out this hormone that is then supposed to tell your brain that you aren't hungry anymore and to increase your metabolism to burn the extra fat stores.

The problem?

We live in a time of "plenty" and most people have way too many fat cells and as a result, they have too much leptin.

This sequence reduces the influence that leptin has on your brain. Your brain thinks you're in a state of starvation and severely lowers your basal metabolic rate (16), whole body metabolism and increases your appetite. 

This process is known as leptin resistance and may be one of the most undiagnosed and underappreciated causes of obesity and weight loss resistance in our society. 

Leptin resistance is associated with extreme obesity and aggregates in families

Leptin resistance also seems to have some genetic (17) component to it as well. Which may explain why some families tend to always struggle with obesity. 

How does Leptin Resistance Impact the thyroid?

As leptin levels (and leptin resistance) increase, your body starts to turn T4 into Reverse T3 in an attempt to slow down metabolism (because it thinks you're starving). 

Recall from above that as Reverse T3 increases your body starts to directly block thyroid hormone and your metabolism and fat burning ability will decrease accordingly. 

How do you diagnose Leptin Resistance?

If you think that you may be suffering from Leptin resistance I recommend asking for the following tests:

  1. Serum Leptin levels: This should be < 10. Anything higher than 10 is a problem indicating that you have leptin resistance if you are also overweight. If your weight is normal and your leptin level is high then that is a normal response. 
  2. Check serum Uric Acid levels: Anything > 5 is a problem and indicates your body has a problem metabolizing fructose.
Uric acid as a predictor of obesity
How do you treat Leptin Resistance?

Leptin resistance is treated much the same way that Insulin resistance is treated. Which would include: high intensity interval training, intermittent fasting, targeted supplements, T3 thyroid hormone replacement, a diet focused on macronutrients and with certain medications such as Saxenda, Victoza and Naltrexone or Contrave.  

  • Quick Tip: Lifestyle changes may not be enough if your thyroid is under-treated, you have systemic inflammation or you still have insulin resistance. If you fall into this category you may benefit from medications that can sensitize your body to leptin. These include exenatide and pramlintide (they are both diabetic medications but help significantly with weight loss and leptin resistance). 

9. Avoid Endocrine Disruptors and Xenoestrogens

Did you know that detox is now mainstream?

Well, at least it should be...

Just recently the Endocrine Society (this is the society that sets the guidelines for how endocrinologists practice) came out with a paper "Executive Summary to EDC-2: The Endocrine Society's Second Scientific Statement on Endocrine Disrupting Chemicals" which outlined how chemicals we come into contact with on a DAILY basis block your thyroid function at the cellular level. 

Executive Summary to EDC 2  The Endocrine Society s Second Scientific Statement on Endocrine Disrupting Chemicals

What's worse? These chemicals lower ACTIVE thyroid hormone (18) in your blood but don't affect the TSH!

This means that if your doctor is only testing your TSH they are behind the times...

It also means that if your Endocrinologist or Doctor isn't teaching you how to avoid these chemicals they are doing you a disservice

What are endocrine disrupting chemicals
How do you avoid Endocrine Disrupting Chemicals?

So let's talk about doing that right now...

Here are several tips you can start doing today to ACTIVELY avoid these chemicals that are likely interfering with your thyroid function:

1. Stop Touching Receipts

Receipts have Bisphenol-A (19) (a known thyroid blocker) that is absorbed through the skin whenever you touch one. From here on out ask the cashier to put the receipt in the bag. 

2. Drink out of Glass Containers/Cups

Avoid plastic containers, water bottles, and canned foods. These contain BPA and/or aluminum.

3. Drink Filtered Water Only:

Get a reverse osmosis filter for your home if possible. But remember that ANY filter is better than no filter, so just get something. 

4. Avoid Plastic Whenever Possible

This means plastic toys, food stored in plastic, food wrapped in plastic, etc. And never reheat (20) or microwave food stored in plastic (this causes more chemicals to leach out). 

5. Say No to Hand-me-Down Plastic Toys

Soft rubber manufactured before 2009 is made with Phthalates (another known thyroid blocker). This would be things like rubber duckies, not hard legos made of plastic. 

6. Eat Organic Food and Grass-Fed Meats, if you Tolerate Dairy Make Sure it is Organic or Fermented

Or better yet just ditch the dairy because it's probably causing inflammation in your body. But at least make sure to buy organic whenever you can. 

7. Avoid Fragrance

If you see the word "fragrance" or "parfum" on the label, run the other way. This is code word for Phthalates.

8. Check your Cosmetics for Chemicals

Use the resource Skin Deep by the Environmental Working Group to grade your cosmetics based on how many hidden chemicals they have. 

  • Quick Tip: Use all of the above strategies and make sure to sweat profusely at least once a week to help Detox the chemicals that you've already been exposed to. 

Real Patients and Real Results...

I know we just went over a ton of information, and to help put this all together I want to show you an exact step-by-step example of what this looks like in a real Hashimoto's patient.  

This patient lost 50+ pounds during treatment with me as I treated her based off of the same information you just read about.

It's one thing to read about, and it's another thing to actually put this information into practice so remember this when you look for providers! 

You can learn more about my approach to weight loss in my metabolism reset guide here

Final Thoughts

If you've been struggling to lose weight with Hashimoto's or Hypothyroidism then this blog post goes out to you. 

Just remember to take your health into your own hands and be your biggest advocate.

It may take some time and energy but if you can go through these topics you WILL be able to lose weight.

Now it's your turn:

Have any of these strategies worked for you? Why or why not?

What have you found to be the most helpful "trick" to weight loss with Hashimoto's and Hypothyroidism?

Leave your questions or comments below! 

References (Click to Expand)

9 step hashimoto's weight loss guide

Dr westin childs photo

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

P.S. Need more help? Check out my free thyroid downloads and resources.

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