Let’s debunk this myth once and for all.
No doubt you’ve heard people claim that their weight gain is due to having thyroid problems.
The reply is always something along the lines:
“Blaming your thyroid is an excuse for not having self-control or for being lazy”.
But is this really true?
Not really, in fact, recent science supports the exact opposite.
This is a big deal for patients who are overweight or for those with thyroid problems because it validates what they are going through.
Your Thyroid and Your Weight
You’re left to believe that weight gain is the direct cause of eating too much and exercising too little.
This message is crammed down your throat on a near-daily basis.
While eating excess calories certainly won’t help your weight loss it’s rarely the sole CAUSE of excess weight.
Instead, you need to think about weight gain and obesity as a metabolic disorder.
A disorder that stems from underlying hormone imbalances that may be caused by the type and quantity of food that you eat, your activity level, your environment, and your mental status.
This is a jump from the conventional way of thinking about weight gain but it is a much more accurate representation of what is actually happening.
Let’s apply this thinking to weight gain and your thyroid:
We know that your weight is intricately connected to thyroid function. This statement isn’t up for discussion as it’s just thyroid physiology 101.
Thyroid hormone (specifically T3) is responsible for activating mitochondrial energy production, increasing heat production, and for regulating the metabolism of your entire body.
To suggest that hypothyroidism does not cause weight gain would be to go against our understanding of thyroid physiology.
So why do people still believe that there is no connection between weight gain and thyroid function?
Much of this controversy stems from the current treatment paradigm as it relates to thyroid hormone replacement.
Here’s what I mean:
If you are a hypothyroid patient who is experiencing weight gain from your thyroid, doesn’t it make sense that treating your thyroid with medication should help you lose weight?
It’s perfectly logical but it’s not what we see in clinical practice.
You know this if you’ve taken (or are currently taking) levothyroxine or other thyroid medications.
In most cases, replacing the lost thyroid in your body doesn’t cause any net change in your weight, and in some cases, it may actually cause you to gain weight.
Knowing this, you can take one of two approaches to this situation which seems paradoxical.
First, you can double down on your position that the thyroid has no impact on weight and that any weight gain must be caused by something else.
This is the position that most doctors take and it’s the reason why they will blame your weight on everything except your thyroid.
You’ll know what I’m talking about if your doctor has tried to blame your weight on your diet, your activity level, your age, or something else.
And second, you can rethink the treatment and current understanding of thyroid function to see if we are perhaps missing something.
The truth is that most physicians have failed patients when it comes to weight loss.
Doctors are stuck in a 20-year-old understanding of weight loss and they are all too eager to blame the patient instead of looking at other factors.
Thyroid hormone management has become “streamlined” into a simple algorithm that basically flows like this:
Is the TSH Normal?
If TSH is > 5.0 then slightly increase the dose of levothyroxine/Synthroid (or start medication if the patient isn’t already on it).
If TSH is < 1.0 then lower the dose of levothyroxine/Synthroid to increase the TSH to a more satisfactory level.
It’s honestly so simplified and so easy that you don’t need years of training or a doctorate degree to understand it.
The algorithm doesn’t allow for any other confounding variables so if you are someone experiencing fatigue, hair loss, or weight gain but your TSH is normal then your symptoms MUST be caused by something else.
Does this even sound logical?
How can something as complex as a hormone, which interacts at a nuclear level in basically every cell in the body, be controlled by one single measure?
It’s not logical at all and it falls short in many cases which is why we have an epidemic of unhappy thyroid patients.
What if instead of focusing on the TSH we evaluated your thyroid in the context of your symptoms?
What if we took into consideration other hormones and how they interact with thyroid hormone in the body?
What if we evaluated how well you are actually converting T4 to T3 in peripheral tissues?
What if we considered the fact that some tissues may have a higher DEMAND for thyroid hormone than other tissues?
Does this sound like a better approach than basing treatment on the TSH?
It is definitely better and it’s the approach that you want your doctor to take.
And this is only the tip of the iceberg.
Below you will find even more information on how connected your thyroid is to your weight to debunk the thyroid obesity myth.
DOWNLOAD 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 avoid if you have thyroid disease of any type.
The Complete List of Thyroid Lab tests:
The list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose and manage thyroid disease correctly!
4 Ways Your Thyroid & Weight Are Connected
#1. Obesity Causes Hypothyroidism
Most people understand that hypothyroidism causes obesity but they fail to realize that obesity can also cause hypothyroidism.
Let’s break this down:
First, you need to realize that being overweight is not a normal condition, and having excess fat on your body really does wreak havoc on your hormones.
This effect is so profound that an extra 10-20 pounds of weight gain can trigger a cascade of hormone imbalances:
First, excess fat cells (adipocytes) secrete a hormone called leptin (1). Excess levels of leptin lead to leptin resistance and changes in TSH.
Second, leptin resistance directly leads to an increase in TSH (2) but also reduces T4 to T3 conversion.
Fourth, inflammation and leptin resistance reduces peripheral T4 to T3 conversion causing tissue-level hypothyroidism (5).
Fifth, as patients gain weight they will be pushed to try calorie-restricted diets which further increases reverse T3 and cause low T3 syndrome (6).
This cascade of events is very well documented, but just not well known among physicians.
The point is this:
You can play the game of ‘which came first, the chicken or the egg’ (in this case it would be ‘which came first, your weight gain or your thyroid’) all day long, but it doesn’t actually matter.
What we know is that there is a bidirectional relationship between your thyroid and your weight such that you can’t look at weight without at least thinking about your thyroid.
And if your doctor is unwilling to entertain the idea that your thyroid is somehow connected to your weight then it may be time to seek a second opinion.
#2. Calorie Restriction Causes Low T3 Syndrome & Hypothyroidism
Here we have another well-documented consequence of dieting.
Calorie restriction (as defined by 21 days of less than 1,000 calories per day) is enough to lower thyroid function.
This is felt to be a protective mechanism by the body.
Because in states of low-calorie intake your body will try to reduce energy expenditure to match energy intake.
In other words, your body tries to match the calories it burns with the calories you consume.
If you lower those calories then your body will lower the calories it burns to match.
Remember when we said that your thyroid helps control your metabolism? This is how it does it.
That means trying to “trick” your body into burning 2,000 calories when you only eat 1,000 calories won’t work.
Your body catches on and then dupes you in the process by lowering your total T3, increasing reverse T3, and putting the brakes on your metabolism (7).
So instead of burning 2,000 calories per day, your body lowers your metabolism down to 1,000 calories.
So as soon as you start eating more food guess what happens?
Your body starts packing on the pounds.
This process isn’t perfect and it occurs differently in each person.
This is why some people (very few) do lose weight when they restrict their calories.
But the catch is that this calorie restriction will eventually catch up to them and prevent future weight loss efforts.
You might think this is mumbo jumbo but this is exactly what happened to the biggest loser contestants.
Researchers found that their weight loss efforts resulted in damage to their metabolism which stuck with them for 7 years.
The most important thing to take from this section is just how damaging calorie restriction can be to your metabolism and your thyroid.
If you are thinking about using any diet which works by reducing your calories (even diets in the range of 1,500 calories per day still count), think long and hard before you do.
It has the potential to make your situation much worse and any weight loss you will see is likely to only be short-lived.
#3. Patients Taking T3 Tend To Lose Weight (This Sometimes Applies To Other Thyroid Medications as Well)
Here is where things get really interesting:
We know that taking levothyroxine and Synthroid usually do not lead to weight loss, but what about other thyroid medications?
In other words, is there something unique about levothyroxine that makes it less likely to help you lose weight? And, conversely, is there something about other thyroid medications which makes them more likely to help you lose weight?
The answer is yes and we have a few studies to help show this.
Studies support and confirm that using T3-only thyroid medication leads to weight loss (9) in certain patient populations (this study suggests the weight loss benefit is secondary to an increase in heat production).
According to the study, patients who are more likely to see benefits from using T3 include:
- Patients taking beta blockers for blood pressure or for other reasons.
- Overweight patients on T4 replacement after treatment for hyperthyroidism (see this post to understand why hyperthyroid patients almost always gain weight).
- Overweight patients on T4-only medications (Read this article for more info).
- In patients who are considered ‘dietary treatment-resistant’ and who have experienced weight increase while stopping cigarette smoking.
- In patients on VLCD (very low carb diet) or LCD (low carb diet) with low T3, and slowed weight loss despite continued calorie restriction (I don’t recommend you do this but the study confirms the need for T3 in these patients).
- In patients with abdominal obesity and metabolic syndrome resistant to dietary intervention or showing inadequate improvement in metabolic aberrations. In other words, changing your diet hasn’t helped you to lose weight, fix your cholesterol, lower blood sugar, and so on.
- In patients showing, before or during dietary treatment, signs, and symptoms of subclinical hypothyroidism (read more about subclinical hypothyroidism and weight gain here).
The study mentioned above provides pretty clear guidelines for what type of patients should consider T3 use.
If you fall into any of the categories listed above then you may want to have a discussion about using T3 with your doctor.
This isn’t all either, we still have more studies to evaluate.
Despite these results, the authors concluded that the “quality of life” was not increased in these patients.
But let me ask you:
If you lost weight would your quality of life increase? I think so.
These conclusions really highlight the bias that exists among doctors for using T4-only thyroid medications.
Another study showed treatment with T4-only medications resulted in lower than normal T3:T4 concentrations (11) even when the TSH is “normal” or considered “euthyroid”.
This study supports the idea that TSH may be an insufficient marker for assessing cellular thyroid levels.
With this information and several clinical studies, we can assert that it’s not that thyroid hormone doesn’t cause weight loss but instead, T4-only medications like levothyroxine and Synthroid don’t.
This supports the idea that patients tend to do much better when using a combination of both T4 and T3 in their treatment and hormone regimen.
If you aren’t familiar with the differences in thyroid medication and which medications contain which hormones please see this information below:
#4. TSH Tracks Perfectly with Weight
Lastly, which shouldn’t come as a surprise, is that changes to circulating TSH and thyroid hormones result in weight gain.
Specifically, weight tends to track quite well with TSH and serum free T4 (12).
As TSH rises (meaning you become hypothyroid) you will find that BMI rises as well.
As free T4 levels fall weight tends to rise.
This study doesn’t prove a causal relationship between the two but when put into context with known thyroid physiology and the other studies we’ve mentioned, we can say with some degree of certainty that the relationship is probably more than correlated.
This is important to mention because there may be times when your thyroid is not the primary cause of your weight gain.
There are still plenty of other factors and issues that can lead to weight gain outside of your thyroid.
For instance, if you can’t control your diet and eat lots of processed or refined foods, then it doesn’t really matter what’s going on with your thyroid because your diet is the issue.
This doesn’t take away anything that we’ve discussed so far but it’s important to understand both sides.
Your Next Steps (Easy)
Hopefully, this is all making sense to you and starting to get you excited.
Because if you know what is actually going on in your body then you can start to reverse the process and get the right treatment.
So the next section is going to focus on what should you be doing now to make a difference.
I’ve split this section into 2 parts:
The easy section and the advanced section.
The truth is that understanding these concepts is really just the beginning, what matters more is actually getting treatment so you can lose weight and feel better.
Some of these easy therapies you can get started with right away while the more advanced options may require a physician for further help.
#1. Support Thyroid Function in your body
The first thing you want to consider is using supplements.
The right supplements can help improve thyroid conversion, reduce inflammation, and help promote normal hormone balance in your body.
There are a lot of supplements that you can get started with so let me simplify this a little bit:
I recommend that you start with an adrenal supplement, a thyroid support supplement, and a probiotic.
Adrenal supplementation will help stabilize your energy levels which will help you stay active and make healthier choices (diet, exercise, and so on).
I’ve found that patients with thyroid issues do best on a combination of adrenal glandulars and adrenal adaptogens.
Thyroid support supplements are a no-brainer because, in order for your thyroid to work properly, you need to make sure you are providing it with the nutrients it needs to function.
This 32-in-1 thyroid multivitamin has everything that your thyroid needs.
And lastly, probiotics act to naturally restore intestinal microflora, reduce systemic inflammation, improve your mood, and may help increase nutrient absorption.
You’ll want to use a probiotic that has at least 100 billion CFU.
If you are ready to step it up a notch you can read this post about further supplementation to support your thyroid.
#2. Clean up your Diet
Your next step should be to clean up your diet.
Changing your diet isn’t likely to result in significant weight loss for all the reasons we mentioned above, but changing your diet is still very helpful.
What you put in your mouth will directly influence hormone levels for better or worse.
Certain foods will either promote inflammation or reduce it, promote fat loss or promote fat gain, balance your hormones, or imbalance them, and so on.
Your diet sets the foundation that all other therapies rest upon.
If your diet is made of sand, well, your long-term outlook isn’t great.
Your goal with diet should be to provide your body with all the nutrients it needs to promote healthy thyroid function and to promote hormone balance.
Anything you can’t get from your diet (for whatever reason) can be obtained through the use of specific supplements.
Ideally, you will want to find the best diet for your body but this will require some work on your part.
You can read more about altering your diet to fit your needs in this post.
#3. Talk to Your Doctor About Adding T3 Medication to Your Regimen
Lastly, you might find tremendous benefits with a small addition of T3 to your existing dose of thyroid medication.
Sometimes as little as 5mcg to 20mcg of Cytomel or liothyronine may help with weight loss and reduce the symptoms you are experiencing.
Most physicians will be reasonable and may consider adding T3 to your current regimen if you let them know how you are feeling.
In addition, you might find some benefit by showing them this article and the clinical studies referenced here.
Your physician wants to help you, they may just not have the time available to them right now to put hours and hours into research.
Make it easier on them by providing them with information that they understand (studies).
Try to avoid having arguments or heated discussions as this won’t help your situation at all and may make your doctor dig their heels in.
Finally, don’t wait forever for a doctor that isn’t willing to budge.
If you’ve been working with the same doctor for more than 6 months and he/she hasn’t shown any signs of meeting you in the middle, then seek out a second opinion.
More Advanced Steps
The “easy” steps listed above are just meant to get you started but are by no means everything you will need.
When talking about complex issues like this, I’ve found that patients can sometimes get information overload which may cause them to enter a paralytic state.
They ingest so much information that instead of taking action they simply don’t make any changes at all, and that’s not how I want you to feel.
So if you are just a beginner start with the steps above, if you’ve already tried them then it’s probably time to move on to these next steps.
#1. Check Other Hormones in Your Body
Hypothyroidism is notorious for causing or potentiating other hormone imbalances.
Identifying these other hormone imbalances can get tricky because they often mimic the signs and symptoms of hypothyroidism.
If you are having trouble with weight loss despite changing your thyroid medication, or your symptoms persist on T3, then it would be a good idea to evaluate the following hormones:
Balancing these hormones requires advanced knowledge so take your time to read through the articles referenced above before you jump into treatment.
#2. Optimize T4 to T3 Conversion
Some patients have difficulty with the peripheral conversion of T4 to T3 due to a variety of reasons.
For patients with reduced peripheral conversion, taking T4-only medication may make your symptoms worse as your body uses T4 to create the inactive thyroid hormone metabolite reverse T3.
If you have high reverse T3 then make sure to assess and treat the following areas (all of which are known to increase reverse T3 levels):
- Systemic inflammation
- GI-related issues like dysbiosis
- Nutrient deficiencies
- NASH/NAFL (Fatty liver)
You can find more information about how to increase free T3 levels here.
#3. Consider Advanced Medications
Lastly, you may need to consider the use of high-powered and targeted medications to help reverse hormone imbalances and help you with weight loss.
I’ve discussed the specific uses of these medications at length in other places on my blog but I will mention them here for reference:
- GLP-1 agonists
- LDN (Low dose naltrexone)
- Hormones such as testosterone, progesterone, and estrogen
These medications aren’t for everyone and must be used in special ways (at reduced doses, higher than normal doses, or pulsed for brief periods of time).
If you use these medications incorrectly they may make your metabolic problems worse.
You can find more information on how to use them correctly here.
Back to you
The bottom line is that there is most certainly a connection between your weight and your thyroid, regardless of what your doctor says.
If you are struggling to lose weight then don’t let your provider put the blame on you.
Understanding some of these topics may be complex, but the reward from spending time learning them will pay you dividends for years to come.
Now I want to hear from you:
Are you struggling to lose weight with hypothyroidism?
Have you been told that your weight is due to something aside from your thyroid, like your age or your diet?
Do you feel that your other hormones are out of balance or that more than just your thyroid is contributing to your weight?
Do you feel that you need to find a new doctor for help?
Did any of this information surprise you?
Leave your comments or questions below!