Why is Weight Loss so Difficult After Thyroid Removal? | Dr. Westin Childs

Why is Weight Loss so Difficult After Thyroid Removal?

Gain 20 Pounds After Thyroid Removal? 

I mean it, it's a serious question. 

Have you gained 20 pounds or more after your thyroid has been removed? 

If so, you are not alone. 

In fact, women, on average, gain around 20 pounds after they get their thyroid removed according to several studies (1) which looked into the matter. 

The question is...

Why does this happen and is there anything that you can do about it?

You already know that your endocrinologist or thyroid doctor is probably not even concerned about your weight gain. 

They probably already attributed your weight gain to your age or some other issue even though the weight gain started RIGHT after your thyroid was removed. 

And this is pretty standard, unfortunately. 

The good news is that there is a REASON for this weight gain and that something CAN be done about it. 

The bad news is that it's often very difficult to lose weight once your thyroid has been removed and that's exactly what we are going to discuss now. 

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4 Reasons Patients without a Thyroid Struggle with Weight Gain

You should be aware that each patient is a little bit different. 

I've seen stories of people who gain weight immediately after their thyroid has been removed and I've seen people were fine for a few years and then suddenly experienced rapid weight gain. 

Others still experience a slow weight gain over many years. 

Whatever flavor of weight gain that you are struggling with once your thyroid has been removed will most likely stem down to these 4 reasons. 

You should be aware of these reasons because the chances are high that your doctor will most likely ignore them. 

It will be up to you to advocate for yourself! 

#1. Your Thyroid Regulates your Metabolism (about 60%)

The PRIMARY reason that women gain weight once their thyroid has been removed is actually quite simple. 

Your thyroid gland controls and regulates the majority of your metabolism

You know, your metabolism, the same thing that controls how many calories you burn on a day to day basis which in turn regulates your appetite. 

The thyroid gland is responsible for controlling about 60% of your entire metabolism (2), give or take a few percentage points based on the person. 

We know this because of clinical studies which have attempted to estimate exactly how much your thyroid contributes to body weight. 

And this shouldn't come as a surprise. 

Why?

Because one of the biggest complaints of people with a low thyroid is WEIGHT GAIN. In fact, it's the #1 most endorsed symptom by women with low thyroid function

Isn't it ironic that women tend to gain weight immediately after their thyroid has been removed knowing that your thyroid controls a huge percentage of your weight? 

I say ironic because your doctor will try to play it off like your weight gain is due to some other cause when the most obvious cause seems to be overlooked. 

The changes that occur to thyroid hormone regulation in your body once your thyroid has been removed are also responsible for why it is so difficult to obtain a regular weight after. 

It's going to be very difficult to manage your weight if the very thing which regulates it is compromised and not back at 100%. 

If you've gained weight AFTER your thyroid has been removed the first place you should look at is your thyroid medication dose

Which brings me to the next topic...

#2. Most thyroid patients are UNDERtreated with thyroid medication

The majority of patients who have had their thyroid removed struggle because they are being undertreated. 

What do I mean?

I'm talking specifically about your thyroid medication dose. 

The prescription medication that you were given once your thyroid was removed. 

EVERYONE who has their thyroid removed will need to be on thyroid medication for the rest of their life. 

It's not an option because thyroid hormone is required to sustain critical functions in the body. 

This is not up for debate. 

But what is up for debate is how MUCH of that prescription thyroid medication you are taking (and what type of medication you are taking). 

This is referred to as your dose. 

And most thyroid patients, including those without a thyroid, are taking a dose which is too small for their body. 

This occurs frequently because most doctors dose based on a test known as the TSH

In addition, they almost always use the weakest form of thyroid medication in levothyroxine and Synthroid

These two reasons account for why most patients without a thyroid are not receiving the right dose. 

natural thyroid supplements version 2

And, obviously, if your dose is inadequate then you will have trouble with your weight. 

Remember when I said that your thyroid controls and regulates your metabolism?

Once your thyroid has been removed you are now counting on your prescription medication to take its place. 

And if you are not replacing it adequately you will continually gain weight and/or have difficultly losing weight (usually both). 

#3. Most thyroidectomy patients are not on T3 thyroid hormone

Are you currently taking levothyroxine or Synthroid?

If so, you are like most other thyroid patients. 

These medications are the go-to medications for most endocrinologists and other thyroid doctors

But there's one big problem:

Your thyroid gland, when it's functioning in your body, produces TWO types of hormones. 

T4 and T3

But when your thyroid gets removed your doctor almost always will put you on only ONE type of thyroid hormone. 

T4. 

The medications I mentioned above, levothyroxine and Synthroid, contain only T4 thyroid hormone

We know that this is a problem because studies have shown that patients who use only T4 medications like levothyroxine never obtain normal healthy free T3 levels after thyroid surgery

How can you consider someone to be adequately treated if you do not at least try to mimic the same hormone production that a healthy thyroid gland produces?

And yet this is exactly what most endocrinologists do. 

The healthy thyroid gland produces roughly 80% T4 and 20% T3 thyroid hormone (3). 

But when your thyroid gets removed your doctor puts you on 100% T4 thyroid hormone and neglects to add in the T3. 

This is a big problem because T3 thyroid hormone is 3-4 times more powerful than T4 thyroid hormone. 

Once your thyroid has been removed you are losing the benefit of 20% of the strongest thyroid hormone in your body and replacing it with an extra 20% of a weaker version. 

With this change to thyroid hormone metabolism, it's no wonder that thyroidectomy patients struggle with weight gain. 

#4. An undertreated thyroid leads to other hormone imbalances

And lastly, another reason that women without a thyroid suffer from weight loss resistance is caused by other hormone imbalances. 

While your thyroid definitely contributes to your overall metabolism, there are other hormones which are regulated by your thyroid that contribute to your weight in other ways. 

For instance, the fat hormone leptin is involved in regulating appetite and metabolism and it is intertwined with thyroid function

If you have your thyroid removed and you do not replace your thyroid levels adequately, it sets the stage for the development of a condition known as leptin resistance

This condition is created by the environment of low thyroid hormone but it is not FIXED by simply taking thyroid medication. 

And leptin isn't the only hormone which is, in part, regulated by your thyroid. 

Another fat storing hormone which is, in part, regulated by thyroid hormone is insulin. 

Women without a thyroid tend to develop insulin resistance and leptin resistance over time if their thyroid is not treated adequately. 

These hormone imbalances make weight loss even more difficult and MUST be addressed if you want to lose weight long term. 

Is Weight Loss Impossible After Thyroidectomy?

What does all of this information mean for you if you don't have a thyroid?

Will it ever be possible to lose weight and get back to a normal healthy weight?

The answer is yes. 

But you should be aware that your weight loss journey will be much slower than people who have a thyroid. 

That's just the unfortunate situation that you are now in once your thyroid is gone. 

I usually tell people without a thyroid to expect weight loss at about a rate of 50% compared to people with a thyroid. 

They will also have to try about twice as hard as the average person. 

Yes, it's slow, and yes it's hard, but it's no impossible. 

Another thing that you should know is that your thyroid medication is going to be a very important part of your weight loss journey. 

Because your thyroid can no longer produce thyroid hormone on its own, you will need to pay close attention to what type of thyroid medication you are using and how much you are using. 

Your goal here should be to try and mimic whatever production of thyroid hormone your thyroid was producing BEFORE it was taken out. 

This will almost always include a combination of T4 and T3. 

If you aren't familiar with T3 thyroid medications then I would recommend you look at both Cytomel and liothyronine

These are prescription medications which contain the T3 thyroid hormone and can be added to your existing dose of levothyroxine or Synthroid. 

You can also get T3 thyroid hormone from other thyroid medications such as Armour thyroid or other formulations of NDT

Either source will work but make sure you do NOT neglect this step!

Do Supplements, Diet, and other therapies Work? 

Assuming your thyroid medication has been optimized your next step will be to get aggressive with additional therapies. 

This means you will absolutely need to look directly at the types of foods that you are eating, the types of supplements you are taking, and how much you are exercising. 

Remember: 

You will need to work twice as hard to lose your weight compared to someone who has a thyroid. 

This usually means that having cheat days from your healthy diet, at least in the beginning, is not really an option for you. 

It certainly isn't fair but it's better to know that this is the case than to not. 

When I talk about diet I'm really talking about healthy eating. 

You want to avoid any type of diet which is considered a "calorie restricted diet" as these types of diets will make thyroid function worse. 

Instead, focus on diets which include healthy whole foods such as the paleo diet, whole30, or any other version such as that. 

I would also recommend that you look into supplements designed to help thyroid hormone do its job, supplements that can help with weight loss directly, and supplements which help manage food cravings. 

These should ALL be done in conjunction with adjusting your diet (as mentioned above). 

Do not make the mistake thinking that taking a couple of supplements will help you lose weight because that is not the case. 

Your Turn

While weight loss can be very difficult and frustrating once your thyroid has been removed it is definitely not impossible. 

I have personally helped many patients without a thyroid lose weight and, at the very least, start to feel like themselves again. 

But I am speaking from experience when I say that the weight loss they experience is much slower than compared to people with a thyroid. 

Understanding this phenomenon will help you manage your expectations and prevent you from getting discouraged when you start your weight loss journey. 

Now I want to hear from you:

Did you gain weight once your thyroid was removed?

If so, how much did you gain?

Are you trying to lose weight right now?

What types of therapies have you tried? What has worked? What hasn't?

Leave your questions and comments below! 

References (Click to Expand)

4 reasons why it's so hard to lose weight after thyroid removal
Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

11 thoughts on “Why is Weight Loss so Difficult After Thyroid Removal?”

  1. I had my thyroid out in Oct 2016. Since then I have gained at least 40 lbs. 8 months after my surgery my TSH was 29. My worthless doctor only did labs once between that time. I didn’t know better. But I knew not being able to get out of bed was a problem…I have struggled to get my levels in “normal” range. I switched to Armour but no matter how high the dose my body was just not absorbing it. It was weird. I’m back on levothyroxine and finally after 3.5 years it’s getting better. But in the meantime I have put on all this weight, more than ever in my whole life. And I haven’t changed my eating habits. I’m hoping to see some others suggestions of what they have done to help the situation.

    Reply
  2. You hit the nail on the damn head, Dr. Childs. Thank you for this post. I’m sorta fired up right now because I have spent the last 6 weeks reading every blog post and studying my tail off to try and get to the bottom of why I feel so awful and have gone from 130 lbs to 180. I had the TT 6 years ago and was fine for 2 years. Then BOOM. I blew up 30 lbs in 2 months. The rest of the gain has been slowly over time.

    I’ve been taking NDT. I’ve been working with not just one but 3 of “the best” functional MD’s in LA, whom I trusted to take care of my lack-of-a-thyroid condition. I’ve been eating 80-90% paleo for 5 years, I work out, get 10k steps, do power yoga and strength training and HIIT. I keep my stress in check and I sleep 7-9 hours.

    And for the past 4 years the docs keep saying, “you’re doing everything right”. I’ve done all the GI tests, SIBO, mold, urine hormones, saliva tests, like all of it.

    Every single doc for the past 4 years has said its insulin resistance. So finally, I bought myself a keto mojo meter and did the keto diet for 3.5 weeks. I completely reversed any sign of insulin resistance in my labs — and gained 4 lbs in the process.

    Then finally after I insisted for the 50th time that my labs were not optimal, I need more medication. The doc added 10 mcg of Cytomel to my usual 4 grain NDT dose (which I still don’t think is right). Its been about 1.5 wee and I have lost 6 lbs. I think I should be on 6 grains, but 5 would be the right place to start. I don’t know why, I have always needed a really high dose.

    I am still very hypo tho. Body temp is between 95.6-96.8, I can’t keep my eyes open past 2 pm and I keep getting dumb blonde jokes because the brain fog is so bad. My BFF has started calling me Rose Nylund (from the golden girls). And I’m normally a sharp snappy person.

    I have been watching the past 4 years of my life blow by me because I am too tired to move. I can barely handle working anymore because I can’t do a full day. I’m so frustrated. because I know in my gut that it doesn’t have to be this way. If someone would just please pay attention.

    What does it take to get even a highly respected functional MDs to listen to a patient?

    TSH 0.06
    FT4 1.3
    FT3 3.2
    RT3 13
    SHBG 140 – H
    estrogen 287.7
    estradiol 30
    progesterone 5.2 (taking bio-identical pills 100mg)
    testosterone 29
    free testosterone 1.0

    IGF-1 137
    cortisol 10.7
    DHEA 121
    leptin 5.7
    Fast glucose 80
    insulin 5.8
    hb1ac 4.8
    HS CRP .9
    Ferritin 59
    I have hemochromatosis (2 genes) and both variants of MTHFR)

    Reply
  3. Just wanted to share something else I just learned about. I had never heard of this before. But in my most recent meeting with my doc, I asked, “so do I have a conversion problem?” He said, “no, it is not conversion exactly but your hormone receptors are not functioning properly”.

    So I google “Thyroid hormone receptor resistance” and mostly get medical studies which are hard for me to read with no medical training. Maybe a gene mutation? or maybe have other causes too.

    The issue I am having is that my dose of meds has always been high. Before I had a TT and weighed 130 lbs I was on 4 grains NDT.
    Now that I am 180, I really think my dose should be 5 grains, maybe even 6. Which sounds scary high. But the doctors are afraid to go higher.

    Doctors say: you have to be careful of your heart and osteoporosis. But I’ve have no hyper symptoms on really high doses, I have tested it. No palpitations or anything other than feeling great and like my old self.

    I read a number of studies and it seems that people with this resistance tend to do fine on higher doses and also tend to have very suppressed tsh, which I always do, no matter my dose.

    I’m wondering if you have any information / advisement to share on this topic?

    Reply
  4. I just started Armour 30mg this past April, recently increased to 60mg. I’ve noticed that I’ve started gaining weight more rapidly. 3 pounds a day. Can Armour cause weight gain?

    Reply
    • Hi Tiffany,

      I’ve seen people gain weight with just about every thyroid medication you can think of, including Armour thyroid. The cause of the weight gain is not always directly related to the thyroid medication, though.

      Reply
  5. Did you gain weight once your thyroid was removed? Yes

    If so, how much did you gain? 40+ lbs

    Are you trying to lose weight right now? Yes

    What types of therapies have you tried? What has worked? What hasn’t? Plant-based – no but also recently diagnosed with Crohns. Interment fasting 18/6 – not really. Juicing – yes. Feel the best. Try to do it every day but eat a clean meal each day. Did you gain weight once your thyroid was removed?
    Was on T3 compound only for over a yr. think this caused fatty liver issues. Body needs T4. Now on T3/T4 combination – 85/155. I walk 5 miles 3X week and do weights 1 to 2x a week

    If so, how much did you gain?

    Are you trying to lose weight right now?

    What types of therapies have you tried? What has worked? What hasn’t?

    Reply
  6. Yes I gained 40 lbs after TT.
    Keto helped me lose 15 but I haven’t been able to maintain the diet.
    I take T3 after begging doc but she only gives me the lowest dose. I still usually lose all energy by 2:00pm.
    I am 66 and 8 years post TT.
    No doctors care about how I feel physically or emotionally.

    Reply
  7. Hello. I had a thyroidectomy in 2006 and have steadily gained roughly 35-40 lbs since. I’ve tried several different changes to my diet and I exercise 5 days a week (not overdoing it) and haven’t lost a pound. Just keep gaining. I’ve tried different supplements for leptin resistance and vitamin deficiencies but that didn’t help. I’ve tried adding cytomel to the NDT I’m on and that didn’t help either.

    Reply
  8. Did you gain weight once your thyroid was removed & If so, how much did you gain?

    – yes 30 lbs, I was an athlete In my early adulthood and remain active, currently 41 years old. I have weighed between 143-153 lbs my entire adult life with the exception of my two pregnancies both of which I topped out at 180 lbs. This year I had two surgeries, the first removing half of my thyroid and then a completion thyroidectomy due to pathology results. Within 6 weeks of the second surgery I weighed 176lbs.

    Are you trying to lose weight right now?
    – yes, I have been watching what I eat keeping my caloric balance for the day between 1000-1500 calories. I have read your blog posts about caloric restriction and reverse T3 production. I wanted to ask if this is caloric balance for example I consume 2000 cal in food and exercise 1000 calories, resulting in a caloric balance of 1000 calories or simply calories consumed. I always eat a minimum of 1200 calories but sometimes the calories expended in exercise have resulted in a caloric balance of between 800-1000 calories. Prior to having my thyroid removed I could easily eat 2500-3000 calories a day and not gain weight and would have easily dropped weight with my current level exercise and attention to diet, however I have struggled to lose even 5 lbs over the last 6 weeks.

    What types of therapies have you tried? What has worked? What hasn’t?

    I am on 125mg of synthroid daily which I take at 5:30 am and usually do not eat breakfast until 8:30-9:00.

    I eat Brazil nuts for selenium, supplement with greens and berries, omega 3, Vitamin D, B vitamin complex, Multi vitamin and iron (due to low ferritin on my last blood test). I also take vitamin B2, Magnesium and CoEnzyme 10 for migraines.

    I am on low dose birth control to control hormonal issues such as acne, irregular and excessively heavy cycles. I am also using seed cycling to try a natural method. As well as 75mg of Effexor for anxiety that was aggravated due to my diagnosis, specifically the inability to control the feeling that my heart is racing.

    I exercise regularly including yoga, cycling and running. Most days I expend 700 calories in exercise.

    My endocrinologist is switching my prescription to a synthroid/cytomel combination next week.

    Reply
  9. Hello, had a TT exactly one year ago, have gained 30lb. Asked dr to change over to NP,60 mg, then just had tsh checked, and is 22! AND just heard of the NP recall, and yes the mfg company was Acella for my meds. Diet includes mostly paleo and glutten free. And just like the previous notes from others, my dr trying to blame it on other stuff. Very frustrated.. NEVER weighed this much and photographs at daughters wedding from 2 weeks ago SHOW every ounce. I want to cry! According to your info, exercise will not help until my levels are optimal, What can i do?

    Reply
  10. Hi,
    I had a thyroidectomy 14 years ago. I have gained 50 pounds. Have also had alot of trouble with dizziness, fatigue, and depression. Have been to multiple doctors who will not increase my thyroid medications (I take synthroid and cytomel), but will always try to increase my depression medications. They blame everything on diet/exercise, but I do both! Very Frustrating! Your post has at least given me an answer!

    Reply

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