Weight loss can be challenging for people with thyroid problems, especially when you have an underactive thyroid. You may find that even after cutting calories and increasing your exercise, it’s difficult or impossible to lose weight. Or, you may be gaining weight despite no change to your diet or exercise plan. There are many ways your thyroid problem is contributing to these challenges. Understanding them can help you overcome this frustrating impediment and finally reach a healthier weight.
1. Going undiagnosed
Millions of Americans have an underactive thyroid but haven’t been diagnosed yet. There are many reasons for this situation, including:
- Your thyroid symptoms, such as fatigue and weight gain, may be attributed to your lifestyle and other factors or misdiagnosed as depression, menopause, or other health and hormonal issues.
- You may have limited access to medical tests and health care providers.
- Your health maintenance organization (HMO) or other health care provider is practicing cost-containment and limiting tests.
- Doctors don’t agree over which test results constitute hypothyroidism, so even if you are tested, doctors can disagree as to whether your results suggest hypothyroidism that warrants treatment.
Undiagnosed hypothyroidism can explain — for some of you — why even the strictest diet and exercise program isn’t working, or why you are gaining weight. The longer your hypothyroidism goes undiagnosed and untreated, the more weight you may gain over time.
Your next step? Insist on a complete thyroid panel — thyroid stimulating hormone (TSH), free T4, and free T3 at minimum—if you are frustrated by your efforts to lose or stop gaining weight. If you undiagnosed, be sure to get properly diagnosed as soon as possible. If a conventional physician will not diagnose or treat subclinical or borderline hypothyroidism, you may want to see an integrative or holistic physician.
2. Insufficient or poor thyroid treatment
Even after being diagnosed with and treated for your hypothyroidism, you may still struggle with continuing symptoms, such as an inability to lose weight. The main reason is that your thyroid hormone replacement treatment may not be optimal. It’s often not enough to just get your thyroid into the reference range. This means a thyroid stimulating hormone (TSH) that is below 2.5, and free thyroxine (free T4) and free triiodothyronine (free T3) levels that are at the higher end of the reference range. To achieve this, you may need an increased dosage of levothyroxine, the addition of a T3 drug like Cytomel to your levothyroxine, or a prescription natural desiccated thyroid (NDT) drug.
Your next step? Ask your practitioner to test your free T4 and free T3, and if you are not in the upper half of the reference range, discuss whether a change of dosage — or the addition of a T3 drug, or a switch to NDT — may be recommended.
3. Reduced energy expenditure
When you’re hypothyroid, or your treatment is not optimal, you are likely to feel more tired, and your muscles may be weaker. You may also have less endurance. All this can translate to less daily movement, and less tendency to formally exercise. The problem is that less movement and exercise lower your daily caloric requirements. And less activity also reduces your muscle mass; muscle burns more calories at rest than body fat. So it’s a downward spiral, as your fatigue reduces your activity, which reduces your muscle mass, which lowers your metabolism and caloric requirements, and makes it even harder to lose weight on fewer calories.
Your next step? Focus on building as much movement as possible into your daily routine. And if you have limited energy to exercise, focus on building muscle. Lifting weights, or programs that use your own body weight — Pilates, yoga, or T-Tapp — can help build muscle without being exhausting.
4. Insulin resistance
Even when treated, hypothyroidism increases your risk of insulin resistance, metabolic syndrome, and type 2 diabetes. Your body can become resistant to insulin, which means that more and more insulin is needed in order to process the glucose in your blood (known as blood sugar). In some cases, the body is unable to produce enough insulin, and you develop high circulating levels of blood glucose. This cascade of hormonal changes is called metabolic syndrome — sometimes referred to as pre-diabetes. At that point, you are at significantly greater risk of developing type 2 diabetes. Insulin resistance and elevated blood sugar also make it harder to lose weight and can contribute to further weight gain — a vicious cycle.
Your next step? A good starting point is to regularly have your hemoglobin A1C (HA1C) tested, as well as fasting glucose. If either or both are high, your goal should be to lower and carefully control HA1C and blood sugar levels. This may require a complete overhaul of how you eat. Some people with hypothyroidism find that they are able to keep insulin resistance, metabolic syndrome, and type 2 diabetes in check by following a very low-sugar (low-glycemic), carbohydrate-controlled diet.
Some of the popular diet plans that fit into this approach include the Paleo Diet, the Ketogenic Diet, and the Rosedale Diet. Even before you qualify for a diagnosis of type 2 diabetes, some practitioners will treat chronically elevated HA1C and fasting glucose levels that don’t respond to dietary changes with type 2 diabetes drugs such as metformin, or injectable drugs like Byetta, Victoza, or Symlin.
5. Leptin resistance
Leptin is a hormone produced by the body, to help transmit two key messages: “store fat” and “burn fat.” In some people with hypothyroidism, the feedback loop that controls leptin becomes imbalanced. More leptin is produced, but the body becomes less sensitive to it, a situation known as leptin resistance. As a result, your body becomes especially efficient at storing fat and inefficient at burning fat, which both make weight loss even more difficult.
Your next step? Start by having your leptin levels measured. Elevated levels can help identify leptin resistance. If you are leptin resistant, one key goal is to lengthen the time between meals, so that your body has time to move into fat-burning mode. Some experts recommend you eliminate snacking, eat only two or three meals per day, avoid eating after 8 p.m. and allow a 10- to 12-hour period between your last meal of the day, and breakfast. Intermittent fasting may also help to increase leptin sensitivity. A good source of information on leptin resistance is Byron Richard’s book, Mastering Leptin.
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Mary Shomon is a thyroid disease, hormonal and autoimmune health writer, and patient advocate. For two decades, Mary has been a leading force advocating for more effective, patient-centered thyroid and hormonal health care. Mary is the New York Times bestselling author of “The Thyroid Diet Revolution,” “Your Healthy Pregnancy with Thyroid Disease,” “Living Well With Hypothyroidism,” and 10 other books on thyroid disease and integrative health. She co-stars in two PBS health specials, “Healthy Hormones,” and “Vibrant for Life.” Follow her on Twitter at @thyroidmary or at her Facebook communities: ThyroidSupport and ThyroidDiet.