Hypothyroidism and weight gain

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Ever since Oprah announced that her sluggish thyroid was contributing to her weight gain, I've had many patients with weight issues ask me, “Is it my thyroid?”

The answer for many of these women is yes, but the solution isn’t quite so simple. Thyroid function is intimately connected with your metabolism — thyroid hormones basically regulate calorie consumption. But a healthy thyroid also depends on the proper functioning of other body mechanisms, including your neurotransmitters, your reproductive hormones and your adrenal glands.

The thyroid and weight gain

Because patients with an underactive thyroid tend to have a very low basal metabolic rate, one of the most noticeable symptoms of hypothyroidism is weight gain and difficulty losing extra weight. (Sometimes an overactive thyroid can mimic an underactive thyroid by causing weight gain, although this is less common.) A minority of women with hypothyroidism don’t gain weight. The difference arises from their individual biochemistry, the quality of the calories they consume, and how they use those calories.

Often the “metabolic burn” continues to fall as calories are reduced when dieting. That’s why some women with low thyroid can have weight gain even when they severely restrict calories. In order to fix your metabolism, you have to understand your entire health picture, not just your thyroid.

The thyroid in women

More women than men suffer from hypothyroidism, and many more women than men with thyroid issues have problems with weight gain. Most thyroid problems occur within the gland itself and often don’t reveal themselves until a broader pattern of hormonal imbalance develops. That’s why thyroid issues, menopause and weight gain often appear together (which is exactly what happened to Oprah).

Why do women experience low thyroid and weight gain with such frequency? The reasons are manifold, but primarily:

  • Women spend much of their lives dieting, usually in a yo-yo cycle of feasting and then fasting. This undermines your metabolism and decreases your metabolic rate, a compounding factor for the thyroid, especially during perimenopause.
  • Women tend to internalize stress, which affects their adrenal function. Overactive adrenal glands produce excess cortisol, which interferes directly with thyroid hormones. In addition, fatigue caused by adrenal dysfunction increases cravings for sweets and simple carbs to provide instant energy and feel-good hormones.
  • Women's bodies have a delicate balance of hormones such as estrogen and progesterone, which can be upset when your body is under stress and not receiving enough support. This resulting hormonal imbalance acts as a trigger for thyroid problems.

What you can do about hypothyroidism and weight gain

The first thing to do if you are experiencing stubborn weight gain is to talk to your practitioner. She or he may ask for a thyroid test or measure TSH (thyroid-stimulating hormone). I have found in my practice that many women who test within the “normal” range of traditional medical standards still need thyroid support. Their TSH may be only slightly elevated, but enough so that it influences their metabolism and causes weight gain.

For these women, supplemental nutrients such as selenium and iodine, combined with a meal plan that balances a proper ratio of protein to carbohydrates increases their metabolic functioning and they begin to lose weight. We also recommend a pharmaceutical-grade multivitamin/mineral to give your body ample nutritional support. In some cases, a low-dose thyroid replacement hormone is also needed.

There is a lot of controversy in the endocrinology world regarding hypothyroidism treatment. There are those that believe that patients who test within the normal range but have very low basal metabolic rates and very low basal temperatures need thyroid supplementation. There are others that argue that only patients with significant abnormalities should be supported with thyroid hormones.

Weight gain is not sufficient evidence to conclude that someone has a thyroid abnormality, but it is one part of the picture we try to bring into focus. Efforts to lose weight without addressing related thyroid issues are doomed to fail. Likewise, thyroid treatments are usually not as effective without addressing the underlying hormonal imbalance. The greatest success is found through a holistic approach that considers thyroid function as an integral part of your overall hormonal balance.


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