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Originally published on 9th April 2016 Last updated on 23rd July 2019
Thyroid disease is often used as a joke or a scapegoat for weight gain. People throw it around, and as such, it’s not taken very seriously.
Many people think it’s just an excuse for being overweight.
But weight gain is a legitimate symptom of an underactive thyroid or hypothyroidism, along with many others. Why?
Why Thyroid Hormones Are Important
A thyroid gland produces five hormones: T1. T2, T3, T4 and Calcitonin.
These 5 hormones are needed for every process, every cell and everything function in your body, especially T3 and T4. So when they are abnormal (i.e. low), a lot of other stuff can go wrong too.
T3 is the most active thyroid hormone.
The main purpose of thyroid hormones, produced by the thyroid gland, is to ensure the metabolism is running properly.
The metabolism’s job is to produce heat and fuel. Heat to keep us warm and fuel to give us energy. Now, if we don’t have enough of those thyroid hormones I told you about, our metabolism won’t work properly and so can’t provide us with adequate heat and fuel.
Therefore, people with an underactive thyroid or hypothyroidism can have a slow metabolism, with symptoms associated with a slow metabolism, such as cold intolerance (from the lack of heat made) and extreme tiredness and weight gain (from the lack of calories burned to make energy).
Medical professionals seem to think that the weight gain from hypothyroidism is usually between 10 and 30 pounds, thinking that the body adjusts for the slower metabolism after while. This is very much disputed, though, as many patients carry on gaining, despite a low calorie diet.
So Shouldn’t the Weight Gain Stop or Come off When You Start Medication?
You would think so, yes, but it’s not always so straight forward.
It all depends on if the hypothyroidism is being optimally treated and corrected. Many thyroid patients are not.
Remember the five thyroid hormones I mentioned at the start of this article? Well, we need to replace them, since the underactive thyroid isn’t making enough of them and this is usually done via medication.
Thyroid medication Comes in a Few Forms
Remembering that a healthy thyroid would be producing five hormones:
- There is synthetic T4-only medicine, which only contains T4
- There is T3-only medicine, which only contains T3
- There is Natural Desiccated Thyroid (NDT) or Compounded Thyroid, which contains all five; T1, T2, T3, T4 and Calcitonin and is made from actual porcine thyroid gland
Doctors prefer using T4-only medication for hypothyroidism and very rarely prescribe the other options, even though they are available on prescription and can really prove useful to thyroid patients who don’t see results on T4-only meds. Why? Well, that’s up for debate. You can read a bit more about why here.
Essentially, NDT was used for many years until it fell out of favour due to a complicated history, at the same time that synthetic T4 was introduced. The result? Many patients are now on t4-only synthetics, like Levothyroxine and Synthroid, and still feel unwell because they need the other thyroid hormones too.
In theory, T4 should convert in to T3, and that’s why doctors refuse to believe that T4-only medication does not help everyone. But a lot of people can’t convert the T4 in to T3, so the medication doesn’t work for them. When they change to NDT, or add T3 to their T4, they usually end up making huge improvements. Like me.
Having optimal thyroid levels and not just ones that are ‘in range’ can also make a big difference to symptoms and weight. Particularly Free T3 and Reverse T3 levels.
However, many people are only having their TSH and perhaps Free T4 tested, which doesn’t show if they’re Free T3 is optimised, and if they’re on T4-only meds, if the T4 is converting to adequate amounts of T3. This too can leave ongoing complaints, symptoms and weight that keeps piling on. Reverse T3 is often also going untested which, if non-optimal, can be attributed to various on going symptoms such as weight gain.
For patients kept on a thyroid medication which is not working for them, or too low a dose, this means they are kept hypothyroid, non-optimally treated, and so their symptoms may get no better. Because of this, their metabolism may not function optimally, leading to weight gain and an inability to lose weight. Along with many other hypothyroid symptoms.
Many of us with thyroid issues may also have adrenal dysfunction. In fact, in Thyroid Pharmacist Izabella Wentz’s experience, adrenal dysfunction appears to be present in 90% of us with autoimmune hypothyroidism. 
The adrenal glands are part of the endocrine system, just like the thyroid gland. They handle many hormones that are important for a lot of bodily processes, such as handling stress. This where cortisol is produced. Adrenal fatigue can include elevated, lowered or mixed levels of cortisol, without it being the full blown condition of one of those two.
Having adrenal dysfunction is often cited to impact weight and weight management, especially weight gain around the abdomen, yet many of us with hypothyroidism or Hashimoto’s are unaware that we have it.
You can order or ask for a 24-hour saliva test, testing cortisol levels at four key points of the day, to find out if you have adrenal dysfunction. If your doctor won’t order this, you can very simply order it yourself and complete it at home. See here and here. Most doctors will only test it with a one time urine or blood sample, which is not as accurate.
Four samples taken over a 24 hour day show how your rhythm of cortisol production is working, so is the most accurate. It should be highest in the morning, tailing off throughout the day. Only four saliva samples taken in one day will tell you this accurately.
Dieting in The Past
How many of us have embarked on restrictive diets in the past?
However, are we all aware of how this can affect our longterm ability to manage weight?
The issue of being unable to lose weight and keep it off becomes more common when someone repeatedly goes on low-calorie diets, fads, or struggles with yo-yo dieting (repeated loss and gain of weight). What many thyroid patients don’t know is that chronic dieting can reduce Free T3 levels, the active thyroid hormone, causing the metabolism to slow down even further and weight loss to become even more difficult as time goes on.
There is also something called your weight ‘set point’ which you should take in to consideration. Your ‘set point’ is the brain’s target weight for you. It is therefore individual. Just as the body aims to maintain a normal body temperature, it also works to maintain a body weight that is physiologically comfortable. The ‘set point’ is maintained by the hypothalamus and is often genetically influenced, however, a number of things can cause this ‘set point’ to change, including moving it to a higher or lower number.
Chronic dieting is the main cause for an abnormal ‘set point’, whereby it can result in slower metabolism. After years of dieting, you may find that your body has adjusted to needing less and less calories to maintain a specific weight.
Ways to address this can include reaching optimal thyroid levels, a more consistent diet and calorie intake (no more yo-yoing, fad diets or calorie restrictions), consistent exercise (no more overexercising followed by needing to heavily rest due to the damage going too far does) and managing your Hashimoto’s if applicable.
Are you a thyroid patient experiencing weight fluctuations?
You can click on the hyperlinks in the above post to learn more and see references to information given.
The book Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tired, which builds on this article in detail. Reclaim your thyroid healthy life and find out what you can do to help yourself get better.
Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing her Thyroid Family email newsletters and speaking on podcasts, as well as being a founding board member for the American College of Thyroidology. She is well-recognised as a crucial contributor to the thyroid community and has a large social media presence. Her books include “Be Your Own Thyroid Advocate” and “You, Me and Hypothyroidism”.